Infectious Disease Tst3 Set2

Front 1

Clinical presentation of acute OM (6)

Back 1

1)otalgia (pulling of ear)
2)hearing loss (due to effusion)
3)fever
4)preceeded by viral URI
5)irritability/lethargy
6)anorexia/vomiting

Front 2

Diagnosis of acute OM (5)

Back 2

LOOK AT TM
a)redness
b)opacity/absence of light reflection
c)bluging
d)immobility
e)otorrhea- discharge if perforation of TM

Front 3

When to tx acute OM (5)

Back 3

1)often resolves spontaneously w/o tx
2)APAP/NSAIDs to decr pain
3)"observation option" if pt over 6months and nonsevere (mild otalgia, temp less than 39)
4)No abx for effusion
5)if less than 6months and severe s/sx treat (severe otalgia and temp over 39)

Front 4

S/sx of acute OM effusion (3)

Back 4

1)may be asympto
2)can cause temp hearing loss due to decr conduction
3)effusion may persist for up to 3months

Front 5

Initial therapy for acute OM (2)

Back 5

1)high dose amoxicillin for 10d if mod susceptible to PCN (no BL) (S. pneumo)
2)high dose amox/clav if BL producer for 10d (H.flu/M.catarrhalis)

Front 6

Acute OM tx if:
a)NOT type 1 allergy to PCN (rash) (3)
b)type 1 allergy to PCN (anaphylaxis/hives) (4)

Back 6

a1)cefdinir (10d)
a2)cefpodoxime (10d)
a3)cefuroxime (10d)

b1)azithromycin (5d)
b2)clarithromycin (10d)
b3)erythromycin/sulfisoazole (10d)
b4)TMP/SMX (10d)

Front 7

Time course for response of acute OM to tx (3)

Back 7

1)may worsen in first 24h, should begin to improve by 48h
2)fever should defervesce within 48-72h
3)reassess therapy if clinical improvement NOT apparent within 48-72h

Front 8

If pt fails amoxicillin and suspected org is H.flu/M.catarrhalis (BL producers) use what? (3)

Back 8

a)high dose amox/clav
b)rash PCN allergy use cefdinir, cefpodoxime, cefuroxime
c)anaphylaxis (type1) PCN allergy use macrolide

Front 9

If pt fails amoxicillin and suspected org is PCN resistant S. pneumo use what?

Back 9

1)ceftriaxone IM or clindamycin ONLY!!!

Front 10

If pt fails amox/clav use...

Back 10

ceftriaxone IV/IM for 3days

Front 11

Chemopropylaxis in acute OM (3)

Back 11

1)controversial due to resistance BUT:
a)amox 20-40mg/kg/d in 1-2 doses
b)sulfisoxazole qd
c)bactrim qd

Front 12

Preventive Measures in acute OM (7)

Back 12

1)alter child care attendance
2)breastfeeding for first 6months
3)avoid supine bottle feeding
4)eliminate pacifier by 6months
5)eliminate tobacco smoke
6)flu vaccine (30% prevention)
7)pneumonia vaccine

Front 13

Acute OM med compliance (2)

Back 13

1)taste terrible
2)less than 50% of kids complete acute OM tx

Front 14

Viral pathogenesis of Sinusitis (2)

Back 14

1)rhinovirus is highly pathogenic
2)common causes rhinosinusitis

Front 15

Bacterial (community)pathogenesis of Sinusitis (5)

Back 15

1)nasal passages and nasopharynx colonized w/ bacteria that cause ACABS (acute, CA bacterial sinusitis)
2)cough, sneeze, nose blowing deposit these bacteria in sinuses
3)high bacterial titers
4)destruction of ciliated epithelial cell occurs after 2-4 days
5)regeneration of new ciliated epithelium needed to remove bacteria and debris

Front 16

Bacterial (nosocomial) pathogenesis of sinusitis (2)

Back 16

1)develop in critically ill pts w/ indwelling nasal tubes
2)happens in 2nd week of hospitalization once colonization of nasal airways w/ bacteria occurs

Front 17

Fungal sinusitis pathogenesis (2 and 3 types)

Back 17

1)fungi are normal flora of upper airway
2)immunocompromised/DM pts at risk

3a)allergic fungal sinusitis
3b)fungus ball
3c)fulminant invasive fungal sinustis

Front 18

Sinusitis risk factors (4)

Back 18

1)preceding viral infexn
2)structural abnormalities (polys/deviation)
3)prior abx therapy
4)immune deficient (ig deficiency, CF)

