PT 2: Upper Respiratory Tract Infections (EXAM 5) - (14 EASYGENERATOR Q's)

*EASYGENERATOR Q* Duration of treatment for a child with rhinosinusitis should be ____1___ whereas the duration of treatment for an adult may be ____2_____

1. 10-14 days 2. 5-7 days

1. QID dosing is _________ preferred in acute otitis externa (neomycin, polymyxin B, hydrocortisone). A. LESS B. MORE 2. Possible side effects of antibiotics when treating acute otitis externa include dermatitis in patients with chronic dermatoses. This is more common with? A. Aminoglycoside (neomycin) B. Quinolone (Ciprofloxacin, Ofloxacin) C. Corticosteroid D. Polymyxin B

1. A 2. A

A throat swab culture and rapid antigen detection test (RADT) are the 2 common diagnostic tests used for patients with s/sx of GABHS pharyngitis. 1. A throat swab culture requires: A. 24-48 hrs B. 12-24 hrs 2. A POSITIVE (+) rapid antigen detection test (RADT)? A. Treat with antibiotics B. Consider a follow-up culture (in children only) 3. A NEGATIVE (-) rapid antigen detection test (RADT)? A. Treat with antibiotics B. Consider a follow-up culture (in children only)

1. A 2. A 3. B

*KNOW* 1. What is the agent of choice for *nonsevere* acute otitis media if *failed therapy at 48-72 hrs* (2-3 days)? A. Augmentin (Amoxicillin-clavulanate) 90 mg/kg/day divided into 2 doses B. Oral 3rd gen Ceph or Ceftriaxone IM x 3 days 2. What is the agent of choice for *severe* acute otitis media if *failed therapy at 48-72 hrs* (2-3 days)? A. Augmentin (Amoxicillin-clavulanate) 90 mg/kg/day divided into 2 doses B. Ceftriaxone IM x 3 days

1. A 2. B

1. The recommendation for a no resolution within 48 hrs acute otitis media that is "non-severe (mild pain, s/sx <48 hrs, fever <102˚F)" is? A. Initiation of 1st line antibiotics & close-follow up B. 2nd line antibiotics 2. The recommendation for a no resolution within 48 hrs acute otitis media that is "severe (+ pain, s/sx >48 hrs, fever >102˚F)" is? A. Initiation of 1st line antibiotics & close-follow up B. 2nd line antibiotics

1. A 2. B

1. The recommendation for unilateral "non-severe (mild pain, s/sx <48 hrs, fever <102˚F)" acute otitis media is? A. Watch & wait OR antibiotics (any age) B. 1st line antibiotics 2. The recommendation for unilateral "severe (+ pain, s/sx >48 hrs, fever >102˚F)" acute otitis media is? A. Watch & wait OR antibiotics (any age) B. 1st line antibiotics

1. A 2. B

1. What is the 1st line therapy choice for children presenting with rhinosinusitis? A. Augmentin 45 mg/kg/day divided into 2 doses x10-14 days B. Augmentin 90 mg/kg/day divided into 2 doses x10-14 days 2. What is the 2nd line therapy choice for children presenting with rhinosinusitis? A. Augmentin 45 mg/kg/day divided into 2 doses x10-14 days B. Augmentin 90 mg/kg/day divided into 2 doses x10-14 days

1. A 2. B *Amoxicillin is NOT recommended due to resistance (H.flu & M.cat)* *Avoid doxycycline in children*

Drops are generally utilized for? A. Otitis media B. Otitis externa

B

1. The recommendation for bilateral "non-severe (mild pain, s/sx <48 hrs, fever <102˚F)" acute otitis media in kids >24 months is? A. Wait & watch OR antibiotics B. 1st line antibiotics 2. The recommendation for bilateral "non-severe (mild pain, s/sx <48 hrs, fever <102˚F)" acute otitis media in kids <24 months is? A. Wait & watch OR antibiotics B. 1st line antibiotics 3. The recommendation for bilateral "severe (+ pain, s/sx >48 hrs, fever >102˚F)" acute otitis media is? A. Wait & watch OR antibiotics B. 1st line antibiotics

1. A 2. B 3. B

*EASYGENERATOR Q* Match each patient to the appropriate 1st line therapy 1. 6 YOM with congestion, fever 102F, head hurts & nasal discharge x 1 week 2. 1 YOF with first ear infection, tugging on ear, fever 102F, and irritability x 3 days 3. 38 YOF with sinusitis symtoms + fever x 8 days 4. 5 YOM with congestion, runny nose and fatigue x 48 hrs 5. 16 YOM with itching, redness, fullness and drainage from ear canal x 4 days A. Supportive care; likely viral B. Augmentin 875/125 mg BID x 7 days C. Cipro HC Otic 3 drops BID x7 -10 days D. Augmentin 45 mg/kg/day in divided doses x 10 days E. Amoxicillin 80-90 mg/kg/day in divided doses x 10days

