URI

Question 1

URI

Answer 1

• Upper respiratory infections
• Usually caused by viruses
• Have non specific symptoms
• Resolve spontaneously

Question 2

Acute Otitis Media

Answer 2

• Impaired mucociliary apparatus leading to Eustachian tube dysfunction
• Middle ear becomes blocked with fluid and tympanic membrane swells
• Bacteria then isn’t cleared and proliferates and causes infection

Question 3

Why is AOM more common in children?

Answer 3

Eustachian tubes are shorter, narrower, and more horizontal than adults

Question 4

AOM Etiology

Answer 4

• 40-75% are viral

- Common bacterial pathogens: S. pneumoniae, H. influenzae, Morazella catarrhalis

Question 5

AOM Clinical Presentation

Answer 5

• Usually follows viral URI: fever, difficulty sleeping, and tugging at ear
• Bulging of tympanic membrane
• Otorrhea (discharge), otalgia (earache)
• Erythema of tympanic membrane

Question 6

Non-Severe AOM

Answer 6

• Mild otalgia < 48 hours
• Temperature: <39 degrees C
• NEED BOTH

Question 7

Severe AOM

Answer 7

• Moderate-severe otalgia for >= 48 hours
• Temperature >= 39 degrees C
• EITHER

Question 8

AOM Treatment: < 6 mo

Answer 8

10 days of antibiotics

Question 9

AOM Treatment: 6-23 months

Answer 9

• Severe/Non-severe bilateral: 10 days antibiotics

- Nonsevere unilateral: Observe or 10 days of antibiotics

Question 10

“Observe”

Answer 10

• Watchful waiting x 48-72 hours with follow-up

- Access to doctor/antibiotics if symptoms don’t improve in 2-3 days or worse at any time

Question 11

AOM Treatment: 2+ Years

Answer 11

• Severe: 10 days of antibiotics

- Non-severe: observe or 7 days of antibiotics

Question 12

AOM: First Line Treatment

Answer 12

• Amoxicillin: 80-90 mg/kg/day PO q12h

- Augmentin: Amox - 90 mg/kg/day and Clav - 6.4 mg/kg/day PO q12h

Question 13

AOM Alternative Treatment

Answer 13

• Cefdinir: 14 mg/kg/day PO q 12-24h
• Cefuroxime: 30 mg/kg/day PO q12h
• Cefpodoxime: 10 mg/kg/day PO q12h

Question 14

AOM Pain Management

Answer 14

• Ibuprofen: 10 mg/kg q6h PRN

- Tylenol: 15 mg/kg q4-6h PRN

Question 15

AOM Treatment Failure

Answer 15

• Should see improvement in 48-72 hours
• Symptoms could worsen right after diagnosis
• Switch antibiotics if no improvement: Amox => Aug => Ceftrixone
• Consider tympanocentesis if still no improvement - Gram stain, culture, susceptibilities

Question 16

AOM Treatment Failure Succession

Answer 16

• 1st Line: Augmentin and Ceftriaxone
• Alternative/Failure of 2nd: Clindamycin: 30-40 mg/kg/day PO q8h +/- 3rd gen ceph.
• Failure of 2nd: also consider tympanocentesis

Question 17

Acute Bacterial Rhinosinusitis

Answer 17

Inflammation of contiguous nasal mucosa/paranasal sinuses

Question 18

ABR Risk Factors

Answer 18

• Anatomic abnormalities (septal defect)
• Allergies/allergic rhinitis
• Tobacco smoke
• Intranasal medications
• Viral respiratory tract infections/winter months
• Swimming/diving

Question 19

ABR Etiology

Answer 19

• 90-98% are viral

- Bacterial causers: S. pneumoniae, H. influenzae, Moraxella catarrhalis

Question 20

ABR Diagnosis

Answer 20

• Persist signs/symptoms for 10+ days with no improvement
• Severe signs/symptoms: Temp >= 39 C AND purulent nasal discharge/facial pain for 3-4+ consecutive days at the start of illness
• Worsening/”double-sickening” signs/symptoms like new fever onset, headache, or increased nasal drainage after a typical 5-6 typical viral URI with improving symptoms

Question 21

Empiric ABR Children Treatment

Answer 21

• Augmentin: 45 mg/kg/day PO q12h

- Augmentin: 90 mg/kg/day PO q12h

Question 22

ABR Children Treatment + Beta Lactam Allergy

Answer 22

-Levofloxacin: 10-20 mg/kg/day PO q12-24 hr

-Clindamycin: 30-40 mg/kg/day PO q8h
AND
-Cefixime: 8 mg/kg/day PO q12h 
OR
-Cefpodoxime: 10 mg/kg/day PO q12h

Question 23

Children ABR Treatment + Severe Hospitalization

Answer 23

• Unasyn: 200-400 mg/kg/day IV q6h
• Ceftriaxone: 50 mg/kg/day IV q12h
• Levofloxacin: 10-20 mg/kg/day IV q12-24h

