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176 Cards in this Set
- Front
- Back
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Most common reason for visit to pediatrician
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Otis Media
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2nd most common surgical procedure in children
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Tympanostomy tube placement
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Inflammation of the middle ear
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Otitis media (OM)
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Rapid onset of signs and symptoms, less than 3 week course of an inflammation of the middle ear
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Acute Otitis Media
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Otitis media of 3 weeks to 3 months
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Subacute Otitis Media
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Otitis Media of 3 months or longer
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Chronic Otitis Media
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Diagnosis of Acute Otitis Media requires the presence of middle ear effusion and:
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Otalgia, Otorrhea, bulging red or yellow tympanic membrane, and fever
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Pathogenesis of Acute Otitis Media:
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Eustachian tube dysfunction, bacteria multiply, efuusion/suppuration, perforation and/or resolution
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Causative organisms of Otitis Media:
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Respiratory Syncytial Virus, parainfluenza virus, H. influenzae nontypable, Strept. pneumoniae, Moraxella catarrhalis
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Gram positive, lancet shaped, diplococci
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Streptococcus pneumoniae
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How Strept. pneumo adheres to epithelial cells of the oro- or nasopharynx
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By pili
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Specific antisera reacts with organism and causes capsular swelling
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Quelling reaction with Strept. pneumoniae
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Polysaccharide capsule (88 different serotypes)
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Streptococcus pneumoniae
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Bile soluble, growth enhanced by CO2, alpha hemolysis, sensitive to optochin
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Streptococcus pneumoniae
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Virulence factors for Strept. pneumoniae
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Pneumolysin, autolysin, C substance, M antigen
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Requires X and V factors for culture
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Haemophilus influenza; highest incidence in elderly (often nontypable)
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Oxidase positive, Gram negative diplococcus
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Moraxella catarrhalis
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Virulence factors for Moraxella catarrhalis
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Endotoxin, Pili for adherence, protein confers resistance to MAC, lactoferrin
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Recommended antibiotics for otitis media with an over 2 year old, afebrile
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Consider analgesic without antibiotics
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Recommended antibiotics for otitis media if no antibiotics have been taken in prior month
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Amoxicillin po HD
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Recommended antibiotics for otitis media if received antibiotics in previous month
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Amoxicillin-clavulinic acid extra strength or oral 2nd or 3rd generation cephalosporin (cefprozil, cefuroxime, cefdinir, or cefpodoxime)
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Recommended antibiotics for otitis media with clinical failure or more serious infection:
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IM ceftriaxone and consider tympanocentesis
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5 conditions account for 75% of all outpatient prescriptions
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Otitis media, Acute sinusitis, Pharyngitis, Cough/bronchitis, Common cold
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Most important pathologic process in Otitis Media
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The obstruction of natural ostia
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Symptoms associated with positive antral aspirate
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Unilateral facial pain, maxillary toothache, symptoms lasting long than 10-14 days
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Causes of Acute Sinusitis
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Respiratory Viruses, Strept. pneumo, H influenzae nontypable, M. catarrhalis, Staph. aureus, Anaerobes
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Peptostreptococcus, Fusobacterium, and Bacteroides
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Anaerobes
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Treatment for uncomplicated Acute Sinusitis
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14 days of amoxicillin
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Treatment for complicated or severe sinusitis
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Azithromycin, Fluroquinolones, Ceftriaxone, Augmentin
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Should be the strongest reason to treat acute sinusitis with antibiotics
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Length of symptoms (2 week minimum)
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Beta-lactams
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Penicillins, Cephalosporins, Carbapenems, and Monobactams
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Penicillins
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Penicillin G and Penicillin V
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Antistaphylococcal penicillins
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Nafcillin, Oxacillin, Cloxacillin, Dicloxacillin, Methicillin (no longer used)
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Extended-spectrum penicillins
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Ampicillin and Amoxicillin
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Antipseudomonal penicillins
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Ticarcillin and Piperacillin
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First Generation Cephalosporins
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Cephalexin and Cefazolin
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Second Generation Cephalosporins
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Cefoxitin, Cefaclor, Cefprozil
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Third Generation Cephalosporins
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Ceftrixone, Ceftazidime, Cefotaxime, Cefdinir
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Fourth Generation Cephalosporin
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Cefepime
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Carbapenems
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Imipenem
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Monobactams
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Aztreonam
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Beta-lactamase inhibitors
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Clavulanic acid, Sulbactam, Tazobactam
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How do beta-lactams work? (4)
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They bind to Penicillin Binding Proteins (PBP), PBP is unable to crosslink peptidoglycan chains, Bacteria are unable to synthesize a stable cell wall, Weakened cell wall leads to lysis of bacteria from osmotic pressure
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Monobactams
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Aztreonam
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Beta-lactamase inhibitors
