Sandbox: Fatima

Sputum Analysis

Sputum Analysis

Acid Fast Stain

Culture on Sabourad's medium

Direct Microscopic Examination

Gentain Voilet Stain

Aerobic Culture

Tuberculosis

Yeast and Fungi

Actinomyces and other mycelia of Fungi

Fusiform Bacteria and Spirochetes

Pyogenic organsims

DD

Rhinitis

Positive Skin Prick or RAST

Negative Skin Prick or RAST

Allergic Rhinitis

Non Allergic

Infectious

Vasomotor

Gustatory

Nonallergic eosinophilic rhinitis syndrome (NARES)

Acute Rhinosinisitis

Chronic Rhinosinusitis

Approach

Diagnostic Paracentesis ❑ Perform ascitic fluid cell count and differential ❑ Perform ascitic fluid culture (Inoculated at bedside)

PMN ≥ 250cells/mm³

If YES ❑ Presumptive SBP ❑ Begin empiric antibiotic therapy(eg:Cefotaxime 2g IV q8H and ❑ IV Albumin on day 1 & day 3 IF serum creatinine 1mg/dl, BUN > 30mg/dl or total albumin > 4mg/dl

IF NO ❑ Look for the signs/symptoms of Infection

Is Culture Positive ?

Absent Symptoms ❑ Is Culture Positive?

Symptoms Present ❑ Begin Empiric Antibiotic Therapy for SBP

Negative Culture ❑ Complete 5 day Antibiotic Course

Confirmed SBP ❑ Narrow the spectrum based on the susceptibility to complete the 5 day course

Culture Negative ❑ No Antibiotics indicated

Culture Positive ❑ Bacterascites: Repeat diagnostic paracentesis when the culture growth is discovered

Diagnostic Paracentesis

Common Presentation	Disease	Symptoms						Physical Examination Findings
		Discharge	Dysuria	Vaginal odor	Dyspareunia	Genital skin lesion	Genital pruritus
Vaginitis	Candida Vulvovaginitis	✔	✔	✔	✔	✔	✔✔	Vulvar edema, fissures, excoriations Thick, curdy vaginal discharge
	Bacterial Vaginosis	✔	—	✔	—	—	—	Fishy odor from the vagina Thin, white/gray homogeneous vaginal discharge Lack of significant vulvovaginal inflammation
	Trichomoniasis	✔	✔	✔	✔	—	✔	Strawberry cervix: petechial haemorrhages on the ectocervix, specific to trichomoniasis Frothy, mucopurulent, yellow-green or gray vaginal discharge
	Atrophic Vaginitis	✔	✔	✔	✔✔	✔	✔	Pale and dry vaginal mucosa Increased friability of the vaginal mucosa with patchy erythema and petechiae Sparsity of pubic hair, fusion of the labia minora, narrow and a shortened vagina
	Aerobic Vaginitis	✔	✔	✔	✔	—	✔	Vaginal mucosa is red and inflamed, severe ecchymotic bleeding points and ulcers can be seen in severe cases Erosions, hyperaemia, scattered bleeding points and ulcers can be demonstrated on the cervix
Cervicitis	Chlamydia	✔	✔		✔	—	✔	Cloudy, yellow mucoid discharge from the cervical os Friable appearance of cervix Cervical motion tenderness may be present
	Gonorrhea	✔	✔	✔	✔	—	—	Mucopurulent urethral, cervical or vaginal discharge Positive cervical motion tenderness Friable cervical mucosa Abdominal pain with negative rebound tenderness Lower abdominal pain (consistent with PID) Right upper quadrant pain (Fitz-Hugh-Curtis syndrome) Labial edema and Bartholin’s gland enlargement and tenderness (Bartholinitis)