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IOS 10 Exam 3

Upper respiratory tract infections

Acute otitis media is An infection & inflammation of the middle ear
Otitis media with effusion Accumulation of liquid in middle ear cavity without s/s of acute infection
Otalgia is Ear pain
Otorrhea is Pueulent discharge through perforation of tympanic membrane or tympanostomy tubes
Respiratory mucosa: nose and ear The middle ear, nose, and nasalpharynx share simular respiratory mucosa
Eustachian tube functions Regulation of atmospheric pressure between both sides of TM, protection of nasophyngeal secretions, and drains secretions from middle ear to nasopharynx
Size and angle of eustaschian tube adult tube us longer and lies 45 angle vs childs 10
Eustacian tube dysfunction Reflux, aspiration, insuffation of nasophngeal bacteria up middle ear
Risk factors for acute otitis media Sex (male), race (causasiam, american Indian), age at diagnosis, environmental (sibling, smoking, day-care) pacifer use, season, malformation, nutrition, immunity, lack of breast feeding, socioeconomic status
Etiology of acute otitis media is Often preceeded by viral URI (44%), or most common bacterial cause H. influenza, S. pneumoniae, Moraxella catarrhalis
Acute otitis more commonly seen in neonates ,1 month S. pyrogenes, S.aureus, E.coli, P. aeruginosa, group B strep
Tympanocentesis is A rare occurance where aspiration of middle ear occurs
Clinical presentation of acute otitis media 3 Elements requires: Recent onset, Presense of middle ear effusion, S/S of middle ear inflammation
Symptoms of acute otitis media Otaligia,fever, otorrhea, TM buldging, limited or abscent mobility of TM, air fluid level behind TM, otorrhea, TM erythema, otalgia interferes with normal activity such as sleep
Tympanic membrane perforation Can occur without any symptoms and may lead to hearing loss
Intracranial Complications of acute otitis media Meningitis, mastoiditis, brain abscess
Intraemporal (More common) complications of acute otitis media Eardrum disease, hearing loss
Prevention of otitis media Breastfeeding (6m), avoid supine bottle feeding, reduce or eliminate pacifier after 6m, limit daycare, eliminate smoke exposure, flu vaccine if >2yo, 7-valent pneumococcal
Treatment of acute otitis media APAP (10-15mg/kg->6m), IBU (5-10mg/kg)
Acute Otitis media treatment if temp<39 C Amoxicillin 80-90mg/kg/d if PCN All- Cefdinir, cefuroxime for 10 days
Acute otitis media treatment if Temp >39C Amoxicillin/clavulanate 90/6.4mg/kg/d if PCN All- Ceftriaxone 1 or 3 days
Otitis Media: Risk of bacterial resistance Daycare, antibiotics within 30 days, age <2years
Otitis Media: S. pneumonia resistance Altered PBP binding
Otitis Media: H. influenza resistance Beta-lactamase 50%
Otitis Media: M. catarrhalis Beta-lactamase 100%
Amoxicillin side effects >20% diarrhea, increased with clavulanate will cause severe diaper rash
Cefixime side effects 11-20% risk of diarrhea other cephalosporins casue 1-3%
Erythromycin side effects N/V, cramping
Azithromycin side effects Increased V/D with shorter dosing and all must be on empty stomach
Otitis Media follow up Symptoms should abate in 1-3 days, if not reassess. Follow-up in 3-4 weeks for repeat ostoscopy
Persistant/recurrent Otitis Media is Persistant -S/S after 1-2 antibiotic courses Recurrent 3 or more episodes in 6 months or 4 or more in 12 months. Suggest gatifloxacin 10mg/kg/d
Tympanostomy tubes are Myringotomy is a surgically placed tiny incision in the eardrum. Any fluid, usually thickened secretions, will be removed. In most situations, a small plastic tube (a tympanostomy tube) will be inserted into the eardrum to keep the middle ear aerated for
Acute sinusitis duration is <4 weeks
Subacute sinusitis duration is 4-12 weeks
