Cases 1/27- Pneumonia, Candida, GERD

Question 1

White and curdy vaginal discharge (cotton cheese like); itchy with vaginal soreness, pain (burning) on urination or dyspareunia; vaginal mucosa is red and inflammed, possibly swollen

Answer 1

Candidal Vaginitis

Question 2

Yellowish green or gray vaginal discharge that is frothy and smelly; Some itching and pain on urination or dyspareunia; vaginal mucosa is reddened with small red granular spots or petechiae in posterior fornix

Answer 2

Trichomonas vaginalis

Question 3

Vaginal discharge that is gray or white thin and smells like fish and gets worse after intercourse; vaginal mucosa is normal

Answer 3

Bacterial vaginosis

Question 4

How do you diagnose trich?

Answer 4

scan saline wet mount for trichomonads

Question 5

How do you diagnose candida vaginosis?

Answer 5

KOH prep for branching hyphae of Candida

Question 6

How do you diagnose bacterial vaginosis?

Answer 6

Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH; vaginal secretions with pH>4.5

Question 7

How do you treat bacterial vaginosis?

Answer 7

Metronidazole

Clindamycin

Question 8

How do you treat candidiasis?

Answer 8

Oral fluconazole

If pregnant: micanazole or clotrimazole

Question 9

How do you treat trichomoniasis?

Answer 9

Oral metronidazole or tinidazole

Question 10

What are risk factors for candidiasis?

Answer 10

DM, ABX use, contraception devices, increased estrogen levels

Question 11

What are the symptoms of GERD?

Answer 11

heartburn, hypersalivation, belching and regurgitation

Atypical- non-allergic asthma, chronic cough, hoarseness, pharyngitis, CP, dental erosions

Question 12

What are diagnostics for GERD?

Answer 12

History, ENDOSCOPY, 24-hour ambulatory pH monitoring, esophageal monometry

Question 13

Treatment of GERD

Answer 13

Lifestyle and diet modifications
Mild= antacids, H2 blockers
Mod= low dose H2 blockers, PPI
Severe = PPI, surgery
Don't use H2 with PPI

Question 14

Complications of GERD

Answer 14

Ulcers, strictures, lung and throat problems, Barrett’s esophagus, esophageal cancer

Question 15

What may nocturnal cough indicate?

Answer 15

GERD, asthma, postnasal drip, CHF

Question 16

What does exercise or cold induced cough indicate?

Answer 16

Asthma

Question 17

What can productive cough be seen in?

Answer 17

pneumonia and bronchitis

Question 18

What is a dry cough seen in?

Answer 18

asthma and post-nasal drip

Question 19

When is hemoptysis seen with cough?

Answer 19

cancer and TB

Question 20

What can diminished breath sounds or bronchial breath sounds indicate?

Answer 20

pneumonia

Question 21

What medications cause dry cough?

Answer 21

ACEI, amiodarone, nitrofurantoin

Question 22

What is pneumonia usually caused by?

Answer 22

Strep pneumo

Question 23

HAP occurs ______ after admission

Answer 23

48+ hours

Question 24

Symptoms of pneumonia

Answer 24

Rigors (chills), fever, cough, SOB, purulent sputum, infiltrates

Possibly: fatigue, HA, mental status changes, confusion, lethargy, disorientation

Question 25

PE of pneumonia

Answer 25

Cyanosis, use of accessory muscles, breath sounds diminished, rhales or rhonchi may be heart

Question 26

Diagnosis of pneumonia

Answer 26

CXR- infiltrates present = gold standard
Blood cultures in hospitalized patients
Mucus culture -not that helpful

Question 27

CAP treatment

Answer 27

Marcolide or doxycycline (if healthy outpatient)

Resp. fluoroquinolones or beta lactam + macrolid (inpatient or outpatient with DRSP risk)

beta-lactam + azithromycin OR beta-lactam + respiratory flouroquinolone (inpatient ICU)

Question 28

HAP treatment

Answer 28

Broad spectrum ABX

Early onset 3rd gen cephalosporin + macrolide OR respiratory fluoroquinolone