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Clavulanic acid, Sulbactam, Tazobactam
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How do beta-lactams work? (4)
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They bind to Penicillin Binding Proteins (PBP), PBP is unable to crosslink peptidoglycan chains, Bacteria are unable to synthesize a stable cell wall, Weakened cell wall leads to lysis of bacteria from osmotic pressure
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Peptigoglycan backbone of alternating sugars
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N-acetylglucosamine (NAG) and N-acetylmuramic acid (NAM)
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During the synthesis of the cell wall, blocks L-alanine from forming D-ala-D-ala
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Cycloserine
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Carrier protein in lipid membrane. Transports building blocks across cytoplasmic membrane for peptidoglycan synthesis
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Bactoprenol
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Binds tightly to ala-ala. This prevents cross-linking & elongation of peptidoglycan (blocks transglycosylase)
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Vancomycin
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Blocks the recycling of bactoprenol
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Bacitracin
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How do beta-lactams block cell wall synthesis
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They block the transpeptidation step..block cross linking of peptidoglycan chains
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Structurally similar to alanine-alanine
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Penicillin
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Characterized by affinity for and binding of penicillin
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Penicillin-binding protein
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Can loosely equate Penicillin-Binding Protein with:
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Transpeptidases
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Use Penicillin G with:
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Most Gram positives (both cocci and rods), a few Gram negatives (like Neisseriae meningococci), some anaerobes and spirochetes (syphilis)
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Bugs with acquired resistance of Penicillin G
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Staphylococcus aureus, Streptococci, Neisseria gonococci
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Compartments not readily reached by Penicillin G
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Prostate, ocular, CSF
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Drug that can slow the process of drugs being pumped out of the blood
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Probenecid
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Half life of Penicillin G
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30 minutes
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How to decrease injection frequency of Pen G
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Pen G procaine and Pen G benzathine
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Breakdown product of Penicillin that acts as a hapten and is the major determinant in an allergic reaction
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Penicilloic acid
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Adverse effects of Penicillin G
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Diarrhea and GI intolerance, Neurotoxicity (seizures), and Superinfections
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Organism causing superinfection leading to pseudomembranous colitis
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Clostridium difficile
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Major mechanism of resistance to the beta-lactam antibiotics
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Beta-lactamases
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Beta-lactamases mostly mediate resistance to:
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Penicillins and 1st and 2nd generation cephalosporins
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In Gram negatives, where are the highest concentrations of beta-lactamases found
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In the periplasmic space
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Extended spectrum beta-lactamases efficiently hydrolyze:
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Penicillins, Cephalosporins, and Monobactams (aztreonam)
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Most common ESBL producers
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Klebsiella pneumoniae and E. coli
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Use Nafcillin for:
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Use naf for staph!
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Reason Antistaphylococcal Penicillins are resistant to breakdown by beta-lactamase
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They contain bulky side chains that don't fit into beta-lactamase's active site
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Adverse effects of Antistaphylococcal agents (Naf,Ox,Clox,Di,Meth)
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Similar to Pen G, but also blood dyscrasia, acute interstitial nephritis, hepatotoxicity
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Organisms that Ampicillin & Amoxicillin work against:
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HELPS; H. influenzae, E. coli, Listeria sp., Proteus, Salmonella
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Clinical uses for Ampicillin & Amoxicillin
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SOUP; Sinusitis, Otitis, UTIs, Pneumonia
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Ampicillin is frequently used (synergistic) with this for broad range coverage in serious infections
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Aminoglycoside (gentamicin)
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Drug of Choice for Listeria meningitis:
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Ampicillin
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Spectrum covered by Ticarcillin and Piperacillin
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Pen G, HELPS, Pseudomonas, Klebseilla, and Serratia
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Broadest spectrum of the penicillins when used in combo with beta-lactamase inhibitor (tazobactam)
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Piperacillin
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Drugs with the adverse effect of Sodium overload potential
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Ticarcillin and Piperacillin
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Beta-lactamase inhibitors
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Clavulanic acid, Sulbactam, and Tazobactam
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Only oral prep combo with beta-lactamase inhibitor
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Amoxicillin and Clavulanic acid
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With each generation of cephalocporins there is increased:
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Activity against Gram negative bacteria and anaerobes, resistance to beta-lactamases, ability to cross BBB
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Spectrum of 2nd generation Cephalosporins (cefoxitin, cefaclor, cefprozil)
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G+, HEN PEcK) Gram positives, H. influenzae, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella
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Cephalosporins are not active against:
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Enterococcus or MRSA
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Adverse effects of Cephalosporins
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Hypothrombinemia and Alcohol intolerance
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Why Cephalosporins can cause hypothrombinemia and alcohol intolerance
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Due to Methylthiotetrazole (MTT) group
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Prophylaxis of surgical procedures
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Cephalosporins 1st generation - Cefazolin
