Term
| What are the most common organisms of acute sinusitis? |
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Definition
| S. pneumoniae, H influenzae, Moraxella catarrhalis or anaerobes and rhinoviruses. |
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Term
| What are the Sx/Exam for acute sinusitis? |
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Definition
| Acute onset of fever, headache, facial pain, or swelling. Most cases involve cough and purulent postnasal discharge. Patients with bacterial sinusitis are typically febrile and have unilateral tenderness over affected area. |
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Term
| How do you diagnose acute sinusitis? |
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Definition
| Clinical findings. Radiographic imaging or CT may help (air fluid level, inflammation of tissues) |
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Term
| How do you treat acute bacterial sinusitis? |
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Definition
| 10 day course of augmentin or cefpodoxime. If pt has diabetes or is immunocompromised, it may be necessary to evaluate for fungi like Mucor or atypical bacteria like pseudomonas. |
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Term
| What is chronic sinusitis? |
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Definition
| sinus symptoms lasting >4wks. |
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Term
| How do you treat chronic sinusitis? |
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Definition
Augmentin x 21 days
intranasal corticosteroids, saline irrigation, mucolytics, and decongestants.
Refractory cases need endoscopic surgery. |
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Term
| What are the Sx/Exam of otitis media? |
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Definition
Fever, unilateral ear pain
Tympanic membrane is typically erythematous, lacks a normal light reflex, and may be bulging. Look for perforation of the TM along with pus in the ear canal. |
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Term
| How do you treat otitis media? |
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Definition
Amoxacillin or TMP-SMX x 10 days.
Patients who do not respond to abx and develop hearing loss should have tympanostomy tubes placed. |
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Term
| What are the risk factors for otitis externa? |
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Definition
| Swimming, eczema, hearing aids and trauma (q-tip). |
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Term
| What are the Sx/Exam of otitis externa? |
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Definition
| Painful ear with foul-smelling drainage. The external ear canal will be swollen and erythematous. Pain with movement of the pinna or tragus. |
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Term
| What is the treatment of otitis externa? |
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Definition
| remove any foreign material, treat with topical ofloxacin with steroids. |
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Term
| 28 yo man with history of IVDU presents to PCP with sore throat, myalgia, fever, and night sweats of 10 days duration. He has cervical lymphadenopathy. In addition for screening for group A strep, what else should be evaluated? |
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Definition
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Term
| What are the most common causes of pharyngitis? |
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Definition
Viral (ghino or adeno) are most commonly implicated.
Group A Streptococcus is implicated in 25% and can lead to rheumatic fever if not treated. |
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Term
| What are sx/Exam of pharyngitis? |
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Definition
| Sore throat, fever, +/- cough, tonsillar exudates and tender anterior cervical adenopathy. |
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Term
| What diagnoses should you keep in mind when pt presents with sore throat? |
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Definition
Mononucleosis: lymphadenopathy and malaise
HIV - Acute retroviral syndrome
Epiglottitis in kids with fever and dysphagia
Strep infection (rapid strep and throat culture) |
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Term
| What are the typical pathogens found in CAP? |
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Definition
| S. pneumonia, H. influenzae, S. aureus |
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Term
| What are the atypical pathogens found in CAP? |
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Definition
| Mycoplasma, Chlamydia, Moraxella, Legionella |
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Term
| What pathogen should be suspected in a smoker with pneumonia, diarrhea, and elevated LDH? |
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Definition
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Term
| What are the symptoms/exam for CAP? |
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Definition
| acute onset fever, chills, productive cough, and pleuritic chest pain. look for consolidation on lung exam |
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Term
| When should you consider atypical organisms in CAP? |
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Definition
| Low grade fever, nonproductive cough, and myalgias. |
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Term
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Definition
Radiographic evidence of infiltrate
Blood, sputum, and pleural fluid culture in immunocompromised
Urine Legionella antigen in pts with reisk factors
Check ABG in pts who appear in destress
Blood cultures if hospitalization required |
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Term
| How do you determine if hospitalization is warranted? |
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Definition
>50 years
Underlying disease (COPD, CHF, Cancer
Unstable vital signs, or high fever |
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Term
