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Family Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Discuss the diagnosis of acute otitis media

A

Acute onset of symptoms and both of the following
Signs of middle ear effusion (any of the following)
- bulging TM
- limited TM mobility
- air fluid levels behind TM
- otorrhea
Signs of middle ear inflammation (any of the following)
- TM redness
- otalgia

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2
Q

Discuss the indications for treatment and indications for 48h observation

A 
Indications for Antibiotic
- age <6 months old
- Fever >38.5
- Perforated TM with purulent drainage
- Significant comorbidities
- Current or previous complicated otitis media
Indications for 48h Observation
- Age >2 years old
- Reliable parents
- If child worsens or fails to improve in 48hrs begin antibiotics
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3
Q

Discuss the antibiotic treatment for acute otitis media

A 
Amoxicillin 75-90mg/kg/day divided BID 
- for 5 days if >2 years old
- for 10 days if <2 or >2 with complicated acute otitis media
Allergy to Amoxicillin
- Clarithromycin
- Azithromycin
- Septra
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4
Q

Discuss secondary therapy for acute otitis media

A

No improvement after two days

- Amox-clav 45-60mg/kg/day divided TID for 10 days

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5
Q

Discuss the history, presentation and treatment for allergic conjunctivitis

A 
History
- atopy or allergies
Presentation
- itching
- rhinitis
- bilateral watery eyes
- papillae
Treatment
- cool compression
- oral/topical antihistamine
- artificial tears
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6
Q

Discuss the history, presentation and treatment for bacterial conjunctivitis

A 
History
- Conjunctivitis
Presentation
- burning
- tearing
- foreign body sensation
- mild photophobia
- blurry vision
- purulent discharge
- papillae
- progress to periorbital cellulitis
Treatment
- topical antibiotic x1 week
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7
Q

Discuss the history, presentation and treatment for gonococcal/chlamydia

A 
History
- sexual contact
- possible vertical transmission in neonates
Presentation
- chronic unilateral conjunctivitis not responsive to drops
- tearing
- foreign body sensation
- urinary tract symptoms
- new sexual partner
Treatment
- Ceftriazone 1g IM once
- azithromycin 1g PO with topical antibiotic
- Ophthalmology referral
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8
Q

Discuss the history, presentation and treatment for viral/adenovirus conjuctivits

A 
History
- sick contact
Presentation
- Recent upper respiratory infection
- Itching
- burning
- foreign body sensation
- Mild photophobia
- Affect one eye and spread to the other
- Clear mucoid discharge
- Follicles
- Tender pre-auricular lymphadenopathy
Treatment
- Self limiting in 2-3 weeks
- Contagious for weeks after symptom onset
- Cold/warm compresses
- Artificial tears
- Proper hand hygiene
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9
Q

Discuss the history, presentation and treatment for herpes simplex keratitis

A 
History
- May be triggered by stress, fever, sun exposure or immunosuppression
Presentation
- Pain
- tearing
- foreign body sensation
- red eye
- decreased vision
- eyelid edema
- dendritic lesions in epithelium that stain fluorescein
- Corneal hypoesthesia
Treatment
- Topic antiviral trifluridine
- systemic acyclovir
- ophthalmology referral
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10
Q

Discuss red flags for red eye

A
  • Decreased visual acuity
  • Sudden, painless vision loss
  • Ciliary flush
  • Photophobia
  • Corneal Opacity
  • Fixed pupil
  • Severe headache
  • Trauma
  • Gonococcal
  • Orbital cellulitis
  • Temporal arteritis
  • Absent red reflex
  • CN III palsy with dilated pupil
  • Proptosis
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11
Q

Discuss the history, presentation and treatment for hordeolum (stye)

A 
History
- acute inflammation of eyelid gland
- Staph Aureus
Treatment
- Warm compresses
- Gentle massage
- Topical antibiotic (erythromycin ointment)
- resolves 2-5 days
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12
Q

Discuss the history, presentation and treatment for chalazion

A 
History
- chronic granulomatous inflammation of meibomian gland
- produced by internal hordeolum
Presentation
- no acute inflammatory signs
Treatment
- warm compress
- no improvement after 1 month consider incision and curretage
- chronic biopsy for malignancy
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13
Q

