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What are the major Bacterial pathogens in Acute Bacterial Rhinosinusitis?
S. pneumoniae, H. influenza, M. Catarrhalis
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What does Streptococcus pneumoniae cause?
ARBS, AOM, CAP.
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How does S.pneumoniae become resistant?
25% are DRSP via altered binding sites, and recent antimicrobial use in past 4-6 weeks.
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What are the common gram negative Respiratory bugs?
H. Influenza,
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What are the common gram positive Respiratory bugs?
Streptococcus Pneumoniae,
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What respiratory pathogens are non-gram stainable (neither neg or pos)?
C. pneumonia, M. pneumoniae, Legionella
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Where does M. Catarrhalis typically cause infection?
Not very common but can cause infection in AOM, ARBS, are CAP in people with advanced COPD
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What is resistant issue in M. Catarrhalis?
90 percent are PCN resistant via Beta-Lactamase action
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What is resistant issue in H. Influenzae?
One Third are PCN resistant via Beta-Lactamase action
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What is the reason for Cephalosporin avoidance in a person with PCN allergy?
PCN is a beta-lactam. Cephalosporins have a beta lactam ring.
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What is the rationale for choosing a Respiratory FQ for ABRS?
Because you want coverage for DRSP in addition
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What is ordered if Beta-lactam allergy (PCN and Cephs)?
Doxycyline, or macrolide
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What drugs are in the macrolide class?
The -mycins. Erythromycin, Azithromycin, Clarithromycin
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What bacteria causes Strept throat?
Streptococcus pyogenes
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What does suppurative mean?
Something that creates pus
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What is a CYP 450 substrate?
Medication metabolized by CYP450 for action on body or to be eliminated. Or turns a lipophilic drug into hydrophilic for excretion
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What is a CYP 450 Inhibitor?
Medication or substance that blocks activity of CYP450, limiting substrate excretion allowing for an increase in the substrate level and perhaps substrate induced toxicity
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What is a CYP 450 Inducer?
Medication or substance that accelerates CYP450 so that a substrate exits without doing its job. Example if common
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What percent of drugs are CYP 3A4 substrates and what is example of common CYP 450 3A4 Substrate?
HALF of all drugs are 3A4 substrates. Sildenafil (Viagra), Atorvastatin, Simvastatin, Venlafaxine, Alprazolam, Rifampin
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Examples of antibiotic CYP 3A4 inhibitors?
Erythromycin, clarithromycin,
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What if someone took a CYP 3A4 inhibitor with a 3A4 substrate and example of reaction?
You would cause the blockage of the substrate metabolism and potential for toxicity. Example is taking erythromycin and being on Atorvastatin will have high statin circulating
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Example of common 3A4 inducer?
St. Johns Wort. Use of this and a substrate can lead to reduced therapeutic effect of the 3A4 substrate drugs.
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Examples of what St Johns Wort can make ineffective?
CYP 450 3A4 substrates such as antivirals, and birth control pills
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What drug is a poly substrate CYP 450 isoenzyme inducer?
Rifampin. Check every single drug for potential issues
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With CYP 450 issues in mind, for instance on a patient who does not know what meds he is on and he needs an antibiotic for ABRS, what do you give?
Amoxicillin and cefdinir is safe. If PCN allergy, Azithromycin.
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What would you find with Weber test with AOM with effusion?
Weber lateralized to affected ear
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Ipratropium Bromide nasal spray role in allergic rhinitis?
Will decrease nasal discharge
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Rope-like discharge in eye?
Allergic conjunctivitis. Often with itch. Red eyes.
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What Cranial Nerves are assessed when checking Extraocular Eye movements?
CN 3, 4, 6
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What is the other word for canker sore?
Aphthous stomatitis
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Optic disc is found closer to nose or ear?
Optic Disc is closer than nose
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What is the physiologic cup to disk ratio in the eye?
Cup is half size of the disc
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What is the artery to vein ratio in the retina?
More veins than arteries. A:V ratio 2:3 to 4:5
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What does senile cataract do to vision?
Lose distant vision and general blurriness of vision
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What is the Amsler grid test used for?
Assessing macular problems and macular degeneration
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What vision is lost in macular degeneration?
Central vision
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What is the most common cause of blindness in the older adults?
Macular degeneration
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Antibiotic eye drop for most suppurative conjunctivitis?
FQ ocular solution. Or Polymyxin B with trimethoprim. Or Azithromycin.
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Otitis externa what pathogen, what treatment antibiotic and self care prevention tip?
Pseudomonas. Ofloxacin otic drops or ciprofloxacin with HCTZ, or polymyxin B with neomycin and hydrocortisone. Clean ear with 1:2 mixture of white vinegar and rubbing alcohol after swimming.
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Malignant Otitis Externa is suspect is treated with?
Oral ciprofloxacin for pseudomonas, may need CT and surgical debridement
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AOM treatment?
Amoxicillin HD. Or Augmentin or cefdinir if tx failure
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What would AOM look like on exam?
Bulging or retracted TM, loss of translucency, loss of TM mobility, displaced light reflex, displaced landmarks, erythema of TM
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What is a cholesteatoma?
Cauliflower like growth in ear, with foul smelling discharge. Benign but can grow and erode CN 7 and mastoiditis.
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Exudative pharyngitis caused by what pathogens?
Group A,C,G streptococcus, viral, HHV 6 or M. pneumoniae
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Treatment for exudative Pharyngitis?
