ID E3 Flashcards
Sinusitis S/sx that might indicate bacterial and need Abx
Purulent anterior nasal discharge
Purulent/discolored posterior nasal discharge
Nasal congestion/obstruction
Facial congestion/fullness
Decreased smell
Fever
Chronic sinusitis classification and treatment plan
S/sx greater than 12 weeks often not infectious caused by s. Pneumonia and H. Influenza
Only C&S no Abx
Bacterial caused sinusitis non pharm TX options
No decongestant/antihistamines
Viral caused sinusitis nonpharm TX options
Decongestants, irrigation, mucolytics
When to use Abx in sinusitis (4)
- Persistent s/sx for greater than or equal to 10 days without evidence of clinical improvement
- Severe s/sx (T > 102F, facial pain, Purulent nasal discharge) for greater than or equal 3 - 4 days at the beginning
- Worsening s/sx such as new onset fever, HA, increased nasal discharge after a typical viral URTI (which is for 5 days). Aka double worsenining
- Presenting to the ER with sinusitus
Pharyngitis s/sx
Suddenly onset of sore throat
Tonsillopharyngeal Inflammation
History of exposure to strep pharyngitis
Anterior cervical adenitis (tender nodes)
Scarlatiniform rash (rosy cheeks)
Palatial petechiae
OM criteria per Pediatric Academy
Middle Ear Effusion + Moderate to severe bulging of tympanic membrane or new onset otorrhea
OR
Middle Ear Effusion + Mild bulging of tympanic member + onset of ear pain within last 48 hrs or intense erythema of tympanic membrane
Criteria for use of Abx in OM
6 months - 1 year old + moderate/severe pain OR T > 102
6 months - 23 months + non severe bilateral acute OM
Criteria for considering Abx use in OM
6 months - 23 months + non severe unilateral acute OM
2 yo - 12 yo + acute non severe OM
Common cause of AOM
Most URTI are virtual
Bacterial, Streptococcus pneumoniae
Common cause of Acute Sinusitus
Most URTI causes are viral
Bacterial, Streptococcus pneumoniae
Common cause of acute pharyngitis
Most URTI causes are viral
Bacterial, group A B-hemolytic streptococcus
S/Sx of pneumonia
Purulent Sputum, Hemoptysis (blood in sputum), Dyspnea (chest pain because of inflammation)
Leukocytosis (>12K, <4K WBC), decreased O2, RR > 30, HR > 100, T > 100 (Fever)
Typical pneumonia s/sx
Abrupt Onset
Unilateral well-defined infiltrate
Significant fever, chills, sweats, dyspnea
Purulent sputum product
Primarily pulmonary symptoms might have pleuritic chest pain
Atypical Pneumonia s/sx
Gradual Onset
Diffuse infiltrates, ground glass appearance
Mild fever, mild dyspnea
Dry cough
Extra pulmonary symptoms common such as myalgias, Diarrhea, Abdominal pain
Viral pneumonia s/sx
Caused by Respiratory syncytial virus (RSV), Influenza A & B, Adenovirus, parainfluenza
Presenting with wheeling, dyspnea and less incisive of febrile episodes
Possible Sources of VAP
Exogenous sources of micro-organism such as the hands of the HC, ventilator circuit, biofilm of the endotracheal tube
Mechanism of pneumonia where the colonized secretions are inhaled into the lungs through the endotracheal tube
Active immunizations Live-attenuated
MMR VIP RZ
Measles
Mumps
Rubella
Varicella
Influenza (LAIV)
Polio (OPV)
Rotavirus
Zoster (ZVL)
Active Immuninzations Toxoids
Diphtheria
Tetanus
Active Immunization Inactivated
HIPP
Hep A
Influenza (IIV)
Pertussis
Polio (IPV)
Active Immunity inactivated Recombinant
Hep B
HPV
Zoster (RZV)
Active immunization conjugated/polysaccharide
Hib
Meningococcal
Pneumococcal
COVID 19 mRNA vaccine
Pfizer
Moderna
Covid 19 adenovirus vaccine
J&J
UTI risk factors
Sexual behavior
Contraceptive devices
Prego
Male gender
Badly controlled T2DM
Transient short term urinary tract catheter
Asymptomatic bacteriuria
Long term catheter treatment
UTI UA significant lab findings
Hallmark sign is pyuria (wbc > 10)
Leukocyte esterase positive, released by WBC
Nitrite positive, e coli possible
Hematuria, blood in urine (0-5)
WBC castes, possibly pyeloneprhoritis
Proteinuria, possibly kidney dysfunction
Bacteria, >2+ GNR
Mild water loss s/sx
Alert
Restless
Increased thirst
Moist/slight dry mucus membranes
Normal/slightly decreased urinary output
Moderate water loss s/sx
Lethargic/restless
Decreased vol (decreased BP, high HR)
Dry mucous membranes
Delayed capillary refill
Dark urine
Severe water loss s/sx
Drowsy
Limp
LOC
Bradycardia
Cyanotic
Skin tenting
No UO
% water loss and their associated water loss level
<5% weight loss (mild)
6-9% weight loss (moderate)
>10% weight loss (severe)
What is not recommend for po supplementation for water loss
Juice, soda, sport drinks, tea, ginger ale, broth
IM vaccines
Covid
Td
Influenza inactivated
PCV13
PPV 23, pneumococcal polysaccharide
RZV herpes zoster
SQ vaccines
PPV 23, pneumococcal polysaccharide
ZVL herpes zost3r
Contraindications for COBI and Boosted PI
Rifampin
Ergotamines
Cisapride
St. Johns wart
Lovastatin
Simvastatin
Sildenafil
Triazolam
Midozalam
Cobi corticosteroid DDI
Budesonide
Fluticasone
Mometasone
Triamcinolone topical
Emtricitabine/tenofovir BBW
Dual NRTI therapy (backbone)
Lattice acidosis
Sever Hepatomegaly
Hep B coinfection
INSTI ade
Brain (cns disturbance)
Rash
Cr (false elevation of SrCr)
Weight gain
GI
INSTI DDI
Cations (al/Mg/CA cations)
Metformin
Boosted PI Ade
GI intolerance
HLD
CV risk
Metabolic syndrome
DDI
NNRTI ade
Liver toxicity
Rash
Hyperglycemia
HLD
Neuropsych effects hence qhs dosing
NNRTI ddi
Cyp3a4
Rilpivirine is substrate
Efavirine is inhibitor
Exception is dovavirine
