Day 6 - Pulm1 Tonsils, Sinusitis, PNA Flashcards Preview

Step 2 DIT Rapid Review > Day 6 - Pulm1 Tonsils, Sinusitis, PNA > Flashcards

Flashcards in Day 6 - Pulm1 Tonsils, Sinusitis, PNA Deck (38):
1

Cause, Dx feat, & Txof peritonsilar abscess

Bn tonsilar and pharyngeal constrictors; Caused by S. pyogenes, S. aureus, or Bacteroides; Severe sore throat, fever, muffled hot potato voice; Abscess on tonsil or deflection of uvula to opposite side; Trismus, drooling; Tx: Needle aspiration or I & D

2

Distinguish acute bacterial sinusitis from rhinosinusitis (or common cold)

Last 7+ days and Any of following: Purulent nasal discharge, Maxillary tooth or facial pain, Worsening sx after initial improvement; No need for imaging confirmation (CT of sinuses can r/o sinusitis)

3

Tx acute bacterial sinusitis

Observation & sx relief (if fever

4

Tx chronic bacterial sinusitis

(3 mo. of sx); Oral steroids if tolerable or 3-6 wks of antibx; Intranasal saline; Intranasal steroids indefinitely; If allergic, tx allergies; If nasal polyps and refractory to steroids, debulking surgery; If allergic fungal sinusitis, then sinus surgery & prolonged steroids

5

Complications of sinusitis

Meningitis; Abscess; Orbital infx; Osteomyelitis

6

Allergic fungal sinusitis p/w & dx

Chronic rhinosinusitis, thick allergic mucin; Seen on CT scan, typically confirmed on sinus surgery

7

Most common cause of PNA & empiric antibx tx in children aged: Newborn - Mo. 1

GBS, Gram (-) like E. coli, Listeria; C. trachomatis; Ampicillin & Gentamycin; If suspect MRSA, consider vancomycin; If Chlamydia, erythromycin

8

Most common cause of PNA & empiric antibx tx in children aged: After first mo. - 4 mo.

RSV; C. trachomatis (if not already dx), Parainfluenza, Bordetella, S. pneumo, S. aureus; Macrolides (Azithromycin or erythromycin) w or w/o Ceftaxime

9

Most common cause of PNA & empiric antibx tx in children aged: 4 mo. - 4 yr.

RSV and other viruses (influenza, parainfluenza, coronavirus, adenovirus); S. pneumo, H. flu, Mycoplasma; Amoxicillin or Ampicillin

10

Most common cause of PNA & empiric antibx tx in children aged: 5- 15 yr.

Strep pneumo; Mycoplasma; Chlamydia; Options: (1) Amoxicillin + Clarithromycin (2) Azithromycin, or (3) Amoxicillin + Doxycycline

11

Indications for pneumococcal vaccination in adults

(1) Age 65+ (2) Serious long-term health problems (Hear disease, SCD, alcoholism, CSF leaks, Lung disease not including asthma, DM, Liver cirrhosis) (3) Resistance to infx lowered (Hodgkin disease, Multiple myeloma, cancer tx, long-term steroid use, bone marrow tx, kidney failure) (4) Certain Alaskan native or American indian populations at higher risk

12

Antibx tx pseudomonas PNA

Antipseudomonal beta-lactam (piperacillin, tazobactam, cefipime, meropenem, imipenem, aztreonam) must be added to one of following for at least 2 weeks for added coverage: (1) Antipseudomonal quinolone (2) Aminoglycoside + Azithromycin (3) Aminoglycoside + Antipseudomonal quinolone

13

XR and lab findings suspicious for PCP as cause of respiratory distress

CXR: diffuse b/l (usually not b/l in other PNA) interstitial infiltrates; CD4 220 (unique to PCP); Rising LDH despite tx portends a poor prognosis

14

Tx PCP

21 days of antibx, choices include: (1) TMP-SMX (first-line) (2) Pentamidine (first-line alternative); (3) Trimetrexate w/ leucovorin (4) Primequin plus clindamycin; If mod-severe, hospitalized & given steroids

15

Ddx for ground glass opacity or infiltrates

DDx: Interstital PNA; PCP PNA; Pulmonary edema; Pulmonary hemorrhage; Hypersensitivity pneumonitis

16

Common cause of PNA: immunocompromised pts

PCP

17

Common cause of PNA: atypical walking PNA

Mycoplasma pneumoniae

18

Common cause of PNA: alcoholics

Klebsiella

19

Common cause of PNA: interstitial PNA in bird handlers

C. psittaci

20

Common cause of PNA: pt w/ hx of bats/bat droppings

Histoplasma caspulatum

21

Common cause of PNA: recently visited CA, south Texas, New mexico

Coccioides imitis

22

Common cause of PNA: currant jelly sputum

Klebsiella

23

Common cause of PNA: Q fever (interstitial fever in livestock handler)

Coxiella burnetti

24

Common cause of PNA: air conditioners

Legionella pneumophila

25

Common cause of PNA: 1 year of age and younger

RSV

26

Common cause of PNA: neonates

GBS

27

Common cause of PNA: children and young adults

Mycoplasma pneumoniae

28

Common cause of PNA: other health problems

Klebsiella

29

Common cause of PNA: viral pneumoniae

(1) RSV (2) Influenza

30

Common cause of PNA: life-threatening wool sorters diease

Bacillus anthracis

31

Common cause of PNA: COPD exacerbation

Haemophilus influenza

32

Common cause of PNA: ventilator patients w/ CF

Pseudomonas aeruginosa

33

Common cause of PNA: Pontiac fever (flu-like sx)

Legionella pneumophila

34

PNA based on lab signs: gram (+) cocci in clusters

S. aureus

35

PNA based on lab signs: gram (+) cocci in pairs

S. pneumo

36

PNA based on lab signs: gram (-) rods in 80 yo

E. coli

37

PNA based on lab signs: gram (+) rods in neonate

GBS

38

PNA based on lab signs: gram (-) rods in neonate

E. Coli

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