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AANP > EENT > Flashcards

EENT Flashcards

1
Q

Acute Rhinosinusitis

A

Inflammation of the nasal mucosal and paranasal sinuses lasting up to 4 weeks casued by allergens, environmental irritants, and or infection (virus [majority], bacteria, and fungi).

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2
Q

Acute Bacterial Rhinosinusitis

A

Secondary bacerial infection of paranasal sinuses
* usually following viral URI
* relatively uncommon Less than 2%
* Majority will resolve without Abx

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3
Q

Most common bacterial causes of ABRS

A
  1. S. pneumoniae (gram+)
  2. H. influenzae (gram -)
  3. M. catarrhalis (gram -)
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4
Q

Diseases cuased by S. pnemoniae

A
  • COMPS
  • Conjunctivitis
  • Otitis media
  • menengitis
  • pneumonia
  • sinusitis (#1 cause)
  • gram+ diplococci
  • > 25% drug-resistant
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5
Q

Diseases caused by H. Influenzae

A
  • COMPS
    1. Conjunctivitis
    2. otiits media
    3. menengitis (B)
    4. Pneumonia
    5. Sinusitis (#2 cause)
  • Gram - baccillus
  • > 30% penicillin resistant via production of beta lactamase - breaks up the beta-lactam ring in most penicillians including amoxicillin, ampicillin
  • most ceplasporins are stable in the presents of beta-lactamase
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6
Q

Diseases Casued by M. catarrhalis

A
  • less common pathogen in ABRS (#3 cause), AOM, uncommon cause of CAP
  • gram- coccus
  • > 90% penicillin resistant via beta lactamase production.
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7
Q

Most common fetures of Acute Bacterial Rhiniosinusitis

A
  • fever and symptom durration more than 10 days
  • maxillary toothache
  • Initial symptom improvement and then worsening of symptoms
  • Cacosmia - sense of bad odor in the nose
  • Unilateral facial pain
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8
Q

Treatment of ABRS

A
  • any prior systemic abx use in last month
  • risk for resistance? (use 2nd line ABX)
  • Initiate first line abx
  • If improvement in 3-5 days continue therapy for 5-7 days
  • Worsening or no improvement in 3-5 days, broaden coverage or switch to different abx class
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9
Q

Initial ABX regimens for ABRS

A
  • Macrolide abx (azithromycin, clarithromycin, erythromycin, and TMP-SMX{bactrim}) are not reccomended in ARBS due to resistance rates and resulting tx failure
  • fluroqinolones (cipro, levo, moxifloxacin) risks outweigh the benifits and should not be used for ARBS, Bronchitis, and uncomplicated UTI, were other treatments are available
  • Amoxicillin 500mg TID or 875mg BID
  • Amoxicillin-clavulante 875/125 PO BID (augmentin)
  • addition of clavulante is a beta-lactamase inhibitor increasing drug effectiveness against h. influinzae and m. catarrhalis
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10
Q

ABRS in penicillin allergy

A
  • usually casue by an allergry to beta-lactam found in penicillins
  • without anaphyaxis hx (cephalosporins)
    1. cefdinir
    2. cefpodoxime
    3. cefuroxime
  • With anaphylaxis Hx (respiratory fluroquinolones)
    1. Levofloxacin (preg risk c)
    2. Moxifloxacin (pre risk C)
    3. Doxycycline (pregnancy risk D)
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11
Q

ARBS treatment failure in 3-5 days

A
  1. Amoxicillin-clavulante
  2. 2/3rd gen cephaloporin (cefpodoxime. cefprozil. cefdinir)
  3. Levo or moxifloxacin
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12
Q

Medication Substrate

A

a medication that is metabolized/biotransformed by the isoenzyme (CYP450 34A) usually found in the liver, inorder for the drug to reach site of action and be eliminated
Ex: sildenafil, atorvostatin, simvastatin, alprazolam

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13
Q

Inhibitor

A

a drug or substance that blocks the activity of the isoenyme (CYP450 34A), limiting substrate excretion, allowing increase in substrate levels, with possible risk of substrate-induced toxicity
* ex: erythromycin, clarithromycin = CYP450 inhibitor
* concomitant use of one of these abx plus drugs that are CYP450 34A substrates will result in increase in substrate levels by decresing iotransformation and elimination.
* ex: Clrithromycin + simvastatin = statin induced rhabdomyolisis risk
* ex: clarithromycin + alprazolam = increased sedation and fall risk

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14
Q

Inducer

A

Accelerates the activity of the isoenzyme (CYP450 34A) so that the substrate is pushed out the exit pathway, leading to a reduction in substrate level causing dimished therapudic effect, possible treatment failure
* Ex: St john’s wort + COC = off loading estrogen/progestin= spotting and potential contraceptive failure

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15
Q

Conductive hearing loss

A
  • Location: outter or middle ear
  • Cause: sound is being blocked ( earwax, forien body, damaged eardrum, serous otits media, bone abnormality)
  • Weber result: sound lateralizes to affected ear - buzzing sound louder in affected ear due to increased tissue denisty
  • Rinne result: abnormal - bone conduction better than air conduction
  • Tx: often self resolves after cerumen removal, post URI or AOM
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16
Q

