PNEUMONIA INFECTIOUS AGENTS

1.Haemophilus influenza -Smokers, COPD
2.Mycoplasma --------Young, otherwise healthy patients
3.Legionella --------Epidemic infection in older smokers, particularly when located near infected water sources, such as air-conditioning systems

4.Pneumocystis jiroveci (formerly carinii) pneumonia HIV-positive persons with <200 CD4 cells not on prophylaxis.
5.Coxiella burnetti (Q-fever) Exposure to animals, particularly at the time they are giving birth
6.Klebsiella Alcoholics
7.Staphylococcus aureus Following viral syndromes or viral bronchitis, especially influenza
8.Coccidioidomycosis Exposure to the deserts of the American Southwest, particularly Arizona
9.Chlamydia psittaci Exposure to birds
10.Histoplasma capsulatum Exposure to bat or bird droppings, spelunking (recreational cave exploration)
11.Bordetella pertussis Cough with whoop and post-tussive vomiting
12.Francisella tularensis Hunters, or exposure to rabbits
SARS, Avian injluenza Travel to Southeast Asia
13.Bacillus anthracis, Yersinia pestis, and Francisella tularensis Bioterrorism

ANDROGEN DEFICIENCY IN MALE

Symptoms and signs suggestive of
androgen deficiency in men

• Incomplete sexual development, eunuchoidism,
aspermia
• Reduced sexual desire (libido) and activity
• Decreased spontaneous erections
• Breast discomfort, gynecomastia
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small or shrinking testes (especially < 5 mL)
• Inability to father children, low or zero sperm counts
• Height loss, low-trauma fracture, low bone mineral
density
• Reduced muscle bulk and strength
• Hot flushes, sweats

THE MANAGEMENT OF VARIZELLA ZOSTER VIRUS EXPOSURE AND INFECTION IN PREGNANCY AND NEW BORN PERIOD

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1.Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection.

2.Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease.

3.Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy.

4.Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox.

5.ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery.

6.Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG.

7.Breastfeeding of babies infected with or exposed to VZV is encouraged.

8.A mother with chickenpox or zoster does not need to be isolated from her own baby.

9.If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative.

10.The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG.

11.After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.

Asthma Management of Exacerbations

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ASTHMA

Managing exacerbations

SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Management of exacerbations in adults

A short (7-10 days) course of oral corticosteroids is the current standard treatment for adults with moderate-to-severe asthma exacerbations.
I
When administering a SABA via MDI during an exacerbation, use a spacer. [√]
In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. II
Merely doubling the maintenance ICS dose is not effective in managing exacerbations. II
Management of exacerbations in children

A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. I
Children who are taking regular preventive medication should continue taking the same dose during an exacerbation. II
When administering a SABA via MDI during an exacerbation, use a spacer. III-1
Merely doubling the maintenance ICS dose is not effective in managing exacerbations in children. II

Understanding Cervical Pathology

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Cervical pathology ! Hot topic in AMC

ASTHMA KEY POINTS

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ACUTE ASTHMA
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Managing acute asthma in adults

If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status.
[√]
Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma.
[√]
Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan.
[√]
Managing acute asthma in children

If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs (< 6 years) or 8-12 puffs (≥6 years) via MDI.
I
Load the spacer with one puff at a time and give each puff separately.
III-1
If treatment with an oral corticosteroid (e.g. prednisolone 1 mg/kg up to 60 mg as a single daily dose) has been initiated for a moderate-to-severe acute episode, continue for up to 5 days.

MCQs

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Hi next to come is MCQ discussion............please mind that you needs to know what exactly is "ASKING".......this will help to select what is the answer.....!!!