Test1

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atmu
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173763
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Test1
Updated:
2012-09-27 07:48:03
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Test 1
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  1. Percent of colds that are viral sinusitis
    90%
  2. Percent of colds that are bacterial sinusitis
    0.5-2%
  3. Duration of viral rhinosinusitis
    7-10 days
  4. 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)
  5. Pathogens that cause bacterial rhinosinusitis
    • 75%
    • 1. S. pneumonea
    • 2. H. influenzea

    • Moraxella cattarhalis
    • ABRS
  6. 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
  7. 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)
  8. 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!)
  9. 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...)
  10. When to use CT scan for rhinosinusitis
    • 1. Chronic rhinosinusitis - after 4+ weeks of treatment
    • 2. To see if infection spread
  11. Viral pharyngitis symptoms not present in bacterial
    • 1. conjuctivitis: associated w/ adenovirus
    • 2. cough and rhinorrhea
    • 3. vesicular lesions (coxsackie virus & herpes)
  12. 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)
  13. Tx for GAS
    • 1. Penicillin for 10 days
    • 2. Amoxicillin

    • Alts:
    • 1. Cephalosporins: cefazolin
    • 2. Microlides: azithromycin, clindomycin

    No response within 48 hrs = amoxicillin
  14. Complications of bacterial pharyngitis
    • 1. Peritonsilar abcess
    • 2. Acute epiglotittis
  15. 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
  16. 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
  17. Mononucleus Sx
    • 1. rash after using Amoxicillin
    • 2. tonsilar exudates
    • 3. splenomegaly
    • 4. Triad: fever, lymphadopathy, severe sore throat
    • 5. palatal petechiae
  18. 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
  19. 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
  20. Croup age, duration, etiology
    • Age: under 5 yrs 
    • Duration: 3-7 days
    • Etiology: mostly parainfluenza
  21. 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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