TBL Dec 13 URI

Question 1

Four reasons to use early ABX treatment in URI?

Answer 1

1. Epiglottitis
2. Pertussis
3. Acute otitis media
4. Group A Strep (strep progenes)

Question 2

Give pt’s with acute laryngitis?

Answer 2

NOT abx

Question 3

Why give pt’s with streptococcal pharyngitis ____ ?

Answer 3

Give penicillin to reduce risk of rheumatic fever

• to alleviate symptoms
• to decrease communicability

Question 4

Bacterial rhinosinusitis, if acute and uncomplicated, tx?

Answer 4

Short-course abx therapy

- amoxicillin (need ammo to kill a rhino)

Question 5

Cough and phlegm only is?

Answer 5

Acute bronchitis - NO abx

Question 6

Treat acute otitis media?

Answer 6

Divided doses of amoxicillin

Question 7

Nasal obstruction
Nasal discharge, can be purulent
Face pain
Cough
Decreased sense of smell

Answer 7

Acute rhinosinusitis
- watch and wait for mild

Amoxicillin for severe/complicated (bacterial)

Question 8

Common cold symptoms

Answer 8

Runny nose, cough, sore throat, sneezing, nasal congestion

Symptomatic treatment

Question 9

Dysphagia + voice change
Tachycardia
SOB, tachypnea > 24
Stridor, respiratory distress
Leaning forward
Fever
Drooling

Answer 9

Epiglottitis

• IV 3rd gen cephalosporin
• PLUS anti-staph agent against MRSA

Could do just: IV ceftriaxone, cefotaxime, ampicillin+sulbactam

Question 10

Sore throat
Fever > 100.4
No cough

Answer 10

Treat based on modified Centor score

Pharyngitis and/or tonsillitis

Question 11

How diagnose bacterial sinusitis?

Answer 11

Symptoms for 10+ days

- often Strep pneumonia, H-flu, or moraxella cat.

Question 12

Nasal obstruction
Drainage
Facial pain
Decreased smell

Answer 12

Rhinosinusitis

• shorter than 10 days - viral
• longer than 10, consider amoxicillin

Question 13

3 Main Causes of Otitis Media?

Answer 13

H-flu
M. catarrhalis
S pneumo

Question 14

Always treat AOM in?

Answer 14

Child < 35 months of age

- bilateral or not

Question 15

Who gets rapid strep test for Pharyngitis/Tonsillitis?

the following five each get 1 point and test for pt’s w/ 2-3 points; treat for those 4+

Answer 15

No Cough
Age 3-14
Anterior cervical lymphadenopathy
Fever
Tonsillar erythema/exudates

Question 16

Centor Criteria: ages

Answer 16

3-14 – 1 point
15-45 – 0 points
Over 45 – -1 point

Question 17

Main cause of epiglottitis?

- reason we worry about it?

Answer 17

H influenza type b

- airway compromise

Question 18

How treat Epiglottitis?

Answer 18

Combo anti-staph w/ MRSA coverage

- plus 3rd gen cephalosporin IV

Question 19

Diagnosing Streptococcal pharyngitis?

Answer 19

Sore throat
Fever > 100.4
Tonsillar exudates
Cervical adenopathy

Question 20

Cough, runny nose, diarrhea?

Answer 20

Viral pharyngitis

Question 21

How treat streptococcal pharyngitis?

Answer 21

Oral Penicillin, 10 days

Amoxicillin more palatable (same efficacy)

Question 22

Two tests for streptococcal pharyngitis?

- GABHS

Answer 22

Culture - 90-95% sensitive

Rapid antigen test - 90-99% sensitive

Question 23

How treat streptococcal pharyngitis if penicillin allergy?

Answer 23

10 days of oral

• erythromycin
• 1st gen cephalosporin

Question 24

If you treat GABHS, do you prevent:

• rheumatic fever?
• glomerulonephritis?

Answer 24

ARF - reduced risk

GN - treatment does NOT prevent