Front 19

Viruses that cause Sinusitis (3)

Back 19

1)rhinovirus
2)parainfluenze virus
3)influenza virus

Front 20

Most common bacteria that cause Sinusitis (COMMUNITY) (3)

Back 20

1)S. pneumonia****
2)H. flu
3)M. catarrhalis

Front 21

Bacteria that cause Sinusitis (HOSPITAL) (6)

Back 21

OFTEN POLYMICROBIAL
a)S. aureus
b)Pseudomonas
c)Enterobacter
d)K. pneumonia
e)P. mirabilis
f)S. marcescens

Front 22

Fungal organisms that cause Sinusitis (4)

Back 22

1)aspergillus
2)pseuallescheria
3)sporothrix
4)zygomyces

Front 23

Common s/sx of Bacterial Sinusitis (4 of many)

Back 23

1)mucopurulent nasal discharge
2)nasal congestion
3)unilateral face pain/tender
4)mucosal erythema

Front 24

Nasal discharge and cough and Bacterial Sinusitis (3)

Back 24

1)for over 10days following a viral infexn
2)viral discharge is clear/thin
3)bacterial discharge is purulent w/ incr viscosity

Front 25

Diagnosis of Sinusitis (3 and 2 are no good)

Back 25

1)history/physical exam (MOST IMP)
2)radiography
3)endoscopic rhinoscopy

1)nasal cultures suck
2)sinus puncture are invasive

Front 26

Adjunct to tx Sinusitis (4 and 2 no good)

Back 26

1)steam inhalation
2)oral decongestants
3)nasal decongestants
4)saline nasal spray

1)NO antihistamines
2)intranasal steroids NO good

Front 27

When to tx Sinusitis and what to usually do (4 and 1)

Back 27

1)Watchful Waiting for 7-10d

1)fever over 102
2)facial pain/tenderness
3)periorbital swelling
4)s/sx persist for 10d or worsen after 5-7d

Front 28

ADULT tx of Sinusitis (4)

Back 28

1)Amox (high dose)
2)Amox/clav (high dose)
3)2nd/3rd Gen Cephalosporins
4)Respiratory Fluoroquinolones (levo/moxi)

Front 29

KIDS tx of Sinusitis (3)

Back 29

1)Amox (high dose)
2)Amox/clav (high dose)
3)2nd/3rd Gen Cephalosporins

Front 30

Sinusitis tx duration (3)

Back 30

Acute: 10-14d

Response should be seen within 3-5d (if none need new abx)

Treat for 1wk after resolution of symptoms

Front 31

Pathogenesis of Pharyngitis (3)

Back 31

1)asymptomatic carriage of S. pyogenes (group A)
2)pathologic changes w/ viral pharyngitis: edema, hyperemia of tongue
3)inflammatory exudate (adenovirus and EBV)

Front 32

Microbiology of Pharyngitis (viral org's) (5)

Back 32

1)rhinovirus
2)coronavirus
3)parainfluenze virus
4)herpes simplex type 1/2
5)influenza A/B

Front 33

Bacterial Org's that cause Pharyngitis

Back 33

1)S. pyogenes***

Front 34

Clinical Presentation of Pharyngitis (w/ common cold--rhino/coronavirus) (5)

Back 34

1)pharyngeal discomfort
2)usually NOT severe pharyngeal pain
3)NO fever, chills, malaise, myalgia
4)mild edema/erythema
5)soreness, scratchiness

Front 35

Clinical Presentation of Pharyngitis (w/ bacteria S. pyogenes) (5 and many more)

Back 35

1)sudden onset
2)fever over 39
3)fiery red pharyngeal membrane (strawberry tongue)
4)age 5-15yrs
5)rash due to exotoxin release (scarlet fever)

Front 36

Diagnosis of Pharyngitis (Group A) (2)

Back 36

1)throat culture is 95% sensitive but takes 24hrs
2)RADT is more expensive, 95% specific, and results in minutes

Front 37

Pharyngitis tx
a)oral (2)
b)IM (2)
c)PCN allergy (3)

Back 37

a1)PenV for 10d
a2)Amox suspension for 10d (young kids)

b1)benzathine PenG (1dose)
b2)benzathine PenG + PenG procaine (1dose)

c1)cefdinir for 10d
c2)macrolide for 10d (5d for azith)
c3)1st gen cephalo for 10d

Front 38

Prevention of Pharyngitis (3)

