infectious disease- abx and ENT

Question 1

unilateral ear pain

relief of pain by pulling the pinna

What is it?

How do you diagnos?

How do you treat?

Answer 1

Unilateral ear pain with relief of the pain by pulling on the pinna is indicitive of OTITIS MEDIA.

Diagnose OTITIS MEDIA with pneumatic insfflation- the TM will be tense and immobile

Treat the first occurance of otitis media with AMOXICILLIN.

Question 2

How do you treat recurrent otitis media?

Answer 2

Treat recurrent otitis media with

AMOXICILLIN-CLAVULANATE

if it comes back 3x/6 mo or 4x/12 months consider ear tubes (tympanoplasty)

Question 3

How do you treat Otitis Media if the patient is allergic to penicillins?

Answer 3

Treat Otitis Media in penicillin allergic patients with

CEFDINIR if there is no hx of anaphylaxis

AZITHROMYCIN if there IS a history of anaphylaxis

Question 4

Swelling behind the ear or an anteriorly rotated ear

what is it?

how do you treat it?

Answer 4

Swelling behind the ear or an anteriorly rotated ear is indicitive of MASTOIDITIS

the risk of mastoiditis is increased with ear tubes (pseudomonas)

and immediate surgical evaluation and decompression is warrented.

Question 5

Unilateral ear pain with pain on palpation of the pinna

What is it?

What is the most likely organism?

Answer 5

Unilateral ear pain that gets worse with palpation of the pinna is

OTITIS EXTERNA

Otitis Externa can be caused by frequent contact with water (PSEUDOMONAS) or because of repeated trauma (STAPH)

Question 6

How do you treat Otitis Externa?

Answer 6

Otitis Externa usually resolves spontaneously.

If it doesn’t resolve, treat with topical abx (cipro ear drops)

and topical steroids

Question 7

What are indications that sinusitus is caused by a bacteria?

Answer 7

Bacterial sinusitis is suspected in the presence of

Long duration (> 10 d)

high fever

worsening sxs

Question 8

How do you treat bacterial sinusitis?

Answer 8

Treat bacterial sinusitis with amoxicillin-clavulonate

and evaluate for any foreign bodies that may be present.

Question 9

What are indications that sinusitis is viral in nature?

Answer 9

Viral sinusitis is usually

short duration

low-grade fever

mild symptoms

the most common causative virus is rhinovirus. it is transmitted through large droplets.

Don’t order any studies on this… just wait it out.

Question 10

pharyngitis + conjunctivitis

what is it?

Answer 10

pharyngitis + conjunctivitis

=

adenovirus

Question 11

Pharyngitis + rash on the palms/soles

what is it?

Answer 11

pharyngitis + rash on the palms/soles

=

coxsackie

Question 12

What is the CENTOR Criteria?

Answer 12

C- absent Cough

E- Exudates

N- Nodes = cervical lymphadenopathy

T- temperature > 38 C

OR- <14 (+1) > 44 (-1)

choice of treatment depends on score. 1= no treatment (its a virus) 2-3 do a rapid strep test, >4 empiric abx (amox-clav)

Question 13

pharyngitis + enlarged spleen

what is it?

Answer 13

Pharyngitis + enlarged spleen

=

EBV.

get an EBV Panel

Question 14

What is the empiric coverage for Staph?

Answer 14

the empiric abx to treat staph is

VANCOMYCIN

Question 15

what drugs can be used for methicillin sensitive staph?

Answer 15

any of the -cillins but think

Nafcillin

(naf for staff)

Question 16

How do you treat VRE?

Answer 16

Treat VRE with linezolid.

*Use sparingly as its the last resort. Resistance to linezolid means there is nothing left to use!

Question 17

What is first line treatment for gram negatives?

Answer 17

coverage for gram negatives starts with amoxicillin (PO) or Ampicilin (IV).

the Aminoglycosides (gentamicin, amikacin) are synergistic with penicillins but are almost exclusively gram negative. They are RARELY the first choice for empiric treatment

Question 18

What can be used to cover pseudomonas?

Answer 18

Pseudamonas can be treated with

ticarcillin/pipercillin

(zocyn = pipercillin + tazobactam)

Carbapenems

Cefepime

Question 19

How should you treat bacterial meningitis?

Answer 19

Bacterial meningitis and inpatient pneumonia should be treated with a 3rd generation cephalosporin because it has sufficient gram negative coverage and it will also cross the BBB.

Bacterial meningitis

=

Vanc + ceftriaxone, + steroids (for boards) +/- ampicillin

Question 20

When do you use a first generation cephalosporin?

Answer 20

Cefazolin- a first generation cephalosporin is used in the treatment of cellulitis and as a prophylatic before surgery.

Question 21

What are the two options for treating anaerobes?

Answer 21

The two options for treating anaerobes are

1. Metronidazole (gut and genitals)
2. clindamycin (everywhere else)

Question 22

What is the treatment of choice for a UTI in a pregnant woman?

Answer 22

use AMOXICILLIN to treat a UTI in a pregnant woman

Question 23

What should you use to treat a person with septic pylonephritis?

Answer 23

septic pylonephritis should be treated with

IV Ceftriaxone

Question 24

How should you treat ambulatory pylonephritis?

Answer 24

ambulatory pylonephritis should be treated with

CIPRO

Question 25

How do you treat outpatient pneumonia?

Answer 25

Out patient pneumonia can be treated with

Doxycycline

Azithromycin

Moxifloxacin

Question 26

Treatment for:

Inpatient Pneumonia

Answer 26

Inpatient Pneumonia:

3rd gen Cephalosporin + Azithromycin (CAP)

Vancomycin + Zocyn (HCAP)