Kevin's Clin Med Exam 3 Tx, Patho, Dx, and Pearls

Herpes

What is the cause of CMV

Human Herpes 4

What is the cause of EBV mononucleosis

corynebacterium diptheria

What is the cause of diptheria

Hemophilis Influenza type B, virus or toxin

What is the cause of Epiglotitis

This disease is usually caused by a virus

What is the cause of viral pharyngitis

Group-A Beta hemolytic strep

What is the cause for bacterial Pharyngitis

Inflammation from smoking, drinking, or over use

What is the cause for laryngitis

Acute tonsilitis

Group A Beta-hemolytic strep

What is the cause for peritonsillar abscesses

"Dental infections

Peritonsillar abscess

Retropharyngeal abscess

Parotitis

Otitis

Mastoiditis"

What is the cause for Deep Neck space infections

"-Rhinovirus, adenovirus,

influenza virus and parainfluenza

virus"

What is acute viral rhinosinusitis (AVRS) caused by

"-Strep pneumoniae

-Haemophilus influenza

-Moraxella catarrhalis

"

What is acute bacterial rhinosinusitis (ABRS) caused by?

What is the most common diagnostic sign for CMV

Owl Eye Occlusion

What is the common diagnostic sign for Mono (EBV)

Monospot, CBC with peripheral blood smear

atypical lymph

What is the common diagnostic sign for diptheria

culture, grey membrane is v apparent

PCR testing to determine toxogenic

What is the common diagnostic sign for esophagitis

"thumb" sign with a lateral neck x-ray or CT scan

clinical examinations are very apparent for patient positioning

What are the common diagnostic tests for viral pharyngitis

throat culture

rapid antigen detection test (RADT)

nucleic acid amplification (NAAT)

What are the common diagnostic tests for bacterial pharyngitis

throat culture

rapid antigen detection test (RADT)

nucleic acid amplification (NAAT)

What are the diagnostic tests for acute laryngitis

clinical diagnosis based on history and physical presentation (noting hallmark symptoms of hoarseness, dry cough, and mild through discomfort following a viral URI or acute vocal strain)

What are the diagnostic tests for chronic laryngitis

Direct laryngoscopy taking note of hoarseness persisting for more than 3 weeks and red-flag risk factors from history (smoking)

What are the diagnostic tests for peritonsillar abscesses

Clinical testing, CT scans, or ultrasounds

What are the diagnostic tests for deep neck space infections

CT scans (sometimes MRI but that takes too long)

What is the diagnostic testing for ARS/AVRS/ABRS

sinus CT scan

What is the tx for ABRS

watchful waiting -> amoxicillin -> Augmentin

Can we use Macrolides as a tx for ABRS

No

Can we use bactrum as a tx for ABRS

No

What is the tx plan for AVRS

Neil Med Sinus Rinse

Saline Spray

Flonase

inhaled Anti-cholinergic

What is the tx for deep neck space infections

First line: Aspiration/surgical drain

vancomycin

IV antibiotics

What is the tx for peritonsilar abcesses

needle aspiration drainage

Pharm: Augmentin or clindamycin

analgesics and antipyretics

Persistence: tonsillectomy

What is the tx for acute laryngitis

self-resolution

What is the tx for bacterial pharyngitis

1st: penicillin -> 2nd: erythromycin

corticosteroids or NSAIDs for swelling

What is the tx for viral pharyngitis

symptom relief

supportive care with analgesics

fluids, anti-pyrectics, rest

What is the tx for epiglottitis

Airway gets treated first always

Intubation

antibiotics (ceftriaxone/vancomycin)

No PO meds

What is the tx for diptheria

antibiotics and diptheria antitoxins

Antibiotics: macrolide or PCN

What is the tx for EBV

Self-limiting:

Symptom relief with antalgestics

anti-pyretic

What is the tx for CMV

self-limiting

antivirals:

-glanciclovor

-valganciclovir

-foscarnet

-Cidoforvir

What is an important clinical pearl with viral pharyngitis

POC testing with RADT and NAAT

u should retest kids if negative but

not for adults.

Whats a clinical pearl for bacterial pharyngitis

McIsaac Testing

When the score is >4 consider doing

a RADT or an NAAT and empiric

antibiotics may be appropriate

What are some clinical pearls for deep neck space infections

Infectious spaces of importance

-Submandibular

-Parapharyngeal

-Retropharyngeal

worried about infection of medianastinum

What are some clinical pearls for AVRS

"•Clinical course is similar to other viral URI

•Partial or complete resolution of symptoms within 7-10 days

•There should be continued improvement until resolution of symptoms"

What are clinical pearls for ABRS

•Symptoms last longer than 10 days •Biphasic pattern ("double worsening") •There is worsening symptoms after an initial period of improvement •Symptoms that lasts more than 10 days with no improvement.

"Gram-negative rod

(pseudomonus or proteus)

fungi (aspergillus)"

What are the pathogen's causes otitis externa

Pseudomonas

What causes malignant otitis externa

"●Viral upper respiratory tract

infections, sinus infection

(congestion closes tubes)

●Allergies

●Obstruction

●Patulous dysfunction

(abnormal patency)"

What causes eustachian tube dysfunction

Traumatic Rupture of TM

AOM complication

External forces

What causes TM perforation

"Eustachian tube dysfunction

upper respiratory infections

allergies

Streptococcus pneumoniae

Haemophilus Influenzae

GAS

Mycoplasma "

What causes Acute Otitis Media

"P aeruginosa, proteus species

staphylcoccus aureus, mixed

anaerobic infections"

What causes Chronic Otitis Media

bacterial spread from middle ear

What causes Mastoiditis

Acquired of Congenital

Cholesteoma

What is the diagnosis for Otitis externa

physical exam

What is the diagnosis for malignant otitis externa

CT scan showing bone erosion

Diagnostic Test for:

Eustachian Tube Dysfunction

Tympanic Membrane Perforation

Acute Otitis Media (OM)

Otitis Media W/ effusion

Chronic Otitis Media

Physical exam

What is the diagnostic exam for mastoiditis

CT scan and CBC culture

What is the diagnostic test for cholesteoma?

