Infectious Disease Flashcards
(37 cards)
1
Q
Discuss the diagnosis of acute otitis media
A
Acute onset of symptoms and both of the following
Signs of middle ear effusion (any of the following)
- bulging TM
- limited TM mobility
- air fluid levels behind TM
- otorrhea
Signs of middle ear inflammation (any of the following)
- TM redness
- otalgia
2
Q
Discuss the indications for treatment and indications for 48h observation
A
Indications for Antibiotic - age <6 months old - Fever >38.5 - Perforated TM with purulent drainage - Significant comorbidities - Current or previous complicated otitis media Indications for 48h Observation - Age >2 years old - Reliable parents - If child worsens or fails to improve in 48hrs begin antibiotics
3
Q
Discuss the antibiotic treatment for acute otitis media
A
Amoxicillin 75-90mg/kg/day divided BID - for 5 days if >2 years old - for 10 days if <2 or >2 with complicated acute otitis media Allergy to Amoxicillin - Clarithromycin - Azithromycin - Septra
4
Q
Discuss secondary therapy for acute otitis media
A
No improvement after two days
- Amox-clav 45-60mg/kg/day divided TID for 10 days
5
Q
Discuss the history, presentation and treatment for allergic conjunctivitis
A
History - atopy or allergies Presentation - itching - rhinitis - bilateral watery eyes - papillae Treatment - cool compression - oral/topical antihistamine - artificial tears
6
Q
Discuss the history, presentation and treatment for bacterial conjunctivitis
A
History - Conjunctivitis Presentation - burning - tearing - foreign body sensation - mild photophobia - blurry vision - purulent discharge - papillae - progress to periorbital cellulitis Treatment - topical antibiotic x1 week
7
Q
Discuss the history, presentation and treatment for gonococcal/chlamydia
A
History - sexual contact - possible vertical transmission in neonates Presentation - chronic unilateral conjunctivitis not responsive to drops - tearing - foreign body sensation - urinary tract symptoms - new sexual partner Treatment - Ceftriazone 1g IM once - azithromycin 1g PO with topical antibiotic - Ophthalmology referral
8
Q
Discuss the history, presentation and treatment for viral/adenovirus conjuctivits
A
History - sick contact Presentation - Recent upper respiratory infection - Itching - burning - foreign body sensation - Mild photophobia - Affect one eye and spread to the other - Clear mucoid discharge - Follicles - Tender pre-auricular lymphadenopathy Treatment - Self limiting in 2-3 weeks - Contagious for weeks after symptom onset - Cold/warm compresses - Artificial tears - Proper hand hygiene
9
Q
Discuss the history, presentation and treatment for herpes simplex keratitis
A
History - May be triggered by stress, fever, sun exposure or immunosuppression Presentation - Pain - tearing - foreign body sensation - red eye - decreased vision - eyelid edema - dendritic lesions in epithelium that stain fluorescein - Corneal hypoesthesia Treatment - Topic antiviral trifluridine - systemic acyclovir - ophthalmology referral
10
Q
Discuss red flags for red eye
A
- Decreased visual acuity
- Sudden, painless vision loss
- Ciliary flush
- Photophobia
- Corneal Opacity
- Fixed pupil
- Severe headache
- Trauma
- Gonococcal
- Orbital cellulitis
- Temporal arteritis
- Absent red reflex
- CN III palsy with dilated pupil
- Proptosis
11
Q
Discuss the history, presentation and treatment for hordeolum (stye)
A
History - acute inflammation of eyelid gland - Staph Aureus Treatment - Warm compresses - Gentle massage - Topical antibiotic (erythromycin ointment) - resolves 2-5 days
12
Q
Discuss the history, presentation and treatment for chalazion
A
History - chronic granulomatous inflammation of meibomian gland - produced by internal hordeolum Presentation - no acute inflammatory signs Treatment - warm compress - no improvement after 1 month consider incision and curretage - chronic biopsy for malignancy
13
Q
Discuss the history, presentation and treatment for blepharitis