Back 38

1)penicillin prophylaxis for S. pyogenes infexn for pts @ risk of recurrent rheumatic fever
2)flu vaccine
3)neuraminidase inhibitors for influenze

Front 39

Lower Respiratory Infexns (3)

Back 39

1)influenza
2)bronchitis
3)pneumonia

Front 40

Influenza properties (5)

Back 40

1)person to person spread
2)incubation period 1-4days
3)infectious from day b4 symptoms to 5days after onset (longer in kids and immunocomp)
4)self limiting, but cough/malaise can last over 2wks
5)secondary bacterial pneumonia can happen in young kids/ppl over 65

Front 41

Common s/sx of Influenza (5 of many)

Back 41

1)fever
2)cough
3)myalgia
4)HA
5)sore throat

Front 42

Diagnosis of Influenza (6)

Back 42

1)rapid tests MOST USEFUL
2)nasopharyngeal/nasal specims preferred over throat swabs
3)viral culture (3-10d)
4)Immunofluorescence DFE (2-4h)
5)RT-PCT (2-4h)
6)EIA (2h)

Front 43

2 Therapies of Influenza

Back 43

Neuraminidase inhibitors (oseltamavir, Zanamavir)- tx fluA and fluB

Uncoating inhibitors (rimantadine, amantadine)- tx fluA only NOT USED UNLESS IN COMBO W/ neuraminidase inhibitor

Front 44

Oseltamivir and Zanamavir things (2)

Back 44

1)less resitance than w/ uncoating inhibitors
2)MUST START WITHIN 2 DAYS OF SYMPTOMS ONSET

Front 45

Bronchitis
a)general def
b)acute bronchitis def
c)chronic bronchitis def

Back 45

a)inflammation of tracheobronchial tree

b)self-limiting, associated w/ generalized respiratory infexn

c)commonly associated w/ COPD

Front 46

Common Clinical Presentation of Bronchitis (4)

Back 46

1)cough (for weeks)
2)fever
3)hoarseness
4)sputum production

Front 47

Common viral etiologies of bronchitis (4)

Back 47

1)influenza
4)parainfluenza
2)adenovirus
3)coronavirus

Front 48

Diagnosis of Bronchitis (3)

Back 48

1)clinical presentation**
2)sputum collection is worthless
3)chest film ONLY for pts w/ suspected pneumonia or heart failrue

Front 49

Cough Suppression tx for Bronchitis (5)

Back 49

1)antitussives
2)antihistamines if cough w/ allergic rhinitis
3)bronchodilators may decr cough duration
4)NSAIDs improve cough w/ rhinovirus infexn
5)steroid inhaler/ipatropim used in chronic sinusitis

Front 50

Abx and Bronchitis (2)

Back 50

1)bad in acute bronchitis
2)good in chronic bronchitis

Front 51

Respiratory Fluoroquinolones (3)

Back 51

1)levo
2)moxi
3)gemifloxacin

Front 52

Therapy for Bacterial Bronchitis caused by Myco or Clamy Pneumoniae (3)

Back 52

1)Macrolides
2)doxy
3)respiratory FQ's

Front 53

Therapy for S. pneumoniae Bronchitis (4)

Back 53

1)macrolides (w/ no suspicion of resistance)
2)high dose Amox
3)cephalosporins
3)respiratory FQ's (not best)

Front 54

Therapy for H. flu and M. catarrhalis Bronchitis (often BL producers) (4)

Back 54

1)amox/clav
2)2nd gen cephalosporins (cipro?)
3)Bactrim (but not for H.flu)
4)respiratory FQ

Front 55

Primary Empiric Abx choice for Bronchitis

Back 55

high-dose Amox

Front 56

Pneumonia
a)def
b)infectious agents gain access by: (3)

Back 56

a)inflammation of lung parenchyma

b1)aspiration (most common)
b2)inhalation of aerosolized material
b3)metastatic seeding of the lung from blood

Front 57

Pneumonia types (4 w/ 0,1,1,4)

Back 57

CAP (community-acquired)

HAP (hospital acquired)
a)pneumonia arising 48hrs+ from admission

VAP (ventilator-associated pneumonia)
a)48-72hrs+ after endotracheal intubation

HCAP (health-care associated pneumonia)
a)hospitalization within 90d
b)received recent IV abx (within 30d)
c)resided in nursing/LTC facility
d)recent attendance at hospital or hemodialysis clinic

Front 58

Most common Pathogens in pneumonia (4)

Back 58

1)S. pneumoniae
2)S. aureus
3)H. flu
4)M. catarrhalis

Front 59

ANAEROBIC pneumonia usually seen in....

