Ios 10 Test #3 Kuma

Front 1

Normal course of illness for URI

Front 2

Acute otitis media def

Back 2

infection and inflammation of
the middle ear

behind the tympanic membrane/eardrum

Front 3

S.S., an 8 mo old WF who attends day care, was
treated 3 days ago with amoxicillin 80mg/kg/d x10
days. She is not improving clinically and has a
fever of 38°C. What is the best treatment option at
this point?

1. Continue same treatment
2. Change to amoxicillin
90mg/kg/d
3. Change to amoxicillin/clav
90mg/kg/d
4. Change to cefuroxime

Back 3

3. Change to amoxicillin/clav
90mg/kg/d

Front 4

Otitis media with effusion:

Back 4

accumulation of liquid in
the middle ear cavity without signs/symptoms of
acute infection

fluid behind the tympanic membrane

Front 5

Tympanic membrane (TM):

Back 5

ear drum

Front 6

Otalgia:

Back 6

ear pain

Back 7

purulent discharge through perforation of
TM or tympanostomy tubes

it can come through the tympanic membrane if it burst

Front 8

Epidemiology AOM

Front 9

T/F are URTI including acute bronchitis viral?

Back 9

True

Front 10

Respiratory mucosa

Back 10

Middle ear shares same as nose and
nasopharynx

that is why the sane bacteria causes infections in both

Front 11

Eustachian tube

Front 12

can otitis media with effusion decrease hearing

Back 12

yep

Front 13

risk factors for AOM

Back 13

Sex (male)

Front 14

if a baby gets an ear infection at _____ they are more likely to have re-current ear infections

Back 14

< 6 months

Front 15

Anatomy of adult and child eustachian tubes

Front 16

pic of eustacian tubes

Back 16

Front 17

Etiology of AOM

Back 17

Typically viral in origin

Front 18

most common bacterial pathogens of AOM

Front 19

Less common pathogens of AOM

Front 20

Tympanocentesis:

Back 20

identification of
pathogen through aspiration of middle ear
contents

only way to determine type of bacteria

not done all that often

Front 21

Clinical Presentation of AOM

Back 21

Diagnosis requires 3 elements
1. Recent onset (just need one of these)

Front 22

how can you tell a baby has otalgia

Back 22

pulling on ear, crying, not sleeping

Front 23

Complications of AOM

Front 24

Prevention of AOM

Front 25

Treatment: Symptomatic Otalgia

Front 26

what is the APAP dose in infants

Back 26

10-15 mg/kg/dose (max 4 doses/day)

Front 27

what is the ibuprofen dose for infants

Back 27

5-10 mg/kg/dose (max 4 doses per day)

Front 28

at what age is ibuprofen ok

Back 28

> 6 months

Front 29

Treatment:
Antibiotics vs Observation for AOM

Front 30

pros of using antibiotics for AOM

Front 31

cons of using antibiotics for AOM

Front 32

Observation: Wait and See Rx for AOM

Front 33

when do most AOM infections resolve

Back 33

within 72 hours

Front 34

Antibiotic Considerations for AOM

Front 35

Activity and Bacterial Resistance for AOM

Front 36

if an infant has the following risk factors what would be first choice antibiotic

day care attendance, antibiotics within
30 days, age <2yrs, frequent AOM

Back 36

augmentin

Front 37

if a patient is suspected to have Beta-lactamase production by H. influenzaem, M. catarrhalis:
what is the first choice antibiotic

Back 37

augmentin

Front 38

Efficacy and Middle Ear
Concentrations of antibiotics

Back 38

Efficacy requires adequate middle ear fluid
concentrations

Front 39

Tolerability: Taste of antibiotics for kids (FYI)

Front 40

Tolerability: Side Effects for antibiotics used for AOM

Front 41

what is a good counceling point to a parent using amox for their kid

Back 41

use a protective barrier such as aquafor to prevent diaper rash from diarrhea

Front 42

if the child has AOM and is <6 months what is the treatment options

Back 42

certain diagnosis and uncertaindiagnsis
antibiotics only, becasue more likely to get re-current infections

Front 43

if the child has AOM and is 6 months-1 year what are the treatment options

Back 43

certain diagnosis
antibiotics if have the 3 elements of diagnosis

uncertain diagnosis
observation (unless severe then antibiotics)

