L42

Question 1

What are the 5 steps of pathogenesis of otitis media?

Answer 1

1. Eustachian tube obstruction
2. Negative pressure created in the middle ear
3. Fluid collects
4. Bacterial colonization
5. Release inflam mediators

Question 2

What is otitis media with effusion?

• Time frame
• Symptoms
• Treat

Answer 2

1 wk - 3 mos post-acute otitis media
Fluid in the ear
- Asymptomatic or mild hearing loss
No treatment

Question 3

What is the difference between acute OM and OM w/ effusion?

Answer 3

Non-specific symptoms likely to be similar
History (of recent OM infection)
Physical exam = different 
- Infection vs fluid 
- Bluging?

Question 4

3 bugs for acute OM

Answer 4

Staph pneumo
H influ
M. catarrhalis

Question 5

Complication on acute OM

Answer 5

Mastoiditis

Question 6

What symptoms make you think sinusitis (as opposed to a cold)?

Answer 6

Symptoms localized to sinuses
Severe headache/focal pain
Ill/fever
Longer duration

Question 7

What are the 3 time courses for sinusitis (in comparison to a cold)?

Answer 7

1. Acute persistent
2. Severe persistent
3. Biphasic

Question 8

3 bugs for sinusitis

Answer 8

Strep pneumo
H influ
M. catarrhalis

Question 9

2 bugs you’d add into consideration for chronic sinusitis (over a month sick)

Answer 9

Staph
Anaerobes
Started as one of the normal 3 bugs –> then this took over and continued the infection

Question 10

Drugs for sinusitis

Answer 10

(Same as OM)
If you give drugs…
Amoxicillin +/- clavulanate
(More likely to add coverage for S.aureus in adults)

Question 11

Complication of sinusitis

Answer 11

Orbital celluitis

Question 12

Bug for pharyngitis

Answer 12

PROBS VIRAL DUDE
Strep pyogenes (grp A strep)

Question 13

Symptoms for bacterial pharyngitis. What symptoms are ABSENT?

Answer 13

Palette pettichae
Scarlet fever rash - sandpaper rash
NO cough

Question 14

How do you diagnose pharyngitis?

Answer 14

Rapid strep test

Always send negatives for culture

Question 15

Drug for pharyngitis

Answer 15

IF NOT VIRAL

Penicillin

Question 16

2 pharyngitis complications

Answer 16

1. Rheumatic fever
2. Glomerulonephritis

Abscesses

Question 17

Which symptoms are you looking for classic CA pneumonia?

Answer 17

Tachypnea in kids
Fever
Crackles 
Decreased breath sounds (b/c lungs full of mucous and alveoli not being aerated) 
Dullness to percussion
Increased vocal femitus

Question 18

What are tell tale signs of bacterial pneumonia?

Answer 18

ACUTE onset - “feel like a train hit me and now I’m really sick”
Lobar distribution

Question 19

3 bugs for CA pneumonia

Answer 19

S. pneumo
H. influ
S. aureus

Question 20

Diagnostic test for outpatient pneumonia

Answer 20

CXR

Blood culture & sputum could be done, but uncommon

Question 21

What are tell tale signs of atypical pneumonia?

Answer 21

Sub-acute onset
Flu-like presentation
Lymphocyte predominance w/ normal to high overall WBC
CXR = diffuse

Question 22

4 bugs for atypical pneumonia

Answer 22

VIRUSES
Mycoplasma pneumo
Chamydophila pneumo
Legionella pneumo

Question 23

Drugs to treat atypical pneumo

Answer 23

Macrolides

Question 24

Tell tale signs of mycroplasma pneumo as cause of atypical pneumo. How do you diagnose?

Answer 24

Rash
COLD AGGLUTININS
Dx = serologies

Question 25

Tell tale signs of legionella pneumo as cause of atypical pneumonia.

Answer 25

Progressive - even if you have right antibiotics
ICU patient
**Extrapulm manifestations (changes to electrolyte panel - Na wasting)
**No organisms in sputum

Question 26

How do you diagnose legionella pneuomonia?

Answer 26

Urine legionella Ag test

Question 27

Which bugs are most likely to cause severe pneumonia - effusions, pneumato-celes, etc?

Answer 27

S.aureus after influenza infection
- Be careful, might be MRSA
Legionella

Question 28

Drug for typical, outpatient pneumonia in patient with concern for macrolide resistance

Answer 28

Resp fluoroquinolone
OR
Azythromycin + beta lactam