| What is empiric therapy for community dwelling outpatients with CAP? |
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Definition
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Term
| What is empiric therapy for patients with comorbidities with CAP? |
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Definition
| Fluoroquinolone or azithromycin PO |
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Term
| What is empiric therapy for inpatient or severe CAP? |
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Definition
| Ceftriaxone IV + azithromycin IV |
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Term
| What is empiric therapy for CF patients CAP? |
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Definition
| Ceftazidime IV + levofloxacin IV + aminoglycoside |
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Term
| What is the empiric therapy for aspiration pneumonia? |
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Definition
| Ceftriaxone IV + azithromycin IV + clindamycin IV |
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Term
| What is the empiric therapy for nursing home patients with pneumonia? |
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Definition
| Ceftriaxone IV + azithromycin IV +/- Vancomycin |
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Term
| How do you diagnose respirator associated pneumonia? |
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Definition
| MSSA, MRSA, Pseudomonas, Legionella, Acinetobacter and other G- rods. |
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Term
| How do you treat respirator associated pneumonia? |
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Definition
| Obtain sputum cultures before starting or changing antimicrobials. Tailor empiric therapy ASAP when cultures are available. |
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Term
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Definition
fever, nonproductive cough, and dyspnea on minimal exertion that resolves quickly at rest
Pts may have finding consistent with atypical pneumonia, or there may be few physical exam findings.
Look for pneumothorax. |
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Term
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Definition
CXR normal to bl interstitial or alveolar infiltrates. Classic is "groud-glass" infiltrates.
Elevated LDH
Get silver stain of sputum or bronchoalveolar lavage to look for PCP |
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Term
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Definition
IV TMP-SMX or IV pentamidine
Concomitant prednisone if Pao2 is <70 or if pt has A-a gradient of >35 on room air. |
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Term
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Definition
| Infection of upper airway, with risk factors of smoking, and COPD. |
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Term
| How does bronchitis present? |
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Definition
| Cough with or without sputum production, dyspnea, fever, and chills. The lungs are clear with possible upper airway noise. |
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Term
| What is the DDX for bronchitis? |
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Definition
| URI, Pneumonia, allergic rhnitis |
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Term
| How do you diagnose bronchitis? |
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Definition
| CBC, CXR, sputum gram stain and culture |
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Term
| How do you treat bronchitis? |
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Definition
Depending on comorbidities and severity, pts may need to be hospitalized.
Cover S. pneumonia and atypicals if bacterial origin is suspected. |
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Term
| What are the symptoms of primary TB? |
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Definition
Fevers and a dry cough
Usually involves the middle or lower lung zones and is associated with hilar adenopathy (Ghon complex) and radiographic abnormalities. The infection usually resolves, but reactivation occurs in 50-60% of patients. |
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Term
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Definition
| Nonactive and noninfectious, but reactivation occurs in 10% of patients, typically involving upper lungs and cavitation. Latent infection can be detected by a +PPD. If PPD is +, next step is to evaluate for possible active disease with CXR. |
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Term
| What is Extrapulmonary TB? |
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Definition
Usually associated with HIV + patients. May involve any organ, but those most commonly affected (in order of frequency):
Lymph nodes
pleura
GU tract
bones and joints
meninges
peritoneum
pericardium
Symptoms are related to the organ involved. Dx is based on AFB culture of affected tissue. |
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Term
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Definition
| After primary infection, TB can cause reinfection. Symptoms include fevers, productive cough, hemoptysis, night swets, and weight loss. Reactivation TB is characterized by fibrocaseous cavitary lesions. Dx is based on AFB sputum culture. |
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Term
| How do you determine if a PPD is +? |
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Definition
Low risk groups >=15mm
Exposure risk groups >=10mm
HIV, prior TB groups >= 5mm |
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Term
| What is the treatment for TB? |
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Definition
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
All four for 8 weeks, then isoniazid and rifampin for another 16 weeks. |
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Term
| How should HIV patients be treated differently when given TB regimen? |
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Definition
| Rifabutin is used instead of Rifampin as rifampin interacts with some HIV medications. |
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