APEA ENT
Acute bacterial rhinosinusitis
Nasal congestion, obstruction • Purulent nasal discharge* • Maxillary tooth discomfort • Facial
pain, pressure worse with bending forward*
Symptoms >10 days without clinical improvement • Onset with severe symptoms (fever, purulent
drainage) lasting at least 3 consecutive days at the beginning of the illness • Symptoms
worsened after initial improvement
Relieve symptoms (nasal stuffiness, rhinorrhea) Promote drainage!!!! or give amoxicillin 5 to 7
days. remember it is a bacterial infection. - ANS-Inflammation of the paranasal sinuses due to
bacterial, viral, or fungal infection, or allergic reaction
sx:
tx:
• Age >65 years • Hospitalization in last 5 days • Antibiotic use in previous month •
Immunocompromised people • Presence of multiple comorbidities • Severe infection (temp
>102F, severe headache) - ANS-Who is at risk for pneumococcal resistance (acute bacterial
infection)?
CT Scan with contrast• Demonstrates: Almost always diagnostic! Air fluid levels Mucosal edema
Air bubbles
With contrast: helpful for a suppurative complication like cellulitis, intracranial infection -
ANS-periorbital cellulitis. What is the imaging study of choice?
Pharyngitis/Tonsillitis - ANS-• An acute inflammation of the pharynx/tonsils
Most important and treatable is Group A Strep (accounts for 5-15% of adults with pharyngitis)
Viruses (50%)
Viruses (50%) • Influenza • Parainfluenza • Coronavirus • Rhinovirus • Adenovirus • Enterovirus
• RSV • Cytomegalovirus • HIV • Epstein Barr virus • Metapneumovirus -
ANS-Pharyngitis/Tonsillitis viruses?
absent cough
, anterior cervical nodes, symmetrical
Temp. greater than 100.4
tonsillar exudate or swelling
3 to 14 years of age get +1
at 1 point for each symptom. if greater than 2 then may have strep - ANS-strep throat sx center
criteria?
Consider screening if Centor score 2 or >
• Screen adults with Centor score ≥3 with RADT
• Adults at high risk for infections (chronic steroid use, DM poorly controlled,
immunocompromised, etc.), throat culture if RADT negative - ANS-screening for strep throat if
points are greater than 2?
penicillin. - ANS-group a streptococcus treatment?
infectious mononucleosis - ANS-Viral infection caused by Epstein-Barr virus (EBV) of the
herpes family of viruses and is characterized by malaise and fatigue
Tetrad 3's and an L
Fatigue can last days to weeks
Fever
Pharyngitis can be painful, severe, exudative
Lymphadenopathy: posterior cervical nodes most commonly
50% have enlarged spleen
Penicillin - ANS-infectious mononucleosis Assessment Findings?
what med should you not give?
Monospot :
May be negative early in infection Detects presence of heterophile antibodies
Viral capsid antigen (VCA):
IgM appears at onset of clinical illness (if positive means have it now)
IgG appears 6-12 weeks after onset of symptoms (if positive means had it in the past)
Viral capsid antigen (VCA): anti-VCA IgM, IgG • CBC: lymphocytosis (12,000-18,000 is
common) (66% of pts exhibit this) • Atypical lymphocytes (75% of pts) • Elevated ALT, AST
(>50% of pts) - ANS-infectious mononucleosis Diagnostic Studies:
monospot?
Acute bacterial rhinosinusitis
Nasal congestion, obstruction • Purulent nasal discharge* • Maxillary tooth discomfort • Facial
pain, pressure worse with bending forward*
Symptoms >10 days without clinical improvement • Onset with severe symptoms (fever, purulent
drainage) lasting at least 3 consecutive days at the beginning of the illness • Symptoms
worsened after initial improvement
Relieve symptoms (nasal stuffiness, rhinorrhea) Promote drainage!!!! or give amoxicillin 5 to 7
days. remember it is a bacterial infection. - ANS-Inflammation of the paranasal sinuses due to
bacterial, viral, or fungal infection, or allergic reaction
sx:
tx:
• Age >65 years • Hospitalization in last 5 days • Antibiotic use in previous month •
Immunocompromised people • Presence of multiple comorbidities • Severe infection (temp
>102F, severe headache) - ANS-Who is at risk for pneumococcal resistance (acute bacterial
infection)?
CT Scan with contrast• Demonstrates: Almost always diagnostic! Air fluid levels Mucosal edema
Air bubbles
With contrast: helpful for a suppurative complication like cellulitis, intracranial infection -
ANS-periorbital cellulitis. What is the imaging study of choice?
Pharyngitis/Tonsillitis - ANS-• An acute inflammation of the pharynx/tonsils
Most important and treatable is Group A Strep (accounts for 5-15% of adults with pharyngitis)
Viruses (50%)
Viruses (50%) • Influenza • Parainfluenza • Coronavirus • Rhinovirus • Adenovirus • Enterovirus
• RSV • Cytomegalovirus • HIV • Epstein Barr virus • Metapneumovirus -
ANS-Pharyngitis/Tonsillitis viruses?
absent cough
, anterior cervical nodes, symmetrical
Temp. greater than 100.4
tonsillar exudate or swelling
3 to 14 years of age get +1
at 1 point for each symptom. if greater than 2 then may have strep - ANS-strep throat sx center
criteria?
Consider screening if Centor score 2 or >
• Screen adults with Centor score ≥3 with RADT
• Adults at high risk for infections (chronic steroid use, DM poorly controlled,
immunocompromised, etc.), throat culture if RADT negative - ANS-screening for strep throat if
points are greater than 2?
penicillin. - ANS-group a streptococcus treatment?
infectious mononucleosis - ANS-Viral infection caused by Epstein-Barr virus (EBV) of the
herpes family of viruses and is characterized by malaise and fatigue
Tetrad 3's and an L
Fatigue can last days to weeks
Fever
Pharyngitis can be painful, severe, exudative
Lymphadenopathy: posterior cervical nodes most commonly
50% have enlarged spleen
Penicillin - ANS-infectious mononucleosis Assessment Findings?
what med should you not give?
Monospot :
May be negative early in infection Detects presence of heterophile antibodies
Viral capsid antigen (VCA):
IgM appears at onset of clinical illness (if positive means have it now)
IgG appears 6-12 weeks after onset of symptoms (if positive means had it in the past)
Viral capsid antigen (VCA): anti-VCA IgM, IgG • CBC: lymphocytosis (12,000-18,000 is
common) (66% of pts exhibit this) • Atypical lymphocytes (75% of pts) • Elevated ALT, AST
(>50% of pts) - ANS-infectious mononucleosis Diagnostic Studies:
monospot?
