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60 Cards in this Set
- Front
- Back
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Etiology of Meniere's disease
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1. Unknown
2. Exacerbated by stress or emotional disturbance 3. Associated with concurrent infection in 50% cases |
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Pathophysiology of Meniere's disease
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1. Swelling of endolymphatic labyrinthine spaces
2. Degeneration of the organ of Corti |
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Prodrome symptoms of Meniere's disease
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Headache
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Triad of symptoms of Meniere's disease
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1. Tinnitus: "Roaring", low tone
2. Vertigo: Recurrent episodic 3. Sensorineural Hearing Loss: fluctuant |
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Characteristics of dizziness in Meniere's disease
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May last minutes to hours, days when severe
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Signs of Meniere's disease
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1. Nystagmus
1. Only present when Vertigo present 2. Sensorineural Hearing Loss 1. Early: Low tones affected 2. Later: All tones affected |
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Management of Meniere's disease: Acute
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1. Diazepam IV
2. Atropine IV 3. Transdermal Scopolamine |
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Management: Maintenance of Meniere's disease:
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1. Medications
1. Diazepam 2. Bellergal 3. Meclizine 2. Low salt diet (<2 grams daily) 3. Decrease caffeine 4. Smoking Cessation 5. Diuretics (Dyazide) |
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Epidemiology of acute Otitis Externa
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1. Five times more common in swimmers than non-swimmers
2. Bilateral involvement in 10% of acute cases 3. Age peaks at 7-12 years and decreases after age 50 |
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Pathophysiology of acute Otitis Externa
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1. Perfect Bacterial Environment: Moist, warm canal
2. Commonly follows swimming or bathing 1. Water in canal washes off oils and wax 1. Results in dry, fissuring skin 2. More susceptible to trauma 3. Excoriation from cotton swabs |
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Differential Diagnosis of infectious causes of acute Otitis Externa
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1. Bacterial Otitis Externa (most common)
2. Fungal Infection (Otomycosis) Viral Infection 3 Herpes simplex and Herpes Zoster |
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Differential Diagnosis of noninfectious causes of acute Otitis Externa
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1. Allergic Otitis Externa
1. Allergic Contact Dermatitis 2. Eczematous Dermatitis (Atopic Dermatitis) 2. Irritant Contact Dermatitis 3. Psoriasis 4. Seborrheic Dermatitis 5. Acne Vulgaris 6. Systemic Lupus Erythematosus |
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Symptoms of acute otitis externa
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otorrhea
pruritus otalgia Conductive Hearing Loss Systemic symptoms absent |
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Signs of acute otitis externa
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Ear canal with erythema, edema, and exudate
Tympanic Membrane mobile Pain with movement of the tragus or auricle Lymphadenopathy at upper neck or around auricle |
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Differential Diagnosis of acute otitis externa
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1. Chronic Otitis Externa
2. Acute Otitis Media with perforated tympanic membrane 3. Localized Otitis Externa (Staphylococcal Folliculitis) 4. Suppurative Perichondritis 5. Malignant External Otitis 6. Chronic Otitis Media complication |
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Most common causes of bacterial otitis externa
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1. Pseudomonas aeruginosa (50% of cases)
1. More common in Diabetes Mellitus 2. See Malignant External Otitis 2. Staphylococcus aureus 3. Proteus 4. Escherichia coli |
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Epidemiology of otitis media
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1. Incidence of infection
1. All children by 1 year of age: 62% 2. All children by 3 years of age: 83% 2. Average of 1.5 Acute Otitis Media episodes per year |
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Risks of recurrent Otitis Media or persistent Effusion
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1. Age < 5 yrs (5 fold relative risk)
2. Otitis prone (4x) (see below) 3. Day care (4x) 4. Respiratory Illness (4x) 5. Smokers in home (3x) 6. Bottle Propped babies (2x) 7. Males (2x) 8. Pacifiers |
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What are some protective factors against otitis media
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Breast feeding
Summer |
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Pathogens seen with otitis media
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Streptococcus Pneumoniae
Haemophilus Influenzae Moraxella catarrhalis Group-A Beta Hemolytic Streptococcus Staph aureus |
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Most common sinus affected with sinusitis in adults
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maxillary
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Second most common sinus affected with sinusitis in adults
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Frontal
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Most commonly infected sinus in children
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ethmoid
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Four types of sinusitis
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Acute, subacute, chronic, recurrent
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Red Flag Symptoms with sinusitis
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1. High Fever over 102.2 F (39 C) or persistent fever
2. Visual complaints (e.g. Diplopia) 3. Periorbital edema or erythema 4. Mental status changes 5. Severe facial or dental pain 6. Infraorbital hypesthesia |
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Diagnosis: Findings most suggestive of bacterial cause of sinusitis
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Symptoms persist beyond 10 to 14 days
Symptoms worsen after 5-7 days ("double sickening") Purulent Nasal discharge Maxillary tooth or facial pain (esp. if unilateral) Unilateral maxillary sinus tenderness |
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Management of acute sinusitis
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Symptomatic relief - Warm, moist compresses over sinuses, tylenol
saline nasal spray Systemic Decongestants Mucolytic Intranasal Steroids Avoid Antihistamines |
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Pathophysiology of an aphthous ulcer
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Benign autoimmune condition
Nutritional deficiency may contribute in some cases. Vit B-12 or folic acid Iron deficiency anemia |
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Symptoms of diphtheria
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1. Sore Throat
2. Dysphagia 3. Weakness 4. Malaise |
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Signs of diphtheria
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1. Toxic appearance
2. Fever 3. Tachycardia (out of proportion to fever) 4. Pharyngeal erythema 5. Gray-white tenacious exudate or "membrane" 1. Occurs at tonsillar pillars and posterior pharynx 2. Leaves focal hemorrhagic raw surface when removed 6. Cervical Lymphadenopathy |
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Differential Diagnosis with diphtheria
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1. Vincent's Angina (Trench Mouth)
1. Also shows pseudomembrane formation 2. Pharyngitis |
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Dx of diphtheria
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1. Complete Blood Count (CBC)
1. Leukocytosis 2. Throat Culture 1. Positive for Corynebacterium organisms |
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Management of diphtheria
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1. Diphtheria antitoxin
2. Erythromycin 20-25 mg/kg q12 hours IV for 7-14 days |
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What is commonly misdiagnosed as croup?
