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107 Cards in this Set
- Front
- Back
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*What are the three most common pathogens associated w/ ACUTE otitis media?
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- Streptococcus pneumonia (40%)
- Hemophilus influenzae (25%) - Morexella catarrhalis (12%) (same as chronic just different rates) |
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*What are the three most common pathogens associated w/ CHRONIC otitis media?
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- Hemophilus influenzae (15%)
- Morexella catarrhalis (10%) - Streptococcus pneumonia (7%) (same as acute just different rates) |
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*What are the risk factors for Otitis Media?
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* Daycare
* Smoke exposure - Pacifier * Lack of breastfeeding - Gender - Family history - Lower socioeconomic status - Cleft palate |
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*How do you treat uncomplicated Otitis Media?
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*Amoxicillin
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How do you treat complicated Otitis Media w/ severe otalgia or fevers?
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- Amoxicillin / Clavulanate
- Ear tubes: pressure equalizing tubes like myringotomy or tympanostomy tubes (allows middle ear to ventilate until eustachian tube is mature) |
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How do you treat Otitis Media in patient who is less than 6 months old, febrile, or toxic?
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Myringotomy w/ culture of pus
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When should you avoid putting ear tubes in?
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Not during acute otitis media unless the child is very ill
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*What are the symptoms of the common cold?
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Hours to days after infection:
- Sore throat - Nasal congestion - Rhinorrhea - Cough - Sneezing |
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*What are the most common pathogens associated w/ the common cold?
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- Rhinovirus (30-50%)
- Coronavirus (10-15%) - Influenza virus (5-15%) - Parainfluenza Virus - Respiratory Syncytial Virus |
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How does the incidence of the common cold change with age?
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Decreases w/ age
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How do you treat the common cold?
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- Supportive
- Antivirals may reduce duration of symptoms of influenza if taken w/in 48 ours of symptom onset |
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What drugs can be used to treat influenza?
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- Amantadine and Rimantadine for influenza A
- Zanamivir and Oseltamivir for influenza A or B |
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What is the most common cause of acute sinusitis?
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Usually viral acutely
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What are the symptoms of sinusitis?
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- Mucosal edema
- Ongoing bacterial infection may cause dropped O2 tension, |
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What are the most common causes of bacterial sinusitis?
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Same as for Otitis Media:
- Streptococcus pneumonia - Hemophilus influenzae - Morexella catarrhalis With ongoing infection, bacterial overgrowth causes a decrease in O2 tension which favors anaerobic infections in chronic sinusitis; G- infections also seen in chronic sinusitis |
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What are the causes of Bacterial Rhinitis?
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- Rhinoscleroderma (K. rhinoscleromatis, G-)
- Actinomycosis - Syphillis - TB (Mycobacterium tuberculosis) |
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What are the phases of infection of Rhinoscleroma?
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K. rhinoscleromatis:
1. Rhinitic phase 2. Granulomatous phase 3. Fibrotic phase. |
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Where does Rhinoscleroma more commonly occur?
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- S. America
- E. Africa - India |
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What are the findings indicative of Rhinoscleroma?
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- G- bacilli inhistiocyte cytoplasm
- CT: nasal masses / obstruction |
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What kind of infection presents as a slowly enlarging mass on the neck or jaw?
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Actinomycosis (bacterial rhinitis)
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What are the microscopic characteristics of Actinomycosis (bacterial rhinitis)?
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- Microcolonies of filamentous branching organisms
- Form tight clusters called sulfur granules |
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How do you treat Actinomycosis (bacterial rhinitis)?
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Long-term Penicillin and surgical debridement
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What kind of bug causes Syphilis?
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Spirochete: Treponema pallidum
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What are the phases of Syphilis?
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1. Primary phase (10-90 days) after initial infection, form painless chancre at site on inoculation
2. Secondary phase - hematogenous spread w/ nasal symptoms including rhinitis and painless ulcers 3. Latent phase 4. Tertiary phase w/ gummata or destructive lesions resulting from inflammatory response to spirochetes, often involving nasal septum |
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What does tertiary syphilis lead to?
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Produces saddle nose deformity
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How do you diagnose Syphilis?
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Serological testing:
- Non-treponemal tests: VDRL and RPR - Treponemal tests: detect Ab to T. pallidum or microscopic dark field exam identification of spirochetes |
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How do you treat Syphilis?
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Penicillin
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What pathogen causes nasal TB?
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Mycobacterium tuberculosis
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How do you diagnose nasal TB?
