Resp 1

Question 1

pharyngitis

Answer 1

usually caused by group a strep (strep pyogenes)

GAS may cause poststrep glomerulonephritis or acute rheumatic fever (now rare in US)

Question 2

GAS pharyngitis presentation

Answer 2

throat pain, usually severe and worse on 1 side

Question 3

avoid what as first line in GAS pharyngitis tx

Answer 3

Azithromycin
strep rapidly develops resistance to macrolides
consider if PCN allergic

Question 4

Fusobacterium necrophorum pharyngitis

Answer 4

newly recognized cause of pharyngitis
endemic in adolescents and young adults
may cause 10% of cases in this age group
may develop lemierre syndrome (life-threatening, mortality rate 5%)
consider txing if lack of cough

Question 5

F necrophorum pharyngitis tx

Answer 5

clindamycin or PCN + metronidazole

Question 6

cough

Answer 6

do not suppress indiscriminately
don’t suppress productive cough
typically suppress if tiring or sleep-limiting

Question 7

nonproductive cough tx

Answer 7

antitussives or cough suppressants

Question 8

productive cough tx

Answer 8

expectorants or mucolytics

Question 9

dextromethorphan

Answer 9

d-isomer of codeine analog of loverphanol
inhibits central (medullary) cough center

Question 10

Guaifenesin

Answer 10

helps loosen phlegm and bronchial sec’s

inc efficacy of mucociliary mech

Question 11

pertusis

Answer 11

chronic cough caused by bordatella pertussis
china: “cough of 100 days”
atypical presentations are v common
(completely or partially immunized pt’s, adolescents or adults)
complications confined to infants < 6 mo’s

Question 12

pertussis cough

Answer 12

paroxysmal

post-tussive emesis occurs frequently

Question 13

pertussis incidence

Answer 13

rising
waning immunity (maybe as short as 3-6 yrs)
morse with newer acellular vaccines
many severe complications with whole cell vaccines
consider in all kids with cough > 14 days

Question 14

topical decongestants

Answer 14

sympathomimetics (a agonists)
produce vasoconst
prolonged use (>3-5 days) may produce rebound congestion
limit dose and freq

Question 15

other long acting topical decongestant

Answer 15

xylometazoline HCl

Question 16

systemic decongestants

Answer 16

much lower incidence of rebound congestion
results typically last longer than topical
due to restrictions on pseudophedrine - sales restriction by law

Question 17

systemic decongestant SE

Answer 17

potent selective a1-agonists (vasoconstrictors)

activate B-rec at higher []s

Question 18

antihistmaines

Answer 18

relieve immediate-type hypersensitivity rxns
red/prevent physiologic effects of histamine release
no effect on pre-released histmaine
first gen prod sedation
second gen are peripherally selective (much less sedating)

Question 19

sedation with antihistmaines

Answer 19

caution against driving or tasks requiring alertness

supervise kids in hazardous activities

Question 20

influenza

Answer 20

prevention is key

promote and practice annual immunization

Question 21

Community Acquired Pneumonia

Answer 21

generally not multi-drug resistant
common org’s: strep pneumonia and H flu
used pneumonia severity index for risk

Question 22

gram + cocci in clusters

Answer 22

staph aureus

consider adding vanco

Question 23

gram negative bacilli

Answer 23

any risk of MDR gram - org?

consider adding an anti-pseudonomal (cefepime, imipenem)

Question 24

few epi cells

Answer 24

good specimen, many epi’s prob a mouth specimen

Question 25

few WBCs

Answer 25

pneumonia less likely,

many WBCs pneumonia more likely

Question 26

few organisms

Answer 26

mixed morphology

pneumonia less likely

Question 27

many organisms

Answer 27

single morphology

pneumonia more likely

Question 28

hospital acquired pneumonia

Answer 28

new pneumonia after 3-5 days as inpatient
greater likelihood of MDR
may need to consider adding vanco
possible broader MDR coverage

Question 29

health care associated pneumonia

Answer 29

long term care facilities are more like hospitals
chronically ill pt’s, longer length of stay, many have instrumentation in place, inc likelihood of MDR colonization
treat more like HAP than CAP

Question 30

aspiration pneumonitis

Answer 30

acute lung injury after inhalation of regurgitated gastric contents
usually witnessed
produces chemical run due to stomach acidity

Question 31

aspiration pneumonia

Answer 31

develops after inhalation of colonized oropharyngeal org’s
required radiographically evident infiltrate in at risk pt
usually not witnessed
produces info due to colonized bacteria
RF: old, antacids, PPI, poor dentition
protection factors: few org’s, cough reflex, active ciliary transport