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1st generation Cephalosporins (Cephalexin and Cefazolin) are very active against:
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Gram positives plus PEcK; Proteus, E. coli, Klebsiella
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How are all 2nd Generation Cephalosporins eliminated from the body (Cefoxitin, Cefaclor, Cefprozil)
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All renally eliminated
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Spectrum of 2nd generation Cephalosporins (cefoxitin, cefaclor, cefprozil)
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G+, HEN PEcK) Gram positives, H. influenzae, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella
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Cephalosporins are not active against:
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Enterococcus or MRSA
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Adverse effects of Cephalosporins
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Hypothrombinemia and Alcohol intolerance
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Why Cephalosporins can cause hypothrombinemia and alcohol intolerance
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Due to Methylthiotetrazole (MTT) group
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Prophylaxis of surgical procedures
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Cephalosporins 1st generation - Cefazolin
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1st generation Cephalosporins (Cephalexin and Cefazolin) are very active against:
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Gram positives plus PEcK; Proteus, E. coli, Klebsiella
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How are all 2nd Generation Cephalosporins eliminated from the body (Cefoxitin, Cefaclor, Cefprozil)
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All renally eliminated
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Dimorphic fungi; infection common in Ohio-Mississippi Valley; yeast form survives phagocytosis
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Histoplasmosis - Histoplasma capsulatum
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Histoplasma growth is particularly associated with:
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Guano of birds (starlings, chickens) and bats
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Do most people who inhale the conidia of Histoplasma come down with the disease?
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No- 95% asymptomatic - recall granuloma/calcification
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Snowstorm pattern
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X-ray finding with Histoplasmosis
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Nutritionally dimorphic; prevalent in semi-arid regions of southwestern U.S, Sonoran desert; disseminated in dust
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Coccidiomycosis - Coccidioidies immitis
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Infection as a result of the inhalation of arthrospores
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Coccidiomycosis
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San Joaquin Valley Fever, Valley Fever, desert rheumatism
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Coccidiomycosis - Coccidioidies immitis
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Endemic to Mississippi-Ohio River Valleys; more frequently in households with dogs
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North American Blastomycosis - Blastomyces dermatiditis
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True fungal pathogen that can disseminate to skin; patients may intitally present with cutaneous lesions
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North American Blastomycosis - Blastomyces dermatiditis
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True fungal pathogen limited to tropical and subtropical areas of Central and South America
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Paracocciodiomycosis (South American Blastomycosis) - Paracoccidioides brasiliensis
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Although route of infection via spore inhalation, disease presents with cutaneous or mucocutaneous ulcers (especially oral and nasal cavaties)
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Paracocciodiomycosis (South American Blastomycosis) - Paracoccidioides brasiliensis
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Systemic (true) fungal pathogens (4)
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Histoplasmosis, Coccidiomycosis, Blastomycosis, Paracoccidiomycosis
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3 distinct pathogenic forms of Aspergillus
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Allergic bronchopulmonary aspergillosis, Aspergilloma, Invasive pulmonary
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Aspergillus is in what form (mold or yeast) at 37 degrees C
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Mold - is non-dimorphic
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Halo sign
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Seen with Invasive Pulmonary Aspergillosis as an area of the lung infected surrounded by air
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Fungal infection of the sinuses, brain, or lungs that occurs primarily in people with immune disorders
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Zygomycosis (think Rhizopus or Mucor)
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Predisposition that lead to the often fall Zygomycosis
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Diabetic ketacidosis
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People getting sick due to spores in the central air
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Ill house/Sick building syndrome
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Stachybotrys chartrum mycotoxins
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Trichothecenes
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Associated with flooding - likes the paper backing behind walls
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Stachybotrys chartrum
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Inflammation of the lung parenchyma
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Pneumonia
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Most sensitive indicator of pneumonia in children < 6 months old
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Tachypnea
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Most common bacteria causing infectious pneumonia between birth and 1 month old
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Group B Streptococci; also E. coli and Strept. pneumo
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Viruses causing infectious pneumonia between birth and 1 month old
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Cytomegalovirus and Herpes Simplex Virus
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Most common bacteria causing infectious pneumonia between 11 month and 6 month old
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Strept. pneumo
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Atypical agents causing infectious pneumonia
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Pertussis, Chlamydia trachomatis, Mycoplasma pneumoniae
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3 stages of Pertussis
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Catarrhal, Paroxysmal, Convalescent
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Infants less than 3 months old with pertussis may not present with the "whooping cough" but instead
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Apnea, choking, or gasping cough
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Presents 1-3 months after acquiring - passed from mothers with untreated vaginal infections to their newborn babies
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Chlamydia trachomatis
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Clinical manifestations of Chlamydia trachomatis pneumonia (4)
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Afebrile, conjunctivitis, Staccato cough, Eosinophilia
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Clinical manifestations of Pertussis (4)
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Afebrile, facial petechiae, scleral hemorrhages, post-tussive emesis
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"Walking pneumonia," cold agglutinins
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Mycoplasma pneumonia
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Pleural effusion with bacterial pneumonia think
