HEENT + Respiratory Infections

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203 Terms

1
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AOM diagnosis

Clinical

+/- tympanometry

+/- tympanocentesis w/ culture

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AOM tx

-PO antibiotics

-observe and monitor

-nasal decongestant

-pain control

-supportive care

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Viral conjunctivitis causative pathogen

adenovirus

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Viral Conjunctivitis diff diagnosis

-Watery, thin discharge

-hyperemia (scleral injection)-red eye

-pruitus, lid swelling

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Viral conjunctivitis treatment

-Cool compresses

-Education/ hand hygiene

-Baby shampoo for crusting

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What can viral conjunctivitis progress to?

Keratoconjunctivitis

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Keratoconjunctivitis

Inflammation of cornea and conjunctiva

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What pathogens cause bacterial conjunctivitis?

1. Staph aureus

2. Strep pneumoniae

3. H. influenza

4. Pseudomonas aeruginosa (contact users)

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Bacterial Conjunctivitis diff diagnosis

-Thick, purulent discharge

-hyperemia (scleral injection)

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bacterial conjunctivitis tx

-Topical antibiotic ointment

-prevention/supportive care

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Allergic Conjunctivitis "pathogen"

-Caused by allergens

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Allergic conjunctivitis diff diagnosis

-Typically bilateral

-Cobblestoning

-history of seasonal allergies

-thin, stringy discharge

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Neonatal Conjunctivitis causative pathogens

-N. gonorrhoeae

-C. trachomatis

-HSV-2

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Neonatal conjunctivitis with more water discharge is caused by

C. trachomatis

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Neonatal conjunctivitis treatment

Systemic antibiotics

OR antiviral therapy

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Neonatal conjunctivitis prevention

Erythromycin ointment in eyes of newborn

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What is trachoma?

Chronic conjunctivitis -world leading cause of blindness

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Trachoma causative pathogen

C. trachomatis

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Trachoma clinical manifestations

Chronic, follicular conjunctivitis

-Trichiasis (inward eyelashes) w/ repeated infections

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Trachoma tx

Antibiotic therapy:

Topical/oral

-surgery to correct trichiasis

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What is Keratitis?

Inflammation and infection of cornea

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Keratitis causative pathogens

-Pseudomonas aeruginosa (Contact users)

-Adenovirus

-HSV

-VZV

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What can keratitis lead to?

blindness

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Keratitis clinical manifestiations

-eye pain

-photophobia

-hyperemia

-discharge

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Keratitis diagnosis

Slit-lamp: binocular scope allows corneal ulcers to be assessed by fluorescein staining

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Bacterial keratitis tx

Empiric antibiotics:

-Antipseudomonals Beta lactams

-Topical Fluroquinolones

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Viral keratitis tx

Topical/oral antivirals

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Keratitis prevention

-Shingles vaccine

-Proper contact cleaning

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What is a Stye/Hordeolum?

Infection of sebaceous gland of eyelid

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Stye/hordeolum causative pathogen

S. aureus

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Stye/hordeolum symptoms

FOCAL pain

Swelling

Erythema

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Stye/hordeolum DDX

Chalazion is NON-infectious + painless

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Stye/hordeolum tx

-Warm compress

-topical bacitracin/ erythromycin

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What is blepharitis?

Inflammation of eyelid margins

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Blepharitis symptoms

-inflammation and plugging of meibomian glands

-can present with increased crusting

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blepharitis tx

-Baby shampoo rinses

-cool compress

-topical bacitracin

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What is Dacrocystitis?

Infection and inflammation of the lacrimal sac

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Dacrocystitis pathogens

-S. aureus (+)

-S. pneumoniae (+)

-H. influenzae (-)

-E. coli (-)

-P. aeruginosa (-)

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Dacrocystitis clinical manifestations

-increased tearing

-pain, swelling, erythema at nasal corner

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Dacrocystitis tx

oral antibiotics

+/- I&D

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What is Preseptal (preorbital) Cellulitis?

Infection anterior to orbital septum

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Complication of sinusitis, trauma, insect bite, or stye can lead to

Preseptal (preorbital) Cellulitis

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Preseptal Cellulitis causative pathogen

-Staphlococcus aureus

-Group A streptococci

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Preseptal Cellulitis clinical manifestations

-Precedes URI

-Edema + erythema of preorbital skin

-Excessive tearing

-Fever

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Preseptal Cellulitis ddx

Does NOT involve structures of orbit

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Preseptal Cellulitis PE findings

-PERRLA

-EOMI

-No visual disturbances

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If orbital cellulitis cannot be ruled out, what should be ordered?

CT scan

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Preseptal Cellulitis tx

-Oral antibiotics

-close follow up

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What is Orbital Cellulitis?

