Approach to RI

Question 1

Sinusitis: most common bacterial pathogen

Answer 1

S. pneumo

Question 2

Sinusitis: first line

Answer 2

Amoxi

Question 3

Sinusitis: second line

Answer 3

amoxiclav

2nd gen ceph

Question 4

Sinusitis: second most common bacterial pathogen

Answer 4

H. influenza
Moraxella
Chlamydia

Question 5

When is sinusitis bacterial?

Answer 5

Rhinorrhea or persistence of dayime cough lasting 10-14+ days
OR
fever + purulent nasal discharge

Question 6

Acute otitis media: most common bacterial pathogen

Answer 6

S. pneumo

Question 7

Acute otitis media: other pathogens

Answer 7

H. flu

M. catarrhalis

Question 8

Acute otitis media: first line

Answer 8

amoxi

Question 9

Acute otitis media: Second line

Answer 9

amoxiclav

ceftriaxone

Question 10

Pharyngitis: most common bacterial

Answer 10

GABHS

Question 11

Signs of bacterial pharyngitis:

Answer 11

fever
NO cough
whitish exudate
cervical adenopathy

Question 12

Pharyngitis: first line

Answer 12

penicillin

allergy: erythromycin

Question 13

Pharyngitis: second line

Answer 13

macrolides and fluoroquinolone

Question 14

Acute bronchitis: most common bacterial

Answer 14

90% are VIRAL

Bordatella
Myco pneumoniae
Chlamydia

Question 15

Indications for pharma treatment of flu?

Answer 15

hospitalized
severe, complicated illness
high risk for complications
comorbidities, immunocomp

Question 16

Most common flu treatment:

Answer 16

rest and hydration

Question 17

First line drug of flu:

Answer 17

oseltamivir

Question 18

MOA of first line flu drug:

Answer 18

neuraminidase inhibitor (prevents release of viruses)

Question 19

When to give first line flu drug?

Answer 19

BEFORE viral release

within TWO days of onset of illness

Question 20

Most common etiological agent of CAP?

Answer 20

S. pneumo

Question 21

Other common causes of CAP

Answer 21

H flu
Moraxella
Staph aureus

Question 22

Atypical CAP causes

Answer 22

mycoplasma 10-30%
chlamydia 5-10
legionella 2-10

Question 23

CURB65 stands for

Answer 23

Confusion
Urea (+ is >7mmol)
RR (+ is >30)
BP (+ is <90/60)

in 65 yo

Question 24

PCAP guideline treatment for low risk with no comorbids

Answer 24

amoxicillin

or extended macrolide

Question 25

PCAP guideline treatment for low risk with comorbid

Answer 25

BLIC Beta lactam inhibitor combo
2nd gen cephalosporin
macrolide

Question 26

PCAP guideline treatment with moderate risk

Answer 26

IV non-antipseudomonal BLIC + macrolide

Question 27

PCAP guideline treatment for SEVERE CAP with no risk of resistance

Answer 27

extended spectrum plus clarithromycin or ciprofloxacin

Question 28

PCAP guideline treatment for SEVERE CAP WITH risk of resistance

Answer 28

benzylpenicillin + ciprofloxacin
OR
cefuroxime + clarithromycin

Question 29

US guideline for less severe CAP (group II)

Answer 29

respiratory quinolone
OR
BL + macrolide

Question 30

US guideline for group I CAP

Answer 30

adv, gen. macrolide (azithro/clarithro)
OR
doxycycline

Question 31

US guideline for severe CAP with shock

Answer 31

BL + clarithro
OR
antipseudomonal + ciprofloxacin

Question 32

HCAP in elderly patient with history of BL therapy, alcoholism, immunosuppression, multiple comorbids, exposure to children in daycare. Modified etiological differential includes:

Answer 32

penicillin resistant pneumococci

Question 33

HCAP with history of residence in nursing home, underlying cardiopulmo disease. Modified etiological differential includes:

Answer 33

Enteric gram negs

Question 34

HCAP in patient with history structural lung disease, corticosteroid therapy, broad spectrum therapy, malnutrition. Modified etiological differential includes:

Answer 34

pseudomonas aeruginosa

Question 35

Early onset HCAP

Answer 35

extended spect. BL

2nd gen cephalosporin

Question 36

Late onset HCAP

Answer 36

Consider antipseudomonals: extended spectrum penicillin, 3rd gen cephs

Question 37

Common agent in HCAP?

Answer 37

Gram negatives