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Staph. aureus
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How long after TB exposure does one have a positive PPD
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2 - 12 weeks after exposure
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TB infection of the skin of the neck - cervical lymphadenitis
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Scrofula
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Extrapulmonary TB that affects the spine
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Pott's disease
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Chronic inflammatory condition of the lung airways; heightens the "responsiveness" or airways to provacative exposure
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Asthma
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Early childhood risk factors for persistant asthma (4)
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Wheezing apart from colds, male gender, low birth weight, tobacco smoke exposure
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Chronic symptoms, intermittent dry cough and expiratory wheeze; may present as chest pain in younger children
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Asthma
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Differential diagnosis for asthma
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Allergic rhinitis, chronic sinusitis, gastroesophageal reflux, vocal cord dysfunction
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How much improvement of FEV1 in response to albuterol is consistent with asthma
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>12%
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Spirometry is generally not reliable until the child is
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> 6 years old
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Peak Expiratory Flow variation from morning-to-evening that is consistent with asthma
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> 20%
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Usually unilateral, purulent, foul smelling discharge; sometimes bleeding; can be a variety of items
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Nasal Foreign Body
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Allergic salute (nasal crease)
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Think Allergic Rhinitis
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First line for Allergic Rhinitis
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Oral antihistamine - also nasal steroids, montelukast
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Sore or "scratchy" throat, nasal obstruction, rhinorrhea, cough, may have fever or myalgia
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Common cold
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Natural course of the common cold lasts:
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7-10 days (worse ones are 3 or 4)
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Sinuses present at birth
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Ethmoidal and maxillary sinuses
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Sinus present by 5 years old
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Sphenoidal sinuses
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Sinus that begins to form around 7 or 8 and not completely developed until adolescence
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Frontal sinuses
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Most common bacterial pathogens for Sinusitis
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Streptococcus pneumoniae, Haemophilus influenza non-typable, Moraxella catarrhalis
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Otitis media caused by infection
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Acute Otitis Media
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Noninfective otitis media
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Otitis Media with Effusion (OME)
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Most common bacteria causing Acute Otitis Media (AOM)
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Streptococcus pneumoniae, H. influenza nontypable, Moraxella catarrhalis
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All cases of Acute Otitis Media (AOM) are technically accompanied by:
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Mastoiditis
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Most common bacteria causing Otitis Externa (swimmer's ear)
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P. aeruginosa, S. aureus, Enterobacter aerogenes
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Most commonly caused by Epstein-Barr Virus
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Infectious Mononucleosis
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Exudative tonsillitis, generalized cervical adenitis, fever/fatigue, splenomegaly
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Mononucleosis
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Usually ulcers on back of mouth; not herpes but Enteroviral infection
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Herpangina
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Ulcers more in front of mouth; actually caused by HSV
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Stomatitis
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Causative agent of Hand, Foot, and Mouth Disease
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Enteroviral (Coxsackie A) infection
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Causative agent of pharyngoconjunctival fever
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Adenovirus
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Child presents with sore throat, fever, abdominal pain, and headache
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Think Strept throat
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Outer ear
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Auricle and external auditory canal
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Middle Ear
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Tympanic membrane, Ossicles, Middle ear space and mastoid
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Inner ear
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Cochlea and Vestibular System
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Why do we cough when cerumen is debrided
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Arnold's branch of the vagus nerve
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Hearing loss with age
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Presbycusis
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Triad of Meniere's syndrome
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Flucuating hearing loss, tinnitus, vertigo
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Medications that can cause disorders in hearing
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Aminoglycosides
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The sensation of movement when there is in fact none
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Vertigo
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Rhinorrhea most commonly associated with eating or exertion
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Atrophic Rhinitis
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Associated with using over-the-counter nasal decongestant sprays
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Rhinitis Medicamentosa
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The result of a common face rash of adults called Rosacea
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Rhinophyma
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How many sets of nasal Turbinates are there
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3 sets
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Length of Acute Sinusitis
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Lasting up to 4 weeks
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Length of Subacute Sinusitis
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4-12 weeks
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Length of Chronic Sinusitis
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12 or more weeks of signs/symptoms
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4 or more episodes of sinusitis per year, with resolution of symptoms between attacks
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Recurrent Acute Sinusitis
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