Discuss the history, presentation and treatment for blepharitis

A 
History
- inflammation of lid margins
- ulcerative dry scals: Staph aureus
- seborrheic: no ulcer, greasy scales
Presentation
- itching
- tearing
- foreign body sensation
- thickened
- red lid margins
- crusting
- toothpaste sign
Management
- warm compressed and lid scrubs
- topical or systemic antibiotics
- ophthalmologist may prescribe corticosteroid
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14
Q

Discuss the history, presentation and treatment for xanthelasma

A 
History
- eyelid xanthoma (lipid deposits in dermis of lids)
Treatment
- pale
- slightly elevated yellowish plaques or streaks
- upper eyelids, bilateral
- hyperlipidemia
Management
- excision for cosmesis
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15
Q

List the microorganism and antibiotic option for community acquired pneumonia in adults (outpatient no comorbidities)

A 
Organism
- Strep pneumonia
- Mycoplasma pneumonia
- C pneumonia
Antibiotics
- Clarithromycin 500mg BID or 1000mg OD for 7-14 days
Amoxicillin 1g TID for 7-14 days
Azithromycin 500mg on first day then 250mg for 4 days
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16
Q

List the microorganism and antibiotic option for community acquired pneumonia in children (outpatient no comorbidities)

A

Microorganism
- 1-3 months: RSV, viruses
- 3 months - 5 years: Strep pneumo, Staph aureus, GAS, H influenza
- 5-18 years: Mycoplasma Pneumonia, C pneumonia, Strep pneumonia, Influenza A or B
Treatment
- 1-3 months: no antibiotic
- 3mon-5yr: Amoxicillin 80mg/kg/day divided TID for 7-10 days
- 5-18yrs: Clarithromycin 15mg/kg/day divided BID for 7-10 days

17
Q

List the microorganism and antibiotic option for acute pharyngitis

A 
Organism
- Group A Strep
Antibiotic
- Penicillin V 600mg BID for 10 days
Erythromycin 250mg QID for 10 days
Children
- Penicillin V 40mg/kg/d Divided BID-TID for 10d (mas 750mg/d)
- Erythromycin esolate 40mg/kg/day divided BID-TID for 10d
18
Q

List the microorganism and antibiotic option for acute otitis media

A 
Organism
- Strep pneumo
- H influenza
- Morexalla catarrhalis
Treatment Adults
- Amoxicillin 500mg TID x 5 days
- Cefprozil 250-500mg BID for 7-10days
19
Q

List the microorganism and antibiotic option for otitis externa

A 
Organism
- Pseudomonas aeruginosa
- Coliforms
- Staph aureus
Treatment
- Ciprodex 2 drops BID
20
Q

List the microorganism and antibiotic option for bacterial sinusitis

A 
Organism
- Strep pneumo
- H influenza
- Morexalla Catarrhalis
- Staph Aureus
Treatment Adults
- Amoxicillin 500mg TID for 5-10 days
- Amox-clav 500mg TID for 5-10 days
Cefuroxime 250-500mg BID x 5-10 days
Treatment Child
- Amoxicillin 80-90mg/kg/day divided BID-TID for 10-14 days
- Amox-clav 40-80mg/kg/day divided BID
- Cefprozil 30mg/kg/day divided BID for 10-14 days
21
Q

List the microorganism and antibiotic option for urinary tract infection

A 
Organism
- E coli
- Staph saprophyticus
Treatment
- Septra 1DS tab BID for 3 days
- Nitrofurantoin 100mg BID for 5 days
- Cephalexin 250-500mg QID for 7 days (pregnant)
22
Q

List the microorganism and antibiotic option for pyelonephritis

A 
Organism
- E coli
- K pneumonia
- P mirabilis
Treatment
- Ciprofloxacin 500mg BID for 7 days
23
Q

List the microorganism and antibiotic option for urethritis

A 
Organism
- N gonorrhea
- C trachomatis
Treatment
- Ceftriaxone 250 mg IM once and 
- Azithromycin 1g PO once
24
Q

List the microorganism and antibiotic option for bacterial vaginosis

A 
Organism
- G vaginalis
- M hominis anaerobes
Treatment
- Metronidazole 500mg BID PO for 7 days
25
Q

List the microorganism and antiviral option for mucocutaneous herpes

A

Organism
- Herpes Simples 1 or 2
Treatment
- Valacyclovir 2g BID once

26
Q

List the microorganism and antiviral option for genital herpes

A

Organism
- Herpes simplex 1 or 2
Treatment
- Acyclovir 400mg TID for 5-7 days

27
Q

List the microorganism and antiviral option for shingles

A 
Organism
- Varicella zoster
Treatment (initiate within 72hrs)
- Valacyclovir 1g TID for 7 days
- Famciclovir 500mg TID for 7 days
28
Q

