URTI

Question 1

Acute otitis media (AOM)

Answer 1

Bulging TM
Middle ear effusion (MEE)
Inflammation
Acute onset of sx

Question 2

AOM RF

Answer 2

Airborne particle allergies
Attend daycare
Bottle feeding
Craniofacial abnormalities
Food allergies
Immunodeficiency
Low SES
Male
Nasopharyngeal colonization with bacterial pathogens
Native American, Eskimo, Australian ethnicities
Pacifier use
Predisposition
Recent viral illness
Sick household member
Tobacco smoke exposure
Under 2 yo

Question 3

Anatomy of eustachian tube by age

Answer 3

Adults - 45 degrees

Infants - 10 degrees

Question 4

Presentation of AOM

Answer 4

MEE with acute sx onset:
Fever
Irritability
Otalgia
Pulling ears
Rhinorrhea

Question 5

AOM otoscopic examination

Answer 5

TM appearance

TM changes

Question 6

AOM TM appearance

Answer 6

Cloudy
Erythematous
Pale yellow
White

Question 7

AOM TM changes

Answer 7

Fullness
Immobility
Otorrhea

Question 8

AOM complications

Answer 8

Temporary hearing loss
TM perforation
Brain abscess or meningitis

Question 9

What delays are seen with hearing loss d/t AOM?

Answer 9

Cognitive abilities
Language
Speech

Question 10

Common causes of AOM

Answer 10

Bacterial (80%): S pneumonia, H flu, M catarrhalis

Viral: RSV, rhinovirus, influenza, adenovirus

Question 11

AOM prevention

Answer 11

PCV 13 (3 vaccine series starting at 2 months)
Hib (3 vaccine series starting at 2 months)
Annual influenza (after 6 months old)

Question 12

AOM recurrence definition

Answer 12

>/= 3 episodes in 6 months
>/= 4 episodes in 12 months

Question 13

AOM recurrence prevention

Answer 13

Abx (AAP argues against but does not have recommendation)

Tympanostomy tube placement)

Question 14

Pharyngitis

Answer 14

Inflammation of the mucous membrane of throat

Question 15

Types of pharyngitis

Answer 15

Nasopharyngitis
Tonsillitis
Tonsillopharyngitis

Question 16

Pharyngitis general s/sx

Answer 16

Throat pain (not required)
Erythema - required
Exudate - required
Ulceration - required

Question 17

Pharyngitis causes

Answer 17

Bacterial: s pyogenes (GAS) most common
Viral: adenovirus, CMV, enteroviruses, EBV, HSV, Influenza

Question 18

Bacterial pharyngitis s/sx

Answer 18

Autumn, winter, spring
Ab pain
Cervical adenopathy
Fever
HA
Nausea
Sore throat
Tonsillar exudate 
Vomiting

Question 19

Viral pharyngitis s/sx

Answer 19

Summer, Autumn
Anterior stomatitis
Conjunctivitis
Coryza
Cough
Diarrhea
Rash (in children not adults)
Ulcerative colitis

Question 20

Diagnosis of bacterial pharyngitis

Answer 20

Throat culture

Rapid antigen detection test (RADT)

Question 21

RADT

Answer 21

Never used alone unless positive

If it is positive, it is accurate. Negative does not mean you do not have it.

Question 22

Treatment of viral pharyngitis

Answer 22

Self-limiting

Sx treatment

Question 23

Treatment of bacterial pharyngitis

Answer 23

Abx for sx GAS
Sx resolution: 3-4 day mark
Beta-lactams
Clindamycin
Macrolides
Sx treatment

Question 24

Beta lactams in pharyngitis

Answer 24

PCN (enteral/IV)
Amox
Duration: 10 days

Question 25

Clinda in pharyngitis duration of therapy

Answer 25

10 days

Question 26

Macrolides pharyngitis duration of therapy

Answer 26

5 days

Question 27

Pharyngitis symptomatic treatment

Answer 27

Treat the pain | Do NOT use antihistamines or decongestants

Question 28

Rhinosinusitis

Answer 28

Inflammation of the mucous membranes: Nose Paranasal area

Question 29

Rhinosinusitis viral causes

Answer 29

``` Most common - common cold Rhinovirus Influenza Parainfluenza Respiratory syncytial virus Adenovirus Enterovirus ```

Question 30

Rhinosinusitis bacterial causes

Answer 30

Secondary infections S pneumonia H influenza M catarrhallis

Question 31

Rhinosinusitis duration classifications

Answer 31

< 30 days = acute 30-90 days = subacute > 90 = chronic

Question 32

Bacterial sinusitis diagnosis

Answer 32

Persistent illness lasting > 10 days (wait) Worsening course after implementation (abx) Severe onset for 3 consecutive days

Question 33

Bacterial sinusitis: persistent illness lasting > 10 days

Answer 33

Daytime cough | Nasal discharge

Question 34

Bacterial sinusitis: worsening course after implementation

Answer 34

Daytime cough Fever New onset nasal discharge

Question 35

Bacterial sinusitis: severe onset for 3 consecutive days

Answer 35

Concurrent fever | Purulent nasal discharge

Question 36

Bacterial sinusitis treatments

Answer 36

Beta-lactams Clinda + cefiximine FQ Sx treatment

Question 37

Bacterial sinusitis beta-lactam treatment

Answer 37

``` Amox (dosing lower than in AOM) Augmentin Cefotaxime Ceftriaxone Duration of therapy - 10 days ```

Question 38

Bacterial sinusitis clindamycin + cefixime duration of therapy

Answer 38

10 days

Question 39

Bacterial sinusitis FQ duration of therapy

Answer 39

10 days

Question 40

Bacterial sinusitis sx treatment

Answer 40

Pain management Antihistamines/decongestants (only if viral - decreases blood flow of where you want abx to go) Saline spray/mist/drops are the only recommendation