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IOS 10 Exam 3
Upper respiratory tract infections
| Question | Answer |
|---|---|
| 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 |
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liza001
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