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What age ranges get abx in strep pharyngitis?
12-20
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How soon do you give CAP tx in the ED?
< 4 hours
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3 viral causes of pneumonia
Influenza, parainfluenza, varicella
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Pt with pneumonia with extrapulmonary manifestations, diarrhea, and sweaty abdominal pain has what type?
legionella
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What is the preferred abx combo for outpt CAP?
Doxy, levo or moxy, and a macrolide (azithromycin)
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What are alternate outpt CAP therapies for pts <50 yo and no comorbidities?
macrolide or doxycycline
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What are alternate outpt CAP therapies for pts >50 yo or with comorbidities?
Fluoro (levo or moxy)
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What are options for empiric abx for hospitalized pneumonia pts?
- 2G or 3G ceph +/- macrolide
- beta lactam/betalactamase inhibitor +/- macrolide
- Quinolone alone
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How do you treat a nursing home pneumonia?
- Pseudomonas: quinolones (cipro, though not as empiric, it doesn't cover strep pneumo)
- 4G ceph (cefapine IV)
- Zosin, gentamycin
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what is a significant urine WBC count?
> 10^5 in non pregnant women, ?100 cfu in men and pregnant women
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Which UTI pts would you suspect having anaerobes?
HIV/AIDs
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Lower UTI tx
short course (3 days) of Bactrim, Cipro or Levo, or macrodantin
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What abx DON'T you use for low UTI?
oral PCN or ceph
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What can cause a clinical UTI with low grade pyuria without bacteruria?
- chlamydia, trichomonas, herpes
- viral (esp. adenovirus)
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Outpt tx for pyelo
- 14 days or longer
- bactrim, quinolone, certain cephalosporins
- NO amp, macrodantin, keflex
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what can prevent rheumatic fever with strep?
- tx started <9 days from onset of sx
- The only abx that can do this is PCN G IM
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what can prevent GN in strep?
no abx, bc GN is an immune reaction
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What are Centor criteria?
- temp >38
- Absence of cough
- Tender and enlarged cervical nodes
- Tonsillar swelling or exudates
- age 3-14 years
- -1 point for age >45
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What are indications for steroids in pharyngitis/tonsillitis?
- difficulty swallowing, pain and inflammation
- dexamethasone or prednisone
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How do you tx severe strep in the ED?
- IVF
- Abx (PCN, Azith, clinda, ceftriaxone)
- Steroid (prednisone, decadron, solumedrol)
- NSAID
- Wait two hours and most pts feel better
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length of abx tx for sinusitis
3 days (may be as good as two weeks due to the fact that a lot of sinusitis is viral)
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most common cause of epiglottitis
traditionally H flu, now it's mostly GM+ bacteria
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epiglottitis tx
- all children get artificial airway (intubate with anesthesia in the OR with ENT present)
- If intubation unsuccessful, do surgical or needle cricothyroidectomy (if that fails then tracheostomy)
- after airway has been secured, do rocephni +/- Vanco
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Most common cause of stridor in children
croup
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Croup tx
Heliox (but not possible if pt requires >40% O2)
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OE tx
- thorough cleansing of ear canal most important
- TM intact: irrigate w/hypertonic saline, h. peroxide, vinegar/alcohol mixture (1:1)
TM perf: cortisporin otic suspension or opthalmic drops
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most useful tool in OM dx
pneumatic otoscopy (light reflex no dx value)
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OM tx failures
- Augmentin, ceph, or zithromax
- If those fail, ceftriaxone
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OM tx length
10 days <6, 5 days if older
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Conjunctivitis tx
- avoid neomycin due to allergy
- Bleph-10 polymixin, quinolones x5d
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