Front 44

if the child has AOM and is >/= 2 years what are the treatment options

Back 44

certain diagnosis
obeservation (unless severe)

uncertain diagnosis
observation

Front 45

Clinical Presentation of AOM

Back 45

Diagnosis requires 3 elements
1. Recent onset

Front 46

treatment guidelines for AOM

Back 46

***Consider amox/clav 1st line for children in
day care and those that took antibiotics within
last 30 days

Front 47

what is the dose for non-severe AOM in children

Back 47

amox 80-90mg/kg/day

usually given BID

Front 48

what route is ceftriaxone given for AOM in children

Back 48

IM

Front 49

what do you do if you have antibiotic failure after 72 hours for AOM

Back 49

switch antiobiobist if started on amox go to augmentin

Front 50

follow up for AOM

Front 51

Persistent/Recurrent Otitis Media

Front 52

Tympanostomy Tubes

Back 52

best for thos ein daycare, hearing loss in both ears, or less than 3

the fall out with growth

used in recurring ear infections in the middle ear

a small incision is made in the ear drum, then fluid if present is removed, small tube is placed in tympanic membrane

allows for fluid to drain
can give antibiotic drops

Front 53

Adenotonsillectomy

Back 53

removal of the adenoids to create space

Did not reduce recurrent AOM vs watchful
waiting in children 2-8yrs

Front 54

S.S., an 8 mo old WF who attends day care, was
treated 3 days ago with amoxicillin 80mg/kg/d
x10days. She is not improving clinically and has a fever of 38°C. What is the best treatment option at
this point?

1. Continue same treatment
2. Change to amoxicillin
90mg/kg/d
3. Change to amoxicillin/clav
90mg/kg/d
4. Change to cefuroxime

Back 54

3. Change to amoxicillin/clav
90mg/kg/d

Front 55

pic of sinuses

Back 55

Front 56

at what age do the frontal sinuses appear

Back 56

12

Front 57

at what age do the ethmoid sinuses appear

Back 57

present at birth

Front 58

at what age do sphenoid sinuses appear

Back 58

3-7

Front 59

Sinusitis

Back 59

inflammation of the paranasal sinus
mucosa
Also called rhinosinusitis, ABRS

Front 60

Acute sinusitis:

Back 60

< 4 weeks duration

Front 61

Subacute sinusitis:

Back 61

4-12 weeks duration

Front 62

Recurrent sinusitis:

Back 62

4 or more episodes/year, each lasting > 7 days with complete resolution between episodes

Front 63

Chronic sinusitis:

Back 63

> 12 weeks duration

Front 64

Epidemiology sinusitis

Front 65

Risk Factors sinusitis

Front 66

Pathogenesis: ABRS

Front 67

Clinical Presentation ABRS

Front 68

time course of sinusitis

Back 68

Front 69

how long does it typically take for all the symptoms to resomve from sinusitis

Back 69

10-14 days

if it presists longer than that suspect bacterial infection

Front 70

Diagnosis sinusitus

Front 71

Transillumination fo sinusitis

Back 71

A light source is placed along the infraorbital rim,
and the hard palate is inspected.

not a very good way to see the maxilary sinus

Front 72

Treatment goals of sinusitis

Front 73

Treatment of sinusitus

Front 74

Adult Symptomatic Pharmacotherapy of sinusitis

Front 75

Adult Antibiotic Guidelines for sinusitis

Front 76

Alternatives: Macrolides and FQ for sinusitis (FYI)

Front 77

Pediatric Symptomatic
Pharmacotherapy of sinusitis

Front 78

Pediatric Antibiotic Guidelines mild sinusitis

Front 79

Pediatric Antibiotic Guidelines for sinusitis Moderate disease OR
antibiotics in last 4-6w

Front 80

Pediatric Antibiotic Guidelines for sinusitis ß-lactam
allergic

Front 81

Follow-Up for sinusitis

Front 82

M.L. is a 14 y/o male who presents to his PCP with a
two-week history of HA, runny nose, and purulent
nasal discharge complicated by tooth pain and now
colored nasal discharge. He has failed decongestants.
What would be the best antibiotic treatment for ML at
this time?
1. Amoxicillin
2. Azithromycin
3. TMP-SMX DS
4. Cephalexin

Back 82

1. Amoxicillin
1000-1500 mg BID

Front 83

Bronchitis:

Back 83

inflammatory condition of the
tracheobronchial tree that is usually
associated with a generalized respiratory
infection

