Articles Family Practice

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mbrieger
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34523
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Articles Family Practice
Updated:
2010-09-13 18:56:01
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Family Practice
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Articles for family practice rotation
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  1. Most common bacterial etiology of acute otitis media
    • Streptococcus aureus g+ cocci, grapelike clusters, falcultative anerobic
    • Streptococcus pneumoniae g+ diplococci, aerotolerant anaerobe
    • Haemophilus influenzae g- rod, aerobic or falcultative anaerobic
    • Moraxella catarrhalis g- diplococci, aerobic
    • Pseudomonas aeruginosa g- rod, aerobic
  2. Otitis media definition, acute vs chronic
    • inflammation of middle ear space
    • acute < 2 - 3 weeks
    • chronic > 3 months
  3. Most common surgery for children in US
    tympanostomy tubes - 1-2mm tubes of teflon, silicone, polyethylene and stainless steel or titanium to allow drainage

    • 2 million yearly
    • Out patient procedure
  4. tympanocentesis should be considered in children who
    fail treatment after 10 to 28 days
  5. Most common complication of tympanostomy surgery
    AOM with otorrhea - acute purulent discharge
  6. Recommended treatment of AOM by CDC, WHO, AAFP, AAP
    1st line -- standard dose amoxicillin x 5 to 7 days

    • If child is <24 mo, attends day care or has been tx'd within 30 days then
    • 1st line - high dose amoxicillin x 10 days
  7. Antibiotic approved for the middle ear that are not ototoxic
    • ofloxacin (fluoroquinolone)
    • ciprofloxacin (fluoroquinolone)/dexamethasone
  8. Which is louder inspiratory or expiratory breath sounds and why
    inspiratory are louder because the airway become progressively smaller as air comes into the lung causing turbulence
  9. tracheal breath sounds
    • very loud
    • relatively high pitched
    • inspiratory sound length = expiratory sound length
    • not routinely auscultated
  10. vesicular breath sound
    • major normal breath sound
    • heard over majority of lung
    • soft low pitch
    • inspiratory sound length > expiratory sound length
  11. bronchial breath sounds
    • very loud
    • high pitched
    • gap between inspiratory and expiratory phase
    • expiratory sound length>inspiratory sound length
    • heard over manubrium
    • indicate consolidation (solid/liquid is present where air was)
  12. bronchovesicular breath sounds
    • intermediate intensity and pitch
    • inspiratory sound length = expiratory sound length
    • heard over 1st and 2nd ICS and between scapula (mainstem bronchi)
    • indicate consolidation
  13. Decreased or absent breath sounds occur in
    • ARDS
    • Emphysema
    • Pleural effusion
    • Pneumothorax
  14. Absent breath sounds occur in
    atelectasis
  15. bronchial breath sounds in abnormal locations indicate
    • consolidation
    • test for egophony and whispered pectroliloquy
  16. crackles
    • discontinous
    • nonmusicle
    • brief
    • more common on inspiration
    • may be classified as fine or course
  17. fine crackle sound
    • high pitched
    • soft
    • very brief
  18. course crackles sound
    • low pitched
    • loud
    • less brief
  19. crackles may be normal in what situations
    • anterior lung bases after
    • maximal expiration
    • prolonged recumbency
  20. crackles are mechanically caused by
    • small airways opening during inspiration and collapsing during expiration
    • incompletely closed airways during expiration
    • bubbles through secretions
  21. Conditions in which crackles are heard
    • ARDS
    • asthma
    • bronchiectasis
    • chronic bronchitis
    • consolidation
    • early CHF
    • pulmonary edema
    • interstitial lung disease
  22. Wheeze are
    • continuous
    • high pitched
    • hissing
    • heard on expiration (sometimes on inspiration)
  23. Wheezes are mechanically caused by
    • air flow through airways narrowed by
    • secretions
    • foreign bodies
    • obstructive lesions
  24. listen for changes in wheezes and crackles after
    deep breath or cough
  25. may indicate if one or both air ways are involved
    monophonic wheezes vs. polyphonic wheezes
  26. Weezing may be present in what conditions
    • asthma
    • chronic bronchitis
    • COPD
    • CHF
    • pulmonary edema
  27. Rhonchi are
    • low pitched
    • continuos
    • musical sounds (similar to wheeze)
    • imply obstruction of larger airway
  28. Stridor is
    • inspiratory musical wheeze
    • loudest over trachea during inspiration
    • suggests obstruction of trachea or larynx --> EMERGENCY
  29. Pleural Rub
    • creaking or brushing sound
    • discontinuous or continuous
    • usually localized over a particular site in chest wall
  30. Pleural rub is caused by
    imflammed or roughened pleural surfaces rubbing against each other
  31. Pleural rub is heard in
    • pleural effusion
    • pneumothrax
  32. mediastinal crunch
    • hamman's sign
    • crunches and crackle synchronized to heart beat (not respiration)
    • heard best in left decubitus position
    • EMERGENCY
  33. mediastinal crunch indicates
    pnumomediastinum
  34. McCaig and Hughes study from 1992 showed that AOM usually resolves without treatment in
    7 days
  35. Required to make a proper diagnosis of AOM
    • pneumatic otoscopy showing decreased movement of TM +
    • unilateral abnormal TM --> bulging, erythematous or cloudy
  36. estimated of URTI in preschool and school aged children per year
    3 to 8 URTI / year
  37. 5 to 10% of children with URTI will develop
    sinus infection as a complication of a antecedent viral infection
  38. bacteria that cause sinusitis
    • streptococcus pneumonia
    • haemophilus influenzae
    • moraxella catarrhalis
    • (same bacteria as with AOM)
  39. duration of symptoms of rhinosinusitus
    7 days
  40. diagnosis of sinusitis in children
    • persistence of nasal purulence > 10 to 14 days +
    • daytime cough
    • commonly following a URTI