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- Identification of acid fast bacilli
- Caseating and non-caseating granulomas |
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How do you treat nasal TB?
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Long term antibiotics w/ multi-durg regimens:
- Rifampin - Ethambutol - Isoniazid - Pyrazinamide |
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What are the causes of viral rhinitis?
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- Rhinovirus
- Coronavirus - Influenza virus (same as for common cold) |
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What are the causes of fungal rhinitis?
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- Blastomycosis
- Rhinosporidiosis - Ubitquitous fungi (Mucormycosis) - Aspergillosis |
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How do you treat Blastomycosis causing fungal rhinitis?
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- Surgical debridement
- Amphotericin B |
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What are the features of Rhinosporidiosis?
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Fungal Rhinitis
- Nasal obstruction - Epistaxis (nose bleeds) - Pedunculated friable vascular mass resembling a strawberry |
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How do you treat Rhinosporidiosis causing fungal rhinitis?
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Surgical excision
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What kind of opportunistic fungi can cause rhinitis in an immunocompromised host? Symptoms?
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Mucormycosis
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When does Mucormycosis infect a patient? What are the symptoms?
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- Ubiquitous, opportunistic fungi that infects immunocompromised hosts
Symptoms: - Fever - Nasal ulcerations - Visual changes - Headaches - Facial pain - Possible intracranial or intraorbital extension |
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How do you treat Mucormycosis?
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- Amphotericin B
- Surgical debridement |
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What are the degrees of Aspergillosis that cause Fungal Rhinitis?
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- Non-invasive: allergic fungal sinusitis
- Invasive: destruction of sinus mucosa and bone |
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How do you treat Aspergillosis that causes Fungal Rhinitis?
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- Amphotericin B
- Surgical debridement |
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What are the causes of parasitic rhinitis?
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- Leishmaniasis
- Myiasis |
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How do you get Leishmaniasis?
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Bite of infected sand fly
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How do you get Myiasis?
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Infestation of mucous membranes by fly larvae of green blowfly
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What are the symptoms of Leishmaniasis?
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Parasitic Rhinitis:
- Mucocutaneous form causes inflammation and ulceration of nasal spetum - Biopsies show lymphocytes and histiocytes filled w/ protozoa termed Leishman-Donovan bodies |
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How do you treat Leishmaniasis?
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Antimonials
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What is Stomatitis? What is it often caused by?
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- Inflammation of mucous membranes of mouth
- Often d/t poor oral hygiene |
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What are the types of Stomatitis?
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- Bacterial
- Viral - Fungal |
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What are the causes of bacterial stomatitis?
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- Acute necrotizing ulcerative gingivitis
- Bacillary angiomatosis - Neisseria gonorrhoeae - Syphilis |
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What happens if acute necrotizing gingivitis (stomatitis) spreads?
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If it spreads to tonsils and pharynx it is calls = Vincent' angina
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What causes Bacillary Angiomatosis (stomatitis)?
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Bartonella infection in immunocompromised host
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What does Bacillary Angiomatosis look like?
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Kaposi Sarcoma
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What lesions look like Kaposi Sarcoma?
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Bacillary Angiomatosis lesions in mouth (stomatitis)
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What STD causes bacterial stomatitis? Symptoms?
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Neisseria gonorrhoeae:
- Painful oral mucosal ulcerations - Inflamed tonsils w/ grey exudate |
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What are the symptoms of Syphilis in the mouth?
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Painless chancres, grayish white patch on soft palate or tongue
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What are the viral causes of stomatitis?
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- Rubeola / Measles
- Coxsackievirus - Human Papillomavirus (HPV) - Herpes Simplex Virus (HSV) |
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What are the symptoms of Rubeola / Measles in stomatitis?
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- Koplik spots = bluish grey specks on erythematous base near molars
- May be complicated by encephalitis and sensorineural hearing loss |
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What is the treatment for Rubeola / Measles?
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Vaccines to reduce incidence
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What is "Hand Foot and Mouth" disease? Where are lesions?
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Coxsackievirus:
- Ulcerations on buccal mucosa, soft palate, hands and feet - Cause of viral stomatitis |
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What kind of lesions occur with HPV stomatitis?
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Intraoral lesions including squamous cell carcinoma
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What kind of lesions occur with Herpes Simplex Virus stomatitis?
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Small painful gingival ulcers in clusters
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What are the fungal causes of stomatitis? Who gets this? Treatment?
