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IPT: ID > Block 2 - URTI/LRTI > Flashcards

Block 2 - URTI/LRTI Flashcards

1
Q

Bugs in ear?

A

SMH

S. pneumoniae
M. catarrhalis
H. influenzae

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2
Q

Bugs in oral?

A

Prevotella
Peptococcus
Peptostreptococcus

Corynebacterium
S. aureus
Strep
Eikenella

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3
Q

Bugs in lungs

A

SMH YMC

S. pneumoniae
M. catarrhalis
H. influenza

Yeast
M. pneumoniae
C. pneumoniae

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4
Q

Acute otitis media (AOM) risk factors?

A

Most common in <5yo

Age of first episode

Daycare

Not breastfed in first 3 months

Genetic bias

Tobacco exposure

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5
Q

AOM pathophysiology?

A

Negative middle ear pressure

Eustachian tube inflammation

Movement of secretions w/ URI flora into middle ear cleft

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6
Q

AOM common bugs?

A

S. pneumoniae
Moraxella catarrhalis
H. influenza

Viral

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7
Q

Common s/sx of AOM?

A

Acute onset otalgia

Tugging on ear

Otorrhea

Redness of tympanic membrane

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8
Q

Diagnosis of AOM?

A

Middle ear effusion (MEE) + one of the following:

Moderate/Severe bulging of TM or New onset otorrhea not due to otitis externa

Mild bulge TM AND recent (48hr) onset ear pain or intense erythema of TM

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9
Q

AOM pain management?

A

APAP/ibuprofen

Abx dont provide pain relief in first 24hrs

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10
Q

S. pneumoniae AOM, Tx?

A

Amoxicillin

RF for resistance, use augmentin or ceftriaxone

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11
Q

M. catarrhalis AOM, Tx?

A

Amoxicillin

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12
Q

H. influenza AOM, Tx?

A

Amoxicillin

RF for resistance, use augmentin or ceftriaxone

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13
Q

What are the RF for resistance to amoxicillin?

A

Received amoxicillin within 30 days

Concurrent purulent conjunctivitis

History of recurrent AOM unresponsive to amoxicillin

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14
Q

Amoxicillin dose for AOM?

A

90mg/kg/day in 2 divided doses

Same goes for augmentin

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15
Q

How long do you give Abx for AOM?

A

<2yo or severe = 10 days

2-5yo with mild/moderate = 7 days

≥6yo with mild/moderate = 5-7 days

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16
Q

Tx algorithm for AOM?

A

First check to see if they have bilateral sx,

Yes = give pain med + abx

No? Then check to see if they’re severe

Yes = give pain med + abx

No? Then give just pain med and “wait + see” with Abx

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17
Q

Sinusitis RF?

A

Allergic rhinitis + asthma

Structural defects

Daycare

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18
Q

Sinusitis s/sx?

A

Purulent discharge

Dental pain

Facial pain/pressure

Fever

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19
Q

How do you differentiate viral and bacterial sinusitis?

A

Viral improves in 5-10 days

Bacterial has persistent symptoms + >10days long, severe sx in the beginning

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20
Q

Diagnosis of sinusitis?

A

Persistent illness (>10 days)

Worsening conditions

Severe (temp >39 and purulent discharge for at least 3 days)

If orbital/CNS complications are present, CT or MRI should be considered

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21
Q

Sinusitis Tx?

A

Abx or observational period

Augmentin 45mg/kg/day BID

x5-7 days in adults

x10 for kids or in adults who dont improve by day 3

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22
Q

Sinusitis complications?

A

Periorbital and intra-orbital inflammation and infection

Brain abscess

Bacterial meningitis

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23
Q

Pharyngitis RF?

A

Children 5-15 yo

Parents of school-aged children

Occupations that work w/ children

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24
Q

Pharyngitis pathophysiology?

A

Direct contact w/ droplets

Mechanism not clearly defined (has asymptomatic carriers)

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25
Q

Pharyngitis common bugs?

A

Viruses account for majority

Bacterial cause = S. pyogenes

26
Q

Which URTI condition should you NOT rely on symptoms to distinguish viral from bacterial?

A

Pharyngitis

27
Q

Pharyngitis diagnosis?

A

Raid GAS antigen test (RADT?)

Positive? no need for culture

Negative? back up culture in kids

**culture is still gold standard

28
Q

Pharyngitis Tx?

A

PCN or amoxicillin x 10 days

Must give within 9 days on onset

May also give supportive care (APAP, NSAIDs, topical anesthetics, NO corticosteroids)

29
Q

Complications of GAS pharyngitis?

A

Rheumatic fever

Glomerulonephritis

Mastoiditis

30
Q

What are the atypical species found in the lungs?

A

M. + C. pneumoniae

31
Q

Clinical pearls of Abx and lungs?