1. D 2. E 3. B 4. A 5. C

Clinical presentation of bacteria pharyngitis includes:

1. Sore throat, pain on swallowing, fever (similar to viral) 2. Erythema/inflammation of tonsils/pharynx 3. Enlarged lymph nodes 4. Red, swollen uvula 5. Petechiae on soft palate 6. Scarlatiniform rash 7. N/V/abdominal pain *rheumatic fever is a significant sign of disease progression*

*KNOW* What is the first line agent for nonsevere (mild pain, s/sx <48 h, Fever <102˚F) acute otitis media? A. Amoxicillin 80-90 mg/kg/day divided into 2 doses B. Augmentin (Amoxicillin-clavulanate) 90 mg/kg/day divided into 2 doses

A

Cephalosporins are NOT usually used 1st line due to poor penetration in the middle ear (exception: Ceftriaxone IM). A. True B. False

A

Intranasal corticosteroids are recommended if patient has history of? A. Allergic rhinitis B. Bacterial rhinosinusitis

A

The watch & wait approach results in reduced antibiotic use thus reduced rates of resistance. A. True B. False

A

What is the 1st line agent for *children* unable or unwilling to tolerate oral medications? A. Penicillin G benzathine (<27 kg) 0.6 million units IM x1 dose B. Penicillin G benzathine (>27 kg) 1.2 million units IM x1 dose

A

What is the 1st line therapy choice for adults presenting with rhinosinusitis? A. Augmentin 875/125 mg PO BID x5-7 days B. Augmentin 45 mg/kg/day divided into 2 doses x10-14 days C. Augmentin 90 mg/kg/day divided into 2 doses x10-14 days

A

Duration of therapy for acute otitis media is? A. 10 days B. 3 days C. 14 days

A *5-7 days is considerable in older children*

Xylitol (birch sugar) is associated with a 25% reduction in AOM recurrence (daycares) but MUST be given __________ to be effective. A. 3-5 times daily B. 2 times daily C. Once daily D. 4-6 times daily

A *formulations include: gum, syrup or lozenge* *usefulness in <2? can't chew gum or lozenge due to safety concerns*

*EASYGENERATOR Q* Which of the following bacterial pathogens are likely in AOM? *select all that apply* A. Streptococcus pneumoniae B. Moraxella catarrhalis C. Streptococcus pyogenes D. Haemophilus influenzae E. Staphylococcus aureus

A, B, D

*EASYGENERATOR Q* Which of the following statements are TRUE regarding pharyngitis? A. 70-90% of pharyngitis cases are viral B. Bacterial pharyngitis is caused by S.pneumo, M.cat & H.flu C. Pen G benzathine 0.6 million units IM x 1 dose would be the BEST option for a 19 kg child unable to tolerate oral medications D. When treating bacterial pharyngitis, duration of therapy for Amoxicillin is 10 days

A, C, D

*EASYGENERATOR Q* AR is a 9 month old female with recurrent AOM. She is currently on Cefdnir for her most recent ear infection, and has a fever of 101F. She weighs 18 lb. Which of the following could be recommended for fever control for this patient? A. Ibuprofen 100 mg q6h prn B. Acetaminophen 100 mg q4-6h prn C. Acetaminophen 180 mg q2-4h prn D. Aspirin 80 mg q8h prn

B

*EASYGENERATOR Q* JJ is a 9 YO 68lb female with sore throat, fever, swollen lymph nodes and petechiae in the roof of the mouth. RADT (+) for Group A B-hemolytic streptococci. Which of the following would be the BEST first line pharmacotherapeutic regimen for JJ? A. Amoxicillin 500 mg PO q6h B. Penicillin G benzathine 1.2 million units IM x 1 dose C. Ceftriaxone 250 mg IM x 1 dose D. Azithromycin 500 mg stat, followed by 250 mg daily x 4 days

B

*KNOW* What is the first line agent for severe (+ pain, s/sx >48 h, Fever >102˚F) acute otitis media? A. Amoxicillin 80-90 mg/kg/day divided into 2 doses B. Augmentin (Amoxicillin-clavulanate) 90 mg/kg/day divided into 2 doses

B

What is the 1st line agent for *adults* unable or unwilling to tolerate oral medications? A. Penicillin G benzathine (<27 kg) 0.6 million units IM x1 dose B. Penicillin G benzathine (>27 kg) 1.2 million units IM x1 dose

B

Antibiotic otic drops should NOT be used in children? A. Pre-tube placement B. Post-tube treatment

