Infective Flashcards
(136 cards)
1
Q
What percent of patients who develop an intracranial complication from rhinosinusitis have a prior history of chronic rhinosinusitis?
A
0.1
2
Q
What are the diagnostic criteria for allergic fungal sinusitis (AFS) as described by Bent and Kuhn?
A
- Allergic mucin. Nasal polyposis.
- CT scan findings consistent with chronic rhinosinusitis.
- Positive fungal histology or culture.
- Type I hypersensitivity diagnosed by history, positive skin test, or serology.
3
Q
What is the incidence of hearing loss after infection with mumps?
A
0.5%.
4
Q
What percent of patients with viral rhinosinusitis develops bacterial rhinosinusitis?
A
0.5-2.0%.
5
Q
What is the incidence of facial nerve paralysis in patients with chronic OM and cholesteatoma?
A
1%.
6
Q
What is the mean interval to the 1st recurrence?
A
10 years.
7
Q
What percent of children with an episode of AOM will still have an effusion present 3 months later?
A
10%.
8
Q
What is the incidence of postmeningitic hearing loss?
A
10-20%.
9
Q
How should contacts be treated?
A
14 days of erythromycin.
10
Q
What is the incidence of Vlllth nerve involvement in patients with Ramsay Hunt syndrome?
A
20%.
11
Q
What percent of patients with Lyme disease have facial nerve paralysis as the sole manifestation?
A
20%.
12
Q
What percent of middle ear fluid cultures are negative for bacteria?
A
25-30%.
13
Q
What is the incidence of facial palsy as the presenting symptom of tuberculous mastoiditis?
A
39%.
14
Q
What is the mean duration of OM with effusion after acute otitis media (AOM)?
A
40 days.
15
Q
What is the outcome of these patients who are treated with steroids alone?
A
42% have a good outcome.
16
Q
What is the incidence of recurrent facial palsy in otherwise healthy patients with Bell’s palsy?
A
5-7%.
17
Q
How is NOE treated?
A
6 weeks of two different IV antibiotics directed against the organism cultured; alternatively, ciprofloxacin and rifampin for several months; hyperbaric oxygen is recommended for advanced NOE.
18
Q
What age group has the highest incidence of OM?
A
6-18 months.
19
Q
What is the incidence of AFS in cases of chronic rhinosinusitis treated surgically?
A
6-7%.
20
Q
What is the outcome of patients with Bell’s palsy who have 90% or more degeneration on ENoG within the first 14 days of onset and undergo decompression?
A
91% have a good outcome (House I or II) 7 months after paralysis.
21
Q
What is the significance of passive smoke exposure on the risk of developing OM?
A
A higher incidence of tympanostomy tubes, chronic and recurrent OM, and otorrhea is seen in children whose mothers smoke. High concentrations of serum cotinine (marker for tobacco exposure) are associated with an increased incidence of AOM and persistent middle ear effusion following AOM.
22
Q
Other than URI, what are the most common causes of persistent cough in infants up to 18 months?
A
Aberrant innominate artery, cough-variant asthma, and gastroesophageal reflux disease.
23
Q
What is the most commonly proposed theory of the etiology of Bell’s palsy?
A
Activation of a latent virus present within the geniculate ganglion leading to entrapment, ischemia, and degeneration of the labyrinthine segment of VII.
24
Q
What is the difference between acute, chronic, and recurrent acute sinusitis?
A
Acute 12 weeks; and recurrent acute >4 episodes/year with resolution between episodes.
25
How do the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) define AOM?
Acute onset (within 48 hours of symptoms), with the presence of middle ear effusion and signs and symptoms of middle ear inflammation.
26
What is the recommended treatment for Ramsay Hunt syndrome?
Acyclovir Boo mg five times a day x 10 days and prednisone taper x 14 days.
27
What are the clinical features of cervical tuberculosis?
Affects all ages, bilateral supraclavicular lymph nodes, positive PPD, positive CXR, respond to curettage, and macrolide antibiotics.
