FINAL REVIEW NSG 6420
OTITIS EXTERNA- cellulitis of external auditory canal “Swimmers ear”
Malignant (necrotizing) seen immunocompromised
and diabetes mellitus. Organisms Pseudomonas aeruginosa and Staphylococcus aureus.
Fungi- Candida and Aspergillus (chronic)
Clinical presentation- acute pain on outside with 48 hours
With feelings fullness, itching, drainage, hearing loss
Physical exam- tenderness palpation to tragus, canal
erythematous and edematous enlarged periauricular
lymph nodes.
Chronic externa- Dry Cerumen absent,
LABS- culture and sensitivity, KOH prep on drainage
TREATMENT-
1- gently remove debris
2- NSAIDS
3- Topical anesthetic (IF TM IS INTACT)
a. Benzocaine otic solution (re-check 2 daysish)
4- Topical antibiotics cover to cover both P. aeruginosa & S. aureus
a. Fluoroquinolone ofloxacin, ciprofloxacin BID x 7 days
b. combo ciprofloxacin & hydrocortisone
c. Aminoglycoside neomycin (S. aures not P ) combine w/polymyxin (ototoxicity INTACT TM)
Fungal- acetic acid (white vinegar) vinegar to alcohol is effective 1:1 or 1:2
P. aeruginosa-> Malignant otitis externa older adults immunocompromised and diabetes
BACTERIAL CONJUNCTIVITIS- “PINK EYE”
1- Thick, purulent discharge
2- History- both eyes “sticky or glued shut”
3- Worse in morning but seen throughout the day
Causative agents- Haemophilus influenzae & Streptococcus pneumoniae (CHILDREN)
S. aureus (ADULTS) lasts 7-10 days
Hyper acute onset- Neisseria Gonorrhoeae (sexually active adults mother to newborn)
(Seen in CHILD-> CHILD ABUSE)
, RAPID PROGRESSISON -> PRMNENT VIS LOST
TREATMENT
1- may clear up on own. Self-limited in nature
2- antibiotics if no improvement
3- trimethoprim-polymyxin or fluroqun (ciproflox) gtt QID x 1 week
Those that need systemic
1- H. influenzae- augment
2- Gonococcal- Rocephin 1 gm IM & azith 1 g
(SAME day referral to ophthalmologist)
3- Chlamydial- azith 1 g one dose
EDUCATION
1- avoid touching eyes
2- Shaking hands
3- Sharing towels, bedclothes
4- No swimming pools
5- WASH hands antimicrobial soap
6- decontaminated surfaces with 1:10 bleach solution
GROUP A STREP
Strep throat
Scarlet fever
Impetigo
Pneumonia
Necrotizing fasciitis
Otitis media (ear infections)
Sinusitis
Cellulitis
Location
Live in your nose
throat, so they are spread through droplets from coughing or sneezing or by direct contact with
the mucus.
Treatment
Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis.
, INFLUENZA
Clinical presentation (incubation period 1-2 days)
1- fever, chills, headache, malaise, myalgia, and
Loss of appetite
2- Respiratory dry cough, nasal congestion, clear discharge, sore throat
Physical
1- face is flushed
2- eyes watery and red
3- skin hot and moist
4- Cervical lymph nodes may be enlarged
5- Rare pharyngeal, erythema and exudates
Diagnosis
Gold standard- viral culture or reverse transcriptase polymerase chain reaction assay
Treatment
1- symptoms
2- rest as much as possible
3- adequate fluid intake
4- Antipyretics and analgesics
5- Fluzone High-Dose Seasonal Influenza Vaccine (trivalent)
DO NOT GO TO SCHOOL OR WORK
BRONCHITIS
Self-limiting inflammation of trachea and major bronchi
Characterized by cough lasting 1-3 weeks without evidence of consolidation, underlying cardiac
Clinically diagnosed by acute cough, with/without phlegm, occasionally dyspnea and wheezing
Viral in orgin
Clinical presentation/physical exam
Cough w/without sputum
Clear @ first -> mucoid
Cough lasts 10-20 days can persist 5-6 weeks
Low-grade fever, wheeze, rhonchi
Color to phlegm mistaken for infection
OTITIS EXTERNA- cellulitis of external auditory canal “Swimmers ear”
Malignant (necrotizing) seen immunocompromised
and diabetes mellitus. Organisms Pseudomonas aeruginosa and Staphylococcus aureus.