    • less common
    • fever 39 or greater
    • malodorous breath
    • HA
    • facial pain or swelling
    • periorbital swelling
    • sore throat
  41. tx for sinusitis
    1st line - normal dose amoxicillin

    • in high risk individuals such as those listed in AOM
    • high dose amoxicillin x 7 - 10 days
    • amoxicillin-clavulanate
    • cefuroxime axetil

    Macrolids for individuals with penicillin allergies
  42. most common cause of sore throat
    • adenovirus
    • EBV
    • parainfluenza
    • RSV
    • herpes simplex
    • influenza A

    and

    non-beta hemolytic streptococcus
  43. most common cause of streptococcal pharyngitis
    streptococcus pyogenes or GABHS
  44. streptococcal pharyngitis peak seasons
    winter and spring
  45. tx of acute streptococcus pharyngitis prevents
    • rheumatic fever
    • peritonsillar abscess
    • toxic shock syndrome
  46. streptococcal pharyngitis diagnosis
    • rapid antigen test
    • throat culture
  47. to assure an accurate rapid strep test
    swab the tonsils and do not touch other parts of the pharynx
  48. tx for streptococcal pharyngitis
    penicillin V 250 mg BID or TID x 10 days, 500mg for adults

    for penicillin allergy --> macrolides (erythromycin)
  49. most common bacteria causing UTI
    E. coli
  50. UTI in infants is a common cause of
    • fever
    • 5%

    children that present with other conditions and fever may have a UTI as well
  51. Diagnosis of UTI
    • gold standard - urine culture obtained by suprapubic aspiration
    • + urinalysis (to speed results and avoid renal scaring from polynephritis)

    • s/s
    • fever > 2 days
    • vomiting
    • diarrhea
    • irritabiltiy
    • flank and suprapubic tenderness
    • malodorous urine
  52. Risk factors for UTI in infants
    • white race
    • < 12 mo
    • > 39 degree C for > 2 days
    • no source of fever
  53. UTI treatment
    • often resistant to trimethoprim-sulfamethoxazole and ampicillin
    • if treatment does not appear to be working
    • tx with 3rd generation cephalosporin, hydration, observation

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