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25 Cards in this Set

  • Front
  • Back
1. Acute Otitis Media (AOM)?
a. A condition of Otalgia, fever, and findings of:
1. Red, opaque, poorly moving, bulging tympanic membrane (TM).
2. Myringotomy and Placement of Pressure Equalization tubes?
a. A surgical procedure involving TM incision and placement of pressure equalization (PE) tubes (tiny plastic or metal tubes anchored into the TM) to ventilate the middle ear and help prevent reaccumulation of middle ear fluid.
3. Otitis Media with Effusion?
a. A condition in which fluid collects behind the TM but w/o s/s of AOM.
b. Sometimes called serous OM.
4. Pneumatic Otoscopy?
a. The process of obtaining a tight ear canal seal w/a speculum and then applying slight positive and negative pressure w/a rubber bulb to verity TM mobility.
5. Tympanocentesis?
a. A minor surgical procedure in which a small incision is made into the TM to drain pus and fluid from the middle ear space.
b. This procedure is rarely done in the primary care office, but rather is done by the specialist.
6. Common bacterial pathogens of Acute Otitis Media?
a. Strep pneumo
b. Nontypeable Haemophilus
c. Moraxella catarrhalis
7. Other organisms of AOM seen in neonates and pts w/immune deficiencies?
a. S. aureus
b. E. coli
c. Klebsiella pneumoniae
d. Pseudomonas
8. Note: Viruses can also cause AOM.
8. Note: Viruses can also cause AOM.
9. Diagnosis of AOM: symptoms?
1. Fever (usually <104 [40C])
2. Ear pain (often nocturnal awakening)
3. Generalized malaise.
b. Systemic sx include:
i. Anorexia, n/v, HA, diarrhea
10. Diagnosis of AOM: Physical Exam?!?!?
a. Red, bulging TM that does NOT move well with pneumatic otoscopy!!!!
b. The TM may be opaque w/pus behind it.
c. The middle ear landmarks may be obscured, and, if the TM has ruptured, pus may be seen in the ear canal.
11. Initial tx of AOM (depending on community’s bacterial resistance pattern)?
a. Amoxacillin at doses of up to 80-90 mg/kg/d for 7-10 days.
12. Tx of AOM if clinical failure is noted after 3 tx days, Change to one of the following?
1. Amoxacillin-clavulanate
2. Cefuroxime axetil
3. Azithromycin
4. Cefixime
5. Ceftriaxone
6. Or tympanocentesis is considered.
13. Adjuvant therapies for AOM?
a. Analgesics or antipyretics are often indicated.
b. Other measures (antihistamines, decongestants, and corticosteroids) are ineffective.
14. For how long after an AOM episode, may middle ear fluid persist?!!!
a. For up to several months!!!!
b. If hearing is normal, middle ear effusion often is treated w/observation.
c. Some practitioners tx w/abx.
15. Tx If fluid does not resolve or recurrent episodes of suppurative OM occur, esp. if hearing loss is noted?
a. Myringotomy w/PE tubes is often used.
16. Rare but serious OM complications?
1. Mastoiditis!
2. Temporal bone osteomyelitis!
3. Facial nerve Paralysis!
b. Others:
i. Epidural and subdural abscess formation, meningitis, lateral sinus thrombosis, and otitic hydrocephalus (evidence of increased ICP w/OM).
c. An AOM pt whose clinical course is unusual or prolonged is evaluated for one of these conditions.
17. Confirmation of AOM?
a. Pneumatic Otoscopy.
b. A “telephone diagnosis” should be avoided!
18. Acute Otitis Externa (Swimmer’s ear)?
a. Severe pain w/ear movement.
b. No fever, N/V, or other sx. (no systemic sx)!
c. May have somewhat red pinna that is extremely tender w/movement, very red and swollen ear canal
d. Essentially normal TM!
19. Tx of Acute Otitis Externa?
a. Application of topical agent.
b. Insertion of a wick may assist in excess fluid absorption in the macerated ear canal.
20. Causative organism in acute otitis externa?
a. Pseudomonas species (or other gram-negative organisms)
b. S. aureus
c. Occasionally fungus (candida or Aspergillus)
21. Dx of mastoiditis?
a. May require CT confirmation.
22. Tx of mastoiditis?
a. Myringotomy
b. Fluid culture
c. Parenteral abx.
d. Surgical drainage of the mastoid air cells may be needed if improvement is not seen in 24-48 hours
23. Tx of very young children w/OM (esp. if irritable or lethargic)?
a. They are at higher risk for bacteremia or other serious infection so hospitalization and parenteral abx often are needed.
24. Review picture of TM on page 118!!!
24. Review picture of TM on page 118!!!
25. Complete.
25. Complete.