ID E3 Flashcards

1
Q

Sinusitis S/sx that might indicate bacterial and need Abx

A

Purulent anterior nasal discharge
Purulent/discolored posterior nasal discharge
Nasal congestion/obstruction
Facial congestion/fullness
Decreased smell
Fever

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2
Q

Chronic sinusitis classification and treatment plan

A

S/sx greater than 12 weeks often not infectious caused by s. Pneumonia and H. Influenza

Only C&S no Abx

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3
Q

Bacterial caused sinusitis non pharm TX options

A

No decongestant/antihistamines

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4
Q

Viral caused sinusitis nonpharm TX options

A

Decongestants, irrigation, mucolytics

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5
Q

When to use Abx in sinusitis (4)

A
  1. Persistent s/sx for greater than or equal to 10 days without evidence of clinical improvement
  2. Severe s/sx (T > 102F, facial pain, Purulent nasal discharge) for greater than or equal 3 - 4 days at the beginning
  3. Worsening s/sx such as new onset fever, HA, increased nasal discharge after a typical viral URTI (which is for 5 days). Aka double worsenining
  4. Presenting to the ER with sinusitus
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6
Q

Pharyngitis s/sx

A

Suddenly onset of sore throat
Tonsillopharyngeal Inflammation
History of exposure to strep pharyngitis
Anterior cervical adenitis (tender nodes)
Scarlatiniform rash (rosy cheeks)
Palatial petechiae

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7
Q

OM criteria per Pediatric Academy

A

Middle Ear Effusion + Moderate to severe bulging of tympanic membrane or new onset otorrhea

OR

Middle Ear Effusion + Mild bulging of tympanic member + onset of ear pain within last 48 hrs or intense erythema of tympanic membrane

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8
Q

Criteria for use of Abx in OM

A

6 months - 1 year old + moderate/severe pain OR T > 102

6 months - 23 months + non severe bilateral acute OM

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9
Q

Criteria for considering Abx use in OM

A

6 months - 23 months + non severe unilateral acute OM

2 yo - 12 yo + acute non severe OM

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10
Q

Common cause of AOM

A

Most URTI are virtual

Bacterial, Streptococcus pneumoniae

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11
Q

Common cause of Acute Sinusitus

A

Most URTI causes are viral

Bacterial, Streptococcus pneumoniae

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12
Q

Common cause of acute pharyngitis

A

Most URTI causes are viral

Bacterial, group A B-hemolytic streptococcus

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13
Q

S/Sx of pneumonia

A

Purulent Sputum, Hemoptysis (blood in sputum), Dyspnea (chest pain because of inflammation)

Leukocytosis (>12K, <4K WBC), decreased O2, RR > 30, HR > 100, T > 100 (Fever)

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14
Q

Typical pneumonia s/sx

A

Abrupt Onset
Unilateral well-defined infiltrate
Significant fever, chills, sweats, dyspnea
Purulent sputum product

Primarily pulmonary symptoms might have pleuritic chest pain

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15
Q

Atypical Pneumonia s/sx

A

Gradual Onset
Diffuse infiltrates, ground glass appearance
Mild fever, mild dyspnea
Dry cough

Extra pulmonary symptoms common such as myalgias, Diarrhea, Abdominal pain

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16
Q

Viral pneumonia s/sx

A

Caused by Respiratory syncytial virus (RSV), Influenza A & B, Adenovirus, parainfluenza

Presenting with wheeling, dyspnea and less incisive of febrile episodes

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17
Q

Possible Sources of VAP

A

Exogenous sources of micro-organism such as the hands of the HC, ventilator circuit, biofilm of the endotracheal tube

Mechanism of pneumonia where the colonized secretions are inhaled into the lungs through the endotracheal tube

18
Q

Active immunizations Live-attenuated

A

MMR VIP RZ

Measles
Mumps
Rubella
Varicella
Influenza (LAIV)
Polio (OPV)
Rotavirus
Zoster (ZVL)

19
Q

Active Immuninzations Toxoids

A

Diphtheria
Tetanus

20
Q

Active Immunization Inactivated

A

HIPP

Hep A
Influenza (IIV)
Pertussis
Polio (IPV)

21
Q

Active Immunity inactivated Recombinant

A

Hep B
HPV
Zoster (RZV)

22
Q

Active immunization conjugated/polysaccharide

A

Hib
Meningococcal
Pneumococcal

23
Q

COVID 19 mRNA vaccine

A

Pfizer
Moderna

24
Q

Covid 19 adenovirus vaccine

A

J&J

25
Q

UTI risk factors

A

Sexual behavior
Contraceptive devices
Prego
Male gender
Badly controlled T2DM
Transient short term urinary tract catheter
Asymptomatic bacteriuria
Long term catheter treatment

26
Q

UTI UA significant lab findings

A

Hallmark sign is pyuria (wbc > 10)
Leukocyte esterase positive, released by WBC
Nitrite positive, e coli possible
Hematuria, blood in urine (0-5)
WBC castes, possibly pyeloneprhoritis
Proteinuria, possibly kidney dysfunction
Bacteria, >2+ GNR

27
Q

Mild water loss s/sx

A

Alert
Restless
Increased thirst
Moist/slight dry mucus membranes
Normal/slightly decreased urinary output

28
Q

Moderate water loss s/sx

A

Lethargic/restless
Decreased vol (decreased BP, high HR)
Dry mucous membranes
Delayed capillary refill
Dark urine

29
Q

Severe water loss s/sx

A

Drowsy
Limp
LOC
Bradycardia
Cyanotic
Skin tenting
No UO

30
Q

% water loss and their associated water loss level

A

<5% weight loss (mild)
6-9% weight loss (moderate)
>10% weight loss (severe)

31
Q

What is not recommend for po supplementation for water loss

A

Juice, soda, sport drinks, tea, ginger ale, broth

32
Q

IM vaccines

A

Covid
Td
Influenza inactivated
PCV13
PPV 23, pneumococcal polysaccharide
RZV herpes zoster

33
Q

SQ vaccines

A

PPV 23, pneumococcal polysaccharide
ZVL herpes zost3r

34
Q

Contraindications for COBI and Boosted PI

A

Rifampin
Ergotamines
Cisapride
St. Johns wart
Lovastatin
Simvastatin
Sildenafil
Triazolam
Midozalam

35
Q

Cobi corticosteroid DDI

A

Budesonide
Fluticasone
Mometasone

Triamcinolone topical

36
Q

Emtricitabine/tenofovir BBW

A

Dual NRTI therapy (backbone)
Lattice acidosis
Sever Hepatomegaly
Hep B coinfection

37
Q

INSTI ade

A

Brain (cns disturbance)
Rash
Cr (false elevation of SrCr)
Weight gain
GI

38
Q

INSTI DDI

A

Cations (al/Mg/CA cations)
Metformin

39
Q

Boosted PI Ade

A

GI intolerance
HLD
CV risk
Metabolic syndrome
DDI

40
Q

NNRTI ade

A

Liver toxicity
Rash
Hyperglycemia
HLD
Neuropsych effects hence qhs dosing

41
Q

NNRTI ddi

A

Cyp3a4
Rilpivirine is substrate
Efavirine is inhibitor

Exception is dovavirine