Question 24

High Dose Augmentin + ABR

Answer 24

Need at least one risk factor:

• High endemic rates of penicillin non-susceptible S. pneumoniae
• Severe infection: systemic toxicity, T >= 39 C, threat of suppurative complications
• Attending daycare
• <2 y.o. or >65 y.o.
• Recent hospitalization
• Antibiotic use within past month
• Immunocompromised

Question 25

ABR Empiric Adult Treatment

Answer 25

- Augmentin: 500/125 mg PO q8h OR 875/125 mg PO q12h - Augmentin: 2000/125 mg PO q12h - Doxycycline: 100 mg PO q12h

Question 26

ABR Adult Treatment + B-lactam Allergy

Answer 26

- Doxycycline: 100 mg PO q12h - Levofloxacin: 500 mg PO q24h - Moxifloxacin: 400 mg PO q24h

Question 27

ABR Adult Treatment + Severe Hospitalization

Answer 27

- Unasyn: 1.5-3g IV q6h - Levofloxacin: 500 mg PO/IV q24h - Moxifloxacin: 400 mg PO/IV q24h - Ceftriaxone: 2g IV q24h

Question 28

ABR Adjunctive Therapy

Answer 28

- Nasal irrigation with saline - Analgesics: NSAIDs, APAP - Intranasal corticosteroids - Decongestants and antihistamines = NOT recommended

Question 29

Pharyngitis

Answer 29

- Acute, painful inflammation of throat - Most commonly effects children 5-15 y.o. - Occurs most in winter and early spring months

Question 30

Pharyngitis Etiology

Answer 30

- Virus: causes majority of cases | - Bacterial causers: GAS (S. pyogenes)

Question 31

Pharyngitis + Viral Symptoms

Answer 31

- Conjunctivitis - Coryza - Oral ulcers - Hoarseness - Diarrhea - Rash

Question 32

Pharyngitis + Bacterial Symptoms

Answer 32

- Abrupt onset of sore throat - Fever - Headache - GI upset - Patchy exudates - Palatal petechiae - Scarlatiniform rash - Anterior cervical adenitis - Exposure to GAS pharyngitis

Question 33

Pharyngitis Patho

Answer 33

- Possible alteration in host immunity - Flora of orotharynx may migrate to cause infection - Pathogenic factors: pyrogenic toxins, streptokinases, proteinases

Question 34

Pharyngitis Diagnosis

Answer 34

- Throat cultures if presentation isn't consistent with viral pharyngitis - Rapid detection tests are highly specific but not sensitive and a negative reading would need to be confirmed by a culture

Question 35

Centor Criteria

Answer 35

- Temp > 38 C: 1 - Absence of cough: 1 - Swollen/tender anterior cervical nodes: 1 - Tonsillar swelling/exudate:1 Age - 3-14 y.o.: 1 - 15-44 y.o.: 0 - >=45 y.o.: -1

Question 36

Pharyngitis Treatment: Penicillin

Answer 36

- Children: 250 mg PO q8-12hr - Adults: 250 mg PO q6h OR 500 mg PO q12h - Duration: 10 days

Question 37

Pharyngitis Treatment: Amoxicillin

Answer 37

- Children: 50 mg/kg/day PO q12-24 h - Adults: 1000 mg PO q24h OR 500 mg PO q12h - Duration: 10 days

Question 38

Pharyngitis Treatment: Benzathine Penicillin

Answer 38

- <27 kg: 600,000 units IM - >= 27 kg: 1,200,000 units IM - 1 dose

Question 39

Pharyngitis Treatment: Cephalexin

Answer 39

- Used for penicillin allergies - Children: 20 mg/kg PO q12h - Adults: 500 mg PO q12h - Duration: 10 days

Question 40

Pharyngitis Treatment: Clindamycin

Answer 40

- Used for penicillin allergies - Children: 7 mg/kg PO q8h - Adults: 300 mg PO q8h - Duration: 10 days

Question 41

Pharyngitis Treatment: Azithromycin

Answer 41

- Used for penicillin allergies - Children: 12 mg/kg PO q24h - Adults: 500 mg day 1, 250 mg days 2-5 - Duration: 5 days

Question 42

Pharyngitis Treatment: Clarithromycin

Answer 42

- Used for penicillin allergies - Children: 7.5 mg/kg PO q12h - Adults: 250 mg q12h - Duration: 10 days

Question 43

Centor Criteria: =<1

Answer 43

- =< 0: 1-2.5% risk of strept infection - 1: 5-10% risk of infection - No further testing or antiobiotics

Question 44

Centor Criteria: 2-3

Answer 44

- 2: 11-17% risk of strept infection - 3: 28-35% risk of infection - Culture all - Antibiotics for positive culture results only

Question 45

Centor Criteria: >=4

Answer 45

- >= 4: 51-53% risk of strept. infection | - Treat empirically with antibiotics and/or culture