EENT part 1 Flashcards by Deborah Karp

Organisms of bacterial conjunctivitis

H. influenzae
H. aegyptius
S. pneumoniae
N. gonorrhoeae

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S/sx of bacterial conjunctivitis

Mucopurulent unilateral or bilateral d/c
Nl vision
Photophobia
Conjunctival injection and edema (chemosis)
Gritty sensation

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Tx of bacterial conjunctivitis

Topical abx- polymycin B-trimethoprim or sulfacetamide 5% or erythromycin for chlamydial
Parenteral ceftriaxone for gonococcus

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Organisms of viral conjunctivitis

Adenovirus
Echovirus
Coxsackievirus

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S/sx of viral conjunctivitis

Mucoid/serous d/c
Nl vision
Photophobia
Conjunctival injection and edema
Gritty sensation
May be hemorrhagic
Unilateral

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Tx of viral conjunctivitis

Self-limited

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Organisms of neonatal conjunctivitis

C. trachomatis
Gonococcus
Chemical
S. aureus

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S/sx of neonatal conjunctivitis

Palpebral conjunctival or papillae

Same as for bacterial infection

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Tx of neonatal conjunctivitis

Ceftriaxone for gonococcus

PO erythromycin for C. trachomatis

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Causes of allergic conjunctivitis

Seasonal pollens or allergen exposure

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S/sx of allergic conjunctivitis

Itching

Incidence of bilat chemosis (edema) greater than that of erythema, tarsal papillae

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Tx of allergic conjunctivitis

Antihistamines
Steroids
Cromolyn

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Organisms of postseptal orbital cellulitis: paranasal sinusitis

H. influenzae
S. aureus
S. pneumoniae
Other streptococci

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Organisms of postseptal orbital cellulitis: trauma

S. aureus

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Organisms of postseptal orbital cellulitis: fungi

Aspergillus

Mucor if immunodeficient

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S/sx of postseptal orbital cellulitis

Rhinorrhea
Chemosis
Vision loss
Painful EOM
Proptosis
Ophthalmoplegia
Fever
Lid edema
Leukocytosis

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Tx of postseptal orbital cellulitis

Systemic abx

Drainage of orbital abscesses

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Organisms of preseptal orbital cellulitis: trauma

S. aureus

Other streptococci

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Organisms of preseptal orbital cellulitis: bacteremia

Pneumococcus
Streptococci
H. influenzae

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S/sx of preseptal orbital cellulitis

Cutaneous erythema
Warmth
Nl vision
Minimal involvement of orbit
Fever
Leukocytosis
Toxic appearance

Tx of preseptal orbital cellulitis

Systemic abx

What is most strabismus caused by?

Refractive error

Muscle imbalance

RFs for infantile strabismus

FHx
Genetic d/os
Prenatal drug exposure
Prematurity or low birth weight
Congenital eye defects
Cerebral palsy

Causes of acquired strabismus

Refractive error
Tumors
Head trauma
Neurologic conditions
Palsy of CNs III, IV, or VI
Viral infections
Acquired eye defects

Esotropia characteristics

Commonly infantile | Accommodative esotropia occurs between 2 and 4 yoa

Characteristics of exotropia

Most often intermittent and idiopathic

Characteristics of hypertropia

Can be paralytic, caused by 4th cranial nerve palsy, or less commonly, as a result of 3rd cranial nerve palsy Occurs congenitally or after head trauma

Characteristics of hypotropia

Can be restrictive

Dx of strabismus

Corneal light reflex test Cover test Alternate uncover test

Tx of strabismus

Patching or atropine drops to attendant amblyopia Contact lenses or eyeglasses for refractive error Eye exercises for convergence insufficiency only Surgical alignment of the eyes

Pathophys of acute otitis media

Bacteria gain access to the middle ear when the nl patency of the eustachian tube is blocked by upper airway infection or hypertrophied adenoids

MC bacterial pathogens of acute otitis media

S. pneumoniae H. influenzae M. catarrhalis

Peak incidence of acute otitis media

Between 6 and 15 mos of life | January and February

Major RFs of acute otitis media

Young age Lack of breastfeeding Passive exposure to tobacco exposure Increased exposure to infectious agents (day care)

Definition of recurrent OM

The presence of six or more acute OM episodes in the 1st 6 yrs of life

Sx of acute otitis media in infants

Fever Irritability Poor feeding

Sx of acute otitis media in older children and adolescents

Fever Otalgia Otorrhea Signs of a common cold

PE of acute otitis media

Bulging TM Air fluid level Visualization of purulent material Poor or absent mobility to negative and positive pressure Light reflex is lost Middle ear structures are obscured and difficult to distinguish

Tx of acute otitis media: otherwise healthy with mild sx, unilateral OM, age 6-24 mos

Acetaminophen | Ibuprofen

Tx of acute OM: otherwise healthy with mild sx, bilat/unilaterial, age 2+ yrs

Acetaminophen | Ibuprofen

What are considered mild sx in acute OM?

Low-grade fever Not screaming in pain Not much bulging in the TM

When are abx indicated in children 6 mos and older with acute OM?

Moderate otalgia Otalgia for >48 hrs Temp of 102.2 (39) or greater Bilat OM if younger than 2 yrs

Tx of acute otitis media with abx: no daycare attendance and no abx within 30 days

High-dose amoxicillin Greater than or equal to 2 yo: 7 days >2 yrs: 10 days

Tx of acute otitis media with abx: daycare attendance and/or abx within 30 days

Augmentin | 10 days

Tx of acute otitis media with abx: failure of amoxicillin

Augmentin | 10 days

Tx of acute otitis media with abx: beta lactam allergy non-anaphylactic

Cefuroxime Greater than or equal to 2 yo: 7 days >2 yo: 10 days

Tx of acute otitis media with abx: beta lactam allergy anaphylactic or cephalosporin allergy

Clarithromycin | 10 days

Tx of acute otitis media with abx: tympanostomy tubes

Ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex) | Ofloxacin