Fungi- Candida and Aspergillus (chronic)
Clinical presentation- acute pain on outside with 48 hours
With feelings fullness, itching, drainage, hearing loss
Physical exam- tenderness palpation to tragus, canal
erythematous and edematous enlarged periauricular
lymph nodes.
Chronic externa- Dry Cerumen absent,
LABS- culture and sensitivity, KOH prep on drainage
TREATMENT-
1- gently remove debris
2- NSAIDS
3- Topical anesthetic (IF TM IS INTACT)
a. Benzocaine otic solution (re-check 2 daysish)
4- Topical antibiotics cover to cover both P. aeruginosa & S. aureus
a. Fluoroquinolone ofloxacin, ciprofloxacin BID x 7 days
b. combo ciprofloxacin & hydrocortisone
c. Aminoglycoside neomycin (S. aures not P ) combine w/polymyxin (ototoxicity INTACT TM)
Fungal- acetic acid (white vinegar) vinegar to alcohol is effective 1:1 or 1:2
P. aeruginosa-> Malignant otitis externa older adults immunocompromised and diabetes
BACTERIAL CONJUNCTIVITIS- “PINK EYE”
1- Thick, purulent discharge
2- History- both eyes “sticky or glued shut”
3- Worse in morning but seen throughout the day
Causative agents- Haemophilus influenzae & Streptococcus pneumoniae (CHILDREN)
S. aureus (ADULTS) lasts 7-10 days
Hyper acute onset- Neisseria Gonorrhoeae (sexually active adults mother to newborn)
(Seen in CHILD-> CHILD ABUSE)
, RAPID PROGRESSISON -> PRMNENT VIS LOST
TREATMENT
1- may clear up on own. Self-limited in nature
2- antibiotics if no improvement
3- trimethoprim-polymyxin or fluroqun (ciproflox) gtt QID x 1 week
Those that need systemic
1- H. influenzae- augment
2- Gonococcal- Rocephin 1 gm IM & azith 1 g
(SAME day referral to ophthalmologist)
3- Chlamydial- azith 1 g one dose
EDUCATION
1- avoid touching eyes
2- Shaking hands
3- Sharing towels, bedclothes
4- No swimming pools
5- WASH hands antimicrobial soap
6- decontaminated surfaces with 1:10 bleach solution
GROUP A STREP
Strep throat
Scarlet fever
Impetigo
Pneumonia
Necrotizing fasciitis
Otitis media (ear infections)
Sinusitis
Cellulitis
Location
Live in your nose
throat, so they are spread through droplets from coughing or sneezing or by direct contact with
the mucus.
Treatment
Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis.
, INFLUENZA
Clinical presentation (incubation period 1-2 days)
1- fever, chills, headache, malaise, myalgia, and
Loss of appetite
2- Respiratory dry cough, nasal congestion, clear discharge, sore throat
Physical
1- face is flushed
2- eyes watery and red
3- skin hot and moist
4- Cervical lymph nodes may be enlarged
5- Rare pharyngeal, erythema and exudates
Diagnosis
Gold standard- viral culture or reverse transcriptase polymerase chain reaction assay
Treatment
1- symptoms
2- rest as much as possible
3- adequate fluid intake
4- Antipyretics and analgesics
5- Fluzone High-Dose Seasonal Influenza Vaccine (trivalent)
DO NOT GO TO SCHOOL OR WORK
BRONCHITIS
Self-limiting inflammation of trachea and major bronchi
Characterized by cough lasting 1-3 weeks without evidence of consolidation, underlying cardiac
Clinically diagnosed by acute cough, with/without phlegm, occasionally dyspnea and wheezing
Viral in orgin
Clinical presentation/physical exam
Cough w/without sputum
Clear @ first -> mucoid
Cough lasts 10-20 days can persist 5-6 weeks
Low-grade fever, wheeze, rhonchi
Color to phlegm mistaken for infection