Front 84

Bronchitis Epidemiology

Front 85

Pathogenesis bronchitis

Front 86

Bronchitis Viral Etiology

Front 87

Bronchitis Bacterial Etiology

Front 88

Bronchitis Clinical Presentation

Front 89

Bronchitis physical exam

Front 90

Data on bronchitis

Front 91

Symptomatic Treatment of bronchitis

Front 92

Honey for
Cough in bronchitits

Front 93

how old does a kid have to be to have honey

Back 93

1 year

Front 94

if a kid is less than 1 and has a bad cough what do you do

Back 94

REFER

Front 95

Bronchitis
Herbal Option:
Pelargonium Sidoides

Back 95

Herbal supplement with some data for acute
bronchitis

Front 96

Antibiotic Treatment and bronchitis

Front 97

B.R. is a 34 y/o male presenting to his PCP with a
3 day history of cough, sore throat and HA. He
has taken acetaminophen for the HA and sore
throat and is now requesting antibiotics. What
would be the best treatment for BR at this time?

a) Azithromycin
b) Doxycycline
c) Albuterol MDI
d) Tussionex cough
syrup

Back 97

c) Albuterol MDI
Possible etiology

Front 98

Acute Pharyngitis

Back 98

One of the most common illnesses for which patients visit primary care physicians
7 million adults/year
Even more common in children
Twice the rate of office visits of any other infectious disease
Cases occur year-round
Most viral infections in fall and spring
Most bacterial infections in winter and early spring

Front 99

Acute Pharyngitis also known as

Back 99

bacterial strep throat

Front 100

Viral Etiology of Acute Pharyngitis

Back 100

Viral etiology in ~50% of cases
Usually in conjunction with colds or influenza
Pharyngitis occurs along with other typical “cold” symptoms
Rhinovirus 20%
Coronavirus ≥5%
Adenoviros 5%
Herpes simplex virus 4%
Influenza, parainfluenza viruses 4-5%
Misc. viruses (EBV, CMV, HIV, etc.) <1-2%

Front 101

Bacterial strep throat

Back 101

Streptococcus pyogenes (Group A strep, “strep throat”)
15-30% of cases in children 5-15 years of age
5% of cases in adults
Accounts for great majority of bacterial causes
Spread through aerosolized nasal or oropharyngeal secretions
Misc. streptococci (Groups C and G -hemolytic streptococci) in 5-10% of cases
Other bacteria, Mycoplasma, Chlamydophila involved in small percentage of cases
Unknown etiology in ~30% of cases

Front 102

what is the most common bacteria to cause acute pharyngitis

Back 102

Streptococcus pyogenes (Group A strep, “strep throat”)

Front 103

alpha hemolyis strep

Back 103

partial

Front 104

beta strep

Back 104

complete
group a strep

Front 105

gama strep

Back 105

nothing

Front 106

Complications of Acute Streptococcal Pharyngitis

Back 106

Peritonsillar, oropharyngeal abscesses
Peritonsillar cellulitis
Pneumonia, bacteremia with metastatic infections(goes throughout the body)
Streptococcal toxic shock syndrome (pyogenes is a toxin producer and the body produces an overwhelming response to the toxin)
Acute rheumatic fever
3% of cases of streptococcal pharyngitis
May result in severe valvular damage, heart failure
Post-streptococcal glomerulonephritis (PSGN)
May occur in up to 10-15% of cases
Most cases asymptomatic or very minor
WANT TO PREVENT THESE COMPLICATIONS

Front 107

Complications of Acute Streptococcal Pharyngitis: Scarlet fever

Back 107

Mediated by streptococcal exotoxins A, B, and C
Desquamating rash which begins on upper trunk & neck, then spreads over trunk and extremities (skin is sloughing off)
Face, palms and soles of feet usually spared
“Strawberry tongue”\

looks like toxic shock syndrom, toxins get into the blood stream and causes generalized complimcations

TOXIN MEDIATED

Front 108

Complications of Acute Streptococcal Pharyngitis: Acute Rheumatic Fever

Back 108

Characterized by inflammatory lesions of the heart, joints, and CNS
Appears to be related to “molecular mimicry” which elicits a chronic autoimmune response over months to years Igs produced against bacteria but they then start targeting the body)
“Heart reactive antibodies” (HRA) are initially targeted against bacterial M protein, other proteins, or polysaccharides
These HRA cross-react with connective tissues of the myocardium, joints, blood vessels, and subcutaneous tissues
May result in severe myocarditis, valvular damage, heart failure
chronic inflammation of the valves leads to heart failure

this is usually a delayed response (months-years)

Front 109

Acute Pharyngitis: Clinical Signs/Symptoms: Viral pharyngitis

Back 109

Sore, scratchy, irritated throat
Cough, rhinorrhea, post-nasal discharge present
Fever modest if any (usually absent), mild edema and erythema of pharynx

