AMBOSS (Usmle step 2ck)_ RESPIRATORY SYSTEM study guide

AMBOSS (Usmle step 2ck)_ RESPIRATORY SYSTEM (1) 1. Cytomegalovirus pneumonia → is highly suspected in immunocompromised deficiency patient, who are positive with pp65 antigen. Treatment includes intravenous ganciclovir. 2. If patient's initial symptoms (watery nasal discharge, fever, headache, and facial pain) are consistent with acute viral rhinosinusitis (AVRS). AVRS usually resolves within 7–10 days; however, the development of mucopurulent discharge with a clinical course greater than 10 days is highly suggestive of bacterial superinfection.Acute bacterial rhinosinusitis can develop following AVRS and is most commonly caused by Streptococcus pneumonia or Haemophilus influenza. Amoxicillin/clavulanic acid is a penicillin antibiotic combined with a β-lactamase inhibitor that is used to treat a number of bacterial infections, particularly respiratory tract infections. This antibiotic is considered the first-line treatment for acute bacterial rhinosinusitis and, therefore, initiation of amoxicillin/clavulanic acid is the most appropriate next step for this patient. A third-generation cephalosporin with or without clindamycin, doxycycline, a respiratory fluoroquinolone, or a macrolide can be used to treat patients with a penicillin allergy. In addition to antibiotic treatment, the patient should receive antipyretic and analgesic therapy and be advised to rest and drink sufficient amounts of fluid.