28
In what age group is tonsillitis from group A streptococci most common?
Ages 6-12.
29
What is the mechanism of resistance for S.pneumoniae?
Altered penicillin-binding proteins.
30
What is the reduction in the need for myringotomy tubes in children who receive the heptavalent pneumococcal vaccine?
Approximately 20%.
31
What% of patients infected with West Nile virus will develop symptoms?
Approximately 20%.
32
What percent of cultured organisms in patients with recurrent tonsillitis produce P-lactamase?
Approximately 40%.
33
What organism is most commonly involved in fungal sinusitis?
Aspergillus species.
34
According to the Paradise study from 1984, what are the criteria for adenotonsillectomy for recurrent tonsillitis?
At least three episodes in each of 3 years or five episodes in each of 2 years or seven episodes in 1year-with each episode documented by a physician.
35
What sort of hearing loss is typical after meningitis?
Bilateral, severe to profound, and permanent.
36
What is the significance of day care on the risk of developing OM?
Children in group day care are more likely to develop OM after URI compared with
37
What factors predispose one to complications from OM?
Chronic infection, history of mastoid surgery, cholesteatoma, diabetes, and immunocompromise
38
What medical conditions predispose a child to OM?
Cleft palate, craniofacial anomalies, congenital or acquired immune deficiencies, ciliary dysfunction, enlarged adenoids, sinusitis, and Down syndrome.
39
What is allergic mucin?
Clusters of eosinophils and their by-products (e.g., Charcot-Leyden crystals and major basic protein).
40
What organisms are commonly cultured from the middle meatus in healthy patients?
Coagulase-negative staphylococci (35%), Corynebacterium species (23%), and S. aureus (8%) in adults. H. influenzae (40%), M. catarrhalis (34%), and S. pneumoniae (so%) in children.
41
What is the outcome of Bell's palsy left untreated?
Complete recovery in 71%; permanent diminished function in 16%; poorer prognosis if \>6o years of age, and if onset of recovery is \>3 months after initial onset of paralysis.
42
In children 6-16 years?
Cough-variant asthma (45%), psychogenic (32%), and sinusitis (27%).
43
What are the indications for emergent surgery in patients with orbital cellulitis?
CT evidence of an intraconal abscess; massive proptosis with retinal or optic nerve ischemia and loss of vision; and visual acuity of 20/ 6o or less in an immunocompromised patient with a subperiosteal abscess.
44
What is the significance of adenoidectomy on OM?
Data by Gates showed a 47% reduction in recurrent effusion in children who received adenoidectomy and myringotomy tubes compared with a 29% reduction in recurrent effusion in children who received only myringotomy tubes.
45
What is the most common complaint of patients with an epidural abscess/granulation tissue?
Deep, constant pain in the temporal area that is very steroid responsive.
46
What are Charcot-Leyden crystals?
Degraded eosinophils.
47
What factors increase the risk of recurrent Bell's palsy?
Diabetes mellitus and family history.
48
What are the intracranial complications of OM?
Epidural abscess/granulation tissue, sigmoid sinus thrombosis, meningitis, brain abscess, and subdural abscess.
49
Which organisms more frequently cause AOM in infants younger than 6 weeks?
Escherichia coli, Klebsiella, and Pseudomonas aeruginosa.
50
How is facial nerve paralysis in patients with chronic OM and cholesteatoma treated?
Expedient elimination of infection.
51
What are the two types of postseptal cellulitis?
Extraconal and intraconal.
52
True/False: Addition of acyclovir to prednisone for treatment of Bell's palsy has not been shown to result in significant improvement of facial nerve function.
False.
53
What are the primary symptoms of West Nile fever?
Fever (lasting about 1week), headache (lasting about 10 days), fatigue (lasting about 1 month), and a generalized rash.
54
What organisms are commonly cultured from patients with chronic sinusitis but rarely seen in patients with acute sinusitis?
Gram-negative bacteria.
55
What organisms are most often associated with facial palsy due to chronic OM?
