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Flashcards in L42 Deck (28)
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1
Q

What are the 5 steps of pathogenesis of otitis media?

A
  1. Eustachian tube obstruction
  2. Negative pressure created in the middle ear
  3. Fluid collects
  4. Bacterial colonization
  5. Release inflam mediators
2
Q

What is otitis media with effusion?

  • Time frame
  • Symptoms
  • Treat
A

1 wk - 3 mos post-acute otitis media
Fluid in the ear
- Asymptomatic or mild hearing loss
No treatment

3
Q

What is the difference between acute OM and OM w/ effusion?

A
Non-specific symptoms likely to be similar
History (of recent OM infection)
Physical exam = different 
- Infection vs fluid 
- Bluging?
4
Q

3 bugs for acute OM

A

Staph pneumo
H influ
M. catarrhalis

5
Q

Complication on acute OM

A

Mastoiditis

6
Q

What symptoms make you think sinusitis (as opposed to a cold)?

A

Symptoms localized to sinuses
Severe headache/focal pain
Ill/fever
Longer duration

7
Q

What are the 3 time courses for sinusitis (in comparison to a cold)?

A
  1. Acute persistent
  2. Severe persistent
  3. Biphasic
8
Q

3 bugs for sinusitis

A

Strep pneumo
H influ
M. catarrhalis

9
Q

2 bugs you’d add into consideration for chronic sinusitis (over a month sick)

A

Staph
Anaerobes
Started as one of the normal 3 bugs –> then this took over and continued the infection

10
Q

Drugs for sinusitis

A

(Same as OM)
If you give drugs…
Amoxicillin +/- clavulanate
(More likely to add coverage for S.aureus in adults)

11
Q

Complication of sinusitis

A

Orbital celluitis

12
Q

Bug for pharyngitis

A
PROBS VIRAL DUDE
Strep pyogenes (grp A strep)
13
Q

Symptoms for bacterial pharyngitis. What symptoms are ABSENT?

A

Palette pettichae
Scarlet fever rash - sandpaper rash
NO cough

14
Q

How do you diagnose pharyngitis?

A

Rapid strep test

Always send negatives for culture

15
Q

Drug for pharyngitis

A

IF NOT VIRAL

Penicillin

16
Q

2 pharyngitis complications

A
  1. Rheumatic fever
  2. Glomerulonephritis

Abscesses

17
Q

Which symptoms are you looking for classic CA pneumonia?

A
Tachypnea in kids
Fever
Crackles 
Decreased breath sounds (b/c lungs full of mucous and alveoli not being aerated) 
Dullness to percussion
Increased vocal femitus
18
Q

What are tell tale signs of bacterial pneumonia?

A

ACUTE onset - “feel like a train hit me and now I’m really sick”
Lobar distribution

19
Q

3 bugs for CA pneumonia

A

S. pneumo
H. influ
S. aureus

20
Q

Diagnostic test for outpatient pneumonia

A

CXR

Blood culture & sputum could be done, but uncommon

21
Q

What are tell tale signs of atypical pneumonia?

A

Sub-acute onset
Flu-like presentation
Lymphocyte predominance w/ normal to high overall WBC
CXR = diffuse

22
Q

4 bugs for atypical pneumonia

A

VIRUSES
Mycoplasma pneumo
Chamydophila pneumo
Legionella pneumo

23
Q

Drugs to treat atypical pneumo

A

Macrolides

24
Q

Tell tale signs of mycroplasma pneumo as cause of atypical pneumo. How do you diagnose?

A

Rash
COLD AGGLUTININS
Dx = serologies

25
Q

Tell tale signs of legionella pneumo as cause of atypical pneumonia.

A

Progressive - even if you have right antibiotics
ICU patient
**Extrapulm manifestations (changes to electrolyte panel - Na wasting)
**No organisms in sputum

26
Q

How do you diagnose legionella pneuomonia?

A

Urine legionella Ag test

27
Q

Which bugs are most likely to cause severe pneumonia - effusions, pneumato-celes, etc?

A

S.aureus after influenza infection
- Be careful, might be MRSA
Legionella

28
Q

Drug for typical, outpatient pneumonia in patient with concern for macrolide resistance

A

Resp fluoroquinolone
OR
Azythromycin + beta lactam