Front 110

Acute Pharyngitis: Clinical Signs/Symptoms Streptococcal pharyngitis

Back 110

Streptococcal pharyngitis
Abrupt onset of pain, edema, & inflammation of pharynx with odynophagia
Pharyngeal membrane = fiery red with grayish-yellow exudates
Tender, enlarged cervical lymph nodes, usually at angle of jaw
Often marked fever of 1030F or higher
Leukocytosis common
Headache, chills, malaise, abdominal pain common
Potentially manifestations of scarlet fever (exotoxin mediated)

Front 111

Diagnosis of Acute Pharyngitis

Back 111

Distinction of viral vs. streptococcal infection important to avoid unnecessary antibiotic use
Diagnosis of streptococcal infection based on positive clinical findings plus positive lab test (fast)
Clinical = four major criteria
Presence of tonsillar exudates
Presence of swollen anterior cervical lymph nodes
History of fever (102-103)
Lack of cough or other “cold” symptoms
Lab = + rapid antigen detection test (“throat swab”)
Can be done in minutes, ≥95% specificity

Front 112

does viral pharyngitis have a cough

Back 112

yes

Front 113

does bacterial pharyngitis have a cough

Back 113

no nor will you have cold symptoms

Front 114

Treatment of Acute Streptococcal Pharyngitis gaols of therpay

Back 114

Prevention of acute rheumatic fever
Prevention of suppurative complications
Improvement in clinical signs/symptoms
Rapid decrease in infectivity to reduce transmission

Front 115

Treatment of Acute Streptococcal Pharyngitis antibiotics

Back 115

Antibiotics
DOC = penicillin VK x 10 days
Alternatives = erythromycin or first-generation cephalosporin x 10 days
Many antibiotic classes could potentially be useful in the treatment of streptococcal pharyngitis, but have not been proven to prevent or decrease occurrence of complications (e.g. rheumatic fever, PSGN)

longer course of therapy to truely irradicate the infection and prevent complications

Front 116

Non-drug Therapy for Acute Pharyngitis

Back 116

Treatment directed at relieving pharyngeal discomfort and associated systemic or respiratory symptoms
Warm saline gargles
Rest
Analgesics (acetaminophen, ibuprofen)
Liquids

Front 117

Prevention of Rheumatic Fever

Back 117

Although effective, primary antimicrobial prophylaxis not commonly used
Secondary prophylaxis commonly used in patients with past history of rheumatic fever
Prophylaxis must be continuous to prevent subsequent streptococcal infections
Preferred regimen is benzathine PCN G 1.2 MU administered IM every 4 weeks
Oral regimens (PCN V 250 mg BID, sulfadiazine 0.5-1.0 Gm QD, or ECN 250 mg BID) less effective and not preferred
Duration varies according to presence of clinical myocarditis +/- valvular disease, but ranges from 5 years to lifelong

Front 118

with acute pharyngitis how long does a patient have to be on antibiotics to not be contagious

Back 118

a full 24 hours

Front 119

Acute Bronchitis

Back 119

»Short-term cough, producing mucoid sputum
»Usually self-limited viral infection

Front 120

Chronic Bronchitis

Back 120

»Productive cough 3months in 2 consecutive years
»Comprises ~85% of COPD (emphysema ~15%)

Front 121

Acute Exacerbation of Chronic Bronchitis (AECB)

Back 121

»Increase in dyspnea or sputum purulence/volume in a patient with chronic bronchitis
»Often bacterial (ABECB)

already have bronchitis but get infected

Front 122

Chronic Bronchitis affects....

Back 122

Affects 10 -40% of U.S. adults > 40 years of age
»14 million patients with chronic bronchitis in the US
»More than 90% receive antibiotics for AECB annually
–$200 -$300 million in ambulatory treatment costs
»$1.5 billion spent on hospitalization
–280,000 admissions
–$1.1 billion in patients ≥65 years old
–$0.4 billion in patients < 65 years old

Front 123

most common time of year for bronchitis

Back 123

May occur at any time of year, but most common in winter

Front 124

most important risk factor for chronic broncitis

Back 124

Cigarette smoking most important

Front 125

how do the lungs appear in a patient with chronic broncitis

Back 125

Chronic irritation, inflammation of bronchi thickening of mucosa, increased thick sputum

chronic colonizaiton, therefore we do not try to eradicate the bacteria just supress it

Front 126

Clinical Presentation of Chronic Bronchitis

Back 126

Chronic cough and production of thick, “tenacious” mucous
»Sputum production usually greatest in morning
»Changes in quantity, quality of sputum important indicators of infection
Fever, other specific signs/symptoms often absent
Abnormal lung sounds on chest exam
“Barrel chest”, cyanosis, etc. nonspecific for AECB
Sputum Gram stain often not helpful