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Cinical Sx Flashcards

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1
Q

Most common otitis externa, usually s. aureus or p aeruginosa. Intense pain and tenderness. Local erythema, heat and tenderness over tragus. Adenopathy. Crusting otorrhea.

A

Acute localized otitis externa

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2
Q

Swimmers ear. P aeruginosa. Hot humid places. Canal erythematous, edematous and sometimes hemorrhagic. Crusty otorrhea and itching in ear canal.

A

Diffuse otitis externa

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3
Q

Complication of OM with resulting draining into EAC. Itching.

A

Chronic otitis externa

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4
Q

Severe necrotizing infection of EAC with invasion into the surrounding tissues including blood vessels, cartilage and none. Paerginosa most frequent. Erythematous, not, tender extern ear and pinn

A

Malignant otitis externa

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5
Q

Sore throat, exudative, scarlintinaform rash, fever, adenopathy

A

Corynebacterium haemolyticum pharyngitis

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6
Q

Sore throat, fever, lymphadenopathy, hepatosplenomegaly, maculopapular skin rash

A

Mononucleosis

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7
Q

Sore throat pathogen associated with conjunctivitis and flu like sx

A

Adenovirus

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8
Q

Sore throat with mucosal vesicles or ulcers

A

Coxsackie a, herpes simplex virus

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9
Q

Tonsillar exudates, tender anterior cervical adenopathy, fever, absence of cough (and hoarseness and rhinorrhea)

A

Streptococcal pneumonia

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10
Q

Strep throat tx

A

If exudates and adenopathy and temp greater tha. 100 Culture and tx. Exudates OR adenopathy and temp, culture and defer tx until confirmed. Tx all with hx of rheumatic fever. Preferred tx: Benzathine PCN given Im. Or pen vk 500mg PO qid x10d. Amox option. Macrolides in PCN allergies.

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11
Q

Strep complications

A

Nonsuppurative: rheumatic fever. Sppurative: pharyngeal abscess, OM , sinusitis.

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12
Q

Carditis, polyarthritis, chorea,subcutaneous nodules, erythema marginatum. Fever, arthralgia, hx. 2 major or 1 major, 2 minor

A

Jones criteria for rheumatic fever. Inflammatory lesions of heart, joints, and CNS following group a strep infection. 6-15yo
Tx: pcn x 10 d

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13
Q

Nasal congestion Ddx

A 
common cold
flu
acute sinusitis
allergic rhinitis
perennial rhinitis
rhinitis medicamentosa (rebound)
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14
Q

Sore throat Ddx

A 
common cold
flu
acute pharyngitis
allergic rhinitis
epiglottitis
acute sinusisits
mono
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15
Q

ear pain Ddx

A 
acute otitis media
otitis externa
cerumen impaction
foreign body in ear
common cold
flu
allergic rhinitis
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16
Q

cough Ddx

A 
common cold
flu syndrome
allergic rhinitis
acute bronchitis
acute sinusitis 
pneumonia
asthma COPD
GERD
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17
Q

chronic bilateral inflammation of lid margin, usually lower. string of whiteish pearls, benign. irritating.

A

blepharitis

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18
Q

uncomfortable infection of lacrimal apparatus

A

dacroysitis

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19
Q

meibomian gland abscess at lid margin. pus filled, feels like pudding

A

hordeloum

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20
Q

a granulomatous inflammation of meibomian gland.more hard and firm. usually not irritating, reoccurring.

A

chalazion

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21
Q

inward turning of the eyelid

A

entropion

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22
Q

outward turning of the eyelid. bad if causes irritation, can refer for surgery

A

ectropion

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23
Q

red eye, ocular discharge

A

acute conjuntivitis

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24
Q

usually s. auerus in adults, s. aur, s. pneumo, h. flu, m cattarhalis in kids. eye redness, purulent discharge, usually unilaterally, pus persists throughout the day

A

bacterial conjunctivitis

tx: antibiotic ocular ointment or drops QID x 7 days: erythromycin, sulfa, polymixin, fluroquinolones

