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IPFC 2 Midterm 1 > ID- Sinusitis > Flashcards

ID- Sinusitis Flashcards

1
Q

How do you diagnosis acute sinusitis

A

2 PODS symptoms with at least one being O or D (nasal obstruction or purulent drainage)
- Facial PAIN
- Nasal OBSTRUCTION
- Purulent DRAINAGE
- Loss of SMELL

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2
Q

What is the duration of acute sinusitis?

A

less than 4 weeks

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3
Q

What are additional uncomplicated symptoms of acute sinusitis?

A
  • cough
  • fatigue
  • halitosis
  • low-grade fever
  • maxillary tooth discomfort
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4
Q

What are complicated acute sinusitis symptoms? (3) What does it stem from?

A

Stem from infectious sinusitis

  1. orbital cellulitis
  2. meningitis
  3. inflammation of frontal bone
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5
Q

What are red flags (urgent referral) for sinusitis?

A
  • stiff neck
  • vision changes
  • body or eyes bulging
  • altered mental status (confusion)
  • Pain with eye movement
  • Severe persistent headache
  • orbital edema or erythema (red skin patches)
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6
Q

What is sputum colour an indication of?

A

Only tells us that there is inflammation in the nose
- does not differentiate between bacterial and viral

**NO SYMPTOMS DIFFERENTIATE

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7
Q

How to diagnose BACTERIAL sinusitis (2)

A
  • Symptoms last 7-10+ days WITHOUT improvement
  • twice sickening (due to secondary infection)
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8
Q

How to diagnose VIRAL sinusitis?

A

Improvement between 7-10 days

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9
Q

Why do we use antibiotics for acute sinusitis? what are false reasons?

A

CURE INFECTION
- 80% of bacterial still resolve within 14 days without therapy

Does not reduce spread
Does not reduce symptomatology
Does not reduce risk of complications

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10
Q

When would you give the following treatment options
1. watchful waiting
2. 72-hr trial of INCS
3. Consider antimicrobial therapy

A
  1. watchful waiting
    - less than 7-10 days of symptoms
  2. 72-hr trial of INCS
    - if symptoms are uncomfortable
  3. Consider antimicrobial therapy
    - 10+ days with no clinical improvement after watchful waiting
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11
Q

What signs and symptoms would you use adjunct therapies ONLY

(already have non-improving/worsening symptoms or twice infection)

A

Mild
- slight discomfort with a minor impact on patient’s functional status

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12
Q

What signs and symptoms would you use adjunct therapies before considering antibiotics or close observation?

(already have non-improving/worsening symptoms or twice infection)

A

Moderate
- Discomfort and constant tolerable symptoms with moderate impact on patient’s functional status

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13
Q

What signs and symptoms would you consider using antibiotics?

(already have non-improving/worsening symptoms or twice infection)

A

Severe
- Major impact on the patient’s functional status and sleep

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14
Q

What type of therapy is used for sinusitis

A

Empiric therapy

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15
Q

What are the common bugs for sinusitis (3)

A

S. pneumoniae
H. influenzae
M. Catarrhalis

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16
Q

How much resistant/risk factors are in each bug?

A

H. influenzae: 50% produce beta-lactamase
M. Catarrhalis: 100% produce beta-lactamase
- give amoxi-clav

S. pneumoniae risk factors (give high dose amox)
- less than 2yo or 65+
- Daycare attendance
- recent antimicrobial use (3mos)

17
Q

How to overcome resistance to Beta-lactams due to altered PBPs (intermediate resistance)
eg. s. pneumo

A

overcome with higher BL doses
- high dose amoxi

18
Q

How do you overcome high-level resistance?

A
  • Levo-/moxi
  • vancomycin
19
Q

What is the relative potency of different beta-lactams?

A

Amox > cefuroxime ~ cefprozil (2nd gen)&raquo_space; cefixime (3rd gen)&raquo_space; cephalexin (1st gen)

20
Q

What are regular and high amoxicillin children dosing for s. pneumo

A

Regular
- 40 mg/kg/day TID

High dose
- 90 mg/kg/day BID

21
Q

What are regular and high amoxicillin adult dosing for s. pneumo

A

Regular
- 500mg TID

High
- 1000mg TID

22
Q

What is drug is effective for S. pneumo

A

Amoxicillin

23
Q

What are regular and high amoxi-clav children dosing for s. pneumo

A

Regular
- 45 mg/kg/day BID to TID

High
- 45 mg/kg/day BID to TID
+
- plain 45 mg/kg/day

24
Q

What is the follow up for adults?

A

5-7 days

25
Q

If you chose delayed prescribing, what education is essential?

A
  1. Do not start unless symptoms do not improve within 7 days
  2. start immediately if symptoms worsen
26
Q

When is amoxi-clav appropriate

A
  • Covers beta-lactamase producing pathogens (H. flu, M. catarrhalis)
  • reasonable for patients who fail amoxi in 3 days (i.e. no improvement in 3 days)

IPFC 2 Midterm 1 (8 decks)

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