*approved 2-49 Contraindications to nasal flu vax under 2 over 50 long term aspirin use (age 2-17) pregnant women Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months. Influenza antivirals taken in last 48 hours Ppl who care for severely immunocompromised ppl (or avoid contact for 7 days) CAP typical organisms strep pneumo (60-70% of all bacterial CAP)

South University NSG6420 124 CAP atypical organisms influenza, mycoplasma, chlamydia, legionella, adenovirus Most common outpatient CAP organisms strep pneumo, mycoplasma pneumo (m.pneumoaniae), h.flu, chlamydophila pneumo (c.pneumoniae), and resp. viruses CAP organisms in ETOH abuse moraxella catarrhalis and klebsiella pneumo CAP organisms in COPD m. catarrhalis gram positive bacteria organisms in CAP s.pneumoniae- leading cause of PNA in any adult age group Gram neg bacteria in CAP h.flu, m.catarrhalis Most common organism in majority of cases of PNA in those younger than 40 yrs m.pnuemoniae Leading cause of PNA in any adult age group? s.pneumoniae s/sx of atypical CAP? fever, HA, myalgias, dry cough *appear less ill than those with bacterial PNA sx may last up to 6 wks and include dry hacking cough

South University NSG6420 125 CAP dx? chest xray sputum analysis (not routine for outpt) CAP tx for previously healthy pts with no antimicrobial therapy in last 3 months? MACROLIDE CAP tx for pts with comorbids? resp fluoroquinolone -or- B-lactam PLUS a macrolide Most common cause of pharyngitis? virus (90%) rhino, adeno, parainflu s/sx of pharyngitis sore throat, cough, hoarse, fever, odynophagia, malaise, HA, chills, anorexia, enlarged tonsills, erythema, exudates, soft palate petechiae, cervical adenopathy, high fever What not to give in viral pharyngitis? aspirin Tx for pharyngitis? Pen V K 500 BID or TID x10 days *E-mycin or cephalexin in PCN allergy Cause of epiglottitis? h.flu or s.pneumo s/sx of epiglottitis?

South University NSG6420 126 SUDDEN ONSET, severe odynophagia, dysphagia, fever, SOB inability to swallow secretions, neck tenderness, drooling, stridor, resp distress *Tripod position to breathe *THUMB SIGN- no c xray Mono acute viral pharyngitis caused by EBV peak ages for mono 15-24 yrs; incubation period 4-6 weeks s/sx of mono pharyngitis, fever, lymphadenopathy, malaise, splenomegaly, tonsillar exudates, H/a, rash Labs for mono CBC with diff- absolute neutropenia *Lymphocytosis with atypical lymphocytes *mono spot (if neg repeat in 7-10 days) How often to f/u with mono pt? q 1-2 weeks; no contact sports or blunt trauma until re-evaluated (x1month+) allergic rhinitis statistics (American adults) 45-64 age group 65-75 age group 10-30% of American adults 10.7% 45-64 7.8% 65-75 years

South University NSG6420 127 PE findings for allergic rhinitis? tip of nose for droop, assess nasal patency, turbinates, septum for polyps, inflammation, watery mucus, cobblestoning, edema and erythema of nasal mucosa Allergic rhinitis labs/smears?