-
7 situations to give abx in AOM
- <6mos old
- Fever >39
- Congenital
- Craniofacial
- Heart/Lung
- Downs
- SADMIST
- Hx OM complications
- Mastoiditis
- Meningitis/Brain Abcess
-
What microbes in perfed AOM
- S aureus,
- P aeuriginosa
- Strep Viridans
-
What is watchful waiting in AOM
- 48-72hrs with analgesia
- 84% vs 93% spont recovery compared to abx
- >6mos reassess in 24hrs
- if not better 2-3 days 10 days Amox 80mg/kg/div TID
- >2yrs
- return if sx worse
- Amox 5 days if symptoms dont improve
-
What bugs in chronic rhino-sinusitis
- S aureus
- GAS
- Enterobacteracea
- Anaerobes
-
what are non abx options for rhino-sinusitis
Saline rinse, decongestants, hydration, intranasal steroids
No anti-histamines, no topical decongestants
-
What should you look for in chronic sinusitis
- polyps/anatomic abnormalities
- Xray, CT
-
Who is at high risk for pseudomonal bronchitis
- FEV <35%
- FEV1 <50% with frequent AECB
- chronic po steroid
- constant purulent sputum
-
Which macrolides have higher levels of resistance
- Azithro>Clarithro>Erythro
- OD/BID/QID dosing
-
What are the components of McIsaac Score
When does it not apply?
- Fever >38
- Absent cough
- Swollen tender anterior LN
- Tonsillar swelling with exudate
- Age 3-14
- Age 15-44 (zero pt)
- Age >44 (-1pt)
not for endemic popln, hx rheumatic fever, valvular HD, SADMIST
-
What are suppurative complications of GAS
- PTA
- RPA
- OM
- Sinusitis
- Nec Fasc
-
What are non suppuratice complications of GAS
- Scarlet Fever
- Strep Toxic Shock
- Acute GN
- Rheumatic fever
- PANDAS
-
What are the Jones criteria
2+ major or 1 major and 2+ minor
- Major
- Heart: carditis/valvulitis
- MSK: Migratory arthritis
- Neuro: Syndehams chorea
- Skin: Erythema marginatum, subcutaneous nodules
- Minor
- Clinical: Arthralgia, Fever
- Labs: ESR/CRP elevated, Prolonged PR
-
What are 8 emergent conditions that may present as sore throat
- PTA
- RPA
- Ludwigs angina
- Lemiere's Dz
- Thyroiditis
- Epiglotitis
- Croup
- Bacterial
- Diptheria
-
What P/E findings are suggestive of emergenc sore throat cuases
- Epiglottitis (drooling, sniff)
- PTA (trismus, hot potatoe voice)
- RPA (nuchal rigidity)
- Ludwigs angina (high riding tongue, tender under jaw)
- Thyroiditis (thyroid tender to palpation)
- Lemiere's (fever, rigors, resp distress, tender jug vein, pharyngeal ulcers)
- Diptheria (pseudomembrane)
-
What are the typical pneumonia organisms
S pneumo, H flu
-
What are the atypical in pneumonia
MC LIRP
- Mycoplasma
- Chlamydophilla
- Legionella
- Influenza
- RSV
- Parainfluenza
-
What are anti-pseudomonal abx
- Flouro: cipro
- Ceph: Ceftaz
- Penicillins: Piperacillin, Ticaracillin
- AG: Gentamycin, Tobramycin
- Penems: Meropenem+cilastin, Imepenem
-
How do you sub-classify pneumonias
- CAP
- Adult: mild/mod
- No comorbidities: amoxicl, Clarithro, Doxy
- Comorbidities/LTC: Amoxil/Amox/clav, Cefuroxime + Macrolide/Doxy OR Resp Flouro
- Adult: severe
- Admit to H: Ceftriazone + Clarithro/Doxy
- Admit to ICU Ceftriaxone + Resp Flouro
- Admit to ICU ? pseudomonas: Cipro + Cefipime/Ceftazadime/Pip-Tazo/Imipenem/Gent
- Peds
- Outpt: Amox 80, Clarithro 15/kg Div BID
- Admit to H: Cefuroxime 150/kg div TID
-
When should aspiration be tx with abx
- LOC,
- Etoh/Overdose,
- Szr
- Esophageal dismotility
- Gingival Dz
Not in ADENTULOUS
-
Who is at risk for MRSA
- I AM An IVDU
- Inmate
- Aboriginal
- Military
- Athletes
- IVDU
-
Who is at risk for pseudomonas
HIS Hottub
- HIV
- ICU
- Structural Lung Dz (bronchiectasis, COPD, CF)
- Hot Tub
-
How long should we treat UTI with
TMP SMX, Nitrofurantoin,
when should Cipro be used
- 3
- 5
- 7
- (reserve for suspected psuedomonas/pyelo!!!!
-
Who should be treated for Asx bacteruria?