A
History - inflammation of lid margins - ulcerative dry scals: Staph aureus - seborrheic: no ulcer, greasy scales Presentation - itching - tearing - foreign body sensation - thickened - red lid margins - crusting - toothpaste sign Management - warm compressed and lid scrubs - topical or systemic antibiotics - ophthalmologist may prescribe corticosteroid
14
Q
Discuss the history, presentation and treatment for xanthelasma
A
History - eyelid xanthoma (lipid deposits in dermis of lids) Treatment - pale - slightly elevated yellowish plaques or streaks - upper eyelids, bilateral - hyperlipidemia Management - excision for cosmesis
15
Q
List the microorganism and antibiotic option for community acquired pneumonia in adults (outpatient no comorbidities)
A
Organism - Strep pneumonia - Mycoplasma pneumonia - C pneumonia Antibiotics - Clarithromycin 500mg BID or 1000mg OD for 7-14 days Amoxicillin 1g TID for 7-14 days Azithromycin 500mg on first day then 250mg for 4 days
16
Q
List the microorganism and antibiotic option for community acquired pneumonia in children (outpatient no comorbidities)
A
Microorganism
- 1-3 months: RSV, viruses
- 3 months - 5 years: Strep pneumo, Staph aureus, GAS, H influenza
- 5-18 years: Mycoplasma Pneumonia, C pneumonia, Strep pneumonia, Influenza A or B
Treatment
- 1-3 months: no antibiotic
- 3mon-5yr: Amoxicillin 80mg/kg/day divided TID for 7-10 days
- 5-18yrs: Clarithromycin 15mg/kg/day divided BID for 7-10 days
17
Q
List the microorganism and antibiotic option for acute pharyngitis
A
Organism - Group A Strep Antibiotic - Penicillin V 600mg BID for 10 days Erythromycin 250mg QID for 10 days Children - Penicillin V 40mg/kg/d Divided BID-TID for 10d (mas 750mg/d) - Erythromycin esolate 40mg/kg/day divided BID-TID for 10d
18
Q
List the microorganism and antibiotic option for acute otitis media
A
Organism - Strep pneumo - H influenza - Morexalla catarrhalis Treatment Adults - Amoxicillin 500mg TID x 5 days - Cefprozil 250-500mg BID for 7-10days
19
Q
List the microorganism and antibiotic option for otitis externa
A
Organism - Pseudomonas aeruginosa - Coliforms - Staph aureus Treatment - Ciprodex 2 drops BID
20
Q
List the microorganism and antibiotic option for bacterial sinusitis
A
Organism - Strep pneumo - H influenza - Morexalla Catarrhalis - Staph Aureus Treatment Adults - Amoxicillin 500mg TID for 5-10 days - Amox-clav 500mg TID for 5-10 days Cefuroxime 250-500mg BID x 5-10 days Treatment Child - Amoxicillin 80-90mg/kg/day divided BID-TID for 10-14 days - Amox-clav 40-80mg/kg/day divided BID - Cefprozil 30mg/kg/day divided BID for 10-14 days
21
Q
List the microorganism and antibiotic option for urinary tract infection
A
Organism - E coli - Staph saprophyticus Treatment - Septra 1DS tab BID for 3 days - Nitrofurantoin 100mg BID for 5 days - Cephalexin 250-500mg QID for 7 days (pregnant)
22
Q
List the microorganism and antibiotic option for pyelonephritis
A
Organism - E coli - K pneumonia - P mirabilis Treatment - Ciprofloxacin 500mg BID for 7 days
23
Q
List the microorganism and antibiotic option for urethritis
A
Organism - N gonorrhea - C trachomatis Treatment - Ceftriaxone 250 mg IM once and - Azithromycin 1g PO once
24
Q
List the microorganism and antibiotic option for bacterial vaginosis
A
Organism - G vaginalis - M hominis anaerobes Treatment - Metronidazole 500mg BID PO for 7 days
25
List the microorganism and antiviral option for mucocutaneous herpes
Organism
- Herpes Simples 1 or 2
Treatment
- Valacyclovir 2g BID once
26
List the microorganism and antiviral option for genital herpes
Organism
- Herpes simplex 1 or 2
Treatment
- Acyclovir 400mg TID for 5-7 days
27
List the microorganism and antiviral option for shingles
```
Organism
- Varicella zoster
Treatment (initiate within 72hrs)
- Valacyclovir 1g TID for 7 days
- Famciclovir 500mg TID for 7 days
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28
List the microorganism and antiviral option for genital warts