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- Oral candidiasis
- Occurs in immunocompromised patients - Treat w/ topical antifungals |
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What are the types of oral candidiasis?
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- Erythematous candidiasis w/ red mucaular areas on palate
- Pseudomembranous candidiasis or thrush w/ white curd-like patches leaving red bleeding surface when scraped off |
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What are the most common causes of bacterial pharyngitis?
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- Most common: Group A β-hemolytic Streptococcus (S. pyogenes)
- Other: Non-group A β-hemolytic Strep, A. hemolyticum, N. gonorrhoeae, Mycoplasma pneumonia, Chlamydia pneumonia, Corynebacterium diptheriae |
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How do you treat Group A β-hemolytic Streptococcus (S. pyogenes) pharyngitis?
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Antibiotics: penicillins
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What are potential problems associated with Group A β-hemolytic Streptococcus (S. pyogenes) pharyngitis?
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- Acute rheumatic fever (3% of ineffectively treated cases) d/t rise in Ab
- Acute Glomerulonephritis |
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What is the clinical presentation of Group A β-hemolytic Streptococcus (S. pyogenes) pharyngitis?
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- Fever
- Sore throat - Erythematous pharynx w/ tonsilar hypertrophy - Rash that starts in axilla and inguinal folds |
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*How do you diagnose Group A β-hemolytic Streptococcus (S. pyogenes) pharyngitis?
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* Rapid antigen testing from throat swab (80-97% sensitive)
* Throat cultures (gold standard) |
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What is the most common cause of pharyngitis?
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Virus (same ones that cause common cold)
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What are the symptoms of patients with Epstein Barr Virus?
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Infectious mononucleosis:
- Pharyngitis - Fever - Splenomegaly |
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What happens to patients with viral (EBV) pharyngitis if you give them ampicillin or amoxicillin?
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90% develop rash
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How do you diagnose Epstein Barr Virus / Mononucleosis?
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Monospot test (rapid slide agglutination test) and presence of atypical lymphocytes on blood smear
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How common is epiglottitis / supraglottitis? What is the most common cause?
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- Rare
- Usually associated with H. influenzae type b |
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What are the symptoms of Epiglottitis / Supraglottitis d/t H. influenzae type B?
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- Sore throat
- Hoarse - Fever - Respiratory distress - Difficulty managing secretions - Children in "tripod" position (sitting upright w/ chin up, mouth open, bracing themselves on their hands |
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How do you diagnose Epiglottitis / Supraglottitis?
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- Lateral neck films show enlarged epiglottis w/ thickening referred to as "thumb sign"
- Direct laryngoscopy shows epiglottic edema |
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How do you treat Epiglottitis / Supraglottitis?
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- Assess and stabilize airway
- Obtain cultures - Broad spectrum antibiotics |
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What kind of pathogens cause bacterial laryngitis, tracheitis, or bronchitis?
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Pathogens similar to pharyngitis and include:
* Staphylococcus (aureus) - Streptococcus |
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How do you manage a patient with bacterial laryngitis, tracheitis, or bronchitis?
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- Supportive care (hydration)
- Airway observation (may require intubuation) - Broad Spectrum IV Antibiotics - Rigid bronchoscopy w/ debridement of tracheal crusts and exudate |
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What are the potential complications of bacterial laryngitis, tracheitis, bronchitis?
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Airway obstruction d/t thick exudates
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How do most patients present with bacterial laryngitis, tracheitis, bronchitis?
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- Several day history of viral URI
- Rapid onset high fever - Toxic appearance - Often have pneumonia |
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How do you diagnose bacterial laryngitis, tracheitis, bronchitis?
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- Lateral neck films: diffusely hazy tracheal air column
- Endoscopic evaluation or open bronchoscopy to get culture and pseudomembrane debridement |
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What is the most important viral laryngitis, tracheitis, bronchitis? Cause?
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Croup laryngotracheobronchitis - caused most commonly by parainfluenza virus types 1 and 2
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Who is most commonly affected by viral laryngitis, tracheitis, bronchitis?
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Children between 6 months and 3 years
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What accounts for 90% of infectious airway obstructions in children 6 months to 3 years?
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Viral laryngitis, tracheitis, bronchitis caused by parainfluenza virus
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What are the characteristic symptoms of a child with viral laryngitis, tracheitis, bronchitis?
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- Barking cough
- Stridor - May progress to airway collapse |
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How do you treat a patient with viral laryngitis, tracheitis, bronchitis?