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25
usually caused by adenovirus. adenopathy, fever, pharyngitis, URI. redness, water/mucoid ocular discharge, morning crusting, irritation of the eyes. usually becomes bilateral is 24-48 hours
viral conjunctivitis tx: self limited, keep home from school/work. can use eye drops, NSAID drops or antihistamine drops if helpful.
26
airborne allergens cause IgG mediate response, degradation of mast cells, iniltration of histamine and other inflammatory mediators in the eye. diffuse ocular injection, water discharge, itching usually bilateral. often other allergy sx will be present. PE shows cobblestoning of conjunctiva.
Allergic conjunctivitis tx: ocular drops, antihistamine + decongestant; mast cell stabilizer + antihistamine.
27
benign yellowish dot?
pinguecula: conjunctivial nodule. benign. surgical removal.
28
growth across the conjunctiva, could grow completely across eye. Once towards the iris, needs to be removed.
ptyergium
29
acute onset of redness, irritation, watering of the eye, 70% female. No pain or vision changes. PE shows localized erythema.
episcleritis no tx. self-limited. often associated with lupus. can use topical lubricants NSAIDS , steroids or oral NSAIDS
30
Acute onset of intense PAIN and photophobia. deep red/purpilsh scleral hue. Dx confirmed with slit lamp
scleritis
31
inflammation of cornea; associated with corneal ulcers. pain, photophobia, tearing, decreased vision. ocular erythema, predominately pericorneal injection, maybe discharge.
keratitis tx: prompt referral bacterial: hazy cornea HSV keratitis: dendritic corneal ulcer
32
lesions on tip of nose
herpes zoster ophthalmicus . needs referral
33
intraocular inflammation. acute pain, erythema, photophobia, vision loss.
uveitis. anterior: inflammatory cells in aqueous psterior: more gradual onset, quiet eye tx: steroids from ophlathlmo.
34
insidious preogressive bilateral peripheral vision, resulting in tunnel vision. may be secondary to trauma.
glaucoma acute angle closure: medical emergency, older agegroup, rapid onset, severe pain, profound visual loss, n/v, red eye, steamy cornea, dilated pupil, orbit hard to palpate Tx: lower IOPacetazolamide 500mg IV, following by 250mg PO QUID. laser irdotomy.
35
opacity of lens, usually bilateral. blurred vision, sensitivity to light, faded colors. white pupil reflection or white reflex.
cataract. | tx: surgery
36
sudden visual loss, abrupt onset of floaters. eye not inflamed
vitreous hemorrhage. multiple causes including DM retinopathy, retinal tears trauma, macular degeneration. ophthalmoscopy shows clear lens but inability to see fundal details clearly. urgent referral.
37
leading cause of permanent visual loss >50yo. risks: caucasian, female, fhx, smoking
macular degeneration. retinal drusen seen by ophthalmoscope. atrophic (dry): degeneration of outer retina pigment epthelium; moderate severity, graudal exudative (wet): choroidal new vessel growth leads to accumulation of serous fluid, hemorrhage, fibrosis; mroe rapid onset, more severe. diabetic reinopathy. tx: laser therapy, vit e/antioxidants
38
sudden monoculalr loss of vision, commonly upon waking. no paid or redness. widespread or sectoral retinal hemorrhages.
central and branch retinal vein occlusions. | screen all for DM, HTN, hyperlipidemia, glaucoma, peripfheral vvascular dz
39
sudden profound monocular loss of vision. no pain or redness. widesprpaed of sectoral retinal pallid swlling.
central and branch retinal arter occlusions excluse temporal arteritis in pts >55/ consider CV risks in all patients; evaluate carotids, cardiac sources of emboli.
40
mild retinal hemorrhages, edema, exudates, dilation of veins, microaneurysms, without visual loss
diabetic retinopathy; background.
41
macular edema, exudates ischemia of macula
diabetic retinopathy; maculopathy
42
retinal new vessels
diabetic retinopathy; proliferative
43
silver wiring and copper wiring due to tortuous and narrowed retinal arteries. AV nicking due to venous compression. flame shaped hemorrhages, edema, cotton wool spots, exudates from acute elevations of BP
Hypertensive retinopathy
44
subacute, unilateral visual loss with papilledema, flame hemorrhages, central scotoma; pain exacerbated by eye movements.
optic neuritis tx: corticosteroids
45
ptosis with down and out eye, EOM restricted in all directions except lateral.
CN III oculomotor palsy. medical causes: DM HTN, temporal arthritis.
46