B *Are occasionally used in AOM in children with tubes*

In Rhinosinusitis, guidelines suggest treatment candidate after __________ of symptoms A. 5-7 days B. 7-10 days C. 10-14 days

B *we treat rhinosinusitis after 7-10 days of symptoms; in the meantime, they can use OTC products to relieve their symptoms*

*EASYGENERATOR Q* JF is an 6 month old male who is tugging on his right ear and waking/crying frequently at night. He has missed 2 days of preschool due to 103F fever and conjunctivitis. JF filled amoxicillin 3 weeks ago for an ear infection. Which steps would you take? A. Encourage LM's father to watch & wait 48 hrs before filling the Rx, as the infection does not seem severe B. Contact the physician's office to recommend ceftriaxone IM x3 doses C. Contact the physician's office to recommend possible change to Augmentin 90 mg/kg/day in divided doses D. Fill the amoxicillin prescription, as this is the most appropriate regimen

C

*EASYGENERATOR Q* What is the appropriate amoxicillin dosage for AOM? A. 45 mg/kg/day in divided doses B. 90 mg/kg/day in divided doses C. 80-90 mg/kg.day in divided doses D. Amoxicillin is not appropriate for acute otitis media

C

1st line ORAL therapy for *adults* with pharyngitis? A. Penicillin VK 500 mg BID x10 days B. Amoxicillin 25 mg/kg/day BID x10 days C. All the above

C

1st line ORAL therapy for *children* with pharyngitis? A. Penicillin VK 250 mg BID-TID x10 days B. Amoxicillin 25 mg/kg/day BID x10 days C. All the above

C

98% of Acute Otitis Externa (AOE) is caused by bacteria. Which of the following bacteria is/are MOST common? A. Staphylococcus aureus B. Pseudomonas aeruginosa C. Both A & B

C

Even though 70-90% of pharyngitis cases are viral, which of the following are the most common bacterial causes of pharyngitis? A. S. pyogenes B. Group A-hemolytic streptococci (GABHS) C. All the above

C

What are the treatment goals for acute otitis media? A. Cure infection B. Pain management C. Both A & B

C

Which of the following antibiotics are NOT recommended for acute otitis media due to resistance? A. Bactrim B. Erythromycin C. Both A & B

C

*Recurrent AOM* A patient is eligible for tympanostomy tubes if: A. 3 episodes in 6 months B. 5 episodes in 18 months C. Both A & B

C *A tympanostomy is a procedure to place drainage (for fluid & pus) tubes in the middle ear*

*EASYGENERATOR Q* Which of the following statements is TRUE regarding rhinosinusitis? A. Doxycycline is a reasonable first line option in pediatric patients with rhinosinusitis B. Cephalexin is recommended if symptoms are mild/nonsevere C. The most common bacterial causes of rhinosinusitis are H.flu, M.cat & S.pneumo D. Initial therapy for an adult with rhinosinusitis is bactrim DS BID x 3days

C *Macrolides, Bactrim & Cephs are not recommended; neither is doxycyline in pediatrics*

Which of the following is/are NOT recommended if bacterial rhinosinusitis is suspected? A. Decongestants B. Antihistamines C. Both A & B

C *May dry mucosa & impede mucosal clearance*

*KNOW* In acute otitis externa, oral therapies have limited utility but they have a possible role in: A. Diabetics B. Patients with MDR C. Both A & B

C *Topical therapies are recommended*

*KNOW* Which of the following agents can be used for pain management in acute otitis media? A. Ibuprofen (5-10 mg/kg) B. Acetaminophen (10-15 mg/kg) C. All the above

C *We NEVER use Aspirin*

*EASYGENERATOR Q* Which of the following are TRUE statements regarding AOE and AOE treatment options? *select all that apply* A. AOE is typically caused by S.pneumo, Pseudomonas & H.flu B. AOE should be treated first line with oral therapies C. Optimal duration of AOE therapy is 10 days D. Aminoglycoside ear-drops may be more likely to cause dermatitis effects in people with history of inflammatory dermatoses

C & D

*EASYGENERATOR Q* Which of the following statements regarding otitis externa and otitis media infections are TRUE? *select all that apply* A. Amoxicillin is recommended 1st line for otitis externa and otitis media due to excellent penetration of the middle ear B. Prophylactic antibiotic therapy is indicated once a child has has >3 otitis media infections in the last year C. The most common pathogens in acute otitis externa are S. aureus and P.aeruginosa D. Antibiotic ear drops are not recommended in AOM, except in specific situations post-tube placement

