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34 Cards in this Set

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Sinusitis causes
- in normal
- in immunocompromised/diabetics/cf
normal: S. pneumo, G- coccobacilli (Moraxella, H.Influenzae)
ic/dm/cf: pseudomonas
otitis media
causes
pe
tx
causes: s.pneumo, moraxella, h.flu
pe: bulging, erythematous tympanic membrane
tx: decongestants and *amoxilliciln* (bactrim/augmentin/cephalosporin if failure
otitis externa
causes
pe
tx
"swimmer's ear"
causes: pseudomonas
pe: "tragal ear" -- hurts when pulled down
tx: polymyxin - neomycin
pharyngitis
causes
dx
rx
complications
causes: strep throat -- s.pyogenes (group A strep)
other causes: viral, fungal, mycoplasma, tb, etc.)
dx: throat cultures
rx: penicillin (amoxicillin if allergy)
compliations: toxic (scarlet fever, tss), pyogenic
deep tissue infections
sx
types
common bugs implicated
types: peritonsillar abscesses, retropharyngeal infections, prevertebral space, parapharyngeal space, ludwig's angina
sx: "hot potato voice," headpain, fever, dysphagia, drooling, sore throat
common bugs: staph, strep, mouth flora
acute epiglottitis
causes
sx
dx
causes: h.flu (b/c of vaccine, this dz is mostly eradicated)
sx: dysphagia, fever, sore throat
dx: cherry red epiglottis, "thumb" sign on lat neck film xray
note: DO NOT CULTURE (could cause layrngospasm) -- protect airway first (tube/tracheostomy)
croup
causes
rx
causes: viral--*parainfluenza*, rsv, adenovirus
rx: cool mist, epinephrine, protect airway
how do you get pna
inhalation of droplets
aspiration of mouth flora
hemotogneous spread (e.g. endocarditis)
cxr findings types
consolidated
necrotizing
interstitial
granulomatous
consolidated cxr pna -- bugs
**s.pneumo**, h.flu
necrotizing cxr pna -- bugs
abscesses formed by anaerobic bac, s.aureus, g- coccobacilli
granulomatous cxr pna -- bugs
TB, fungi (histo, aspergillus)
types of pnas
community acquired
atypicals
nosocomial
immunocompromised (e.g. pcp)
pna: s.pneumo
productive cough, pleuritic pain
rust colored sputum
CXR: consolidation + patchy infiltrate
ID: g+ cocci, + quelling rxn, encapsulated, IgA protease
tx with penicillin, flouroquinolones if drug-resistant, or cephalosporin
pna: s.pyogenes
productive
tx. with penicillin
pna: s.aureus
productive cough
hospital acquired
pink salmon-colored sputum
CXR: patchy bronchial infiltration; seen in infants/immunocompromised/elderly
ID: G+ cocci, Coagulase +
Tx: methicillin, vancomycin for mrsa
pna: h.influenze
productive cough, pleuritic pain, may be preceded by URI
CSR: patchy bronchial infiltration or lobar consolidation
ID: G- coccobacillus, req's X and V, pili, IgA protease, encapsulated
tx w/ HIB Vax; ampicillin, cephalosporins if resistant
pna: klebsiella
**alcoholics** (aspiration)
reddish "currant jelly" sputum
CXR: multiple lobes, abscesses
tx: cephalospirines +/- aminoglycosides
pna: pseudomonas aeruginosa
cystic fibrosis patients
hospital acquired
productive cough
ID: g- bacillus, blue-green colonies, fruity odor, gun-metal sheen
pna: mycoplasma pneumonia
atypical (nonproductive cough) "walking pneumonia" -- looks fine, cxr horrible
community acquired
cervical lymphadenopathy?
CXR: patchy infiltrates, appears worse than sx
ID: cholesterol membranes, cold agglutinins
Tx: Erythromycin / Azithromycin
pna: legionella
community/hospital acquired
atypical (productive?? cough), diarrhea, confusion, ataxia
csr: patchy infiltrate +/- lobar consolidation
ID: PMNs on gram stain, no bacteria
epi: elderly male, alcoholic, exposed to water
tx: erythromycin
pna: tb
fever, cough, blood tinged sputum, weight loss, night sweats, anorexia
CXR: +/- ghon complex, cavitary lesion
ID: ppd
tx: inh, rifampin, more..
pna: PCP
opportunistic, slow appearance
CXR: minimal changes @ first
pna: viral
most common in kids
causes:
RSV
parainfluenza
influenza
adenovirus
cmv (noonates, IC)
CXR: patchy infiltrates
TX: amantadine for influA, gancyclovir for CMV
pna: chlamydia
c. trachomatis: neontal PNA, retinits
c. psittaci: "parrot fever"
c. pnemo: pna in young adults

TX: tetracycline, erythromycine
pna: histoplasmosis
starlings (bat shit)
fungal
typical pnas
acute onset of fever, productive cough
s.pneumo
h.flu
klebsiella
moraxella
s.aureus
atypical pnas
slow onset, nonproductive cough, minimal increase in wbc
mycoplasma
pneumo
tb
chlamydia
legionella
coxiella
viral
community-acquired pnas
s.pneumo
h.flu
legionella
viral

younger pts:
mycoplasma
chlamydia
hospital-acquired pnas
s.pneumo
h.flu
legionella
e.coli
klebsiella
enterobacter
proteus
serratia
pseudomonas
s.aureus
alcohol abuse pnas
klebsiella
s.pneumo
h.flu
COPD pnas
s.pneumo, h.flu, moraxella
post influenza pnas
s.aureus, h.flu, s.pneumo
special exposure:
birds
cattle, hides
animals, white powders...
birds: chlamydia psattaci
cattle: coxiella burnetti
animals, white powders: bacillus anthracis