Back 59

alcoholics (will have REALLY bad breath)

Front 60

Problem w/ Kleb Pneumonia

Back 60

has ESBL so hard to treat and NO B-lactams

Front 61

Pseudomonas pneumonia is usually seen in.... (2)

Back 61

ppl frequently using abx

severe underlying disease

Front 62

Acinetobacter pneumonia is usually seen in....

Back 62

Ventillator pneumonia

Front 63

Atypical Pneumonia
a)Mycoplasma pneumonia
b)Chlamydia pneumonia
c)Chlamydia trachomatis
d)Legionella

SEEN IN....(2)

Back 63

younger adults

"walking pneumonia"

Front 64

Fungal Pneumonia
a)Aspergillus
b)Candida
c)Cryptococcus
d)Histoplasma
e)Pneumocystis jiroveci

SEEN IN...(2)

Back 64

1)neutropenic
2)immunocompromised/HIV

Front 65

Rickettsial pneumonia seen in...

Parasitic pneumonia seen in...

Kids usually get what pneumonia

Back 65

animal/insect exposure

cat feces (so cleaning the cat litter)

VIRAL

Front 66

Common Community-acquired Pneumonia (CAP) etiologies (6)

Back 66

1)viral (most common)
2)S. pneumoniae (most common bacteria)******
3)H. flu (smokers)
4)M. catarrhalis (more in kids)
5)Myco/Chlamy pneumonia in young adults
6)Legionella (other)

Front 67

Risk factors for CAP (4)

Back 67

1)chronic corticosteroids
2)severe bronchopulmonary disease
3)alcoholism
4)freq. abx therapy

Front 68

Common clinical presentation of CAP (6)

Back 68

1)cough
2)fever
3)sputum production
4)dyspnea
5)blood pressure changes
6)mental status changes in elderly

Front 69

Diagnostic Testing of CAP (5)

Back 69

1)sputum gram stain/culture
2)lab tests (CBC w/ differential)
3)O2 sat (determines if pt is ICU or ward)
4)urinary antigen testing
5)flu testing

Front 70

OUTpatient Abx therapy for pneumonia
a)previous healthy/no recent abx (2)
b)recent abx or comorbidities (2)
c)Regions w/ high macrolide-resistant pneumococci

Back 70

a1)macrolide
a2)doxy

b1)respiratory FQ's
b2)B-lactam plus macrolide

c)B-lactam plus doxy

Front 71

Comorbidities for Outpatient CAP abx (4)

Back 71

1)COPD
2)malignancy
3)DM
4)CRF/CHF

Front 72

Inpatient CAP B-lactams (4)

Inpatient CAP AP B-lactams (anti-pseudomonal) (5)

Back 72

a1)cefotaxime
a2)ceftriaxone
a3)ampicillin/sulbactam
a4)ertapenem

b1)Pipercillin/tazobactam
b2)imipenem
b3)meropenem
b4)cefepime
b5)aztreoman (w/ PCN allergy)

Front 73

Antibiotic Therapy for CAP (INPATIENT)
a)medical ward (2)
b)ICU (no pseudomonas) (2)
c)ICU (pseudomonas) (2)
d)Concern for CA-MRSA

Back 73

a1)respiratory FQ
a2)B-lactam plus macrolide

b1)B-lactam plus azithromycin
b2)B-lactam plus respiratory FQ

c1)AP B-lactam plus Cipro or Levo
c2)AP B-lactam plus AG (and azithromycin OR respiratory FQ)

d)add vanco or linezolid

Front 74

Drugs for coverage of Atypical pneumonia (2)

Back 74

1)respiratory FQs
2)azithromycin

Front 75

Monotherapy for Pseudomonas pneumonia

Back 75

ALWAYS REQUIRES 2 DRUGS

Front 76

Duration of abx therapy in CAP (3)

Back 76

1)typical course inpt is 10-14d
2)minimum of 5d for outpt
3)pts must be afebrile for 48-72h b4 dc abx

Front 77

Flu VACCINE prevention groups for CA-Pneumonia (6)

Back 77

1)50+ yrs old
2)COPD/asthma
3)chronic renal/CV/hepatic disease
4)DM
5)immunosuppression
6)neurologic disease

Front 78

Pneumococcal VACCINE prevention groups for CA-Pneumonia (7)

