OM Flashcards Preview

Specialty Medicine > OM > Flashcards

Flashcards in OM Deck (74):
1

What is AOM?

Acute inflammatory disease of the middle ear and TM with or without purulent middle ear fluid

2

What is the definition of OME (OM with effusion)?

Presence of middle-ear effusion without any local or systemic signs of inflammation

3

What are the physical exam findings of AOM? (3)

-Bulging
-Erythema
-Perforation w/ drainage

4

What are the symptoms of AOM? (4)

-Otalgia
-Irritability
-Fever
-Ear tugging

5

What percent of children are diagnosed with OM by 9 months of age?

40%

6

What percent of children are diagnosed with OM by 2 years of age?

60%

7

What is the peak age for recurrence of OM?

6-12 months of age

8

True or false: The incidence of OM is increasing in the developed world

False--decreasing

9

True or false: the heavy burden of OM is still in the developing world

true

10

What are the two ethnicities that have an increased incidence of OM in the US?

native american
Eskimo

11

Children with an atypical course of OM should be worked up for what?

Immune workup looking for common variance of immunosuppression, such as IgG subclasses deficiency

12

Why are kids with T21 more susceptible to OM?

Craniofacial abnormality predisposes them

13

What is the effect of an untreated cleft palate and the incidence of OM?

Increased significantly

14

What is the chromosome that may play a role in predisposition to OM?

19q

15

What are the environmental risk factors for the development of OM? (3)

-Smoking
-daycare
-Season

16

What is the role of breastfeeding and the incidence of OM?

Increased risk for 3 or more OM in children who are breastfed less than 6 months

17

What is the role of pacifiers and the incidence of OM?

Unknown

18

True or false: for the most part, kids with OME are asymptomatic

True

19

What is the main concern with OME?

Long term consequences of hearing loss

20

What is the usual precipitating event for OME?

Viral illness

21

What is the suspected pathophysiology of OME?

Eustachian tube dysfunction

22

What are the three most common pathogens that cause OM?

1. Strep pneumo
2. H. influenza
3. Moraxella catarrhalis

23

What is the trend in the causes of OM?

-Increase in H. influ, decrease in Strep

24

What is the role of antihistamines in the treatment of OM?

Do not use

25

What is the role of corticosteroids in the treatment of OM?

Do not use

26

What is the role of decongestant in the treatment of OM?

Do not use

27

What is the role of allergies in the development of AOM?

Thought to play a role, but unsure

28

What is the relation between kids with gastroesophageal reflux and AOM?

Positive correlation, with treatment of GERD leading to decreased rates

29

What GI protein has been identified within the middle ear of pts undergoing placement of myringotomy for OME?

Pepsin and pepsinogen

30

What is the major preventive strategy against AOM?

Immunization

31

What are the vaccines available for AOM?

13 valent
23 polysaccharide

32

What, epidemiologically, has changed with the development of the strep pneumo vaccine?

Decreased incidence of AOM, and major decrease in invasive disease

33

How is the strep pneumo vaccine made to induce a response to the polysaccharide capsule?

Conjugated to the H. influenza protein D

34

What are T cell independent antigens?

Ones that do not use T cells to produce an immune response

35

The Hib vaccine is for the polysaccharide capsule. Explain how it is effective.

Conjugated to the diphtheroid toxin

36

What is happening to the incidence of non typeable influenzae infections?

Increasing

37

What is the most common organism that causes extracranial infections 2/2 recent AOM?

Strep pneumo

38

What is the usual presentation of infections of moraxella catarrhalis?

Lots of secretions

39

What is the relationship between the flu and AOM?

Recent flu infection predisposes to AOM

40

What is the most common etiology of AOM: viral, bacterial, or fungal

Viral

41

What is the current treatment approach to AOM?

Supportive

42

Under what age is a contraindication for observation of AOM?

Under 6 months

43

What are the four major absolute contraindications to just observing AOM?

-Less than 6 months
-Immunodeficiency
-Severe illness or previous treatment failure
-Inability to ensure f/u

44

True or false: previous treatment failure is not a contraindication to observation for AOM

False-- it is an absolute

45

True or false: an inability to ensure f/u is a contraindication to observing AOM

True

46

What are the four relative contraindications for observation with AOM?

-Relapse within the last 30 days
-Otorrhea
-Bilateral AOM if less than 2 yo
-Craniofacial malformation

47

Relapse of AOM within how many days is a relative contraindication to observation with AOM?

30 days

48

True or false: otorrhea is an absolute contraindication to observation for AOM

false--relative contraindication

49

Bilateral AOM under what age is a relative contraindication to observation?

2 yo

50

What is the first line abx for the treatment of AOM? What about if severe?

Normal = Amoxicillin
Severe = augmentin

51

What is the abx of choice for AOM if there is a PCN allergy?

Cephalosporin

52

What is the abx of choice for AOM if there is a PCN and a cephalosporin allergy?

Macrolide

53

When should kids be reevaluated for an episode of AOM with treatment?

48-72 hours

54

What are the two abx of choice if there is failure to respond to amoxicillin?

-Augment if not already tried
-Ceftriaxone if has tried above

55

How is ceftriaxone administered?

IM q 3 days

56

First line therapy for AOM is not an option if recurrence of AOM is within what timeframe?

30 days

57

What is the average course of abx for a short course of AOM? Increased severity?

Average = 5-7 days
Severe = 10 days

58

When is surgical management (TM tube placement) indicated for recurrent AOM?

Recurrent AOM, with greater than 3 infections in 6 months
OR
4 infections in 12 months

59

When is TM tube placement indicated for OME? (3)

When effusion present over 4 months
-Significant hearing loss w/ language issue
-Structural changes in the middle ear

60

True or false: Often there is a dramatic change in kids' behavior following tympanostomy tube placement

True

61

What are the signs of chronic, degenerative changes of the middle ear 2/2 recurrent AOM?

-TM perforation
-Chronic otorrhea
-Chronic mastoiditis
-Cholesteatoma
-Hearing loss

62

What are the two categories of complications with AOM?

-Intratemporal but extracranial
-Intracranial

63

What are cholesteatomas?

A destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Usually 2/2 to untreated chronic OM.

64

What are the s/sx of a cholesteatoma?

Hearing loss
*Otorrhea*
Balance issues

65

What are the four major intratemporal, but extracranial infections associated with AOM?

-Mastoiditis
-Petrositis
-Labyrinthitis
-facial nerve palsy

66

What CN involvement is an indication for an emergency TM tube placement?

Bell's palsy

67

What is the classic sign of mastoiditis?

Forward ear protrusion

68

Picket fence fevers = ?

Sigmoid sinus infections

69

What are the intracranial problems with untreated AOM?

-Meningitis
-Subdural or brain abscesses
-Otitic hydrocephalus
-Sigmoid sinus thrombophlebitis

70

What is otitic hydrocephalus?

Idiopathic hydrocephalus 2/2 AOM

71

What are the signs that indicate a complicated course of AOM? (5)

-Low intensity pain for more than one week
-Foul smelling otorrhea
-Retroorbital pain
-Facial nerve palsy
-Vertigo

72

What type of organisms are associated with mastoiditis with abscesses, and not seen with AOM?

Anaerobic

73

What is the most common organism that causes meningitis 2/2 AOM?

Strep pneumo

74

What are the two most common bacteria that are associated with cholesteatoma?

Pseudomonas
Bacteroides