Chronic sinusitis duration is >12 weeks
Recurrent sinusitis is defined 4 or more episodes/year lasting > 7 days with complete resolution between episodes
Until age 12 children lack ___ sinuses Children have ethmoid and Maxillary sinus and develop the frontal and Sphenoid, by about 12 yo
Risk factors for Acute sinusitis Prior URTi, allergic rhinitis, environmental,concurrent group A, dental infection, hormonal changes, adenodial hypertrophy, iatrogenic, anatomic variation, swimming, immunodefiency, secretory disturbances, abnormal mucocillary, bronchietasis, nasal polyp
Pathogenesis of acute sinusistis 43% S. pneumonia, 20% H. influenza, Moraxella catarrhalis
Clinical presentation of acute sisusitis Nasal drainage, conjestion, facial pain, maxillary dental pain, fever, HA, post-nasal drip, cough(children), fatique, ear-fullness, Halitosis, hyposmia, anosmia
Clinical predictors of acute sinusitis Colored nasal discharge, Maxillary tooth pain, Poor resonse to decongestents, purulent nasal secretions, abnormal transilumination 4-5 high likelyhood 1=virus
Diagnosis of acute sisusitis S/S for 10 days or worsening after 5-7 days, sinus aspirations and culture, radiograph, transillumination, intranasal cultures, CT/MRI
Sinitis: Adult symptomatic pharmacotherapy Decongestants:topical exymetazoline, phenylephrine (3 days max), Systemic pseudoephedrine), analgesics, Mucolytics (guaifenesin 2400mg), nasal corticosteroids, nasal spray, humifiders, sleep upright
Sinitis: Symptoms greater than 10 days or worsen after 5-7days, Adult antibiotic guide Mild dx- Amoxicillin 1.5-4g QD, Augmentin 4g QD Moderate- Levofloxacin, Ceftriazone, B-lactam ALL-Macrolide, ketolide, quinolone (Newer agents - azithromycin 500mg for 3 days)
Sinitis: Pediatric symptomatic pharmacotherapy No data(antihistamines, decongestantsm mucolytics) minimal benefit-nasal saline, intranasal corticosteroids
Sinitis: Pediatric antibiotic guideline Mild- Amoxicillin 90mg/kg, Augmentin 90/6.4 mg/kg/d Moderate Augmentin 90/6.4mg/kg/d, ceftriazone 50 mg/kg/d B-lactam ALL- bactrium, macrolide
Acute sinusitis follow-up Symptoms should abate in 2-5 days if not consider switching antibiotics, or refer to specialist
Acute bronchitis is Inflammatory condition of the tracheobronchial tree usually associated with respiratory infection- common during the winter months (cold climates, higher air pollution, cigarette smoke)
Pathogenesis of bronchitis Hyperemic and edematous mucus membranes, increased bronchial secretions and impaired bronchial mucocillary function
Viral Etiology of bronchitis Virus is the Most common cause- Adenovirus & influenza (most adults) Respiratory syncytial, Rhinovirus, Coronavirus,and parainfluenza (children)
Bacterial Etiology of bronchitis Secondary bacteral infection- Mycoplasma pneumonia (most frequent), chlamydia pneumonia, bordetella pertussis (Lung disease pt- S. pneumoniaw, H. influenza, M. catarrhalis, staph spp-)
Clinical presentations of bronchitis Cough< 3 weeks (hallmark), runny nose, malaise, HA, sore-throat, low-grade fever
Bronchitis: Physical exam results Unimpressive, variable rhinitis, Chest-rhonchi, rales bilaterial, CXR-normal, sputum cultures contaminated, WBC normal
Diagnosis of bronchitis Made on typical history and PE without microbiologic confirmation
Symptomatic treatment of bronchitis Increase hydration, APAP, albuterol, Dextromethorphan, codeine (severe), guaifenesin, vaporizer
Antibiotic treatment of bronchitis Discouraged unless patient has fever for > 4-6 days and then treat for 10-14 days think atypicals
Clinical trials of bronchitis showed Azithromycin was equal to vitamin C. NOTE color of nasal drainage does not warrant antibiotic therapy
Created by: liza001



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