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Percent of colds that are viral sinusitis
90%
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Percent of colds that are bacterial sinusitis
0.5-2%
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Duration of viral rhinosinusitis
7-10 days
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Sx of acute bacterial rhinosinusitis
- 1. Gets worse after it gets better
- 2. Lasts more than 7 days
- 3. Purulent nasal discharge (major)
- 4. Unilateral maxillary tenderness in sinus (major)
- 5. Maxillary tooth or facial pain (minor)
- 6. Hyposmia (major)
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Pathogens that cause bacterial rhinosinusitis
- 75%
- 1. S. pneumonea
- 2. H. influenzea
- Moraxella cattarhalis
- ABRS
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Tx of bacterial rhinosinusitis
- 1. Empiric antibiotics: amoxicillian; Macrolides: azithromycin & clarithromycin; TMP-SMZ
- 2. Topical Glucocorticoid: budenoside
- 3. Mucolytics
- 4. Oral corticosteroids: prednisone 20mg, medrol pak
- 5. Decongestants
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Complications of bacteria rhinosinusitis that need referral
- 1. Periorbital edema
- 2. abnormal vision
- 3. Change in mental status
- 4. Eyeball stuff
- A. Preseptal/periorbital cellulitis (puffiness very outside of eye)
- B. Orbital cellulitis (infection posterior to orbital septum)
- C. Orbital abcess (pus sac around eye; pushes it out)
- D. Subperiorbital abcess (pus sac median side of eye)
- E. Cavernous sinus thrombosis (fucked)
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Duration types of bacterial rhinosinusitis
- 1. acute = 4 weeks or less
- 2. subacute = 4 - 12 weeks
- 3. recurrent acute = 4 episodes in 1 year (REFER!)
- 4. chronic = lasting more than 12 weeks (REFER!)
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Factors predisposing bacterial rhinosinusitis
- 1. Allergic rhinitis
- 2. Pollution
- 3. Abnormal structure (deviation)
- 4. Polyps (Samter's Triad: asthma, aspirin sensitivity, and nasal/ethmoidal polyposis)
- 5. Other (GERD, pregnancy, DM, etc...)
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When to use CT scan for rhinosinusitis
- 1. Chronic rhinosinusitis - after 4+ weeks of treatment
- 2. To see if infection spread
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Viral pharyngitis symptoms not present in bacterial
- 1. conjuctivitis: associated w/ adenovirus
- 2. cough and rhinorrhea
- 3. vesicular lesions (coxsackie virus & herpes)
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GAS immune mediated sequela
- 1. Scarlet fever (sandpaper rash, strawberry tongue)
- 2. Acute rheumatoid fever (Jones critera: 2 major [chorea, arthritis, carditis, erythema marginatum] or 2 minor [arthralgia, ESR, CRP, fever] + 1 major:
- 3. Acute glomerulonephritis (proteinuria, hematuria, dark piss)
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Tx for GAS
- 1. Penicillin for 10 days
- 2. Amoxicillin
- Alts:
- 1. Cephalosporins: cefazolin
- 2. Microlides: azithromycin, clindomycin
No response within 48 hrs = amoxicillin
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Complications of bacterial pharyngitis
- 1. Peritonsilar abcess
- 2. Acute epiglotittis
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Peritonsilar abcess Sx and Tx and what does it come from?
-Sx: sore throat (often unilateral), headache, malaise, dysphagia, trismus, referred ear pain
-Tx: I&D, Amoxicillin and Clindamycin (14 days)
Complication of bacterial pharyngitis
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Acute supraglottitis Sx and Tx andwhat does it come from?
-Sx: 3D's, tripod
-Tx: Protect airway, O2, empiric antibiotics (cephalosporins, MRSA killers), steroids
Comes from bacterial pharyngitis
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Mononucleus Sx
- 1. rash after using Amoxicillin
- 2. tonsilar exudates
- 3. splenomegaly
- 4. Triad: fever, lymphadopathy, severe sore throat
- 5. palatal petechiae
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Diagnostic tests for mono
- 1. Serum transaminase
- 2. IgM (acute) and IgG (indicate past infection)
- 3. ESR
- 4. Peripheral smear (lymphocytosis > 60%, increased atypicals > 10%)
- 5. Monospot
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Laryngitis types and what is it a category of
- 1. acute (< 3 weeks) - URI (bacterial and viral) and vocal strain
- 2. chronic (> 3 weeks) - refer to ENT!
- 3. reactive (PND, GERD, LPR, vocal strain)
it is in category of hoarsenes
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Croup age, duration, etiology
- Age: under 5 yrs
- Duration: 3-7 days
- Etiology: mostly parainfluenza
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Croup Tx
- 1. Nebulized epinephrine
- 2. Dexamethasone: reduce symptoms in patients with moderate-to-severe croup.
- 3. Nebulized budesonide: has been shown in several studies to be equivalent to oral dexamethasone
- 4. Inhaled Decadron: also used when budesonide is unavailable.
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