PCN x 10 days. Or Erythromycin x10 days. Or Azithromycin x 5 days.
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What causes conductive hearing loss?
Sound cannot enter external or middle ear. Due to Fluid, Cerumen, or foreign body.
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What are the systemic concerns for Strept throat caused by strept pyogenes?
Scarlet fever. Rheumatic Fever- antibiotic with infection will minimize risk of RH. Acute Glomerulonephritis- antibiotic with infection will not minimize risk of GN.
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What is hairy Leukoplakia, where is it found and what can it indicate?
Lateral tongue positive for white discoloration with Elongated papilla. Need to Rule out HPV.
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What is the mononucleosis Triad?
Fever, pharyngitis, lymphadenopathy
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What medication should not be given in Mono patient?
Ampicillin or amoxicillin can cause rash when given in acute mono
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What drugs are ototoxic?
Aminoglycosides, loop diuretics, vancomycin, erythromycin, antimalarials, and cisplatin
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What pupil change is noted in acute glaucoma?
Fixed, dilated OVAL shaped
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What are cotton wool patches (or soft exudates) noted in?
HTN retinopathy
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What are flame hemorrhages noted in?
HTN retinopathy
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What are hard exudates noted in?
HTN and DM retinopathy
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What is neovascularization noted in?
DM retinopathy
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What is copper and silver wire arterioles noted in?
HTN retinopathy
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What is another name for Hordeolum and what causes it?
Stye. Due to staphylococcal infection of eyelid sebaceous gland at hair follicle. Painful.
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What is a Chalazion?
Chronic inflammation of the meibomian gland (sweat gland) of the eyelid. Not as painful.
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What medication is used to treat all glaucomas?
Topical beta adrenergic antagonists- timolol. And topical alpha 2 antagonists- brimonide. And topical carbonic Anhydrase inhibitors- dorzolamide.
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What is meniere�s diease?
Acute vestibular imbalance with vertigo and hearing loss. Causes dizziness and low frequency hearing loss, tinnitus.
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What is typical meninere episode?
Repeat attacks that can last minutes to hours. Triggers can be food, drinks, stress, menses. Causes severe N/V, imbalance, vertigo, hearing problems.
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What causes Meniere disease?
Ototoxic drugs such as aminoglycosides, salicylate therapy, chemo, loud noise exposure. Causes an increase pressure in endolymphatic system of ears
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What is included in treatment of Meniere's disease?
Oral diuretics, low sodium diet. Otherwise, surgery , vestibular neurectomy or labyrinthectomy (will result in hearing loss)
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What is Cheilosis and what can cause?
Skin fissures and maceration at corners of mouth. Oversalivation< IDA
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Angular cheilitis is caused by what organism and how is it treated?
Candida. In immunocompromised people. Treat with Nystatin.
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What can cause exudative pharyngitis and what is first line treatment?
Virus, HHV-6 (human herpes), Group A, C, and G streptococcal, M. pneumoniae. PCN is first line treatment
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What are the risk factors for oral cancer?
Age, tobacco use, ETOH, and chronic infection with HPV 16
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What is infectious mononucleosis virus name and what is the classic triad?
Epstein-Barr Virus. HHV-4. Acute pharyngitis, fatigue, lymphadenopathy
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What is the concern with EBV and sports?
EBV can cause hepatosplenomegaly and spontaneous splenic rupture. Must do abdominal US prior to release for sports.
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What are the risk factors for ABRS?
Allergies, tobacco, sinus structure abnormalities, recent viral infection,
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What is the Rosebaum chart?
Used to assess near vision
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What is acute iritis?
Throbbing eye pain, irregular shaped pupil, construction with ciliary flush (redness of circumcorneal area) photophobia, blurred vision. Immediate referral needed
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What is A/V nicking seen in?
HTN Retinopathy
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What is the leading cause of blindness in 20 to 60 year olds?
Diabetic retinopathy. Progressive microangiopathy with small vessel damage and occlusion
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What is the most common cause of sensorineural healing loss?
Presbycusis. Gradual decline in cochlear function, related to age
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What are the most common causes of conductive hearing loss?
Permanent: otosclerosis (stapes fixation), TM scarring or sclerosis, and trauma. Temporary: objects in ear, wax, fluid, etc
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What do miotic drops do, use in glaucoma, and what are examples?
Constrict pupils. Anticholinergics (pilocarpine) given in open angle glaucoma to cause sphincter contraction to promote vision by facilitating aqueous humor outflow
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What do mydriatic drops do and what is it use in glaucoma, and examples?
Dilate pupils. Used in eye exams. Atropine like. Tropicamide (Mydriacyl) Avoid in angle closure glaucoma, will make worse.
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What is typical nasal mucosa of someone with chronic allergic rhinitis?
Swollen, boggy, pale gray.
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What is the classification for Tonsil grading?
1+ to 4+. 3+ touches uvula. 4+ touches other tonsil
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What are the symptoms of acute angle closure glaucoma?
Halos around lights, blurred vision, eye pain, N/V, conjunctival injection, HA, cloudy cornea, Increased IOP
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Symptoms of detached retina?
Sudden vision loss, 'Curtain came down over my eye', flashing lights, floaters. Retina looks pale, opaque, folds and undulates.
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Differentiation between Trigeminal Neuralgia and Temporal arteritis symptoms?
TN is sharp, piercing, shooting pain, severe. TA is deep, throbbing, HA, tender torturous artery noted. ESR may be elevated.
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