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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
Pharyngitis common bugs?
Viruses account for majority Bacterial cause = S. pyogenes
26
Which URTI condition should you NOT rely on symptoms to distinguish viral from bacterial?
Pharyngitis
27
Pharyngitis diagnosis?
Raid GAS antigen test (RADT?) Positive? no need for culture Negative? back up culture in kids **culture is still gold standard
28
Pharyngitis Tx?
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
Complications of GAS pharyngitis?
Rheumatic fever Glomerulonephritis Mastoiditis
30
What are the atypical species found in the lungs?
M. + C. pneumoniae
31
Clinical pearls of Abx and lungs?
Dapto is inactivated by surfactants in the lungs Aminoglycosides have poor penetration
32
How is pneumonia (PNA) diagnosed?
New infiltrate + one of the following: New onset fever Purulent sputum Leukocytosis Decline in oxygenation
33
Which PNA is classified as "walking PNA"?
CAP
34
What is CURB 65?
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
How do you tell if CAP is severe?
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
CAP outpatient "healthy" pt Tx?
Amox or Doxy
37
CAP outpatient "with comorbidities" pt Tx?
Beta lactam + anti-atypical
38
CAP inpatient nonsevere Tx?
Beta lactam + anti-atypical or Resp. FQ (Levo, Moxi, Dela)
39
CAP inpatient severe Tx?
Beta lactam + (macrolide or resp FQ)
40
What are the anti-atypical abx?
Fluro (levo, moxi, dela) Tetra Pleuromutilin (lefamulin) Macrolides
41
How long is CAP treated?
5 days unless afebrile, then its 2-3 days
42
IV to PO 1:1 Anti-MRSA?
Doxy Zyvox Bactrim
43
IV to PO 1:1 Anti-Atypicals?
Azithr Doxy Fluoro (levo and moxi)
44
What is HAP?
Occurs 48hrs+ after admission that was not incubating at time of admission Early = within 4 days Late = 5+ days
45
HAP RF for MRSA?
Abx within 90 days Ventilation** Septic shock** Local prevalence >20% **RF for mortality
46
No RF for MRSA nor mortality HAP Tx?
Monotherapy that covers both MSSA + P. aeruginosa No aminoglycosides nor colistin x7days
47
RF for MRSA only not mortality HAP Tx?
Anti MRSA + monotherapy for P. aeruginosa No aminoglycosides nor colistin x7days
48
RF for mortality or Abx IV within 90 days HAP Tx?
Anti MRSA + double P. aeruginosa coverage
49
What is VAP?
Occurs 48-72 hrs after endotracheal intubation
50
Compare HAP and VAP double P. aeruginosa coverage
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
RF for aspiration pneumonia?
Intoxicants Loss of consciousness Supine (instead of 45 degrees) Dysphagia
52
When do you give Abx for aspiration pneumonia?
If symptoms persist >48hrs and no abscess or empyema
53
When do you give Abx for chemical pneumonitis?
You dont
54
Do you give abx for empyema?
Yes + drainage
55
Aspiration PNA diagnosis?
Aspiration event PNA s/sx Chest X-ray (RLL is most common) Sx dont resolve in 1-2 days)
56
Empyema diagnosis?
Need pleural fluid samples Suspect w/ failure of pneumonia to respond clinically within a few days
57
What are some ways to prevent/control infection of aspiration PNA?
Head above bed (45 degrees) Oral chlorhexidine
58
How do you treat empyema?
Community acquired? *2nd/3rd gen Ceph + Flagyl or *Amino-PCNw/BLI Hospital acquired? *MRSA+P.aeruginosa (noAG) + anaerobe x2-6wks
59
Viral PNA diagnosis?
Influenza RADT Oropharyngeal sample (influenza type A and B)
60
Viral PNA Tx?
1st line: Neuraminidase inhibitors Tamiflu or Zanamivir (inhaled) or peramivir (IV) Others: Baloxavir (PO)
61
Monitoring parameters and viral PNA Rx Tx?
``` Tamiflu = confusion Zanamivir = behavior changes Peramivir = rash, behavior changes Baloxavir = dont take w/ cations ```
62
Viral PNA shots?
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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