Otitis & Sinusitis

Question 1

Contraindicated Meds in AOM & Sinusitis

Answer 1

Decongestants & Antihistamines d/t thickened mucous

Question 2

Tx of AOM in Infants <6mo

Answer 2

Always tx if suspected

Question 3

Tx of AOM in Infants 6mo - 2 yr

Answer 3

Tx if diagnosis is certain or systemic symptoms present (fever, lymphadenopathy)

Question 4

Tx of AOM in Kids > 2 yr

Answer 4

Tx if systemic symptoms present (fever, lymphadenopathy

Question 5

MC AOM Pathogens

Answer 5

S. pneumoniae; H. flu; M. cat

Question 6

1st line tx for AOM

Answer 6

Amoxicillin x 7 d

Question 7

2nd line tx for AOM (Amoxil failed)

Answer 7

Augmentin (preferred); Macrolides (Azithro or Clarithro); Bactrim DS

Question 8

3rd line tx for AOM

Answer 8

Cefdinir (Omnicef)

Question 9

AOM tx for PCN allergic

Answer 9

Macrolides (Azithro or Clarithro) or Bactrim DS

Question 10

Clarithromycin (Biaxin XL) Unique AE

Answer 10

Metal taste in mouth

Question 11

Cefdinir (Omnicef) Unique AE

Answer 11

Red stools

Question 12

ABX requiring refrigeration

Answer 12

Augmentin

Question 13

ABX requiring room temp

Answer 13

Azithromycin & Clindamycin & Cefdinir

Question 14

Clindamycin drawback

Answer 14

Tastes terrible

Question 15

Azithromycin drawback

Answer 15

Resistance; dosing packs (requires 2)

Question 16

When to switch tx in AOM

Answer 16

No response within 72 hours of initiating tx

Question 17

Aurodex

Answer 17

Pain relief ear drops (contain benzocaine)

Question 18

OM with Effusion - Signs of Severity

Answer 18

Lasts > 3 mo; Sustained hearing or speech impairment; recurrent AOM

Question 19

Tx of OM with Effusion

Answer 19

Tympanostomy tubes

Question 20

OE - Signs of Severity

Answer 20

Periauricular Erythema; Lymphadenopathy; Fever

Question 21

OE tx

Answer 21

Remove cerumen, desquaminated skin & purulent material; topical abx

Question 22

1st line tx for OE

Answer 22

Ofloxacin 0.3% sol’n (Floxin Otic); Ciprofloxacin & Hydrocortisone (Cipro HC otic); Tobramycin & Dexamethasone (Tobradex) x 7 - 14 days

Question 23

Contraindications for Ear Drops & Aural Irrigation

Answer 23

Ruptured TM

Question 24

2nd line tx for OE or Severe OE

Answer 24

Oral FQs (Cipro/Levo)

Question 25

OE Pathogens

Answer 25

Pseudomonas; S. aureus; Polymicrobial (1/3 of all cases)

Question 26

How many days should a patient have s/sx of sinusitis before ABX are administered?

Answer 26

10 days

Question 27

Tx for Sinusitis with 1-10 days of symptoms

Answer 27

Intranasal glucocorticoids (Flonase); Mucolytics (Mucinex)

Question 28

1st Line ABX for Bacterial Sinusitis

Answer 28

Amoxicillin x 10 - 14 d

Question 29

PCN Allergic Tx for Bacterial Sinusitis

Answer 29

Macrolides (Azithro or Clarithro); Bactrim DS; or 3rd Gen Cephalosporins (Cefdinir or Cefixime)

Question 30

2nd Line ABX for Bacterial Sinusitis (Amoxil failed)

Answer 30

Augmentin; 2nd/3rd gen Ceph (Cefuroxime or Cefdinir); Levo or Moxifloxacin (avoid FQs in peds d/t bone/joint problems)

Question 31

Adjuntive Tx to Avoid in Peds with Sinusitis

Answer 31

Decongestants & Antihistamines & Nasal corticosteroids

Question 32

Rhinitis medicamentosa

Answer 32

Rebound congestion d/t prolonged use of Afrin or nasal corticosteroids

Question 33

Safe Length of Use for Afrin

Answer 33

72 h

Question 34

Pseudoephedrine MoA

Answer 34

Alpha-adrenergic stimulation >> Vasoconstriction of resp mucosa; Beta stimuation >> ^ Rate & contractility of heart; bronchorelaxation

Question 35

Pseudoephedrine Side Effects

Answer 35

Cardio (tachy, palpitations, arrhythmia, ^BP); CNS (Dizzy, HA, Insomnia, Nervous, CNS stimulation)

Question 36

Nasal Corticosteroids

Answer 36

Fluticasone Propionate (Flonase); Mometasone (Nasonex); Fluticaone furae (Veramyst); Budesonide (Rhinocort); Triamcinolone (Nasacort)

Question 37

Nasal Corticosteroids Tx Length

Answer 37

1-2 sprays/nostril qd x 10-14 d; May take 3 days for noticable effect

Question 38

Viral causes of Pharyngitis

Answer 38

Rhinovirus; Coronavirus; Adenovirus

Question 39

MCC of Bacterial Pharyngitis

Answer 39

S. pyogenes

Question 40

1st Line Tx for Bacterial Pharyngitis

Answer 40

Amoxicillin x 10 d

Question 41

2nd Line Tx for Bacterial Pharyngitis (Amoxil fail)

Answer 41

Augmentin

Question 42

PCN Allergic Tx for Bacterial Pharyngitis

Answer 42

Cefdinir (Omnicef); Cefuroxime (Ceftin); Azithro; Clarithro