Otoscopy of pearly mass

CT temporal bone

What is the tx for traumatic auricular hematoma

"incision and drain +

compress dress

pharm manage:

Amoxicillin

Augmentin

Levoflaxin"

What is the tx for perichondritis

incision and drainage

antibiotics if needed

What is the tx for otitis externa

"1) remove infected debris

2) pH acetic acid or ciprofloaxacin

and hydrocortisone

3) Acetaminophen ibuprophen"

What is the tx for malignant otits externa

"Ciproflaxacin

surgical debrievement of bone"

What is the tx for Eustachian tube dysfunction

"Corticosteroids

Systemic and intranasal

decongestion

Autoinflation"

What is the tx for tm perforation

"Trauma causes usually resolves on

their own

Avoid ear drops that involve gentamicin,

neomycin, or tobramycin

Surgical treatment"

What is the tx for acute otitis media

"Analgesics (pain reliever)

Antibiotics vs watchful waiting

Antibiotic of choice = amoxicillin

Refer to ENT"

What is the tx for otitis media with effusion

Flonase/Claritin

What is the tx for chronic otitis media

"- remove debris

- earplug use

- topical antibiotic drops (ofloxacin .3%

w/ dexamethasone) for exacerbation.

- oral antibiotics

- surgery "

what is the tx for mastoiditis

IV antibioticsmastoidectomy

what is the tx for cholesteoma

Surgical marsupilization of sac

What clinical pearls for mastoiditis

cranial nerve 7 is effected

Chronic otitis media pearls

TM perforations and recurrent or chronic infections 2-6 wks

Clinical pearls for Acute Otitis Media

"No longer mostly caused by strep

the top cause of vaccinations

most common cause is now H. Influenza

Can lead to acute or chronic complications:

Acute = periforation, mastoid, meningitis, abcess, thrombosis

Chronic = Hearing loss, TM damage/change, sclerosis"

Clinical Pearl for Eustachian Tube Dysfunction

"NO PREDNIZONE

Give antihistamines and let it DRY

Avoid Air Travel, altitude changes,

underwater diving until resolution"

Main cause is bacterial overgrowth and meibomian gland dysfunction

leads to ocular surface irritation

Blepharitis

Chronic meibowmian gland obstruction

retained lip secretions

chalazion

"Acute, localized staphylococcal

infection/abcess of an eyelid gland"

Hordeolum

caused by mechanical and common with age

Ectropion

"viral or bacterial ifection

idopathic/autoimmune"

Dacryoadenitis

"tear stasis

secondary infection with obstruction"

Dacryocystitis

congenital delayed canalization

Dacryostenosis

"age/hormonal changes,

autoimmune disease

meiobian dysfunction

environment"

Keratoconjunctivitis Sicca

caused by UV exposure

pterygium

Caused by viral infection of the cornea

infectious keratitis

caused by bacterial infection of the cornea

bacterial keratitis

herpes (HSV) with corneal epithelium involvement

Herpetic keratitis

"Caused by Disruption of the blood-aqueous barrier"

Anterior Uveitits/Iritis

autoimmune/vasculitic disease involving the sclera

scleritits

"trabecular meshwork obstruction

narrow anterior chamber angle

closes"

Acute Angle-Closure Glaucoma

"optic-disc cupping

increased aqueous outflow through

trabecular meshwork = increase IOP"

Chronic Primary Open-Angle Glaucoma

"microorganisms enter the

intraocular space"

Endophthalmitis

What are the risks associated with blepharitis

"Rosacia, seborrheic dermatitis,

dry eyes, meibomian gland dysfunction"

What are the risks associated with dacryoadentitis

"viral exposure

autoimmune disease"

What are the risks associated with Dacryocystitis

NL duct obstruction,

age

nasal disease and trauma

What are the risks associated with Dacryostenosis

prematurity, craniofacial abnormal

What are the risks associated with Keratoconjunctivitis Sicca

"Sjogren disease

blepharitis

contact lenses"

What are the risks associated with pterygium

"UV light

dry/windy environments"

What are the risks associated with keratitis

"dirty lens/eyes

occular trauma"

What are the risks associated with Endophthalmitis

recent eye surgery

What are common diagnostic signs of herpetic keratitis

"slit-lamp exam

will see dendritic branches"

What are diagnostic signs of Anterior Uveitits/Iritis

slit lamp= cells/flares

What are diagnositic signs for Acute Angle-Closure Glaucoma

"Marked elevated IOP

slit-lamp

gonioscopy"

What are diagnostic signs for Chronic Primary Open-Angle Glaucoma

"Tonometry

fundoscopy

automated visual-field testing"

What are the clinical pearls for blepharitis

Crusty dusty lid margins

Clinical pearls for Chalazions

"Recurrent or atypical lesion

in the same location ->

reconsider the diagnosis"

Clinical pearls for hordeolums

A painful style external = near eyelash follicle

internal = near meibomian gland