Term
| What are the 3 most common bacteria in AOM? |
|
Definition
1. Strep pneumoniae 40-50%
2. Haemophilis influenzae 30-40%
3. Moraxell catarrhalis 10-15% |
|
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Term
| What percentage of Step pneumoniae are resistant to penicillin? Cephalosporins? Trimethoprim/sulfamethoxazole (Bacterim)? |
|
Definition
|
|
Term
| What are the only oral drugs effective against serotype 19A Strep pneumoniae? |
|
Definition
| fluoroquinolones or linezolid |
|
|
Term
| What 3 factors must be present in order to diagnose OM? |
|
Definition
1. History of acute onset
2. Signs of middle ear effusion - immobile, bulging TM
3. Middle ear inflammation - erythema of the TM, otalgia |
|
|
Term
| What is the gold standard for diagnosis of OM? |
|
Definition
|
|
Term
| When is tympanocentesis appropriate? |
|
Definition
1. child with sepsis
2. treatment failure with multiple abx with possible hearing loss
3. children with immune deficiencies (likely atypical pathogen) |
|
|
Term
| What % of OM cases resolve spontaneously? |
|
Definition
|
|
Term
| What is the most common indication for prescribing abx? |
|
Definition
|
|
Term
| What is the first line of treatment for uncomplicated AOM? |
|
Definition
1.
Amoxicillin - safe, inexpensive, acceptable taste, and narrow microbiologic spectrum |
|
|
Term
| What is the low dose of amoxicillin for AOM? High dose? |
|
Definition
40-45 mg/kg/day in divided doses BID x 10 days
80-90 mg/kg/day in divided doses BID x 10 days |
|
|
Term
| What is the dosing for amoxicillin/clavulanate for AOM? |
|
Definition
1. amoxicillin 80-90 mg/kg/day
2. clavulanate 6.4 mg/kg/day
3. divided doses BID x 10 days |
|
|
Term
| What is the dosing of Clindamycin for AOM after treatment failure? |
|
Definition
| 17-25 mg/kg/day in 3-4 doses x 10 days |
|
|
Term
| What are some risk factors for AOM recurrence? |
|
Definition
1. younger than 15 months
2. hx of recurrent AOM in this child or sibling
3. male sex
4. not being breastfed
5. bilateral disease
6. day care
7. winter months
8. passive smoking |
|
|
Term
| Tympanometry is not reliable in infants younger than ____. |
|
Definition
|
|
Term
| How do you help prevent AOM? |
|
Definition
1. alter day care attendance
2. breastfeed for first 6 months
3. avoid supine bottle feeding
4. reduce/eliminate pacifier use
5. pneumococcal conjugate vaccine |
|
|
Term
| What % of OE are bacterial? |
|
Definition
|
|
Term
| What type of OE infection has a green, foul-smelling discharge? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What does fluffy gray to bluish green discharge suggest? |
|
Definition
|
|
Term
| What abxs are used to treat OE> |
|
Definition
Colistin/neomycin/hydrocotisone
ofloxacin
ciprofloxacin/dexamethasone |
|
|
Term
| What is a contraindication for the use of colistin/neomycin/hydrocortisone? |
|
Definition
|
|
Term
| Which medication is approved for treatment of OE with perforated TM? |
|
Definition
|
|
Term
| When is ciprofloaxin/dexamethasone (steroid) contraindicated? |
|
Definition
| viral or fungal infection |
|
|
Term
| What % of patients treated for chronic OE had a positive skin patch test for neomycin allergy? |
|
Definition
|
|
Term
| How do you treat fungal OE? |
|
Definition
2% acetic acid solution
1% clotrimazole
tolnafate |
|
|
Term
| When is a wick indicated? |
|
Definition
| When the ear canal is narrowed by 50%, remove in 2-3 days |
|
|
Term
| How long should treatment of otitis externa last? |
|
Definition
|
|
Term
| What is the 5th most common condition for which abx are prescribed in the U.S.? |
|
Definition
| Acute bacterial rhinosinusitis |
|
|
Term
| How many days must a patient be symptomatic before it is no longer assumed to be VIRAL rhinosinusitis? |
|
Definition
|
|
Term
| hat meds are useful for rhinosinusitis? |
|
Definition
oxymetazoline
phenylephrine
azelastine
use 1-3 days only |
|
|
Term
| What % of Community Acquired Acture bacterial rhinosinusitis are caused by Haemophilis influenzae? Strep pneumoniae? |
|
Definition
|
|
Term
| What 4 items are on the diagnostic point system for acute bacterial rhinosinusitis? |
|
Definition
1. purulent nasal discharge - worse on one side
2. bilateral rhinorrhea
3. unilateral maxillary sinus tenderness (or frontal sinus tenderness)
4. Pus in the nasal cavity on examination |
|
|
Term
| What is the likelihood of ABRS if 3-4 points? 2 points? 0-1 points? |
|
Definition
|
|
Term
| What type of fever favors diagnosis of ABRS? |
|
Definition
|
|
Term
| How do you treat ABRS in peds? |
|
Definition
1. high dose amoxicillin
2. high dose amoxicillin/clavulanate
3. cefidinir
4. clindamycin |
|
|
Term
| How do you treat ABRS in adults? |
|
Definition
1. high dose amoxicillin or amoxicillin/clavulanate
2. cefpodoxine
3. moxifloxacin
4. clarithromycin |
|
|
Term
| Are nasal steroids useful in ABRS? |
|
Definition
|
|
Term
| What is the first line of therapy for ABRS? |
|
Definition
|
|
Term
| If a patient is allergic to penicillins, what do you use to treat ABRS? |
|
Definition
| trimethoprim/sulfamethoxazole or a macrolide |
|
|
Term
| If a patient has used abx in the last 4-6 weeks, what do you use to treat ABRS? |
|
Definition
1. fluoroquinolone
2. high dose amoxicillin/clavulanate |
|
|
Term
| What % of children 5-9 years with sore throat have GABHS? |
|
Definition
|
|
Term
| What % of 10-19 years with sore throat have GABHS? |
|
Definition
|
|
Term
| What % of adults with sore throat have GABHS? |
|
Definition
|
|
Term
| What is included in the diagnostic point system for GABHS pharyngitis? |
|
Definition
1. Tonsilar exudates
2. absence of cough
3. tender anterior cervical lymph nodes
4. history of fever >100.4
5. <15 years
6. >45 years |
|
|
Term
| What is an uncommon, but very specific, finding for the diagnosis of GABHS pharyngitis? |
|
Definition
1. scarlatiniform rash (sandpaper rash)
2. palatine petechiae? |
|
|
Term
| What should be avoided with a GABHS pharyngitis? |
|
Definition
| NSAIDs - may increase the risk of necrotizing fasciitis or toxic shock syndrome |
|
|
Term
|
Definition
| a mixture of drugs (anesthetics and others) that help relieve the symptoms of pharyngitis |
|
|
Term
| What is the DOC for GABHS pharyngitis? |
|
Definition
1. penicillin G bezathine IM
2. Penicillin VK in adults
3. Macrolide for penicillin allergy - clarithromycin |
|
|
Term
| What type of drug is guaifenesin? |
|
Definition
|
|
Term
| What type of drug is dextromethorphan? |
|
Definition
|
|
Term
| What might you use to treat watery, itchy eyes? |
|
Definition
olopatadine
azelastine
both are antihistamine and mast cell stabilizers |
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