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epiglottitis
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Definition of epiglottitis
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Potentially fatal infection of supraglottic tissue
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Etiology of epiglottitis in children
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Haemophilus Influenzae type B
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Etiology of epiglottitis in adults
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1. Group A beta hemolytic Streptococcus
2. Streptococcus Pneumoniae 3. Haemophilus Influenzae |
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Symptoms of epiglottitis (Acute onset with rapid progression)
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1. Severe Pharyngitis (82%)
2. Fever Mild or subtle Stridor (77%) 3. "Look worse then they sound" (opposite of Croup) 4.Shortness of Breath (100%) 5.Irritability or restlessness (46%) 6.Dysphagia (64%) 7.Drooling (41%) 8.Soft muffled voice or Hoarseness (31%) |
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Diagnosis of epiglottitis (Differentiate from Croup)
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1. Absence of cough
2. Dysphagia (difficult swallowing with Drooling 3. Toxic appearance |
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What sign will you see on an x-ray with epiglottitis?
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Thumb shaped epiglottis (swollen supraglottis)
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What should avoid if you suspect epiglottitis
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using a tongue depressor or other oral instruments. You can lose your airway
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What medications should be avoided with epiglottitis
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racemic epinephrine
systemic steroids |
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what is the etiology of mononucleosis?
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Epstein-Barr Virus
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Transmission of mononucleosis?
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1. Transmission through infected Saliva (kissing)
2. Oral secretions transmit for up to 6 months |
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Epidemiology of mononucleosis?
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Adolescents and young adults
Commonly occurs in congested, confined spaces 1. College Students 2. Military recruits |
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Symptoms of mononucleosis?
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1. Fever (in >97% of cases)
1. Persists for 7-10 days 2. Chills 3. Malaise 4. Fatigue (Test Sensitivity: 93%) 5. Myalgia 6. Severe Sore Throat |
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Signs of mononucleosis
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1. Exudative Pharyngitis (>97%)
2. Prominent cervical Lymphadenopathy (>97%) 1. Posterior cervical Lymphadenopathy most common 2. Axillary and Inguinal Lymphadenopathy also common 3. Pharyngeal erythema and edema (85%) 4. Splenomegaly (75%) 5. Palatal Petechiae (50%) 6. Periorbital edema (33%) 7. Hepatomegaly (20%) |
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Diagnosis of mononucleosis
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Throat culture
Lymphocyte predominance: >50% Lymphocyte atypia >10% Heterophil Antibody Test Monospot Test) Efficacy: 95% sensitive and Specific Antibodies to EBV antigens: |
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Management of mononucleosis
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Rest
non-caffeinated beverages for hydration NSAIDS or APAP Avoid strenuous Exercise or contact sport Antibiotics - only with coexisting strep throat |
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Demographics of parotitis
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Most common in age >50 years
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Organisms seen with acute parotitis
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1. Staphylococcus aureus (most common)
2. Streptococcus species 3. Gram Negative Bacteria 4. Anaerobic Bacteria |
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Symptoms of parotitis
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1. Acute pain localized over affected Salivary Gland
2. High fever with chills often present |
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Signs of parotitis
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Ill appearing patient
Tender, swollen Salivary Gland (usually Parotid Gland) Regional Lymphadenopathy Pus at affected Salivary duct orifice 1. Parotid duct (Stensen's Duct) at upper second molar |
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Differential Diagnosis with parotitis
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Sialolithiasis
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Risk factors for peritonsillar abscess
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1. Exudative Tonsillitis
2. Periodontal Disease 3. Tobacco Abuse |
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Most common organism seen with peritonsillar abscess
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Streptococcus Pyogenes
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Symptoms with peritonsillar abscess
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Fever over 39.4 suggests more serious infection
Severe, unilateral throat pain Dysphagia Trismus Muffled ("hot potato") voice Drooling |
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Signs with peritonsillar abscess
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1. Ill appearance
2. Uvula deviates to the opposite side 3. Localized swelling of Soft Palate over affected tonsil 4. Swollen tonsil (usually superior pole) 1. Indurated, fluctuant mass 2. Exudate may be present 3. Erythematous peritonsillar area 4. Usually unilateral |
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Differential Diagnosis with peritonsillar abscess
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1. Peritonsillar Cellulitis (no pus in capsule)
2. Tonsillar abscess 3. Mononucleosis 4. Cervical adenitis 5. Dental infection (e.g abscessed tooth) 6. Sialolithiasis or Sialadenitis 7. Mastoiditis 8. Internal carotid artery aneurysm 9. Malignancy (e.g. Lymphoma) |
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What is the triad?
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nasal polyps, ASA sensitivities, rhinnitis
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