Ear Infections/Allergic Rhinitis

Question 0

Otitis externa etiology

Answer 0

psuedomonas, staph epi, staph aureus, fungal

Question 1

ear pain, tender tragus. Pruritis, discharge, erythematous and edematous EAC. Conductive hearing loss

Answer 1

Otitis externa

Question 2

Otitis externa treatments for bacterial infection (2)

Answer 2

Bacterial: Corticosporin otic suspension (Polymyxin, neomycin, and hydrocortisone)- not for perforated TM

Otic solution for perforated TM, Ciprodex

Question 3

Otitis externa lifestyle changes

Answer 3

No swimming for 7-10 days

Prophylaxis: vinegar solution or commercial product

Question 4

intense ear pain and discharge. Red, granulation tissue in the EAC. Possible periauricular lymphadenopathy, trismus
Seen in diabetics and immunocompromised patients

Answer 4

Malignant otitis externa

Question 5

Malignant otitis externa involves?

Answer 5

Osteomyelitis

Question 6

Malignant otitis externa treatment

Answer 6

IV antibiotics, wound debridement

Question 7

Malignant otitis externa etiology

Answer 7

primarily psuedomonas

Question 8

otalgia, reddened TM w/ decreased mobility, signs of effusion, loss of visible landmarks.
Can be preceded by URI. Ear may feel “full,” may have conductive hearing loss
(adults)

Answer 8

Acute otitis media

Question 9

otalgia, reddened TM, reduced TM mobility, etc
PLUS fever, irritability, tugging on the ear

(peds)

Answer 9

Acute otitis media in peds

Question 10

Otitis media etiology

Answer 10

Strep pneumo, mostly

Question 11

Acute Otitis Media treatment schedule

Answer 11

Age 24 mo w/ severe symptoms and certain AOM diagnosis- Antibiotics
Antibiotics and/or observation for others
Symptomatic care

Question 12

severe clinical signs of AOM

Answer 12

moderate-severe otalgia, otalgia for at least 48h, or temp of 39 (102.2 F) or higher

Question 13

Antibiotic dosage for AOM (2)

Answer 13

Amoxicillin 90 mg/kg BID for 7-10 days

Augmentin 90 mg/kg 6.4 mg/kg BID 7-10 days

Question 14

drainage from the middle ear > 2 weeks & associated TM perforation that is usually painless. Conductive hearing loss

Answer 14

Chronic otitis media

Question 15

Chronic otitis media etiology

Answer 15

recurrent otitis media, trauma, cholesteatoma

Question 16

Chronic otitis media tx

Answer 16

refer to ENT

Question 17

+/- pain, +/- otorrhea, conductive hearing loss, associated with acute/chronic OM, immobile TM

Answer 17

TM perforations

Question 18

TM perforation tx

Answer 18

heals spontaneously- resulting in tympanosclerosis (scarring)

Question 19

extension of otitis externa or acute otitis media into mastoid air cells.
Postauricular pain and erythema, fever, deep temporal pain

Answer 19

Mastoiditis

Question 20

Mastoiditis treatment

Answer 20

IV antibiotics, ENT consult, mastoidectomy

Question 21

ear fullness, hearing loss. Middle ear effusion secondary to inflammation, URI, Eustachian tube issues

Answer 21

Serous otitis media

Question 22

Pt. afebrile, amber-colored fluid behind TM, may see bubbles, retraction of TM produces prominent landmarks, immobile TM, possible conductive hearing loss

Answer 22

Serous Otitis Media

Question 23

Serous otitis media treatment

Answer 23

most resolve spontaneously; topical nasal decongestants may help- No Antibiotics

Question 24

Serous otitis media referral conditions

Answer 24

refer to ENT for persistent (>3 mo.) cases or for kids

Question 25

discomfort or damage to ear due to pressure differences between middle ear and external ear Associated w/ altitude changes, URIs, allergies

Answer 25

Ear barotrauma

Question 26

Ear barotrauma treatment

Answer 26

prevention- nasal decongestants, antihistamines, Valsalva manuever, chewing gum

Question 27

benign, acute inflammation or infection of the vestibular system Most commonly associated with URI, AOM, meningitis

Answer 27

Labyrinthitis

Question 28

Acute onset of severe vertigo, nausea & vomiting, balance issues, tinnitus, unilateral hearing loss

Answer 28

Labyrinthitis

Question 29

positive head thrust indicates?