Gram-negative organisms and Staphylococcus aureus.
56
What are the most common pathogens cultured from otorrhea after tympanotomy tubes in children younger than 3?
H. in.fluenzae and Diplococcus pneumoniae.
57
What are the most common organisms causing nonfatal bacterial meningitis in children \> 2.5 years?
H. influenzae, Neisseria meningitides, and S. pneumoniae.
58
What are the three most common organisms causing meningitis secondary to OM?
H. injluenzae type b, S. pneumoniae, and Neisseria meningitidis.
59
How does hearing loss caused by mumps usually present?
Hearing loss develops as the parotitis is resolving.
60
What viruses are most commonly implicated in the etiology of Bell's palsy?
Herpes simplex and herpes zoster viruses.
61
What is the first-line treatment for AOM in patients 6 months to 2 years of age?
High-dose amoxicillin (go mg/kgjday); for patients with severe illness (moderate to severe otalgia or temperature of 39°C or higher) and where there is significant concern for -lactamase-positive Haemophilus injluenzae or Moraxella catarrhalis, amoxicillin-clavulanate is indicated.
62
those in home care. The rate of tympanostomies and adenoidectomies is 59-67%
higher in children
63
How is croup managed?
Humidification, dexamethasone, and racemic epinephrine.
64
What are host risk factors for chronic rhinosinusitis?
Hypogammaglobulinemia, selective IgA deficiency, AIDS, cystic fibrosis, granulomatous disorders (especially sarcoidosis), primary ciliary dyskinesia, chronic stress, and asthma.
65
When is a CT scan obtained for acute mastoiditis?
If signs of progression arise while on IV antibiotics or if the patient presents with possible intracranial complications.
66
When is mastoidectomy indicated?
If the CT scan shows coalescent mastoiditis and/ or intracranial involvement.
67
When should an asymptomatic patient with a positive posttreatment culture for group A streptococci be treated?
If the patient or someone in his family has a history of rheumatic fever.
68
Decreased levels of which immunoglobulin are common in children who are prone to OM?
IgG2.
69
What is the significance of age in the etiology and pathogenesis of postseptal orbital cellulitis?
In children under 9, one organism, usually a streptococcus, is responsible. Older children are more likely to be infected with multiple organisms. The likelihood of resolution with a prolonged course of intravenous antibiotics decreases with age (10% in the 9-15 years old age group to o% in patients older than 15). At age 12, the maxillary sinus comes in contact with molar tooth roots; infection of the molars can lead to orbital cellulitis.
70
What are negative prognostic factors for Ramsay Hunt syndrome?
Increased age and a simultaneous onset of paralysis with vesicular eruption.
71
Vaccination against what virus had been shown to decrease the incidence of AOM in infants and children?
Influenza.
72
What is the most common organism found in patients with atrophic rhinitis?
Klebsiella ozaenae.
73
What is the most common form of extraconal infection?
Medial subperiosteal phlegmon or abscess caused by extension of bacteria from adjacent ethmoid sinusitis.
74
What is the most common valvular problem resulting from rheumatic fever?
Mitral valve stenosis.
75
What are the two most common inflammatory salivary diseases of childhood?
Mumps parotitis and recurrent parotitis of childhood.
76
Of all the viruses associated with hearing loss, which one is most likely to be associated with unilateral hearing loss?
Mumps.
77
What are the most common organisms causing nontuberculous mycobacterium?
Mycobacterium avium-intracellulare complex and Mycobacterium scrofulaceum.
78
What local factors predispose to sinusitis?
Narrow osteomeatal complex, osteomyelitis, polyps, accessory maxillary sinus ostia, nose blowing, and dental disease.
79
Which adjuvant therapies have proven to hasten recovery from acute sinusitis?
No adjuvant therapies (e.g., antihistamines, decongestants, and steroids) have proven to hasten recovery from acute sinusitis.
80
What is the leading cause of chronic cervical lymphadenopathy in young children?
Nontuberculous mycobacterium or atypical TB.