C & D

*EASYGENERATOR Q* Which of the following would be the BEST treatment option for acute otitis externa in an adult patient? A. Neomycin based otic drops once daily x 3days B. Penicillin G benzathine 1.2 million units IM x 1 dose C. Augmentin 90 mg/kg/day PO in divided doses x 10 days D. Ofloxacin otic drops BID x 10 days

D

*EASYGENERATOR Q* Your patient is a 3 YO with acute otitis media of the right ear. She is watched at home by her grandmother, and weighs 36 lbs. This is her first ear infection. Which of the following would be the BEST treatment option at this time? A. Ofloxacin otic drops BID x 10 days B. Ceftriaxone IM x 1 dose C. Augmentin 730 mg PO BID x 10 days D. Amoxicillin 700 mg PO BID x 10 days

D

*KNOW* Acute Otitis Media (AOM) is MOST commonly caused by which of the following bacteria? A. Streptococcus Pneumoniae (S.pneumo) B. Haemophilus influenzae (H.flu) C. Moraxella catarrhalis (M.cat) D. All the above

D

Initiate B-lactamase coverage (Augmentin) for INITIAL therapy if: A. Child has received amoxicillin in the last 30 days B. Child has a history of recurrent AOM resistant to amoxicillin C. Child has concurrent purulent conjuctivitis D. All the above

D

Resistance risk factors for Acute otitis media (AOM) include: A. Attendance to child care centers B. Antibiotics in the last 30 days C. Age <2 years D. All the above

D

Topical options for acute otitis externa include: A. Acetic acid B. Corticosteroid C. Antibiotics (AG's, quinolone, polymyxin B) D. All the above

D

Ways to prevent acute otitis media include: A. Vaccination (influenza & PCV13) B. Exclusively breastfeeding for 6 months C. Avoid smoke exposure D. All the above

D

What is the typical treatment duration for acute otitis externa? A. 3 days B. 5 days C. 7 days D. 10 days

D

When deciding on treatment options, there is no significant advantage of using one product over another for acute otitis externa BUT one study showed a small increase in cure rate with: A. Acetic acid B. Corticosteroid C. Aminoglycoside (neomycin) D. Quinolone antibiotic E. Polymyxin B

D

Which of the following agents are NO longer recommended for the treatment of rhinosinusitis? A. Bactrim B. Macrolide's C. Cephalosporins D. All the above

D

Which of the following is TRUE regarding nasal decongestants (OTC) used to relieve symptoms of rhinosinusitis? A. Examples include Oxymetazoline (Afrin) & Phenylephrine (Neo-Synephrine) B. They should NOT be used for more than 3 days C. They can cause rebound congestion if used for more than 3 days D. All the above

D

*KNOW* Rhinosinusitis is majorly viral BUT bacterial causes can include: A. Streptococcus pneumoniae (S.pneumo) B. Haemophilus influenzae (H.flu) C. Moraxella catarrhalis (M.cat) D. All the above

D *SAME as acute otitis media*

OTC agents for treatment of symptoms associated with acute rhinosinusitis include: A. Nasal decongestant sprays B. Oral decongestants C. Saline irrigation D. All the above

D *Saline irrigation is often used in combination with OTC products*

*EASYGENERATOR Q* What is the appropriate Amoxicillin dosage for Rhinosinusitis in a child? A. 45 mg/kg/day in divided doses B. 90 mg/kg/day in divided doses C. 80-90 mg/kg/day in divided doses D. Amoxicillin is NOT appropriate for Rhinosinusitis

D *only augmentin*

*KNOW* Which of the following is TRUE regarding Ceftriaxone IM? A. 3 day treatment results in better outcomes B. It's not used first line due to the need for multiple office visits (3 separate days) & dosing might need to be split (multiple injections at once) C. It's reconstituted with lidocaine D. It would be first line in severe refractory vomiting OR after trying both Amoxicillin & Augmentin E. All the above

E

Clinical presentation of acute otitis media (AOM) includes: A. Ear pain B. Tugging ear C. Irritability/difficulty sleeping D. Fever (<25%) E. All the above

E

Which of the following is TRUE regarding oral decongestants (OTC) used to relieve symptoms of rhinosinusitis? A. Examples include Pseudoephedrine (SudaFed) & Phenylephrine (SudaFed PE) B. Pseudoephedrine is more effective C. When recommending, make sure its appropriate and safe for the patient D. It should be taken in the morning & started on the lowest effective dose E. All the above

E *Pseudoephedrine can cause vasoconstriction, affect the heart, affect BP, cause insomnia & headaches*

2nd line Augmentin 2000 mg PO BID (high dose) is recommended in: A. >65 years old B. Recent hospitalization C. Antibiotic use within the last month D. Immunocompromised E. All the above

E *due to concerns about resistance (PRSP)*