VAP - ✔✔ Occurs >48h after intubation
DD: heart fx, atelectasis, aspiration, ARDS
S/S: 2+ more findings (leukocytosis, fever, purulent sputum) w/
... [Show More] new opacities on CXR
Dx: Blood cx, CXR, clinical s/s
Tx: Empiric abx (Cipro, ceftazadine) - to kill K. aureus
HAP - ✔✔ Occurs w/in 48h after admission
DD: heart fx, atelectasis, aspiration, ARDS
S/S: 2+ more findings (leukocytosis, fever, purulent sputum) w/ new opacities on CXR
Dx: Blood cx, CXR, clinical s/s
Tx: Empiric abx (Cipro, ceftazadine) - to kill K. aureus
H. influenzae - ✔✔ Common CAP causes in infants and children, can cause meningitis (needs tx for 7d), can cause otitis media, epiglottis
What is the abx choice for H. influ that causes otitis media? - ✔✔ Amoxicillin 500mg-1g PO TID for 10d
What bacteria causes epiglottis? - ✔✔ Encapsulated H. influ (can cause potientally life-threatening airway obstruction
FUO - ✔✔ Illness >3wk duration, fever >38.3
Classification of causes of FUO - ✔✔ Infx (TB/endocarditis), neoplasms (leukemia), autoimmune disorders (SLE), misc, undiagnosed FUO
FUO: lab tests - ✔✔ Routine lab studies, BC, urine cx, sputum cx, etc.
FUO: imaging - ✔✔ CXR, sinus CT, barium enema, C/A/P CT, MRI for detection of nervous system lesions,
FUO: tx - ✔✔ Abx are rarely helpful, may impact infectious disease dx
Neutropenic fever - ✔✔ Pts w/ fever 38.3, for 4+ weeks as an OP or 3+d as inpatient, neutrophils <500, cx are negative
What are possible causes of fevers in neutropenic pts - ✔✔ Fungal infx, occult bacterial infx
What classifies an immunocompromised pt? - ✔✔ pts w/ HIV, absolute neutrophil counts <1000), immunosuppressive meds, of >5mg/d of prednisone
pulm infiltrates in the immunocompromised host: clinical findings - ✔✔ Need examination of expectorated sputum
BAL is helpful in diagnosing what? - ✔✔ P. jirovecii PNA in pts w/ HIV/AIDS
Peritonsillar abscess (quincy) - ✔✔ Presents w/: severe sore throat, odynophagia, trismus, medical deviation of the soft palate, abnormal muffled voice (hot potato)
What is helpful in dx peritonsillar abscess, but not required? - ✔✔ ultrasound
How do you confirm the dx of peritonsillar abscess? - ✔✔ By aspirating pus just superior and medial to the upper pole of the tonsil
What is the tx for peritonsillar abscess in the ER? - ✔✔ Parenteral amoxicillin (1g), amoxicillin-sulbactam (3g), or clindamycin (600-90mg)
Peritonsillar abscess: tx for less severe cases that can do PO intake - ✔✔ 7-10d w/ PO abx, amoxicillin 500mg TID, clindamycin 300mg QID
How do you prevent recurrence of a peritonsillar abscess? - ✔✔ Quinsy tonsillectomy
AOM: general considerations - ✔✔ Bacterial infx of the middle ear, usually precipitated by a viral URI that causes eustachian tube obstruction
What are the most common pathogens of AOM? - ✔✔ S. PNA, H. inf, S. pyogenes
AOM: S/S - ✔✔ Otalgia, aural pressure, decreased hearing, fever
physical findings: erythema and decreased motility of the tympanic membrane, occasionally bullae
AOM: when is tympanic membrane at risk for rupture? - ✔✔ When middle ear empyema is severe, the TM bulges outward
AOM: S/S of TM rupture - ✔✔ Sudden decrease of pain, followed by an onset of otorrhea
AOM: Tx - ✔✔ Abx w/ nasal decongestants
- amoxicillin (80-90 mg/kg/d divided 2x daily)
AOM: recurring/resistant infx - ✔✔ Complete tympanocentesis for bacterial of fungal cx
AOM: tx when complication arises (mastoiditis, meninigitis) - ✔✔ Surgical drainage of the middle ear (myringotomy)
AOM: recurrent tx - ✔✔ Single daily dose of sulfamethoxazole (500mg) or amoxicillin (250 or 500mg) given over 1-3m - fx of this tx results in insertion of ventilating tubes
What is the main concern for pts who have pharyngitis/tonsillitis? - ✔✔ Group A beta-hemolytic streptococcal (GABHS) since it can lead to rheumatic fever and glomerulonephritis
Pharyngitis/tonsillitis: S/S (GABHS) - ✔✔ Clinical features of GABHS: fever >38, tender anterior cervical adenopathy, lack of a cough, pharyngotonsillar exudate (if 2-3 factors: intermediate likelihood of GABHS)
Pharyngitis/tonsillitis: S/S (not GABHS) - ✔✔ IF only 1/4 symptoms present: not suggestive of GAHBS (no swab needeD) Severe sore throat w/ odynophagia, tender adenopathy, and scarlatiniform rash, elevated WBC, left shift- NO cough
Pharyngitis/tonsillitis: S/S suggestive of mono - ✔✔ marked lymphadenopathy and a shaggy, white-purple tonsillar exudate, often extending into the nasopharynx (avoid ampicillin d/t rash that might occur)
Pharyngitis/tonsillitis: LAB FINDINGS - ✔✔ Single-swab throat cx and rapid antigen detection testing for GABHS
Pharyngitis/tonsillitis: if someone has 4/4 criteria for GABHS, do they need a throat cx? - ✔✔ No, tx w/ empiric abx w/o swab
Pharyngitis/tonsillitis: Treatment - ✔✔ Penicillin V potassium (250mg TID, or 500mg BID for 10d) or Cefuroxime axetil (250 mg PO BID for 5-10d)
Pharyngitis/tonsillitis: Ancillary Tx - ✔✔ Analgesics and anti-inflammatory agents (ASA, tylenol, corticosteroids)
Spinal cord compression: general considerations - ✔✔ Cancers that cause SCC most commonly metastasize to the vertebral bodies, resulting in physical damage to the spinal cord
SCC: S/S - ✔✔ Back pain at the level of the tumor mass - usually develops in the epidural space, resulting in a mixture of nerve root and spinal cord symptoms (progressive weakness and sensory changes) - bowel/bladder symptoms are late findings
SCC: Dx - ✔✔ MRI or PET scan [Show Less]