L42 Flashcards
What are the 5 steps of pathogenesis of otitis media?
- Eustachian tube obstruction
- Negative pressure created in the middle ear
- Fluid collects
- Bacterial colonization
- Release inflam mediators
What is otitis media with effusion?
- Time frame
- Symptoms
- Treat
1 wk - 3 mos post-acute otitis media
Fluid in the ear
- Asymptomatic or mild hearing loss
No treatment
What is the difference between acute OM and OM w/ effusion?
Non-specific symptoms likely to be similar History (of recent OM infection) Physical exam = different - Infection vs fluid - Bluging?
3 bugs for acute OM
Staph pneumo
H influ
M. catarrhalis
Complication on acute OM
Mastoiditis
What symptoms make you think sinusitis (as opposed to a cold)?
Symptoms localized to sinuses
Severe headache/focal pain
Ill/fever
Longer duration
What are the 3 time courses for sinusitis (in comparison to a cold)?
- Acute persistent
- Severe persistent
- Biphasic
3 bugs for sinusitis
Strep pneumo
H influ
M. catarrhalis
2 bugs you’d add into consideration for chronic sinusitis (over a month sick)
Staph
Anaerobes
Started as one of the normal 3 bugs –> then this took over and continued the infection
Drugs for sinusitis
(Same as OM)
If you give drugs…
Amoxicillin +/- clavulanate
(More likely to add coverage for S.aureus in adults)
Complication of sinusitis
Orbital celluitis
Bug for pharyngitis
PROBS VIRAL DUDE Strep pyogenes (grp A strep)
Symptoms for bacterial pharyngitis. What symptoms are ABSENT?
Palette pettichae
Scarlet fever rash - sandpaper rash
NO cough
How do you diagnose pharyngitis?
Rapid strep test
Always send negatives for culture
Drug for pharyngitis
IF NOT VIRAL
Penicillin
2 pharyngitis complications
- Rheumatic fever
- Glomerulonephritis
Abscesses
Which symptoms are you looking for classic CA pneumonia?
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
What are tell tale signs of bacterial pneumonia?
ACUTE onset - “feel like a train hit me and now I’m really sick”
Lobar distribution
3 bugs for CA pneumonia
S. pneumo
H. influ
S. aureus
Diagnostic test for outpatient pneumonia
CXR
Blood culture & sputum could be done, but uncommon
What are tell tale signs of atypical pneumonia?
Sub-acute onset
Flu-like presentation
Lymphocyte predominance w/ normal to high overall WBC
CXR = diffuse
4 bugs for atypical pneumonia
VIRUSES
Mycoplasma pneumo
Chamydophila pneumo
Legionella pneumo
Drugs to treat atypical pneumo
Macrolides
Tell tale signs of mycroplasma pneumo as cause of atypical pneumo. How do you diagnose?
Rash
COLD AGGLUTININS
Dx = serologies
Tell tale signs of legionella pneumo as cause of atypical pneumonia.
Progressive - even if you have right antibiotics
ICU patient
**Extrapulm manifestations (changes to electrolyte panel - Na wasting)
**No organisms in sputum
How do you diagnose legionella pneuomonia?
Urine legionella Ag test
Which bugs are most likely to cause severe pneumonia - effusions, pneumato-celes, etc?
S.aureus after influenza infection
- Be careful, might be MRSA
Legionella
Drug for typical, outpatient pneumonia in patient with concern for macrolide resistance
Resp fluoroquinolone
OR
Azythromycin + beta lactam
