Respiratory and EENT Infections

Question 1

pneumonia patho

Answer 1

organism invades lung parenchyma and host defenses depressed. bacterial pneumonia happens when lungs primary defenses altered by viral infection or immunological probs. chronically ill patients all ages more prone.

Question 2

pneumonia treatment goals

Answer 2

return to baseline resp status. fever resolves 2-4d. leukocytosis resolves day 4 of treatment. CXR may take 4+ weeks to normal.

Question 3

pneumonia common pathogens (adults)

Answer 3

s. pneumonae. if underlying lung disease, nontypeable hemophilus influenza and moraxella catahhralis. staph aureus is a co pathogen with influezna. mycoplasm pneumonae. viral pneumonia.

Question 4

CAP treatment categories

Answer 4

1 (previously healthy with no risk factors for DRSP) 2 patients with risks 3&4 (hosptial/ICU). CURB 65 criteria evaluates confusion, uremia, RR, low BP, age 65+

Question 5

treatment of pnumonia for cat 1 (healthy adult, no risk factors)

Answer 5

macrolide (azythromycin, clarithromycin, erythromycin). if allergy, doxycycline. treat for min 5 days

Question 6

treatment of pnumonia for cat 2 (comorbiditiy or risk for DRSP)

Answer 6

respiratory flouroquinolone (moxi, gemi, or levofloxacin)
or
beta lactam + macrolide (amoxicilin, amoxicillin/clavulinate, cefpoxidome, cefuroxime, or parenteral ceftriaxone followed by oral cefpoxidime). doxycycline may be used as alt to macrolide

Question 7

adult age >60 with comorbidities pneumonia treatment option outpatient

Answer 7

ceftriaxone (Rocephin) 1g daily via IV or IM or levofloxacin 500mg IV daily . switch to PO once can tolerate

Question 8

treatment of CAP in prego

Answer 8

main pathogens s. pneumonia, h. influenziae, m. pneumoniae, and viruses. treat with macrolides (erythromycin, azithromycin cat B, clarithro cat C) . if high risk (comorbid, high risk DSRP): bet lactam + macrolide

Question 9

patient ed for pneumonia

Answer 9

can be viral or bacterial or mycoplasmal. ed regarding abx rx. hydration, no smoke, rest. symptoms of worsening status. expect clinical improvement in 48-72h

Question 10

common pneumonia pathogens children

Answer 10

s. pneumonia (most common in all ages of ppl). increase in viral pneumonia with PCV7vaccine. consider chlamydia in infants 4-16 weeks. consider mycoplasm if >5 through teens. MRSA can also cause.

Question 11

treatment of pneumonia in kids <5 with s. pneumoniae

Answer 11

amoxicillin 80-90mg/kg/d
ceftriaxone 50mg/kg/d until able to take PO
if allergic to penicillin: clindamycin or macrolide

Question 12

treatment of pneumonia in infatn with suspected chlamydial pneumonia

Answer 12

aithromycin 20mg/kg/d x3 d
or
eyrythromycin EryPed 50mg/kg x14 days

Question 13

treatment of pneumonia kids >5

Answer 13

mycoplasm or other atypical most likely.
azythromycin 10mg/kg on day 1 and 5mg/kg day 2-5
clarithromycin 15mg/kg/d in 2 divided dose (max 1g/d)
erythromycin 40-50mg/kg/d

Question 14

decongestants for URI

Answer 14

systemic sympathomimetics (pseudoephedrine, phenylephrine), topical decongestants (phenylephrine/Neosinephrine, oxymetazoline/Afrin). constrict capillary vessels, decreasing congestion. ADRs: tachycardia, HTN, anxiety/restless/irritable. dont give in young children

Question 15

URI patient education

Answer 15

proper dosing of decongestants. avoid in child <4, elderly, CV disease. URIs resolve 7-10 days. no abx needed. fever not in adult, but low grade in kids sometimes.

