Final Exam: NR569 / NR 569 (Latest
Update ) Differential
Diagnosis in Acute Care Practicum |
Study Questions and Answers |
Grade A | 100% Correct –
Chamberlain
Question:
Malignant otitis externa (MOE): (Necrotizing)
Answer:
is a life-threatening infection that mainly affects the external auditory canal
and skull base, and the infection can also invade the stylomastoid and jugular
foramina.
The disease ends up with osteomyelitis of the temporal bone after starting as
simple otitis externa.
,Question:
What facial nerves can be affected with MOE?
Answer:
The facial (VII) nerve is most commonly affected
The glossopharyngeal (IX) nerve
The vagus (X) nerve
The accessory (XI) nerve
Rarely, the hypoglossal (XII) nerve[21]
Question:
Malignant otitis externa symptoms
Answer:
-Ongoing drainage from the ear that is yellow or green and smells bad.
-Ear pain deep inside the ear. Pain may get worse when you move your head.
-Hearing loss.
-Itching of the ear or ear canal.
-Fever.
-Trouble swallowing.
-Weakness in the muscles of the face.
,Question:
Labs for eval of MOE
Answer:
-WBC: White blood cell count can be normal or slightly elevated, and a left
shift is not commonly present in MOE.
-ESR/CRP: Inflammatory markers are usually high, used as an indicator for
the response for antimicrobial therapy. levels of ESR and CRP should be
checked and followed regularly until they are back in the normal range. ESR
starts to decrease within two weeks of starting treatment
-Culture from external auditory canal
Question:
Management of MOE
Answer:
-CT and MRI to show extension of infection into bony structures
-Assess for elevated erythrocyte sedimentation rate (ESR) and C-reactive
protein (CRP)
-Culture ear canal drainage for bacteria and fungus
-Consider blood cultures if patient looks systemically ill and in
immunocompromised patients (who may not show overt signs of bacteremia)
-Administer antipseudomonal antibiotics
-Consider fungal etiology, especially if not resolving with antibacterial agents
-Urgent referral to ENT
, Question:
Abx therapy for MOE
Answer:
-Oral ciprofloxacin can be used in the outpatient setting in cases which are
not complicated by cranial nerve involvement, or the need for admission for
pain control and diabetes.
-Resistant cases can be treated with parenteral antibiotics using
antipseudomonal beta-lactam antibiotics with or without an aminoglycoside.
-The duration of treatment depends on the response to therapy, which is
evaluated using a gallium citrate Ga 67 scan every 4 to 6 weeks during
treatment.
-The treatment should be stopped one week after a normal gallium citrate Ga
67 scan.
Update ) Differential
Diagnosis in Acute Care Practicum |
Study Questions and Answers |
Grade A | 100% Correct –
Chamberlain
Question:
Malignant otitis externa (MOE): (Necrotizing)
Answer:
is a life-threatening infection that mainly affects the external auditory canal
and skull base, and the infection can also invade the stylomastoid and jugular
foramina.
The disease ends up with osteomyelitis of the temporal bone after starting as
simple otitis externa.
,Question:
What facial nerves can be affected with MOE?
Answer:
The facial (VII) nerve is most commonly affected
The glossopharyngeal (IX) nerve
The vagus (X) nerve
The accessory (XI) nerve
Rarely, the hypoglossal (XII) nerve[21]
Question:
Malignant otitis externa symptoms
Answer:
-Ongoing drainage from the ear that is yellow or green and smells bad.
-Ear pain deep inside the ear. Pain may get worse when you move your head.
-Hearing loss.
-Itching of the ear or ear canal.
-Fever.
-Trouble swallowing.
-Weakness in the muscles of the face.
,Question:
Labs for eval of MOE
Answer:
-WBC: White blood cell count can be normal or slightly elevated, and a left
shift is not commonly present in MOE.
-ESR/CRP: Inflammatory markers are usually high, used as an indicator for
the response for antimicrobial therapy. levels of ESR and CRP should be
checked and followed regularly until they are back in the normal range. ESR
starts to decrease within two weeks of starting treatment
-Culture from external auditory canal
Question:
Management of MOE
Answer:
-CT and MRI to show extension of infection into bony structures
-Assess for elevated erythrocyte sedimentation rate (ESR) and C-reactive
protein (CRP)
-Culture ear canal drainage for bacteria and fungus
-Consider blood cultures if patient looks systemically ill and in
immunocompromised patients (who may not show overt signs of bacteremia)
-Administer antipseudomonal antibiotics
-Consider fungal etiology, especially if not resolving with antibacterial agents
-Urgent referral to ENT
, Question:
Abx therapy for MOE
Answer:
-Oral ciprofloxacin can be used in the outpatient setting in cases which are
not complicated by cranial nerve involvement, or the need for admission for
pain control and diabetes.
-Resistant cases can be treated with parenteral antibiotics using
antipseudomonal beta-lactam antibiotics with or without an aminoglycoside.
-The duration of treatment depends on the response to therapy, which is
evaluated using a gallium citrate Ga 67 scan every 4 to 6 weeks during
treatment.
-The treatment should be stopped one week after a normal gallium citrate Ga
67 scan.
