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  1. Allergic Rhinitis

    Description: Inflammation of mucous membranes in nose.  

    Etiology:IgE mediated response to substance. rupture of mast cells, release of histamines, leukotrienes, and prostaglandins. Sources include pollen, grass, trees, weeds, mold, animal dander, dust mites, and smoke. 

    s/s: dark discolored under eye lids. conjunctival injection. pale, boggy turbines.  clear secretions. ST. enlarged tonsils. palpable lymph nodes. 

    Meds:
    saline nasal spray
    antihistamines
    nasal steroids
    leukotriene modifier if asthma present
    decongestants
  2. Sinusitis

    General: inflammation of paranasal sinuses due to bacterial, viral, or fungal infection or allergic reaction. 

    Etiology:
    Bacterial: strep, h. influenza, staph
    Viral: rhinovirus, coronavirus, influenza, parainfluenza, RSV

    S/S: 
    fever
    nasal congestion
    HA
    ST
    PND
    Sinus pressure/pain
    cough
    halitosis
    periorbital edema

    nonpharm:
    saline irrigation
    humidified air
    increase fluid intake

    Pharm:
    abx after 10 days of s/s
    5-7 days of treatment is as effective as 10-14 days
    oral decongestants better than topical
    analgesics oft HA
    antipyretics for fever
    topical nasal steroids will help symptoms

    abx:
    1. amoxicillin
    2. Augmentin
    3. Doxycycline
    4. Omnicef
    5. Clindamycin
    6. Azithromycin
    7. Levaquin
    8. Avelox
  3. Pharyngitis

    General:
    acute inflammation of the pharyngitis/tonsils. 

    Etiology:
    Viral: rhinovirus, adenovirus, parainfluenza, epstein barr virus

    Bacterial: group A beta hemolytic strep, H. influenza, M. pneumonia, N. gonorrhoeae

    S/S:
    ST and pharyngeal edema
    tonsillar exudate
    enlarged tonsils
    malaise

    Strep:
    cervical adenopathy
    fever
    no resp findings
    petechiae on soft palate
    beefy red tonsils
    sandpaper rash
    abd pain, HA
    distinct breath odor

    Viral:
    conjunctivitis
    nasal congestion
    hoarseness
    cough
    diarrhea
    viral rash

    Nonpharm:
    change toothbrush
    increase fluids

    pharm:
    tylenol
    motrin

    abx:
    1. pcn vk
    A: 500mg po bid x 10 days
    P: 250 mg po bid-tid x 10 days

    2. pcn G benzathine
    A: 1.2 mil units IM x 1 dose
    P: <27kg: 0.6 mil. units IM x 1
    P: >= 27kg: 1.2 mil u IM x 1 dose

    3. Amoxil 
    A: 875mg po bid x 10 d
    P: >40kg dose as adult
    P: 50mg/kg daily x 10 days
  4. Infectious Mononucleosis

    General:
    Viral illness characterized by malaise and fatigue

    Etiology: Epstein-Barr virus (EBV) of the herpes family of viruses

    10% of pts are co-infected with strep.

    Incubation period is 4-8 weeks. 

    Spread by contact with oral secretions

    S/S:
    malaise and fatigue
    *Tetrad- Fatigue, Fever, Pharyngitis, Lymphadenopathy*
    splenomegaly
    headache
    tonsillitis
    hepatomegaly
    palatal petechiae
    abdominal pain
    nausea

    Diagnostic Studies:
    -CBC shows lymphocytosis
    -monospot positive by 2nd or 3rd week of illness
    -EBV titers can be collected for unusual presentation
    -liver enzymes often elevated
    -US to diagnose and follow enlarged spleen

    Nonpharm:
    Rest
    No vigorous exercise for 2 mo or until spleen is normal
    avoid stress
    eat well
    drink well

    Meds:
    Tylenol unless LFT elevated
    avoid ASA due to Reye's syndrome
    Avoid amoxicillin due to increased reaction

    Other:
    Acute phase lasts about 2 weeks
    monospot will always remain positive
    students may return to school when afebrile
  5. Influenza (Flu)

    General:
    highly contagious acute viral illness of the respiratory tract. Mostly occurs october-april.

    Etiology:
    Influenza virus type A and B
    H1N1 Swine flu is a variant of influenza A

    S/S:
    High fever
    sudden onset
    cough
    rhinorrhea
    pharyngitis
    headache
    malaise
    myalgia
    cervical lymphadenopathy
    GI in kids
    irritated mm

    Diagnostic Studies:
    Nasal swab
    CBC
    CXR if pneumonia suspected

    Immunize 6mo and older yearly
    careful with egg allergy and flu shot

    Antiviral meds:
    initiate within 2 days of symptoms
    monitor for neuro symptoms
    may cause n/v
    avoid live vaccine with tamiflu

    1. Zanamivir (Relenza)
    A: 10mg bid x 5 days.  take 2 doses on the first day separated by 2 hrs.
    prophylaxis: 10mg daily x 10 days

    Avoid in pts with underlying airway dz. 
    2. Oseltamivir (tamiflu)
    A: 75mg bid x 5 days
    prophylaxis: 75mg qd x 10 days. 

    Other:
    pt. should follow up if s/s longer than 10 days or if no improvement over 3-5 days.
  6. Otitis Externa (Swimmer's Ear)

    General:
    An infection of the external auditory canal producing much inflammation, itching, and/or pain. 

    Etiology:
    Excessive moisture precipitates otitis externa: removes cerumen and increases pH of external auditory canal and increase bacterial and fungal growth. 

