Medical Quiz on Rhinosinusitis and Urinalysis

ABRS in adults is treated with antibiotics for 5-7 days. Amoxicillin-clavulanate is the first-line choice, but alternatives like amoxicillin or doxycycline can be used for penicillin allergies. If the patient is not improving within 48 hours, consider resistant organisms or misdiagnosis and refer to ENT.

Along with antibiotics, supportive care for ABRS includes saline irrigation, pain relief (ibuprofen and acetaminophen), saline drops, and a neti pot.

Patients with ABRS should be advised to return if their symptoms haven't improved after 48 hours. They should avoid smoking, allergens, irritants, and engage in activities like humidifying the air, elevating the head of bed, and staying hydrated.

AOM is mainly caused by bacterial pathogens like Streptococcus pneumoniae and Haemophilus influenzae, but viral and fungal pathogens are also possible causes.

AOM typically presents with earache, fever (may or may not be present), hearing loss or muffled sound, stuffiness, fullness, and sometimes vertigo.

A quick and inexpensive test that uses a dipstick to detect certain substances in urine, helping to identify a possible UTI.

A substance released by white blood cells (neutrophils) that indicates inflammation or infection in the urine.

Presence of nitrate in urine strongly suggests a UTI.

Measures the concentration of dissolved substances in urine, reflecting the kidneys' ability to concentrate urine.

A lab test determines which antibiotics are effective against the bacteria causing a UTI.

Inflammation of the mucous membranes lining the paranasal sinuses, causing blockage of normal drainage pathways, leading to mucus retention, decreased clearance, and bacterial growth.

Antibiotics are considered when there is persistent or worsening symptoms for at least 10 days, severe symptoms (high fever, purulent discharge, facial pain) lasting 3-4 days, or new onset of symptoms after a typical viral URI.

Rhinosinusitis can be caused by infectious agents (bacterial or viral) like Streptococcus pneumoniae, Haemophilus influenzae, Moraxella, or viruses like adenovirus, or by non-infectious factors like allergies.

Factors that can increase the risk of rhinosinusitis include recent URI or influenza, allergic rhinitis, environmental pollutants, anatomical abnormalities, hormonal changes, and medications.

Common symptoms include nasal congestion or obstruction, nasal discharge, loss of smell (anosmia), dental pain, increased head pressure, sore throat, cough, throbbing facial pain, bad breath, fatigue, and malaise.

Imaging is recommended when there is facial swelling, rhinosinusitis unresponsive to antibiotics for 48 hours, toxic appearance, or suspicion of chronic or recurrent rhinosinusitis.

Double sickening refers to new onset of fever, headache, or increased nasal discharge following a typical viral URI that was initially improving. It suggests a bacterial infection and may warrant antibiotic treatment.

Medical history and physical examination are crucial for assessing rhinosinusitis. They help determine the cause, severity, and duration of symptoms, guiding treatment decisions and identifying potential complications.

Adenovirus, parainfluenza, coronavirus, coxsackievirus, EBV, and CMV are frequent culprits behind viral pharyngitis. These viruses commonly cause the typical symptoms associated with this condition.

Group A Streptococcus, commonly known as GABHS, is the most prevalent bacterial pathogen causing pharyngitis. This bacterium leads to characteristic symptoms such as sore throat, fever, and swollen lymph nodes.

Viral pharyngitis is characterized by a gradual onset of sore throat, often accompanied by other URI symptoms such as cough, congestion, conjunctivitis, and hoarseness. It typically involves a low-grade fever or no fever at all.

Streptococcal pharyngitis presents with an abrupt onset of severe sore throat, tender and swollen lymph nodes, and a lack of other URI symptoms. The presence of pharyngeal erythema, tonsillar edema, and tonsillar exudate is common.

The presence of acute onset pharyngitis with tonsillar exudate, fever, cervical lymphadenopathy, and absence of other URI symptoms strongly suggests strep throat

Pharyngitis caused by Neisseria Gonorrhoeae is treated with a single injection of Ceftriaxone 500 mg IM.

Allergic pharyngitis is characterized by intermittent symptoms and an absence of fever. It is often associated with persistent post-nasal drip, and can be triggered by allergens, leading to symptoms like sneezing, itchy eyes, rhinorrhea, and sore throat that worsens when lying down.

Treatment for viral pharyngitis typically involves supportive care with over-the-counter medications such as NSAIDs, Tylenol, and decongestants, along with warm water gargling and lozenges for symptom relief.

For more persistent or severe cases, treatment may include a combination of nasal corticosteroids and antihistamines, minimally sedating oral antihistamines or decongestants, or even injection immunotherapy.

Pharyngitis caused by Group A Streptococcus is typically treated with penicillin VK 500mg PO BID for 10 days. If allergic to penicillin, alternative options include Cephalexin 500mg PO BID x 10 days, or Azithromycin 500mg/day on the first day followed by 250mg PO daily for 4 days.

