TBL Dec 13 Red eye

Question 1

Red eye / conjunctivitis is cardinal sign of?

- how treat?

Answer 1

Ocular inflammation

- broad spectrum abx (b/c can’t test if viral/bacterial)

Question 2

When do emergency ophthalmic referral?

Answer 2

Moderate/severe pain
Vision loss
Distorted pupil
Rash, discharge
Burn, trauma

Question 3

Highly contagious viral conjunctivitis caused by?

Answer 3

Adenovirus

• supportive
• cold compress
• artificial tears
• ocular decongestants

Question 4

Hyperacute bacterial conjunctivitis?

Answer 4

Neisseria gonorrhea
 - sudden onset
 - rapid progression
CORNEAL PERFORATION
Purulent discharge, pain, vision loss

Question 5

Causes of common bacterial conjunctivitis?

Answer 5

Adults: staph aureus
Kids: strep pneumo, H-flu

Question 6

When suspect chlamydial conjunctivitis?

- how treat?

Answer 6

Sexually active pt that doesn’t respond to standard abx treatment
- topical erythromycin + oral azithromycin x1
Remember to treat sexual partners

Question 7

How treat corneal abrasion?

Answer 7

Dx w/ cobalt blue filter/wood lamp
Supportive care w/ NSAIDs
(possible atropine)

Question 8

Most common infection of lung parenchyma in community?

Answer 8

Pneumonia

- Strep pneumo

Question 9

Symptoms of pneumonia?

Answer 9

Fever + chills
Pleuritic chest pain
Cough w/ mucopurulent sputum

Question 10

Physical exam for pneumonia?

Answer 10

Dullness to percussion
Tachycardia
Tachypnea
Asymmetric breaths sounds
Pleural rubs
Egophony
Increased fremitus

Question 11

Prevention of CAP?

Answer 11

Influenza vaccine

Pneumococcal vaccine

Question 12

When think legionella?

Answer 12

Multi-lobar involvement
GI abnormalities
Neurological abnormalities

Question 13

What 2 patient populations have higher CAP?

Answer 13

HIV

COPD

Question 14

What vital signs should lead you to order CXR?

Answer 14

T > 100
HR > 100
RR > 20

Question 15

What symptoms should lead you to order CXR?

Answer 15

Decreased breath sounds Need 2+ of these
Crackles (rales)
Absence of asthma

Question 16

What is CURB-65 Mortality Prediction Tool for CAP?

Answer 16

Confusion           3 pts = ICU             CARBB-65
Age > 65             2 pts = inpatient
RR > 30
BUN > 20
BP systolic < 90, diastolic < 60

Question 17

CAP treatment?

- previously healthy outpatients

Answer 17

Macrolide

Doxycycline

Question 18

CAP treatment?
- outpatients w/ comorbidities
(or abx in past 3 months)

Answer 18

Levofloxacin or other -floxacin
Augmentin (amox+clav)
Cefpodoxime
(plus macrolide)

Question 19

CAP treatment?

- inpatient, not ICU

Answer 19

• floxacin + macrolide

- or beta-lactam + macrolide

Question 20

CAP treatment?

- ICU

Answer 20

Beta-lactam + azithromcin/-floxacin