    Bacterial: pseudomonas, staphylococcus, streptocuccus

    Fungal: Aspergillus, candida albicans

    S/S: 
    otalgia
    Edema and redness in external canal
    itching
    purulent discharge
    tarsal and/or pinna pain
    normal tympanic membrane

    Medications:
    2% acetic acid drops after swimming for prevention

    Antibacterial with and without steroid such as cipro HC otic or ciprodex otic or cortisporin or florin otic.  See medication - ear drops card.

    Should improve with in 24-48 hours.
  7. Otitis Media

    General:
    Acute otitis media (AOM) is the rapid onset of s/s of inflammation in the middle ear. 

    Otitis media with effusion (OME) is fluid accumulation in middle ear without evidence of infection, also called middle ear effusion (MME)

    Etiology:
    Viruses 
    Streptococcus pneumoniae
    H. influenza
    M. catarrhalis
    Group A beta hemolytic streptococcus
    S. aureus

    S/S:
    otalgia
    irritability
    erythema of TM
    decreased TM mobility
    distorted landmarks
    displaced light reflex
    cloudy, dull, opaque TM
    bulging TM
    Fever
    N
    V
    decreased hearing
    dizziness

    Nonpharm Tx:
    warm compress
    swallowing

    Medications:
    oral analgesics
    -tylenol
    -motrin
    -narcotic with codeine

    Abx for AOM:

    I. Penicillin
    1. amoxicillin  (amoxil)
    A: 875mg q 12 hr x 7 days or 1000mg q 12 hr x 7 days. 
    P (2mo-12): 80-90mg/kg/day in bid dosing. max dose not to exceed adult dose. 
    <2mo: 30mg/kg/day in bid dosing. 

    Amoxicillin is not stable in the presence of beta lactamase producing organisms. 

    Considered first line agent in otitis media unless patient has had antibiotic exposure in the last 90 days. 

    2. amox/clavulanate (augmentin)
    A: 875mg po bid x 10
    P(2mo-5yr): 90mg/kg/day bid dosing x 10 days
    P(6-12yr):90mg/kg/day bid dosing x 5-10days

    First line in AOM with severe illness or recent abx use.  

    Two 500mg augmentin tablets are not equal to a 1000mg tablet. 

    Give with food. II. Second generation cephalosporin

    1. Cefuroxime (ceftin)
    A: 250-500mg po bid
    P: 30mg/kg/day bid x 10 days

    Do not use in pts with hives with pcn

    III. Third generation cephalosporin
    1. Cefpodoxime

    A: 200-400mg bid x 7-10 days

    P: 2mo-5yr. 10mg/kg/day bid dosing x 10 d. 6-12yr: 10mg/kg/day bid dosing x 5-10d. max 400mg/dose. 

    Again, avoid use in hive pcn allergy. 

    2. Cefdinir (omnicef)
    A: 300mg po bid x 10d.
    P: 6mo-5yr. 14mg/kg q12-24hr x 10d.
    6-12yr: 14mg/kg q 12 hr x 5-10d OR q24 hr x 10d. Max 300mg/dose or 600mg/day

    Avoid antacids within 2 hrs due to absorption interference. 

    Stools may appear red. 

    3. ceftriaxone (rocephin)
    P: 50mg/kg/day IM or IV x 3 days

    Max not to exceed 1000mg/dose

    Again, No if true PCN allergy.  hives or anaphylaxis. 

    IV. Extended Spectrum Macrolides

    1. azithromycin (zithromax)
    A: 500mg daily x 3 days
    P: 6 mo: 30mg/kg as single dose. Max 1.5 gms.

    OR 10mg/kg daily x 3 days. Max 500mg daily.  

    OR 10mg/kg on day one, followed by 5mg/kg day 2-5.  Max day 1 = 500mg.  Max day 2-5 = 250mg. 

    Considered first line for PCN allergy, but lots of resistance. 

    2. clarithromycin (biaxin)

    A: 500mg po bid x 7 days
    P: 2mo-5yr: 15mg/kg/day bid dosing x 10days.
    6-12: 15mg/kg/day in bid dosing x 5-10 days. Max: 500mg/dose. 

    Some medication interactions. 
    Take with food. 

    V. Lincosamide
    1. Clindamycin (cleocin)
    A: 150mg-300mg q 6 hr x 5-10d. 
    More serious infection: 300-450mg q 6 hr x 5-10days. 
    P: 2mo-5yr: 30-40mg/kg/day 3 divided doses x 10 days + 3rd generation cephalosporin

    6-12: 30-40mg/kg/day in 3 divided doses x 5-10 days + 3rd generation cephalosporin.  Not to exceed adult dose. 

    Save for worse infections. 
    S/E pseudomembranous colitis, C. Diff.
    Take with full glass of water.

    Other Drugs:
    ear gtts with or without steroid.
    tylenol
    ibuprofen

    Other: 
    Refer to ENT for 3 occurrences in 6 months.
  8. Vertigo

    General:
    sensation or impression that an individual is moving, or that objects around him are moving, when actually no movement is occurring. 

    Etiology:
    peripheral: otogenic, menieres, myringitis, infection, otitis media, acute labyrinthitis, BPPV
    Central: migraine, TIA, postural hypotension
    Neuro: MS, seizures, cervial disc, syphilis, demyelination, acoustic tumors, brainstem or cerebellar lesions

    S/S:
    asymptomatic otherwise
    nystagmus
    tinnitus
    hearing loss
    carotid bruit
    HA
    diplopia
    slurred speech
    hypotension

    Pharm:
    1. dramamine
    2. meclizine
    3. phenergan
    4. compazine

Card Set Information

Author:
jrhobbs
ID:
324235
Filename:
ENT
Updated:
2016-10-13 03:21:00
Tags:
ENT
Folders:
ENT
Description:
Ears, Nose, and Throat
Show Answers:

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