Conjunctivitis
Most common cause of infectious conjunctivitis
Viruses (adenovirus)
obesity prevalence in the United States
2021 national health and nutrition examination survey: 41.9%
Prevalence of ADHD in the US
14.6% in 2022
Definition
Adults: lasting longer than 8 weeks
Children: lasting longer than 4 weeks
Risk factors
Overstimulation of milk production (hyperlactation or excessive pumping)
Recent antibiotic use
Nipple shields
Poor infant latch
Wearing tight clothes or bras
Most common examination finding in allergic conjuunctivitis
bilateral conjunctival injection
Other findings: mild chemosis, watery discharge, eyelid edema, evidence of venous congestion below the eyes
laboratory and diagnostic testing
CBC, CMP, lipid profile, TSH, A1C
DSM-5 diagnostic criteria
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development (sx present for at least 6 months) beginning prior to age 12 years old. Symptoms are present in 2+ settings.
UACS
Asthma
Non-asthmatic eosinophilic bronchitis
GERD
Laryngopharyngeal reflux
Most common pathogens
Staph and strep
Most common pathogens implicated in acute bacterial conjunctivitis (children and adults)
Haemophilus influenzae in children
Staph aureus in adults
First line medications for management of obesity
guidelines currently don't specify which medications are first-line, pharmacotherapy should be individualized for each patient
Differential diagnoses of ADHD (5)
Anxiety
MDD
Mania/bipolar depression
PTSD
Substance use disorder
Nonasthmatic eosinophilic bronchitis treatment
inhaled corticosteroids for at least 2 months
Lifestyle and behavioral interventionss
Ice or cold application (vasoconstrict blood vessels)
NSAIDs
Continuing to feed infant (limit pumping)
Avvoid nipple shields
First line treatments for allergic conjunctivitis (3)
preservative-free artificial tears
topical antihistamines with mast cell-stabilizing activity
intranasal corticosteroids
threshold BMI for consideration of bariatric surgery (american society for metabolic and bariatric surgery)
BMI > 35
BMI > 30 with T2DM
BMI > 30 without substantial weight loss using nonsurgical methods
Medications that are used when first line are not tolerated (2)
Non-stimulants: atomoxetine, viloxazine
Drug therapy first line
amoxicillin 500 mg 4x/day for 10-14d
cefadroxil 500 mg BID for 10-14d
cephalexin 500 mg 4x/day for 10-14d
dicloxacillin or flucloxacillin 500 mg 4x/day for 10-14d
How long to minimize physical contact with others for viral conjunctivitis
10-14 days from onset of symptoms in the last affected eye
- adenovirus can shed up to 14 days
- avoid touching frace, practice strict handwashing, don't share personal items
threshold BMI for starting pharmacotherpay
nonpregnant patients with BMI > 30
BMI > 27 with any metabolic comorbidities (HTN, T2DM, dyslipidemia)
Adverse effects of first line therapy
Insomnia, headaches, elevated. blood pressure, elevated HR, decreased appetite, weight loss, dry mouth, anxiety, depression
Red flags for chronic cough for adults
Abnormal findings on exam or chest imaging, dysphagia, hemoptysis, hoarseness, new or worsening cough in > 45yo who smoke, prominent dyspnea, recurrent pna, vomiting, weight loss
Drug therapy second line
Clindamycin 300 mg 4x/d for 10-14 days
Trimethoprim/sulfamethoxazole one double strength tablet BID for 10-14 days