List the microorganism and antiviral option for genital warts

A

Organism
- human papilloma virus
Treatment
- cryotherapy q1-2 weeks

29
Q

List the microorganism and antiviral option for infleuza

A

Organism
- Influenza A or B
Treatment
- Oseltamivir (tamiflu) 75mg daily for 10 days (begin 48hrs after exposure)

30
Q

Discuss the presentation and management of allergic rhinitis

A
  • increased IgE levels to certain antigens resulting in excessive degranulation of mast cells to release of inflammatory mediators and cytokines leading to inflammatory reaction
    Management
  • reduce exposure to allergens
  • oral antihistamines
    - cetirizine (reactine)
    - loratadine (Claritin)
  • intranasal corticosteroids for severe or persistant (>1mon) symptoms
31
Q

Discuss the presentation and management of bronchitis

A 
Organism
- 80% viral: rhinovirus, adenovirus, influenza
- 20% bacterial: Mycoplasma pneumonia, C pneumonia, S pneumonia
Bacterial Presentation
- high fever
- excessive purulent sputum
- COPD
Investigations
- CXR if cough >3week, abnormal vital signs and chest findings
Management
- infection control
- 3-4L/d of fluids
- Salbutamol
32
Q

Discuss the presentation and management of acute rhinitis

A 
Organism
- rhinovirus
- incubation 1-5 days
Presentation
- nasal congestion
- clear to mucopurulent secretions
- sore throat
- cough
- mild fever
- erythematous oropharyngeal mucosa
Management
- peak 1-3 days and subside in 1 week
- secondary bacterial 3-10 days after onset
- Nasal irrigation
- acetaminophen
- dextromethorphan
- decongestants
33
Q

Discuss the presentation and management of sinusitis

A

Etiology
- rhinovirus
- strep pneumonia
- H influenza
- M catarrhalis
Presentation
- symptoms for >7 days or <7 days but acute worsen then bacterial likely
- require nasal obstruction or nasal purulence/discolored postnasal discharge and one other PODS symptoms
- Facial Pain
- Nasal obstruction
- Nasal purulence/discolored postnasal discharge
- Hyposmia/anosmia
- symptoms for 3-4 days with high fever
Management
- mild to moderate then intranasal corticosteroids and reassess in 72h
- severe then intranasal corticosteroids and antibiotics
- first line: amoxicillin
- second line: amox-clav, fluoroquinolones

34
Q

Discuss the presentation and management of pharyngitis

A 
Etiology
- adenovirus (90% viral)
- rhinovirus
- group A beta-hemolytic strep
Presentation - Viral
- pharyngitis
- conjunctivitis
- rhinorrhea
- hoarseness, cough
- fever, malaise
Presentation - Bacterial
- pharyngitis
- fever
- headache
- abdominal pain
- absence of cough
- tonsillar/pharyngeal erythema/exudate
- swollen anterior lymph nodes
Investigations
- rapid strep test
Management - Bacterial
- antibiotics to decrease risk of transmission, rheumatic fever and suppurative complications
- risk of glomerulonephritis unchanged
35
Q

Discuss the Modified centor score for risk of Group A Beta-hemolytic strep infection

A
  • Cough present
  • History of fever >38
  • Tonsillar exudate
  • Swollen, tender anterior nodes
  • Age 3-14
  • Age 15-44 (0 points)
  • Age >45 (-1 points)
    Scoring
  • score 0-1 then no culture or treatment
  • score 2-3 then culture and treat if positive
  • score >=4 then culture and treat immediately
36
Q

Discuss the presentation and management of ebstein barr virus (infectious mononucleosis)

A 
Presentation
- pharyngitis
- tonsillar exudate
- fever
- lymphadenopathy
- rash
Investigation
- peripheral blood smear
- antibody test
Management
- symptomatic
- avoid physical activity and contact sports for 1 month until splenomegaly resolves
37
Q

Discuss the presentation and management of coxsackie virus (hand, foot, mouth disease)

A

Presentation

  • fever
  • pharyngitis
  • abdominal pain
  • vomiting
  • small vesiscles that rupture and ulcerate on tonsils, soft palate and pharynx
  • ulcer that are pale grey with surrounding erythema on hands and feet

Family Medicine (12 decks)

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