81
Compared with children with chronic sinusitis, children with recurrent sinusitis are more likely to be what?
Older.
82
What is the significance of the seasons on the risk of developing OM?
OM is most common in the winter and lasts longer when it occurs in the winter.
83
What organisms most frequently cause chronic suppurative OM?
P. aeruginosa (most common), S. aureus) Corynebacterium, and Klebsiella.
84
What is the most common causative organism ofNOE?
P. aeruginosa.
85
What is the most common cause of laryngotracheobronchitis (croup) in children?
Parainfluenza virus.
86
What factor strongly correlates with survival and long-term neurologic deficits in patients with a brain abscess?
Patient's level of consciousness at the time of diagnosis.
87
What signs and symptoms are specific for necrotizing otitis externa (NOE)?
Persistent otalgia for longer than 1month. Persistent, purulent otorrhea with granulation tissue for several weeks. Diabetes mellitus, another immunocompromised state, or advanced age. Cranial nerve involvement.
88
What is the most common notifiable and vaccine-preventable disease in children under age 5?
Pertussis.
89
What is Gradenigo's syndrome?
Petrositis involving VI in Dorello's canal causing retro-orbital pain, diplopia, and otorrhea.
90
What are the most common signs and symptoms of sigmoid sinus thrombosis?
Picket fence fever, cannon ball infiltrates on CXR, torticollis, jugular foramen syndrome, and otitic hydrocephalus.
91
When is surgery indicated in the treatment ofNOE?
Progression of pain despite aggressive medical therapy, persistence of granulation tissue, and development of cranial nerve involvement.
92
What are the early signs and symptoms of intracranial infection?
Prolonged suppurative OM, fetid discharge and persistent pain despite adequate treatment, and bony destruction of inner cortex of mastoid on CT scan.
93
Which organism was found, using PCR techniques, to be present in the sinus tissue of most patients with sarcoidosis?
Propionibacterium granulosum.
94
What differentiates herpes zoster oticus from Ramsay Hunt syndrome?
Ramsay Hunt syndrome is herpes zoster oticus +facial nerve paralysis.
95
Which etiology of facial nerve palsy has a worse prognosis: Bell's palsy or Ramsay Hunt syndrome?
Ramsay Hunt syndrome.
96
What are the three most commonly identified viruses in middle ear fluid?
Respiratory syncytial virus (RSV) (74%), parainfluenza, and influenza.
97
What is the significance of genetics on the risk of developing OM?
Risk of OM is higher if a sibling has a history of recurrent OM.
98
What are the most common pathogens cultured from otorrhea after tympanotomy tubes in children older than 3?
S. aureus and P. aeruginosa.
99
What organism is the most common cause of bacterial tracheitis in children?
S. aureus.
100
Patients with perennial allergic rhinitis have a significantly higher rate of nasal carriage of which organism?
S. aureus.
101
What is the most common organism cultured from the blood of patients with preseptal orbital cellulitis?
S. pneumoniae (H. influenzae type b if not vaccinated).
102
What are the most common organisms causing acute bacterial rhinosinusitis?
S. pneumoniae, H. injluenzae, Branhamella catarrhalis, S. aureus, anaerobes (
103
What is the most common pathogen isolated from opacified maxillary sinuses in children?
S. pneumoniae.
104
Which organism most commonly causes postmeningitic hearing loss?
S. pneumoniae.
105
How many serotypes of pneumococcus are responsible for 83% of invasive disease in children
Seven.
106
What is the outcome of these patients who undergo surgical decompression \>14 days after injury?
Similar outcome as patients treated with steroids.
107
What is the Pretz maneuver?
Sinus irrigation where saline is flushed into one nostril and aspirated from the other nostril while the patient is supine with the nasopharynx parallel to the floor.
108
In children 18 months to 6 years?
Sinusitis (so%), cough-variant asthma (27%).
109
What organisms most frequently cause AOM?
Streptococcus pneumoniae (30-35%), nontypeable strains of H. influenzae (20-25%), and M. catarrhalis (10-15%).