A

Dapto is inactivated by surfactants in the lungs

Aminoglycosides have poor penetration

32
Q

How is pneumonia (PNA) diagnosed?

A

New infiltrate + one of the following:

New onset fever

Purulent sputum

Leukocytosis

Decline in oxygenation

33
Q

Which PNA is classified as “walking PNA”?

A

CAP

34
Q

What is CURB 65?

A

Assesses site of treatment for CAP

Confusion
Uremia (BUN>20mg or 7mmol)
RR≥30
BP≤90/60

65+ age

0-1 = outpaitnet
2 = hospital
3 = hospital or ICU
4+ = ICU
35
Q

How do you tell if CAP is severe?

A

3+ minor or 1+ major

Minor = RR≥30, Uremia, WBC<4, PLT<100, <36 degrees, hypotensive and needs fluids

Major = invasive mech ventilation or septic shock w/ vasopressors

36
Q

CAP outpatient “healthy” pt Tx?

A

Amox

or

Doxy

37
Q

CAP outpatient “with comorbidities” pt Tx?

A

Beta lactam + anti-atypical

38
Q

CAP inpatient nonsevere Tx?

A

Beta lactam + anti-atypical

or

Resp. FQ (Levo, Moxi, Dela)

39
Q

CAP inpatient severe Tx?

A

Beta lactam + (macrolide or resp FQ)

40
Q

What are the anti-atypical abx?

A

Fluro (levo, moxi, dela)

Tetra

Pleuromutilin (lefamulin)

Macrolides

41
Q

How long is CAP treated?

A

5 days unless afebrile, then its 2-3 days

42
Q

IV to PO 1:1 Anti-MRSA?

A

Doxy

Zyvox

Bactrim

43
Q

IV to PO 1:1 Anti-Atypicals?

A

Azithr

Doxy

Fluoro (levo and moxi)

44
Q

What is HAP?

A

Occurs 48hrs+ after admission that was not incubating at time of admission

Early = within 4 days

Late = 5+ days

45
Q

HAP RF for MRSA?

A

Abx within 90 days

Ventilation**

Septic shock**

Local prevalence >20%

**RF for mortality

46
Q

No RF for MRSA nor mortality

HAP Tx?

A

Monotherapy that covers both MSSA + P. aeruginosa

No aminoglycosides nor colistin

x7days

47
Q

RF for MRSA only not mortality

HAP Tx?

A

Anti MRSA + monotherapy for P. aeruginosa

No aminoglycosides nor colistin

x7days

48
Q

RF for mortality or Abx IV within 90 days

HAP Tx?

A

Anti MRSA + double P. aeruginosa coverage

49
Q

What is VAP?

A

Occurs 48-72 hrs after endotracheal intubation

50
Q

Compare HAP and VAP double P. aeruginosa coverage

A

They share prior IV abx within 90 days and septic shock

VAP has extra stuff like: 5+ hospitliazation days, RRT prior to VAP, >10% GN are resistant to monotherapy

HAP only has ventilation as an extra item

51
Q

RF for aspiration pneumonia?

A

Intoxicants

Loss of consciousness

Supine (instead of 45 degrees)

Dysphagia

52
Q

When do you give Abx for aspiration pneumonia?

A

If symptoms persist >48hrs and no abscess or empyema

53
Q

When do you give Abx for chemical pneumonitis?

A

You dont

54
Q

Do you give abx for empyema?

A

Yes + drainage

55
Q

Aspiration PNA diagnosis?

A

Aspiration event

PNA s/sx

Chest X-ray (RLL is most common)

Sx dont resolve in 1-2 days)

56
Q

Empyema diagnosis?

A

Need pleural fluid samples

Suspect w/ failure of pneumonia to respond clinically within a few days

57
Q

What are some ways to prevent/control infection of aspiration PNA?

A

Head above bed (45 degrees)

Oral chlorhexidine

58
Q

How do you treat empyema?

A

Community acquired?

*2nd/3rd gen Ceph + Flagyl
or
*Amino-PCNw/BLI

Hospital acquired?

*MRSA+P.aeruginosa (noAG) + anaerobe

x2-6wks

59
Q

Viral PNA diagnosis?

A

Influenza RADT

Oropharyngeal sample (influenza type A and B)

60
Q

Viral PNA Tx?

A

1st line: Neuraminidase inhibitors

Tamiflu or Zanamivir (inhaled) or peramivir (IV)

Others: Baloxavir (PO)

61
Q

Monitoring parameters and viral PNA Rx Tx?

A 
Tamiflu = confusion
Zanamivir = behavior changes
Peramivir = rash, behavior changes
Baloxavir = dont take w/ cations
62
Q

Viral PNA shots?

A

Trivalent = 2 A + 1 B

Quad = 2 of each

High dose >65yo

FluBlok for anyone allergic to flu vaccines

IPT: ID (11 decks)

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