Stillwell lectures for pulm Flashcards
common cold `
- usually VIRAL -> rhinovirus, influenza virus
- purulent nasal discharge does NOT mean bacterial infection
- Afrin/Otrivan used SHORT term to prevent RHINITIS MEDICAMENTOSA
pharyngitis
- usually VIRAL -> Adenovirus, rhinovirus, coronavirus
- bacterial -> GAS, Diphtheria (myocarditis, bull neck, nerve palsies; NOT scrape off)
- fungal -> Candida scrapes off
- diagnose w/ throat culture -> NO tests if you are going to treat anyway
conjunctivitis, coryza, cough, diarrhea, ulcerative lesions
suggests VIRAL instead of bacterial infection
Peritonsillar/Parapharyngeal abscesses
- usually polymicrobial
- UVULAR deviation
- hot potato mouth
odontogenic infections
- dental carries caused by STREP MUTANS
- acute ulcerative gingivitis -> caused by Fusobacterium & non-syphilitic spirochetes
- Ludwig angina -> elevation of mouth, gland swelling, trismus
- Actinomyces -> lumpy jaw and sulfur granules
stomatitis
- HSV, Enteroviruses, Angular chelitis from CANDIDA
- stomatitis + ulcers -> symptoms in HIV patients
HPV
subtype 16 -> oropharyngeal SCC and cervical cancer
- squamous cell papilloma -> CAULIFLOWER
- verruca vulgaris -> PARSNIPS
Parotitis/Sialadenitis
- caused by MUMPS virus
- caused by STAPH AUREUS in NOSOCOMIAL setting
Sinusitis
- usually VIRAL -> many
- bacterial -> Strep pneumo, H. influenza, Moraxella
- fungal -> MUCORMYCOSIS in immunodeficient & uncontrolled diabetics
- Pott’s puffy tumor
- cavernous sinus thrombosis w/ septic thrombophlebitis -> CN6 most affected
- NO benefit in treating w/ antibiotics if not improving 7-10 days or less -> follow up in week
- treat w/ amoxicillin-cluvalonic acid
Otitis Media
-bacterial -> strep pneumo, H. influenza, Moraxella
- acute -> BACTERIAL
- serous -> NOT infectious -> do not use antibiotics; use decongestants
- blisters on tympanic membrane -> bullous myringitis
- risk of cholesteatoma and mastoiditis
- treat w/ amoxicillin
Otitis Externa
- caused by staph or GAS
- diabetics -> PSUEDOMONAS aeruginosa -> MALIGANT otitis externa
Facial cellulitis
- GAS in adults
- H. influenza in children
-erysipelas -> bright red, sharp margins
Epiglottis
- caused by strep pneumo and H. influenza
- do NOT inspect back of throat if suspected -> spasm & compress airway
- THUMBPRINT sign
Croup (laryngotracheobronchitis)
-caused by PARAINFLUENZA virus
- barking cough
- STEEPLE sign
-treat w/ steroids
Lemierre’s syndrome
-caused by FUSOBACTERIUM necrophorum -> thrombophlebitis of IJV
Infectious Esophagitis
- caused by GERD or Candida
- treat w/ FLUCONAZOLE for Candida
- COBBLESTONE w/ Candida
- if HSV -> multinucleated giant cells
- if CMV -> Owl’s eye
Infected Cervical Lymphadenitis
- usually Staph or Strep - also bartonella, tularensis, myc. TB
- POSTERIOR cervical lymphadenopathy w/ African trypanosomiasis if from Africa -> WINTERBOTTOM sign
Infectious Conjunctivitis “pinkeye”
- usually VIRAL -> Adenovirus
- Pre-auricular adenopathy
- chlamydia trachomatis in mom -> blindness in newborns
Infectious Keratitis (cornea)
- bacteria (most common) -> Staph aureus and Pseudomonas
- viral -> Adenovirus (SUBCORNEAL infiltrate) or HSV (DENDRITIC ulcers)
- amoebic -> Acanthamoeba in contacts
- parasite -> Onchocerca volvulus
Atelectasis
- usually UNILATERAL
- caused by obstruction (resorption), contraction, extra/intrapulmonary compression
Bronchiectasis
- caused by pneumonia, smoking, CF, kartagener
- bacteria -> H. influenza and Pseudomonas***
- SIGNET RING sign & TREE IN BUD
Kartagener Syndrome aka Primary Ciliary Dyskinesia
-defects in DYNEIN arms
- Bronchiectasis
- Chronic Rhinos-sinusitis
- Situs inversus w/ dextrocardia
also infertility
Cor Pulmonale
-COPD/chronic bronchitis -> vasoconstriction of pulmonary artery due to low O2 -> dilation/hypertrophy of RV
most common causes of community acquired pneumonia (CAP)?
strep pneumonia and H. influenza