Infection posterior to orbital septum (fat + muscle tissue)

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Orbital Cellulitis may be a complication of

-Preorbital cellulitis

-sinusitis

-trauma

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Orbital cellulitis causative pathogen

Polymicrobial:

-S. aureus

-Group A strep

-Anearobic bacteria

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Orbital cellulitis symptoms

-preceds URI symptoms

-facial pressure/pain

-pain wiht eye movements/limited movement

-proptosis

-decreased visual acuity

-decreased visual acuity

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Orbital cellulitis diagnosis

clinical + CT

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Orbital cellulitis tx

Broad spectrum antibiotics

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What is Otitis Externa?

outer ear infection, "swimmer's ear"

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Otitis Externa pathogens

-Pseudomonas aeruginosa

-Proteus spp.

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Otitis Externa Risk factors

-swimming

-trauma

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Otitis Externa clinical manifestiations

-otalgia

-otorrhea

-edema of auditory canal

-pruritis

+/- conductive hearing loss

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Complication of Otitis Externa?

Malignant Otitis Externa

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How does Malignant Otitis Externa present?

-persistent foul discharge

-deep pain

-tenderness

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Otitis Externa tx

otic antibiotic solutions

+/- steroids

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Malignant Otitis Externa tx

IV

PO antipseudomonal

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What is Acute Otitis Media (AOM)?

Middle ear infection

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AOM causative pathogens

-S. pneumoniae

-H. influenzae

-M. catarrhalis

-RSV

-rhinoviruses

-coronaviruses

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AOM complication?

Mastoiditis

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AOM symptoms

-bulging and redness of TM, loss of mobility

-loss of light reflex

-otalgia

-conductive hearing loss

-otorrhea

Infants: ear pulling + irritability

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AOM treatment

-PO antibiotics

-ear tubs with recurrent disease

-supportive care

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What is Mastoiditis?

Complication of AOM; infection spreads to mastoid bone.

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Mastoiditis tx

-IV antibiotics

-drainage

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Common Cold MC causative agent

rhinoviruses

adenoviruses

enteroviruses

conornaviruses

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Common cold transmission

-Aerosolation of viral particles

-Direct contact

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Common cold clinical manifestations

-nasal congestion

-rhinorrhea, sneezing, anosmia

-cough

-malaise

-pharyngitis

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Common cold PE findings

-erythematous + edematous nasal mucosa

-pharyngeal erythema

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Common cold prevention

-hand washing

-hygiene

-limit exposure

-masks

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What is Sinusitis?

Inflammation of paranasal sinuses

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Sinusitis MC causative pathogen

Viral-RACE

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Sinusitis can develop into...

Bacterial superinfection:

-S. pneumoniae

-H. influenzae

-M. catarrhalis

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Sinusitis clinical manifestations

-facial pain

-nasal congestion

-purulent nasal discharge

-anosmia

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Sinusitis tx

-PO Antibiotics (severe)

-intranasal steroids

-decongestants

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What is Pharyngitis + it's clinical manifesations?

infection and inflammation of the pharynx;

sore throat + fatigue

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What is a complication of pharyngitis?

peritonsillar abscess

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Pharyngitis causative pathogens (viral-most common)

-Adenovirus, parainfluenza, influenza, rhinovirus

-EBV

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Viral pharyngitis treatment

supportive care

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Pharyngitis causative pathogens (bacterial)

-Streptococcus pyogenes

-Corynebacterium diphteriae

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GABHS "strep throat" pharyngitis pathogen

Streptococcus pyogenes

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GABHS Centor Criteria

-Fever

-Tender ANTERIOR cervical lymphadenopathy

-LACK of cough

-Pharyngotonsillar exudate

-Modified age (3-14: +1); (14-44: +0); (>45: -1)

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GABHS pharyngitis diagnosis

-rapid antigen test

-throat culture

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GABHS treatment

PO antibiotics

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Infectious Mononucleosis pathogen

Epstein-Barr virus (EBV)

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Infectious Mono clinical manifestations

-Fever, sore throat, fatigue, malaise, anorexia

-painful POSTERIOR cervical lymphadenopathy

-Splenomegaly

-maculopapular rash

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Mono Spot Test

Heterophile antibody test for infectious mononucleosis.

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Mono treatment

supportive care, rest

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Diphtheria pathogen

Corynebacterium diphtheriae

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Diphtheria pharyngitis clinical manifestations

-grey, psuedo-membrane which produces toxins

+/- airway obstruction

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Diphtheria pharyngitis dx

-clinical

-throat culture

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diptheria treatment

antitoxin, airway management

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Scarlet Fever is a complication of...

Streptococcal pharyngitis

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Scarlet fever symptoms

-high fever

-bright red "sandpaper" rash

-strawberry tongue

-pastia's lines

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What can scarlet fever lead to?

TSS

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What is Peritonsillar Abscess?

Infection that penetrates tonsillar capsule