Sensorineural hearing loss

A
  • Location: inner ear vestibulocochlear nerv CNV111V
  • Cause: inner ear or nerve becomes damaged-advanced age, ototoxic meds, immune disorders, trauma
  • Weber result - sound lateralizes to the unaffected ear
  • Rinne result: normal air conduction > bone conduction
  • Tx: hearing aids, cochlear implant possible
17
Q

Common cold Vs. Flu/COVID

A
  • Cold: primary symptoms are sneez, achs and pain. runny/stuffy nose, and sore throat
  • Flu Same as above without sneeze, and the addition of fever, diarhhea, and headache
  • Covid: similar to flu with the addition of loss of taste/smell and SOB
18
Q

Allergic rhinitis treatment

A

inflammatory, IgE-mediated, characterized by nasal congestion, rhinorrhea, sneezing, intraocular and/or nasal itching.
1. Allergen avoidance
2. Controller therapy - prevent symptoms by preventing formation of or inactivating inflammatory mediators
* Intranasal corticosteroids 1st line (fluticasone, triamcinolone) - up to a week for relief
* Intranasal antihistamine - azelastine - rapid symptom relief
3. Reliver therapy - to relieve acute symptoms by blocking histamine
* 2nd gen oral antihistamine - loratadine, certirazine, levocetirazine
* ocular antihistamine

Therapies not reccomended: Leukotrine modifier (montelukast) or systemic corticosteroids

19
Q

Oral Cancer

A

Sqamous Cell Carcinoma 95% cases, HPV16 contributing factor

Risks Factors: Longstanding HPV infection, Tabacco use, alcohol misuse
Presentation: painless, ulcerating oral lesion, usually present many months prior to presenting clincally. Adjacent lymphadenopathy = imobile, nontender node usually >1cm
Dx: referral for bx

20
Q

angle -closure glaucoma

A
  • sudden increase in intraoccular pressure
  • Usually unilateral, acutely red, painful eye with vision change including halos. eyeball firm when compared to other
21
Q

Macular degeneration

A
  • painless gradual central vision loss
  • risks: advanced age, hx of smoking, light eye color, sun exposure, family hx
  • test: amsler grid test
  • fundoscopic: drusden - soft yellow deposits in macular region
22
Q

open angle glaucoma

A
  • gradual peripheral vision loss
  • avoidable with treatment
  • Risks: older adult, African american, long standing DM
  • test: abnormal tonometry
23
Q

Bacterial Vs. Viral Pharyngitis

A

Bacterial
* significant anterior cervicle lymphadenopathy
* frontal headaches without body aches
* patchy exudates in posterior pharynx - bad breath
* sudden onset

Viral
* Clear nasal drainage
* horseness
* scattered small vessicles on soft palate and tonsils
* generalized body aches
* sore throat preceeded by nasal drainage

24
Q

Exudative pharygitis treatment

A
  • only with documented group a beta-hemolytic strep infction using positive strep screen or throat culture
  • Abx therapy:
    1. Penicillin V PO x10 days or amoxicillin 500 PO BID
    2. alterantive 1st or 2nd gen cephalosporin x4-6 days
    3. beta lactam allergry (penicillan allergry) - azithromycin, clarithromycin, clindamycin (macrolides)
25
Q

Suppurative conjunctivitis treatment

A

Common pathogen - S. Aureus, s. pneumoniae, h. influenzae (outbreaks coused by s. pneumoniae)
1. cipro ocular solution, or polymixin B with trimethoprim opthalmic solution
2. alternative axithromycin opthalmic solution

26
Q

Otitis Externa

A

Common pathogen: Psudomonas spp., S. aureus, rarely fungi
1. mild: acedic acid with propylene glycol and hydrocortosone drops
2. Mod-severe: otic cipro, with hydrocortisone or dexamethasone

  • decrease risk of infection by using 1:2 white vinegar and rubbing alcohol
  • do not use neomycin - containing product if TM rupture suspected.
27
Q

Malignant Otitis externa (necrotizing)

A
  • persons with DM,HIV/AIDS or on chemo
  • Pseudomonas
  • Treatment oral Cipro
  • risk for osteomylitis of skull or TMJ
28
Q

Otitis media with effusion

A
  • Hx: sensation of fullness or pressure, itch and/or otalgia, conductive hearing loss, no fever or otorrhea
  • Exam: air fluid level visable, often with bubbles, opaque yellow or blue, cone of light or bony landmarks diminished. TM mobility limited
  • Tx undrlying cause usually allergic rhininitis. usually resolves 1-3 weeks without special intervention.
29
Q

Acute otitis media

A
  • Hx: sensation of ear fullness, pressure and otalgia, conductive hearing loss, fever common
  • Exam: TM redness, bulging, cone of ligt and bone landmarks absent, TM mobility absent, otoorrhea possible with TM rupture.
  • Tx: analgesia, abx typically given
30
Q

AOM ABx

A

if no abx in prior month
* amoxicillin high dose or
* amoxicillin-clavulante ER or
* cefdinir

If Abx in last month
* amoxicillin-clavulante or
* ceftriaxone

If allergy to beta-lactam (options are less effective)
* TMP-SMX
* or macrolide

AANP (20 decks)

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