Back 78

1)65+ yrs old
2)asthma/COPD
3)chronic renal/CV/hepatic disease
4)DM
5)immunosuppression
6)asplenic (anatomic/fxnal)
7)alcoholism

Front 79

Early Onset vs Late Onset HAP (hospital acquired Pneumonia) (6)

Back 79

EARLY
a)within first 4d of hospitalization
b)LOW RISK for multi drug resistant MOs
c)NO need for broad spectrum coverage

LATE
a)occurs 5+ days after admission
b)INCR risk of MDR MOs
c)broad spectrum coverage reqd

Front 80

MOST common etiologies of HAP (4)

Back 80

1)Enterobacter
2)HA-MRSA (DM, ICU, head trauma)
3)P. aeruginosa
4)rarely viral/fungal in immunocompetent pts

Front 81

HAP risk factors (5)

Back 81

1)severe underlying disease
2)preexisting pulmonary disease
3)prior surgery
4)intubation/mechanical ventilation/enteral feeding
5)exposure to abx

Front 82

Risk factors for MDR Pathogens in HAP (6)

Back 82

1)abx therapy in past 90d
2)current hospitalization for 5 or more days
3)high frequency of abx resistance in the community or specific hospital unit
4)duration of mechanical ventilation
5)presence of risk factors for HCAP
6)immunosuppressive disease and/or therapy

Front 83

Risk factors for HCAP (6)

Back 83

1)hospitalization for 2 or more days in the past 90 days
2)reside in nursing home or extended care facility
3)home infusion therapy (including abx)
4)chronic dialysis within 30d
5)home wound care
6)family member w/ MDR pathogen

Front 84

Common clinical presentation of HAP/HCAP (4)

Back 84

1)new-onset fever
2)purulent sputum production
3)elevated WBC
4)decline in oxygenation (O2 sat)

Front 85

Diagnosis of HAP/HCAP (3)

Back 85

1)O2 sat
2)respiratory cultures (quantitative or semi-quantitative to differentiate b/w infexn vs colonization)
3)chest radiograph (necrotizing suggests Pseudomonas)

Front 86

Potential Pathogens for HAP/VAP WITH NO RISK FACTORS FOR MDR PATHOGENS (6)

Back 86

1)S. pneumo
2)H. flu
3)MSSA

Abx sensitive G-
4)E. coli
5)Kleb. pneumonia
6)Enterobacter/Proteus/Serratia species

Front 87

Abx for HAP/VAP w/ no risk factors for MDR pathogens (4)

Back 87

1)ceftriaxone
2)levo/moxi/ciprofloxacin
3)ampicillin/sulbactam
4)ertapenem

Front 88

Potential Pathogens for HAP/VAP w/ late-onset disease OR risk factors for MDR pathogens (4)

Back 88

Sensitive Pathogens (see last slide) AND
1)P. aeruginosa
2)Kleb pneumonia (w/ ESBL)
3)Acinetobacter
4)MRSA

Front 89

Treatment for HAP/VAP w/ late-onset disease OR risk factors for MDR pathogens (bunch)

Back 89

AP cephalosporin (cefepime or ceftazadime) OR AP carbapenem (imipenem or meropenem) OR AP B-lactam/BL inhibitor (pip-tazo)

PLUS

AP FQ (cipro or levofloxacin) OR AG (amikacin, gentamicin, tobramycin)

PLUS

linezolid or vancomyin (ONLY IF MRSA IS SUSPECTED)

Front 90

Duration of HAP/VAP therapy (2)

Back 90

1)uncomplicated HAP/VAP/HCAP: 7-8d
2)pts should be afebrile for 48-72h b4 dc

Front 91

Common Pneumonia Pathogens w/...
a)alcoholism (2)
b)COPD/smoking (4)

Back 91

a1)S. pneumonia
a2)anaerobes

b1)S. pneumonia
b2)H. flu
b3)M. catarrhalis
b4)Legionella

Front 92

Common Pneumonia Pathogens w/...
a)IVDU (4)
b)Influenza outbreak (4)

Back 92

a1)S. aureus
a2)anaerobes
a3)M. tuberculosis
a4)S. pneumonia

b1)influenza
b2)S. pneumonia
b3)S. aureus***
b4)H. flu

Front 93

Common Pneumonia Pathogens w/...
a)Nursing home/elderly (6)

Back 93

a1)S. pneumonia
a2)G- bacilli
a3)H. flu
a4)S. aureus
a5)anaerobes
a6)C. pneumonia

EVERYTHING

NOTICE S. AUREUS IS IN EVERYONE