- Pregnacy (screen at 12wks, if confirmed by culture x 2 treat and culture q 1month x rest of P
- Pro-op for GU instrumentation
-
How do we prophlylax UTI
- Non pharma: Cranberry juice
- Pharma:
- TMP SMX 1DS tab Q every other HS or post coital
- Nitrofurantoin: 100 QHS/post coital
- Keflex 125 QHS/post coital
-
What are McIsaac for UTI
- Dysuria
- Leuks (>trace)
- NItrites (any including trace)
- 0-1 do UC Tx empirically if severe sx otherwise wait for UC
- 2-3 Treat empirically dont wait for UC
-
What are categories of UTI recurrence
- Re-infection
- >2wks after complete Abx
- different organism
- most common
- Relapse
- <2wks after complete Abx
- same pathogen
- <10% women
-
What Abx are safe in Pregnancy
- Keflex
- Amoxil
- Ceftriaxone for pyelo
- Nitrofurantoin CI >36wks (hemolysis)
- TMP SMX CI T1 and T3 (folic acid and kernicterus)
-
What are CI to Nitrofurantoin
- ALlergy
- Pregnancy T3
- G6PD
- CrCL
- Pyelo (no penetration of kidney parenchyma)
-
Who do you urine culture
- Recurrent cystitis
- Pyelo
- Pregnancy
- SADMIST
- Complicated UTI
- COMSS (catheter, Obstruction, Men, Structural, SCI
-
How do you manage a <28 day old with Rectal temp >38
- FSWU =
- Culture: Blood, Urine, CSF +/- Stool
- CXR, UA, CBC, Lytes
- Treatment
- Ampicillin 50mg/kg and 1 of
- Cefotaxime 50mg/kg
- Gentamicin 2.5mg/kg
- Acyclovir 10mg/kg if vesicles, neuro changes, Szr, Tpenia, High CSF WBCs
-
How do you manage a 29-90 day old with rectal temp >38
- Investigations
- Culture: Blood, Urine, CSF, Stool
- CXR, UA, CBC, Lytes
- Most in US do LP until 60 days old
- Criteria to avoid admission/LP = Rochester/Boston/Philadelphia
- Treatmente
- Ceftriaxone 50mg/kg
- Vancomycin 20mg/kg
- Consider Dex if >6wks to prevent deafness, give within 1 hr of Abx
-
Who do you need to get a cath'ed your sample on
- Febrile
- Girls <24months
- Boys Uncirc <12
- Boys Circ <6
-
What is a febrile Szr
- 6mos-6yrs old
- <15mins
- 1/24hrs
- Generalized
- Return to Baseline neuro status
-
What are 3 microbes affecting neonates
-
What are 3 deadly bugs in 29-90 days old
- S pneumo
- H flu
- N menigitides
-
What are 4 non-infectious cuases of fever
- Inflammation: SLE, RA, Sarcoid, Corhns
- Malignancy: leukemia, lymphoma
- Endocrine: T4, AI
- Environmental: Heat stroke
- Drugs:
- Drug fever: NSAIDS, ABX, Anti-Epileptic
- Withdrawal: Etoh, Opiod
- Intoxication:
- Sympathomimetics: Cocaine, Crystal
- Anticholinergics: pesticide
- Overdose: ASA
- Drug Rection: NMS, Serotonin sx
-
Investigations in FUO
- Neuro:
- ENdo: TSH
- Cardio Resp: CXR, sputum for AFB
- Heme: Blood culture/CBC, HIV, VDRL
- Liver: LFT's, Viral Hep serology,
- Pancreas: AMylase/Lipase
- GU: Urine culture/UA, TVUS, Cervical swabs
- MSK: CK, ESR/CRP, RF, ANA, ANCA, antidsDNA, SPEP
CT chest/abdo
-
What classes of Rx commonly cause drug fever
- NSAIDS
- Abx
- Heparin
- ANti-convulsants
- Allopurinol
-
What are Duke Criteria for Endocarditis
- 2 major, 1 major 3 minor or 5 minor
- Major:
- +ve culture for S viridan/bovis or S aureus, enterococcus, HACEK (haemophilus, actinobacillus, cardiobacter, Eikenella, Kingella kingae
- Echo with Veg
- Minor:
- Fever >38.5
- Vascular phenomena: Janesway, Splinter hemorrhage, arterial emboli
- Immunologic: Oslers, Roths, RF factor, GN,
- Positive BC with other organism
- Abnormal echo but no Veg
-
What characterizes NMS
- FARM
- Fever
- Autonomic instability
- Rigidity
- Mental status changes
-
What are Well's criteria for DVT
- Virchows + 3Us CTAngio
- Endothelial injury
- Surgery/Trauma <12wks
- Stasis
- Paralysis, Plaster, Paresis
- Hypercoag
- Prev DVT, Active Ca
- Unilateral
- entire leg swell
- calf swell 3cm > then other
- pitting edema
- Collateral superficial veins
- Tenderness over DV
- Alt Dx less likely
-
What are Well's criteria for PE
- DO (3pts) HIP (1.5pt) CHeck (1pt)
- DVT signs and symptoms
- Other Dx less likely
- HR >100
- Immobility
- PmHx: VTE
- Cancer
- Hemoptysis
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