Common Primary Care Infections

Question 1

Anticholinergic mnemonic

Answer 1

Dry as a bone (dry mouth)
Hot as a hare (hyperthermic)
Mad as a hatter (confusion)
Red as a beet (flushed)
Can't see (vision changes)
Can't pee (urinary retention)
Can't spit (dry mouth)
Can't sh!t (constipation)

Question 2

Strep throat

Answer 2

S/t GABHS—»> can lead to scarlet/rheumatic fever, peritonsilar abscess
c/p: acute onset pharyngitis, pain with swallowing, recent sick contact, LAD- ant/submandibular nodes
PE: red/pink pharynx, adults usually febrile, yellow-t-green tonsilar exudate, hard plate is petechial, LAD-anterior/submandibular nodes
DX- throat culture/rapid strep
TX
1- PCN QID X10d
PCN allergy- ZPACK x5d, levaquin(>18yo) x 10d

Repeat culture after tx if high risk- PMH MVP, or Valve sx

Question 3

AOM

Answer 3

S/t STREP PNA(+), hflu/moraxella (g-)- high b-lactam resistance
CP- worse otalgia, popping, muffled hearing. Usually following AR/URI flare. Afebrile or low grade.
Tx
1- amoxicillin 500-875 tid-bid x10-14 (if not better in 48-72- change to 2 line- augmentin, ceftin, cefzil bid or rocephin 3g x1
PCN allergic- ZPACK/biaxin bid x5d
Bactrim BID x10 or levaquin/moxi >18

Question 4

Bullous Myringitis

Answer 4

Worse otalgia, bulla/blistered, reddened bulging TM with decreased motion. Rinne- BC>AC, worse with bending down, maxillary/frontal sinus tenderness. Weber lateral uses to affected ear.
Tx
1- amoxicillin 500-875 tid-bid x10-14 (if not better in 48-72- change to 2 line- augmentin, ceftin, cefzil bid or rocephin 3g x1
PCN allergic- ZPACK/biaxin bid x5d
Bactrim BID x10 or levaquin/moxi >18

Question 5

OM WITH EFFUSION

Answer 5

May follow chronic OM, or AR
CC- ear pressure, popping and muffled hearing (inner ear fluid sterile)
PE: TM- bulging or retracted, non-reddened
Tx
PO decongestant
Nasal steroids/ocean BID/TID X few weeks
AR, nasal steroid and 2g antihistamine

Question 6

OE

Answer 6

ORG- pseudomonas (-). Staph aureus (+)
CP- external ear pain, swelling and green purulent d/c. Recent h/o swimming or wet ears
PE- ear pain with palpation. Red swollen ear canal
TX
Corticosporin Otic QID x7
Nothing goes in the ears
Recurrent?– Otic domedoro, etoh+vinegar
Malignant OM- in-patient (DM, IMMUNOCOMP)

Question 7

Allergic Rhinitis

Answer 7

C/p: Chronic nasal congestion with clear mucous d/c or PND. +nasal itch and frequent sneezing- often r/r environmental allergens.
P/e: blue/place turbs, clear mucous, posterior pharynx reddened with clear/white/yellow or green d/c (r/o sinusitis)
Tx
Controller- Flonase/nasal steroids, singulair, nasal crom, optho crom/nedocrom BID
Reliever- po antihistamine 1st or 2nd
Nasal antihistamine- azelastine- not for peds
Po decongestant
Anticholinergic- atrovent
Po CS (short duration)