Answer 29

Labyrinthitis

Question 30

head thrust sign

Answer 30

can't fix vision as head is moved | horizontal nystagmus

Question 31

Labyrinthitis treatments (4)

Answer 31

Symptomatic- bed rest, hydration Benzos Anticholinergics (as an anti-emetic)- Prochlorperazine/Compazine Antihistamines (as a vestibular suppressant similar to dramamine)- Neclizine/Antivert

Question 32

amoxicillin dose

Answer 32

900 mg/kg BID

Question 33

rhinorrhea, sneezing, itchy eyes, itchy nose, nasal congestion, PND, ~cough

Answer 33

Allergic rhinitis

Question 34

What histories should be considered for allergic rhinitis? (4)

Answer 34

hx of hay fever, asthma, eczema, and allergies

Question 35

On physical diagnosis: pale, "blue" mucosa, clear discharge; pale, swollen conjunctiva with some injection

Answer 35

Allergic rhinitis

Question 36

External eye characteristics of allergic rhinitis

Answer 36

"allergic shiners" & Denie Morgan Lines

Question 37

skin folds under eye consistent w/ allergic conjunctivitis

Answer 37

Denie Morgan Lines

Question 38

First line drug treatment for allergic rhinitis

Answer 38

2nd gen topical intranasal corticosteroids | Fluticasone (Flonase), Triamcinolone (Nasacort)

Question 39

1st gen topical intranasal steroids | and what they're used for?

Answer 39

Beclomethasone (Beconase), Flunisolide (Nasolide) | alternative to 2nd gen for treatment of allergic rhinitis

Question 40

Antihistamines for 2nd line allergic rhinitis (5)

Answer 40

Chlorpheniramine (Chlor-trimeton) or Diphenhydramine (Benadryl) Loratadine (Claritin), Fexofedadine (Allegre), Cetirizine (Zyrtec)

Question 41

Which symptoms of allergic rhinitis can be alleviated by antihistamines?

Answer 41

sneezing, rhinorrhea, itching | No congestion relief

Question 42

allergic rhinitis treatment that vasoconstricts to decrease edema and secretions

Answer 42

Sympathomimetics (Decongestants) | Psuedoephedrine (Sudafed)

Question 43

Psuedoephedrine (Sudafed) contraindications

Answer 43

HTN, heart disease

Question 44

Last line, most intense allergic rhinitis treatment

Answer 44

Immunotherapy- "allergy shots"

Question 45

allergy shot mechanism of treatment

Answer 45

increased production of specific IgG antibodies

Question 46

nasal congestion, rhinorrhea no itching, sneezing normal nasal mucosa normal IgE antibodies

Answer 46

Perennial Non-Allergic (Vasomotor) Rhinitis

Question 47

Perennial Non-Allergic (Vasomotor) Rhinitis sxs

Answer 47

nasal congestion, rhinorrhea | no itching, sneezing

Question 48

abnormal autonomic responsiveness triggered by stress, sexual arousal, perfumes, smoke, temperature change

Answer 48

Perennial Non-Allergic (Vasomotor) Rhinitis

Question 49

Perennial Non-Allergic (Vasomotor) Rhinitis treatments (5)

Answer 49

Trigger avoidance, topical steroids***, topical antihistamines, topical anticholinergics, 1st gen oral antihistamined

Question 50

Pedunculated, non-tender, grey, soft tissue growths | Nasal congestion/obstruction

Answer 50

Nasal polyps

Question 51

Nasal polyp treatment

Answer 51

refer to ENT

Question 52

rebound congestion following overuse of topical decongestants (afrin)

Answer 52

Rhinitis medicamentosa

Question 53

Rhinitis medicamentosa physical exam findings

Answer 53

Erythematous nasal mucosa

Question 54

Rhinitis medicamentosa treatment

Answer 54

discontinue medication (taper) and supplement with intranasal glucocorticoid

Question 55

Tx for fungal otitis media?

Answer 55

Fungal: Clotrimazole (3 drops BID for 14 days), acetic acid irritation

Question 56

Anticholinergics for labrynthitis

Answer 56

Anticholinergics (as an anti-emetic)- Prochlorperazine/Compazine