Organism
- human papilloma virus
Treatment
- cryotherapy q1-2 weeks
29
List the microorganism and antiviral option for infleuza
Organism
- Influenza A or B
Treatment
- Oseltamivir (tamiflu) 75mg daily for 10 days (begin 48hrs after exposure)
30
Discuss the presentation and management of allergic rhinitis
- increased IgE levels to certain antigens resulting in excessive degranulation of mast cells to release of inflammatory mediators and cytokines leading to inflammatory reaction
Management
- reduce exposure to allergens
- oral antihistamines
- cetirizine (reactine)
- loratadine (Claritin)
- intranasal corticosteroids for severe or persistant (>1mon) symptoms
31
Discuss the presentation and management of bronchitis
```
Organism
- 80% viral: rhinovirus, adenovirus, influenza
- 20% bacterial: Mycoplasma pneumonia, C pneumonia, S pneumonia
Bacterial Presentation
- high fever
- excessive purulent sputum
- COPD
Investigations
- CXR if cough >3week, abnormal vital signs and chest findings
Management
- infection control
- 3-4L/d of fluids
- Salbutamol
```
32
Discuss the presentation and management of acute rhinitis
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Organism
- rhinovirus
- incubation 1-5 days
Presentation
- nasal congestion
- clear to mucopurulent secretions
- sore throat
- cough
- mild fever
- erythematous oropharyngeal mucosa
Management
- peak 1-3 days and subside in 1 week
- secondary bacterial 3-10 days after onset
- Nasal irrigation
- acetaminophen
- dextromethorphan
- decongestants
```
33
Discuss the presentation and management of sinusitis
Etiology
- rhinovirus
- strep pneumonia
- H influenza
- M catarrhalis
Presentation
- symptoms for >7 days or <7 days but acute worsen then bacterial likely
- require nasal obstruction or nasal purulence/discolored postnasal discharge and one other PODS symptoms
- Facial Pain
- Nasal obstruction
- Nasal purulence/discolored postnasal discharge
- Hyposmia/anosmia
- symptoms for 3-4 days with high fever
Management
- mild to moderate then intranasal corticosteroids and reassess in 72h
- severe then intranasal corticosteroids and antibiotics
- first line: amoxicillin
- second line: amox-clav, fluoroquinolones
34
Discuss the presentation and management of pharyngitis
```
Etiology
- adenovirus (90% viral)
- rhinovirus
- group A beta-hemolytic strep
Presentation - Viral
- pharyngitis
- conjunctivitis
- rhinorrhea
- hoarseness, cough
- fever, malaise
Presentation - Bacterial
- pharyngitis
- fever
- headache
- abdominal pain
- absence of cough
- tonsillar/pharyngeal erythema/exudate
- swollen anterior lymph nodes
Investigations
- rapid strep test
Management - Bacterial
- antibiotics to decrease risk of transmission, rheumatic fever and suppurative complications
- risk of glomerulonephritis unchanged
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35
Discuss the Modified centor score for risk of Group A Beta-hemolytic strep infection
- Cough present
- History of fever >38
- Tonsillar exudate
- Swollen, tender anterior nodes
- Age 3-14
- Age 15-44 (0 points)
- Age >45 (-1 points)
Scoring
- score 0-1 then no culture or treatment
- score 2-3 then culture and treat if positive
- score >=4 then culture and treat immediately
36
Discuss the presentation and management of ebstein barr virus (infectious mononucleosis)
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Presentation
- pharyngitis
- tonsillar exudate
- fever
- lymphadenopathy
- rash
Investigation
- peripheral blood smear
- antibody test
Management
- symptomatic
- avoid physical activity and contact sports for 1 month until splenomegaly resolves
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37
Discuss the presentation and management of coxsackie virus (hand, foot, mouth disease)
Presentation
- fever
- pharyngitis
- abdominal pain
- vomiting
- small vesiscles that rupture and ulcerate on tonsils, soft palate and pharynx
- ulcer that are pale grey with surrounding erythema on hands and feet