A condition characterized by sores in the lining of the stomach or duodenum.

A type of bacteria that can infect the stomach and cause peptic ulcers.

Ulcers caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.

Pain in the upper middle part of the abdomen, often described as sharp, burning, aching, or gnawing.

Indigestion, characterized by heartburn, bloating, and a feeling of fullness after eating.

Frequent loose stools, typically more than three bowel movements a day with liquid consistency.

Diarrhea that lasts for less than four weeks.

Diarrhea that lasts for more than four weeks.

A serious bacterial infection that causes severe diarrhea, often after antibiotic treatment.

A treatment for C. difficile where healthy donor stool is inserted into the patient's colon.

Difficulty or infrequent bowel movements, often accompanied by hard, dry stools.

A chart that categorizes stool consistency and appearance, helping to identify different bowel habits.

A state of lacking sufficient body fluids, often caused by diarrhea or vomiting.

A laboratory test that identifies bacteria or other microorganisms present in stool.

Microscopic amounts of blood in stool, often undetectable by the naked eye.

The half-life of Savaysa (edoxaban) is 10 to 14 hours. This means it takes about 10 to 14 hours for the body to eliminate half of the drug from the system.

Warfarin reversal agents include Vitamin K (2.5-10 mg IV/PO) and fresh frozen plasma (FFP). Vitamin K is more effective in the long term, while FFP provides immediate impact but has a shorter duration.

The reversal agent for Pradaxa (dabigatran) is Praxbind (idarucizumab) 5g IV, administered in two 2.5g doses 15 minutes apart. It neutralizes the anticoagulant effect within minutes.

The reversal agent for Eliquis (apixaban) and Xarelto (rivaroxaban) is Andexxa (andexanet alfa) 400mg-800mg IV bolus followed by an IV infusion for up to 2 hours, resulting in a rapid onset of action.

The 'Tripod Sign' is a positive finding in a straight leg raise test, indicating irritation of spinal nerves L5-S1. It involves the patient in the supine position, the examiner raising the extended leg to 70-90 degrees of hip flexion with the foot dorsiflexed, causing pain between 30-60 degrees.

The 'Femoral Stretch' is a test used to assess nerve irritation in the L2-4 region, which runs along the femoral nerve pathway.

Back pain can be categorized as either 'Mechanical' or 'Systemic'. Mechanical back pain is related to physical issues like muscle strain, herniated discs, and spinal stenosis. Systemic back pain arises from underlying medical conditions such as infections, cancers, or inflammatory diseases.

Carpal Tunnel Syndrome is caused by compression of the median nerve in the wrist, often due to repetitive movements involving wrist flexion, extension, or arm raising.

Carpal Tunnel Syndrome symptoms include intermittent pain, numbness, or tingling in the first three fingers and the radial half of the fourth finger, often worse at night.

De Quervain’s Tenosynovitis is an inflammation of the tendons that control thumb movement, specifically the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis.

Lateral Epicondylitis, commonly known as 'Tennis Elbow', is caused by inflammation and irritation of the tendons on the outer part of the elbow (lateral epicondyle) that control wrist extension, often due to overuse or repetitive motions.

Lateral Epicondylitis (Tennis Elbow) is typically treated with conservative measures like rest, counterforce braces, NSAIDs, and physical therapy. If these measures don't work, a corticosteroid injection may be considered.

Lateral Epicondylitis affects the outer part of the elbow and involves wrist extensor muscles, causing pain with resisted wrist extension. Medial Epicondylitis affects the inner part of the elbow and involves wrist flexor muscles, causing pain with resisted wrist flexion.

Olecranon Bursitis is an inflammation of the bursa (fluid-filled sac) located at the tip of the elbow (olecranon process). The bursa cushions the joint, and inflammation can occur due to injury, overuse, or infection.

Ulnar Nerve Entrapment occurs when the ulnar nerve is compressed at the elbow, typically due to prolonged bending or leaning on the elbow, or direct blows.

Ulnar Nerve Entrapment symptoms include pain on the inner side of the elbow, numbness or tingling on the ulnar side of the fourth and fifth fingers. In severe cases, motor weakness and sensory loss may also occur.

Rotator Cuff Tendinitis is inflammation of the tendons in the shoulder that help rotate the arm. It's common in athletes and individuals who perform overhead activities.

Common symptoms of Rotator Cuff Tendinitis include pain with lifting or reaching overhead, particularly localized to the lateral deltoid. The pain can also occur at night.

Rotator Cuff Tendinitis is inflammation of the tendons in the shoulder, while a Rotator Cuff Tear involves a partial or complete tear of these tendons. Both conditions often cause similar symptoms, but a tear typically involves more severe pain and weakness.

Dyspnea, often known as shortness of breath, can be caused by various factors. The most common causes are cardiac problems, such as congestive heart failure, and pulmonary issues, such as COPD, asthma, or pneumonia.