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29 Cards in this Set

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  • Back
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bordetella pertussis presentation in adults
usu do not have inspiratory whoop, but vomit with cough;
diagnostic clues for bordetella (3)
leukocytosis and lymphocytosis, afebrile pt, nl CXR
3 MCC chronic cough
postnasal drip syndrome, asthma, GERD
presentation of postnasal drip syndrome
postnasal drainage, throat clearing, nasal discharge, cobblestone appearance of oropharyngeal mucosa, mucus in oropharynx
how to r/o cough-variant asthma?
methacholine challenge
tx of postnasal drip
intranasal corticosteroids and antihistamines; if cough, consider cough suppressant (eg codeine)
most sens/spec test for GERD, when used
24hr esophageal pH monitoring (only for pts who don't respond to initial acid-suppression tx
how prevalent is cough-variant asthma among asthmatics?
most appropriate test to dx cystic fibrosis
pilocarpine iontophoresis sweat chloride test
suspect what dz in outpatient with pseudomonas postive sputum culture?
cystic fibrosis
recent URI, nasal exudate, and cobblestoning in posterior pharynx with cough -- whats the etiology of the cough?
post-nasal drip
presentation of viral vs bacterial pharyngitis (5)
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
PE findings of otitis externa
TTP of tragus, traction of pinna
tx of otitis externa
ear drops -- hydrocortisone, neomycin, polymixin; NOT oral abx
how to remove cerumen plugs that completely occlude external ear canal?
1) ceruminolygic (incl H2O2); curettes only if partial occlusion, like irrigation
causes of heterophile-negative mono
EBV! Heterophile antibody test often negative at first --> should be repeated; CMV can cause heterophile negative mono-like Sx but is more rare
what is oxymetazoline?
topical decongestant usu in nasal spray; sympathomimetic effects (like sudafed) but no systemic effects b/c only used topically
where do you get histoplasmosis?
disruption of soil / spelunking
what population most often afflicted by hantavirus?
native americans and other residents from southwest
findings in atypical mycobacterial infections
similar to TB: upper-lobe cavitary infiltrates in I/C or pts with underlying pulm dz
complications of varicella
pneumonia (in adults, esp pregnant women)
empiric tx for community-acquired pneumonia
cephalosporin/macrolide or cephalosporin/fluoroquinolone
risk factors for pseudomonas
bronchiectasis, daily corticosteroid tx, recent abx tx, malnutrition
most common organisms in pt with bronchiectasis
pseudomonas and staph aureus
empiric tx of pseudomonas
usually double coverage, eg fluoroquinolone and an aminoglycoside; alternatives include 3rd or 4th gen cephalosporin, aztreonem, others
risk factors for aspergillus pneumonia
prolonged neutropenia / other significant immunsuppression (eg HIV)
what bug suspected in pneumonia with diarrhea and mental status changes
risk factors for legionella
smoking; underlying diseases (renal failure, cancer, DM, COPD, immunsuppression from chemo); EtOH; steroids; >40yo
first step when suspecting legionella
empiric abx -- diagnostic measures have either poor sensitivity or long turnaround times