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29 Cards in this Set
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- 3rd side (hint)
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bordetella pertussis presentation in adults
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usu do not have inspiratory whoop, but vomit with cough;
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diagnostic clues for bordetella (3)
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leukocytosis and lymphocytosis, afebrile pt, nl CXR
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None
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3 MCC chronic cough
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postnasal drip syndrome, asthma, GERD
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presentation of postnasal drip syndrome
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postnasal drainage, throat clearing, nasal discharge, cobblestone appearance of oropharyngeal mucosa, mucus in oropharynx
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how to r/o cough-variant asthma?
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methacholine challenge
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tx of postnasal drip
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intranasal corticosteroids and antihistamines; if cough, consider cough suppressant (eg codeine)
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most sens/spec test for GERD, when used
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24hr esophageal pH monitoring (only for pts who don't respond to initial acid-suppression tx
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how prevalent is cough-variant asthma among asthmatics?
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57%
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most appropriate test to dx cystic fibrosis
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pilocarpine iontophoresis sweat chloride test
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suspect what dz in outpatient with pseudomonas postive sputum culture?
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cystic fibrosis
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recent URI, nasal exudate, and cobblestoning in posterior pharynx with cough -- whats the etiology of the cough?
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post-nasal drip
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presentation of viral vs bacterial pharyngitis (5)
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bacterial infection made more likely by: 1) duration > 7d; 2) purulent nasal discharge; 3) worsening of sx after initial improvement; 4) tooth pain; 5) failure to improve with decongestants
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PE findings of otitis externa
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TTP of tragus, traction of pinna
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tx of otitis externa
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ear drops -- hydrocortisone, neomycin, polymixin; NOT oral abx
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how to remove cerumen plugs that completely occlude external ear canal?
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1) ceruminolygic (incl H2O2); curettes only if partial occlusion, like irrigation
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causes of heterophile-negative mono
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EBV! Heterophile antibody test often negative at first --> should be repeated; CMV can cause heterophile negative mono-like Sx but is more rare
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what is oxymetazoline?
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topical decongestant usu in nasal spray; sympathomimetic effects (like sudafed) but no systemic effects b/c only used topically
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where do you get histoplasmosis?
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disruption of soil / spelunking
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what population most often afflicted by hantavirus?
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native americans and other residents from southwest
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findings in atypical mycobacterial infections
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similar to TB: upper-lobe cavitary infiltrates in I/C or pts with underlying pulm dz
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complications of varicella
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pneumonia (in adults, esp pregnant women)
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empiric tx for community-acquired pneumonia
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cephalosporin/macrolide or cephalosporin/fluoroquinolone
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risk factors for pseudomonas
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bronchiectasis, daily corticosteroid tx, recent abx tx, malnutrition
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most common organisms in pt with bronchiectasis
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pseudomonas and staph aureus
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empiric tx of pseudomonas
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usually double coverage, eg fluoroquinolone and an aminoglycoside; alternatives include 3rd or 4th gen cephalosporin, aztreonem, others
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risk factors for aspergillus pneumonia
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prolonged neutropenia / other significant immunsuppression (eg HIV)
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what bug suspected in pneumonia with diarrhea and mental status changes
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legionella
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risk factors for legionella
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smoking; underlying diseases (renal failure, cancer, DM, COPD, immunsuppression from chemo); EtOH; steroids; >40yo
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first step when suspecting legionella
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empiric abx -- diagnostic measures have either poor sensitivity or long turnaround times
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