convergent squint with failure of abduction. horizontal diplopia.
CN VI Abducens palsy | may be dute to trauma, neoplasm, brainstem lesions
47
Ddx: Red Eye
``` acute conjunctivitis: bacterial, viral, allergic, mechanical episcleritis scleritis acute angle glaucoma herpes keratitis iritis (uveitis) subconjuntival hemorrhage hypema (pus) hypopyon ```
48
DDx: eye pain
``` forein body, corneal abrasion acute angle closure glaucoma optic neuritis scleritis keratitis optic neuritis ```
49
Ddx: ocular discharge
conjuntivitis keratitis dacrocytitis
50
Ddx visual loss
``` refractive errors retinopahty macular degeneration optic neuritis keratitis, uveitis glaucoma cataract vitreous hemorrhage retinal vessel occlusions ```
51
Red flags of the eye
reduction of visual acuity, ciliar flush: a pattern of injection i which the redness is most pronounced in a ring at the limbus; photopobia, severe foreighn body sensation that prevents pt from ekeping eye open; corneal opacity; fixed pupil; sesvere headache with nausea
52
COPD cor pulmonale
JVD, hepatomegaly, peripheral edema
53
most common causes of acute cough
``` URIs acute bacerial sinusitis bordetlla pertussis infection excerbation of COPD allergic rhinitis environmental irritant rhinitis ```
54
most common causes of subacute cough following URI
post infectious cough bordetella pertussis bacterial sinusitis asthma
55
the 3 most common causes of cough in children above the age of 1 and adults
Post nasal drip asthma GERD
56
Chronic cough is most often due to one or more of the following
``` PND Asthma GERD chronic bronchitis bronchiesctasis non-asthmatic eosinophilic bronchitis ```
57
chronic cough in pt that is non-smoker, not taking ACE I, normal chest xray:
PND Asthma GERD eosinophillic bronchitis
58
combination of primary lung lesion (granuloma) with paratracheal lymph node granulomas.
Ghon complex in TB
59
fever, cough, weight loss, sputum production, hemopysis. pe may be normal or may show adenopathy or chest signs (sonsolidation, percussion dullness) or be normal
TB.
60
TB Treatment
Isoniazid Rifampin Pyrazinamide Ethambutol For latent/recent conversion: INH daily for 6-9mo or RIF is INH resistant. Any positive PPD age 35
61
minimal fever, rhinorrhea, anorexia, mild cough. cough can last 100 days
pertussis. whooping cough in kids.
62
cough fever, sputum production, chest pain, dyspnea, usually productive cough all day. may have abrupt onset with shaking chills, fever, tachypnea
CAP. pneumococcal / s. pneumoniae = rusty sputum lung abscess tx: clindamycin, flagyl plus cephalosporin. tx needs to be prolonged.
63
modifying factors that increase the risk of infection with specific pathogens
PCN resistant and drug resistant pneumococci: age >65, B-lactam therapy within 3 mo, alcoholism, immunosuppresive illness, multiple medical comorbidities, exposure to a child in a daycare center. enteric gram-neg organisms: residence in a nursing home, underlying cardiopulmonary disease, multiple medical comorbidities, recent anitbiotic therapy p. aeuruginosa: structural lung disease (bronchiectasis), corticosteroid therapy >10mg prednisode/day, broad-spectrum antibiotic therapy >7days/last mo, malnutrition
64
Tx for outpatient CAP with no cardiopulmonary dz or modifying factors
probable organisms: s. pneumoniae, c. pneumonia, m pneumonia (usually young people), h. flu, viruses, misc. tx: macrolide (asithromycin or clarithroycin OR doxycycline.
65
Outpaitnet CAP with cardiopulmonary disease and/or modifying factors
s. pneumoniae, atypical pathogens such as m. pneumonaie or c. pneumonia, h. flu, viruses, ENTERIC GRAM NEG BACILLI, misc. Tx: NOT cipro. Selected B-lactam (cefpodxime, cefuroxime, high dose ampicillin, amoxicillin/clauvaunate) PLUS macrolide/doxyclcine OR levofloxin alone (1pill/day easier).
66
Hospitalized patients with CAP
s. pneumoniae, h. flu, m.pnue or c. pne, aerobic gram neg bacilli, legionella spp, respiratory viruses, misc. TX: selected b-lactam with antipneumococcal activity (ceftriaxone, cefotaxime, ampicillin/sulbactam, high dose amp.) IV. PLUS macrolie or doxyclicne. OR antipenumoccal quinolone alone, IV.
67
Patients with CAP pseudomonal risk factors
``` Tx: Cipro PLUS antipseudomonal, antipneumococcal B lactam (imipenem, meropenem, cefepime, piperacillin/tazobactam) OR nonpseudomonal quinolone (levofloxacin) or macrolide PLUS antipseudomonal B lactam PLUS aminoglycoside ```

Pulmonary Diseases (3 decks)

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