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House AMP > Ear and sinus infections > Flashcards

Ear and sinus infections Flashcards

1
Q

Otitis externa

Characterized by :
General ________ and ________, with associated _______, with or without ______

A

Oedema

Erythema

Itchy discomfort

Eat discharge

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2
Q

Otitis externa

Causative agents :

List 3

A

Pseudomonas species

Staphylococci

Streptococci/Gram negative rods

Fungi( Aspergillus/candida species)

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3
Q

Treatment for Otitis externa:

Most common pathogens are :_____,______,_______, and ———

Treatment :
_______
________
__________
___________

A

Pseudomonas , staph, E.coli, and proteus

Ear toilet
Antibiotics
Medicated wicks
Analgesics

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4
Q

Treatment for Otitis externa:

Avoid _______ or ________ or ________

A

Water entry

Cotton buds

Digital manipulation of ear canal

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5
Q

Fungal Otitis Externa
(Otomycosis)

• Aspergilus niger -I- ______ headed filamented growth

• Aspergilus fumigatus- _______

• Candida albicans- ______/______ deposits

• Secondary fungal infection may be seen in patients using ___________ for otitis externa/ middle ear suppuration

A

black ; brown

white/creamy

topical antibioties

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6
Q

Fungal Otitis Externa
(Otomycosis)

• _____________ -I- black headed filamented growth
• ________________- brown
• ________________- white/creamy deposits

A

Aspergilus niger -I-

Aspergilus fumigatus

Candida albicans

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7
Q

OTITIS MEDIA
Definition: Presence of a ___________

A

middle ear infection

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8
Q

OTITIS MEDIA

Acute Otitis Media: occurrence of ________ infection within the ___________

Otitis Media with Effusion: presence of __________ within the ___________

A

bacterial infection ; middle ear cavity.

nonpurulent fluid ; middle ear cavity

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9
Q

OTITIS MEDIA

OM is the _______ most common clinical problem in childhood after _____________________

A

second

upper respiratory infection.

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10
Q

RISK FACTORS for OM

_________________ Infections
_________
_________ abnormalities (_________) _________ Syndrome
_________ smoking
(Boys or Girls?) > (boys or girls?)
Daycare

A

Upper Respiratory

Allergies

Craniofacial ;cleft palate

Down’s ; Passive

Boys > girls

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11
Q

SIGNS & SYMPTOMS of otitis media

Neonates/Infants: change in _______,
irritability, ______ at ears, decreased _______, vomiting.

Children(2-4): ______, fever, _____ in ears,
cannot _____ properly, changes in _______

Children (>4): complain of _______, changes In _________-

A

behavior ; tugging ; appetite

otalgia ; noises ; hear ; personality

ear pain ; personality

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12
Q

EPIDEMIOLOGY of otitis media

Peak incidence in the _____ years of life (esp. _____months)

(Boys or Girls?) more affected than (boys or girls?)

50% of children under ___ yr of age will have at least 1 episode.

1/3 of children will have 3 or more infections by age _____

90% of children will have at least one infection by age ____.

50,000 deaths / year worldwide

A

first two ; 6-12 months

Boys ; girls

1 ; 3 ; 6

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13
Q

causative agents of otitis media

_____________ —————-
_____________ —————-(non-typeable)
_____________ —————-
Group ___ Streptococcus
_____________ —————-
_____________ —————-
____ associated with _____________

A

Streptococcus pneumoniae Haemophilus influenzae(non-typeable) Moraxella catarrhalis
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa
RSV assoc. with Acute Otitis Media

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14
Q

Most common cause of Acute otitis media is???

Most uncommon cause of AOM

A

Streptococcus pneumoniae

Pseudomonas aeruginosa

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15
Q

Treatment Considerations for otitis media

________________ (DRSP) incidence is increasing

Patients at high risk for DRSP
– Attending _______
– <___ years old
– Antibiotic therapy in _________

A

Drug resistant S. pneumoniae

day care

2; preceding 3 months

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16
Q

Number Need to Treat (NNT) NNT for antibiotic therapy in AOM

________ children with AOM would have to be treated with antibiotics to prevent one case of clinical failure by 1 week.

One review estimated the need to treat ________ in order for 1 child to have improved pain at 2 days.

In addition, ______ were associated with almost twice the rate of vomiting, diarrhea, and rashes.

A

7 to 8

17 children

antibiotics

17
Q

Definitions

Non-severe illness is :______ otalgia and fever ____°C in the past 24 hours

Severe illness is __________ otalgia OR fever _____°C

A

Mild; <39

Moderate to severe

> or equal to 39

18
Q

certain diagnosis of AOM meets all 3 criteria …

1)______ onset
2) Signs of _____
3) Signs and symptoms of ____________

A

Rapid

MEE

middle-ear inflammation.

19
Q

Otitis media

Observation is only appropriate when …

_______ can be ensured and ______ therapy initiated if symptoms persist or worsen

A

Follow-up

antibiotic

20
Q

Why Focus on Pneumococcus?