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- Usually resolves w/o intervention
- Infrequently requires hospitalization |
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How do you diagnose viral laryngitis, tracheitis, bronchitis / Croup?
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Anterior / posterior neck films show "steeple sign" or dynamic narrowing of subglottic area
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What is the pathogenesis of strep pharyngitis?
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- Adhesion of organism to epithelial cells in oropharynx through pili on surface of organism
- Evasion of phagocytosis through hyaluronic acid in capsule of organism and through anti-phagocytic proteins produced and secreted by organism - Constitutional illness (headaches, muscle pains, rash, abdominal pains) result from exotoxins produced by the organism |
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How does strep pharyngitis spread?
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Through large droplets containing the organism by coughing, sneezing, or even through simple conversation
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How does the common cold spread?
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- Direct contact
- Aerosolized droplets - Virus enters nose - Mucociliary clearance to nasopharynx |
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What is the pathogenesis of the common cold?
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- Virus enters epithelial cells via intercellular adhesion molecule-1
- Virus replicates once enters cell (75% become symptomatic) - Viral shedding peaks at day 2 and can be present for several weeks |
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What are the respiratory outcomes of the common cold?
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- Vasodilation
- Increased mucus secretion - Extensive respiratory epithelial damage |
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What is the function of Eustacian tubes?
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Ventilate middle ear space
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What are the indications for ear tubes?
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- Chronic middle ear effusion ± conductive hearing loss
- Recurrent suppurative otitis media (constantly going on antibiotics) - Atelectasis of middle ear (inadequate ventilation by auditory tube and retraction/deformation of tympanic membrane) |
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What are the paranasal sinuses?
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- Air filled cavities that are found in the bones of the face / head
- Ethmoid - Maxillary - Sphenoid - Frontal |
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What causes sinus disease?
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Inflammation:
- Causes swelling → narrows sinus ostia → impedes drainage → mucus fill sinus → bacteria grow → sinus infection Anatomy: - Narrows sinus ostia → impedes drainage → mucus fills sinus → bacteria grow → sinus infection |
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What causes inflammation in sinuses?
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- Viral infections
- Environmental allergens (dust, mites, dander, pollen) - Environmental irritants (dust, smoke, chemicals) - Mucus - Medications - Bacterial infections - Fungus |
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What is the term for the lymphoid tissue surrounding the upper aerodigestive tract? What is in it?
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Waldeyer's ring: contains lymphocytes and plasma cells
- Tonsils and adenoids |
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What are the indications for an adenotonsillectomy (T&A)?
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Upper airway obstruction (most common)
- Adenoids (nasopharynx) - Palatine tonsils (oropharynx) - Lingual tonsils (hypopharynx) Recurrent/chronic infection - Tonsillitis (β-hemolytic Group A Strep) - Peritonsillitis / peri-tonsillar abscess Neoplasia (lymphoma / carcinoma) - Unilateral hypertrophy (often d/t HPV) |
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What is the procedure for culturing the throat?
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- Culture each tonsil and posterior pharyngeal wall
- Twist, rotate swab into tissue to obtain good specimen - Culture results no better than specimen - Avoid touching tongue (to avoid gag reflex) - Immediate transfer to transport medium |
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Supraglottis Airway Obstruction:
- Onset - Symptoms - Stridor - Location - Etiology - Treatment |
- Rapid onset
- Sx: drooling, fevers, sitting up, SICK - Inspiratory stridor - Supraglottic location - Usually caused by H. influenzae (type B) - Tx: secure airway, Abx (higher mortality rate) |
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Croup (Subglottic) Airway Obstruction:
- Onset - Symptoms - Stridor - Location - Etiology - Treatment |
- Gradual onset
- Sx: barking cough, low fevers - Biphasic stridor - Subglottic location - Usually caused by virus - Tx: racemic epi, steroids, humidity |
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How does the onset differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: rapid onset
- Subglottic / Croup: gradual onset |
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How do the symptoms differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: drooling, fevers, sitting up, SICK
- Subglottic / Croup: barking cough, low fevers |
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How does the stridor differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: inspiratory stridor
- Subglottic / Croup: biphasic stridor |
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How does the cause differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: H. influenzae (type B)
- Subglottic / Croup: viral |
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How does the treatment differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: higher mortality rate, secure airway and treat w/ Abx
- Subglottic / Croup: racemic Epi, steroids, humidity |
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How do the x-ray findings differ for an airway obstruction above or below the vocal cords?
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- Supraglottic: thumb sign
- Subglottic / Croup: steeple sign |