Question 16

sinusitis strict criteria and pathogens

Answer 16

persistent, not improving at least 10 days. common pathogens s. pneumoniae 30%, h. flu 20%, moraxella catahrallis 20%, rarely staph. bacteria isolated in 70% of patients

Question 17

first line abx for sinusitis

Answer 17

amoxicillin (adults 500mg TID) (kids 80-90mg/kg/d in high risk, 45 in low risk).
also high dose Augmentin option

Question 18

first line abx for sinusitis, penicillin allergy

Answer 18

adults: doxycycline or resp flouro (levo)
kids: cefdinir, cefuroxime, cefpodoxime

Question 19

if sinusitis worsens after 72h

Answer 19

consider resistance . switch to Augmentin if amoxicllin was first choice. If AUgmentan was first choice, consider levo for adults or cefdinir, cefuroxime, or cefpodoxime for kids

Question 20

sinusitis education

Answer 20

saline nasal spray or drops liquefy secretions and decreases crusting near sinus ostia. topical decongestants decrease tissue edema and nasal resistance, likely enhance drainage of secretions from sinus ostia. corticosteroids helpful if chronic, no evidence for acute.

Question 21

AOM cause

Answer 21

Eustachian tube dysfunction (neg pressure causes reflux of bacteria into middle ear). pathogens: s. pneumonaia, nontypeable h. influenziae, m. catahhralis, microbiology changing d/t pneumonia vaccine (s. pneumonia decreeing, h. influenzia increasing). respiratory viruss account for 40-75% of AOM in kids

Question 22

dx of AOM and goals

Answer 22

moderate to severe bulging of TM or new onset ottohrea, mild bulging of TM and <48h ear pain or intense redness of TM . goals: clear infection from middle ear fluid; since treatment empiric, change of abx may be needed

Question 23

AAP/AAFP guidelines for AOM treatment kids

Answer 23

observation without abx for 48-72h in child >2 with non severe illness. if giving abx, first choice amoxicillin 80-90mg/kg/d. other choice amoxicillin/clavulinate same amoxicillin dose

Question 24

when in IOM should abx be given without first observation period?

Answer 24

all AOM in 6mos-2y/o unless just unilateral without otorrhea. in those >2, should not observe first if otorrhea with AOM or with severe symptoms

Question 25

treatment of AOM if PCN allergy

Answer 25

cefinidir 14mg/kg/d in 1-2 doses
cefpoxidime 10mg/kg/d once daily
cefuroxime 30mg/kg/d in 2 doses
ceftriaxone 50mg IM 1 day or x 3 days

Question 26

how is AOM treated if treatmetn failure at 48-72hr

Answer 26

if initially used amoxicilin or other first line, give augmentin or ceftriaxone IM/IV x3 days. if penicillin allergy, clindamycin plus 3rd gen cephalosporin

Question 27

AOM education

Answer 27

proper use abx, predicted course of infection once start abx, fu in 2-3 days if no improvement, pain control, prevention (reconsider daycare attendance, breastfeed first 6mos, avoid bottle propping or supine bottle feeding, no tobacco smoke exposure, vaccine)

Question 28

who can get initial observation before abx for AOM

Answer 28

low risk patients (>2y, mild otalgia, temp <39), adequate pain management essential, safety net rx WASP wait and see rx

Question 29

pain management with AOM

Answer 29

tylenol 15mg/kg/dose ibuprofen 5-10mg/kg/dose
topical analgesic (drops, TM must be intact, combo of antipyrine, benzocaine, glycerin)

Question 30

gonococcal meningitis treat/prevent

Answer 30

eyrthryomycin ointment w/in 1 hour birth. treatment: IM ceftriaxone

Question 31

chlamydial conjunctivitis in newborn treatment

Answer 31

systemic erythromycin

Question 32

treatment of gonococcal conjunctivities

Answer 32

newborns, sexually promiscous teens/adults. parenteral ceftriaxone and sterile saline irrigations

Question 33

conjunctivitis -otitis syndrome

Answer 33

children <6. h. influenzae majority. treat with high dose amoxicillin

Question 34

viral conjunctiviitis

Answer 34

adenovirus, HSV, herpes zoster. treat with opthamalic abx. if suspect herpes keratitis, refer

Question 35

patient education for contagous eye

Answer 35

admin instructions to prevent contamination, how to instill drops/ointment. ADRs. lifestyle: handwashing, dont share towels, throw away eye makeup, clear purulent discharge with wet cotton or washcloth

Question 36

malignant otitis externa

Answer 36

rare but poss leathal infection by p. auruginosa. OE extends, invades surrounding tissues, causing osteomylitis of base of skull and purulent meninges. parenteral abx: aminoglycocide and carbenicilln for 4-6 weeks plus surgical debreidment

Question 37

group A beta-hemolitic streptococci treatment

Answer 37

Penicillin V FOR 10 DAYS to prevent rheumatic fever even if no symptoms
250mg 2-3 times per day <27kg
500mg 2-3 times per day teens/adults >27kg