Lecture 2 - Orbital Infection to Wegeners Flashcards Preview

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Flashcards in Lecture 2 - Orbital Infection to Wegeners Deck (66)
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1

Fascia behind the orbicularis, between the orbital rim and tarsus, serves as a BARRIER BETWEEN LIDS AND ORBIT

Orbital Septum

2

superior orbital septum blends with the tendon of which lid muscle

Levator palpabrae

3

inferior orbital septum blends with which lid muscle?

inferior tarsus

4

Chandler classification for infections of the orbit and adnexa: What is stage 1?

NORMAL septum - preseptal cellulitis

5

Chandler classification for infections of the orbit and adnexa: What is stage 2?

Diffuse cellulitis - contained in cone and EOMs

6

Chandler classification for infections of the orbit and adnexa: what is stage 3?

Subperiosteal abscess - abscess outside of the muscle cone

7

Chandler classification for infections of the orbit and adnexa: what is stage 4?

Abscess contained within the orbit

8

Chandler classification for infections of the orbit and adnexa: what is stage 5?

Cavernous sinus thrombosis

9

Infection of the soft tissue of eye lids anterior to the orbital septum - no involvement of globe and orbit - injury, bites, conjunctivitis, sinusitis, chalazion - Usually Staph Aureus or Strep

Preseptal Cellulitis

10

What 2 anaerobic bacteria should be suspected in cases involving preseptal cellulitis caused by human or ANIMAL bites?

peptostreptococcus and bacteroides

11

which bacteria should be suspected in preseptal cellulitis cases caused by skin trauma: laceration or INSECT bites

S. Aureus, S. Pyogenes

12

From where in the body can bacteria travel hematogenously to cause a remote infection in the form of preseptal cellulits? (2)

upper respiratory tract or middle ear

13

Is Preseptal cellulitis unilateral? is there proptosis or EOM restriction? can the eye always open? are VA's affected? What are the symptoms you would expect? what will a CT show?

unilateral, no proptosis/restriction, cant always open eye, No VA effect, fever, redness/ tenderness/ irritable children - Opacification anterior to septum

14

What is unique about preseptal cellulitis cases that are caused by H. Influenza?

Red-Purplish in color, important to ask about vaccines

15

You suspect preseptal cellulitis, but upon further testing, you observe proptosis, pain with EOM test, decreased VA, fever, and chemosis. What is the differential diagnosis?

ORBITAL cellulitis

16

You suspect preseptal cellulitis, but then observe acute inflammation (not entire lid area), a palpable mass, and pointy meibomian gland. What is the diferential diagnosis?

Chalazion

17

You suspect preseptal cellulitis, but upon further testing you find there was sudden onset, itching, redness, a history of allergies, and the patient began using a new kind of eye product (cls solution, drops etc) . What is the differential diagnosis?

Swelling of the eyelid due to an allergic reaction

18

You suspect preseptal cellulitis, but upon further testing you find proptosis, paresis (partial paralysis- weakness) of III, IV, VI bilaterally, and decreased sensation of 1st (ophthalmic- upper eye lid, forehead, cornea, nose) and 2nd division (maxillary- teeth, mouth) of CN V, What is the differential diagnosis?

Cavernous sinus thrombosis

19

You suspect preseptal cellulitis, but find a rapid streptococcal cellulitis with CLEAR DEMARCATION, fever, and chills. what is the likely cause?

Erysipelas- acute, recurrent bacterial infection with large raised patches, especially on the face

20

We cannot just assume that preseptal cellulitis is in fact preseptal. in order to determine if the infection has spread to the septum, what tests can we do to rule out orbital cellulitis?

VA's - loss = orbital cellulitis
EOM's- pain= orbital cellulitis
Presence of proptosis
Direct/Consensual Pupillary Response - RAPD = Orbital cellulitis

21

A CT scan should be ordered if you suspect what alternatives? How should the CT look if your initial diagnosis of preseptal cellulitis is correct?

Significant trauma or Intra-Ocular Foreign Body. CT will show opacification strictly anterior to the septum

22

If the area appearing as preseptal cellulitis has an open wound or drainage, what tests need to be ordered?

gram stain and bacterial culture

23

Why would you palpate the perioribital area, head, and neck lymph nodes if you see what appears as preseptal cellulitis?

There could be a lymphoma or other lacrimal gland mass giving the appearing of preseptal swelling

24

So all signs lead to preseptal cellulitis, how do you treat it? Lets say the patient is a child older than 5, no fever? (2 choices) - dont worry about doses

Augmentin - Amoxicillin AB and Clavulanate -- beta lactamase inhibitor) - 20 mg per kg divided into 3 doses

Cefaclor (ceclor) - 2nd gen cephalosporin - inhibits cell wall synthesis - 1 g/day

25

So all signs lead to preseptal cellulitis, how would you treat an adult patient? (3)

Augmentin or Ceclor or Dicloxacillin

26

All of your testing lead to a positive diagnosis of preseptal cellulitis in an Adult person who is known to be allergic to penicillins, how should you treat it?

Bactrim - Trimethoprim and sulfamethazole

27

Penicillins that can be used to treat Presptal Cellulitis

Flucloxacillin, Dicloxacillin, Cloxacillin

28

Cephalosporins used to treat Preseptal Cellulitis - When are they the best to use?

Ceclor, Cephalexin, Cefadroxil, Cephradine
Best for Kids, especially with Gram + infection

29

Macrolides that can be used to treat Preseptal cellulitis, when are they not good to be used?

Azithromycin Z-pack or Clarithromycin
Not good against Gram - bacteria like H. INFLUENZA

30

Fluoroquinolones that can be used to treat Preseptal Cellulitis, When should they not be used?

Ciprofloxacin, Levofloxacin
Never in patients under 18 - causes tendonitis
Can also lead to secondary candida growth in females