110
What are the three most common organisms of OM that result in intracranial infections?
Streptococcus faecalis, Proteus, and Bacteroides fragilis.
111
What is the most common organism cultured from an intracerebral abscess resulting from rhinosinusitis?
Streptococcus milleri (commensal found in the mouth, vagina, and feces).
112
What are the most common intracranial complications of rhinosinusitis?
Subdural empyema (38%), intracerebral abscess, extradural abscess, meningitis, and cavernous and superior sagittal sinus thrombosis (listed in decreasing order of frequency).
113
What are the extracranial complications of OM?
Subperiosteal (Bezold's) abscess, petrositis, labyrinthitis, and facial nerve paralysis.
114
What is the most common complication of acute mastoiditis?
Subperiosteal abscess.
115
What distinguishes bacterial from viral rhinosinusitis?
Symptoms that worsen after 5 days, persist longer than 10 days, or are out of proportion to those typical of viral infection are characteristics of bacterial rhinosinusitis.
116
Why are infants more prone to meningitis as a complication of rhinosinusitis?
The arachnoid mater normally serves as a barrier to infection, but in infants, the arachnoid mater is immature.
117
What is the significance of breast-feeding on the risk of developing OM?
The duration of breast-feeding is inversely related to the incidence of OM.
118
Why is it difficult to treat infections involving the perichondrium or cartilage?
The metabolic demands of cartilage are low, and its blood supply is hence diminished.
119
Why are diabetics more prone to NOE?
The pH of their cerumen is higher and more conducive to bacterial growth.
120
Why must the dose of acyclovir be larger for patients with varicella zoster virus (VZV)?
The thymidine kinase of VZV is much less sensitive to acyclovir than the herpes simplex virus.
121
What are the AAO-HNS indications for myringotomy and tympanostomy tubes?
Three or more episodes of OM in 6 months; four or more episodes in 12 months. Hearing loss \>30 dB from OME. OME \> 3 months. Chronic TM retraction. Impending mastoiditis or other complication of OM. Autophony secondary to patulous eustachian tube. ET dysfunction secondary to craniofacial anomalies or head and neck radiation.
122
How does the infection spread from the external canal to the skull base?
Through the fissures of Santorini.
123
True/False: Enhancement of the facial nerve is commonly seen on MRI of patients with Bell's palsy and is likely to resolve in 2-4 months.
True.
124
True/False: The 23-valent pneumococcal vaccine is not effective in children \< 2.
True.
125
True/False: Since the introduction of the heptavalent pneumococcal vaccine, overall rates of pneumococcal meningitis have decreased in the United States, but rates caused by non-PC7-related serotypes have increased, primarily in children younger than 2.
True.
126
True/False: Fluid collections are rare in all forms of fungal disease.
True.
127
True/False: The risk of intracranial complications from orbital cellulitis is higher in teenagers than in infants.
True.
128
What proportion of children will have had at least one episode of OM by age t?
Two-thirds.
129
What is the treatment for uncomplicated acute mastoiditis?
Tympanocentesis for culture and IV antibiotics.
130
What are the clinical features of cervical nontuberculous mycobacterium?
Typically affects children ages 1-5 years, unilateral, upper cervicofacial lymph nodes, negative or weakly positive PPD, normal CXR.
131
What are the clinical features of recurrent parotitis of childhood?
Typically presents at age 5-7, more common in males, unilateral, gets less severe with time, 55% will resolve spontaneously, and frank pus is rarely seen.
132
What is the most common cause of cough in children?
URI.
133
Which cranial nerves are most commonly involved in NOE?
VII (75%), X (70%), XI (56%).
134
Which two cranial nerves are most commonly affected in West Nile neuroinvasive disease?
VII and VIII.
135
What is the most common cause of epidemic encephalitis in the US?
West Nile virus
136
What is the treatment for otogenic facial palsy in association with acute suppurative OM?
Wide myringotomy, cultures, and IV antibiotics.