Most common _________ pathogen
Most common isolate after ______
Least likely bacterial pathogen to _______
Most likely to cause _____ otitis media
Most likely to cause _______ complications of otitis ( __________ )

A

initial bacterial

failed therapy

self resolve; severe

suppurative

mastoiditis

21
Q

In allergy to Amoxicilin

Alternative therapy in the penicillin-allergic patient who is being treated for infection that is known or presumed to be caused by penicillin-resistant S pneumoniae is _________ at 30 to 40 mg/kg per day in ___ divided doses.

In the patient who is vomiting or cannot otherwise tolerate oral medication, a _____ dose of _______ __________ (50 mg/kg) has been shown to be effective for the initial treatment of AOM.

A

clindamycin; 3

single; parenteral ceftriaxone

22
Q

Duration of therapy for otitis media

For children ≥ 6 years of age with mild to moderate disease _______ days is appropriate

For younger children and for children with severe disease, a standard ____-day course is recommended

A

5 -7

10

23
Q

Treatment Failure
No improvement in ear pain, fever, or tympanic membrane otorrhea, bulging or redness after ______ of antibiotic therapy

2nd Line Therapy
–_______
– ___________ producing _________ and __________

A

3 days

DRSP

Beta-lactamase

H.influenza and M. cattarhalis

24
Q

Prevention of Otitis Media

_____________ pneumococcal conjugate vaccine (n=37,868)

Reduction of ______________

Reduction of _________ prescriptions

Influenza vaccine: Goal: decrease number of URI

______________

A

Heptavalent

otitis office visits; antibiotic

Breast feeding

25
Q

Prevention

Prophylaxis
3 episodes in _______ or 4 episodes in ______

<6 months with ____ episode

Cause of resistance in the community

A

6 months ; 1 yr

> 1

26
Q

AOM is common amongst _______ and the complications can be serious and sometimes life threatening.

Guidelines advocates ____________

However with emerging resistance issues in the causative pathogens HD ____________ is advocated.

The PK/PD results of this time dependent drug has achieved cure in > ___% in clinical trials

A

children ; amoxicillin

amoxicillin clavuate

96%

27
Q

Infection of the sinuses

The sinuses are _____ paired cavities (spaces) in the head.

They are connected by (narrow or wide?) channels

The sinuses make (thin or thick?) mucus that drains out of the channels of the ________ , helps keep the nose _____ and free of _________

A

four ; narrow

thin ;nose

clean ; bacteria

28
Q

The sinuses

Normally filled with ______, the sinuses can get ______ and filled with _______

When that happens, _____________ and cause an infection (bacterial sinusitis)

A

air ; blocked

fluid; bacteria can grow

29
Q

(Viruses or Bacterias?) cause most sinus infections, but (virus or bacteria?) can cause some sinus infections

A

Viruses

bacteria

30
Q

Types of sinuses

The paranasal sinuses are located in your _____ near your _____ and ______. They are named after the _______ that provide their structure.

A

head

nose and eyes.

bones

31
Q

Types of sinuses

.
The ethmoidal sinuses are located _______ your eyes.

The maxillary sinuses are located _______ your eyes.

The sphenoidal sinuses are located _______ your eyes.

The frontal sinuses are located _______ your eyes.

A

between

Below

Behind

Above

32
Q

Types of sinuses

The biggest sinus cavity is the ______ cavity, and it is one of the cavities that most often becomes infected.

A

maxillary cavity

33
Q

Sinusitis can be caused by a virus, bacteria, or fungus that ______ and ______

A

swells and blocks the sinuses

34
Q

Sinusitis

Specific causes include:
The ____________
Nasal and seasonal _______
________
A _______ septum

A weak immune system from illness or medications.

A

common cold; allergies

Polyps; deviated

35
Q

Sinusitis

Specific causes include:

For infants and young children, spending time in ________, using _______ or drinking bottles while _________ could increase the chances of getting sinusitis.

For adults, ———- increases the risks for sinus infections

A

day cares; pacifiers

lying down

smoking

36
Q

Signs and symptoms of sinusitis

Post ________ (mucus _________________).

Nasal discharge ((thin or thick?) _______ or _______ discharge from nose) or ____ nose

Facial _________ (particularly around the nose, eyes, and forehead), headache and or pain in your _______ or _______.

Halitosis Cough Tiredness Fever

A

nasal drip; drips down the throat

Thick; yellow or green

stuffy; pressure

teeth or ears

37
Q

pathogenesis
The early stage of sinusitis is often a _______ infection that generally lasts up to _______ and that ______________ in 99% of cases

However, a small number of patients may develop a ______________ infection that is generally caused by _______ bacteria

(e.g, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)

Initially, the resulting acute sinusitis involves only _____ type of aerobic bacteria

Persistence of the infection, _______ flora, _______ organisms, and, occasionally, _______ [contributes to the pathogenesis, with anaerobic bacteria of oral flora origin often eventually predominating

A

viral ;10 days

completely resolves in

secondary acute bacterial

aerobic ; one

mixed ; anaerobic ; fungus

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