Primary Healthcare, Antimicrobial Therapy, Respiratory Viral Infections, and Immunoprofilaxis

Comprehensive practice flashcards covering primary healthcare principles, national antimicrobial guidelines, management of respiratory infections (influenza and COVID-19), and immunoprofilaxis protocols.

According to the Centor criteria for acute tonsillitis/pharyngitis, what four clinical signs and symptoms are each assigned 1 point?

Fever higher than $38\,^\circ\text{C}$, absence of cough, presence of tonsillar exudate, and anterior cervical lymphadenopathy.

What antibiotic regimen is recommended as first-line therapy for acute tonsillitis/pharyngitis in adults with a Centor score of 3--4?

Penicillin V (phenoxymethylpenicillin) $1.0\,\text{MIU}$ every 6 hours or $2.0\,\text{MIU}$ every 12 hours orally for 5 to 10 days.

How do oral absorption and peak serum concentration compare between phenoxymethylpenicillin and amoxicillin?

Phenoxymethylpenicillin has an oral absorption of $15\text{--}30\%$ (decreased by food) and a peak serum concentration of $1.5\text{--}2.7\,\mu\text{g/mL}$, whereas amoxicillin has an oral absorption of $74\text{--}80\%$ (unaffected by food) and a peak serum concentration of $7\text{--}8\,\mu\text{g/mL}$.

What proportion of Haemophilus influenzae strains produces beta-lactamases?

Between $30\%$ and $50\%$ of strains.

Under what clinical conditions is symptomatic treatment without antibiotics appropriate for acute otitis media in adults?

When illness duration is less than 4 days, there is no fever or severe pain, and there is no tympanic membrane perforation or otorrhea.

What C-reactive protein (CRP) thresholds guide antibiotic prescribing in acute bronchitis?

A CRP level below $20\,\text{mg/L}$ indicates no antibiotics; CRP between $20\,\text{mg/L}$ and $100\,\text{mg/L}$ requires an individual decision; CRP greater than $100\,\text{mg/L}$ indicates antibiotic treatment.

Which respiratory pathogens intrinsically lack a cell wall and are naturally resistant to beta-lactam antibiotics?

Mycoplasma pneumoniae and Chlamydophila pneumoniae.

What are the first-line oral antibiotic options for acute uncomplicated cistitis in non-pregnant adult women?

Short-acting Nitrofurantoin ($100\,\text{mg}$ every 6--12 hours for 3--5 days), Nitrofurantoin monohydrate ($100\,\text{mg}$ every 12 hours), Fosfomycin ($3\,\text{g}$ single dose), or Trimethoprim ($160\,\text{mg}$ every 12 hours for 3--5 days).

In acute bronchitis, which adult patients belong to the higher risk group for complications requiring antibiotics?

Patients with comorbidities aged over 65 years presenting with 2 or more risk criteria, or over 80 years with 1 or more risk criteria (hospitalization in the last year, type 1 or 2 diabetes, congestive heart failure, or corticosteroid use).

What is the recommended first-line oral antibiotic for cellulitis localized near the eye or nose in adult patients?

Amoxicillin with clavulanic acid ($500/125\,\text{mg}$ orally every 8 hours for 7 days).

What specific symptom distinguishes COVID-19 from seasonal influenza in clinical symptom profiles?

Loss of taste or smell (anosmia/ageusia), which occurs in COVID-19 but is absent in seasonal influenza.

What is the biochemical mechanism of action of nirmatrelvir against SARS-CoV-2?

Nirmatrelvir selectively inhibits the SARS-CoV-2 main protease ($3\text{CL}^{\text{pro}}$ / $\text{M}^{\text{pro}}$) by forming a reversible covalent bond with the catalytic cysteine residue $\text{Cys145}$, blocking polyprotein processing and viral replication.

Why is ritonavir co-administered with nirmatrelvir in Paxlovid?

Ritonavir inhibits the cytochrome P450 enzyme $\text{CYP3A4}$, which slows the metabolic clearance of nirmatrelvir to maintain therapeutic plasma concentrations.

What relative risk reduction in COVID-19-related hospitalization or death was demonstrated by nirmatrelvir/ritonavir in the final EPIC-HR trial analysis?

An $88.9\%$ relative risk reduction compared to placebo ($P < 0.001$) over 28 days, with zero deaths recorded in the nirmatrelvir/ritonavir group.

What is the standard adult dosing regimen for nirmatrelvir/ritonavir in patients with normal renal function?

$300\,\text{mg}$ nirmatrelvir (two $150\,\text{mg}$ tablets) plus $100\,\text{mg}$ ritonavir (one $100\,\text{mg}$ tablet) taken together orally every 12 hours for 5 days.

How should nirmatrelvir/ritonavir be dosed in patients with moderate renal impairment (eGFR $30\text{--}<60\,\text{mL/min}$)?

The dose is reduced to $150\,\text{mg}$ nirmatrelvir (one $150\,\text{mg}$ tablet) combined with $100\,\text{mg}$ ritonavir (one $100\,\text{mg}$ tablet) every 12 hours for 5 days.

What role does viral neuraminidase play during the influenza viral cycle?

Neuraminidase cleaves sialic acid residues on host cell surfaces to facilitate new virion release, prevents viral aggregation post-release, and protects the virus from inactivation by respiratory tract mucus.

What is the standard oral dosage and treatment duration for oseltamivir in adults with seasonal influenza?

$75\,\text{mg}$ twice daily per os for 5 days.

How does initiating oseltamivir within different timeframes from symptom onset impact influenza illness duration?

Initiating treatment at 0 hours reduces illness duration by 3.8 days; at 6 hours by 3.5 days; at 12 hours by 3.1 days; at 24 hours by 2.3 days; and at 36 hours by 1.2 days (compared to starting after 48 hours).

Which patient groups should receive immediate antiviral treatment for influenza regardless of vaccination status or symptom duration?

Hospitalized patients of any age, outpatients with severe or progressive illness, patients at high risk of complications (chronic diseases, immunosuppression), children under 2 years, adults aged 65 years or older, and pregnant or postpartum women (within 2 weeks post-delivery).

What proportion of total healthcare system encounters is managed at the primary healthcare (PSP) level?

Approximately $80\text{--}90\%$ of all healthcare encounters.

What percentage of national healthcare funding is allocated to primary healthcare in Lithuania?

Approximately $17.5\%$ of total healthcare funding.

How is primary healthcare in Lithuania structured financially?

Through a mixed payment system ($70/30$ ratio) based primarily on capitation per registered inhabitant (approximately $150\,\text{EUR}$ per person per year) combined with fee-for-service and performance incentive payments.

What is the 'gatekeeper' (vartininkas) mechanism in primary healthcare?

A structural requirement where patients must first be evaluated by a primary healthcare physician to obtain a referral before accessing secondary or tertiary specialized medical services.

Who are the core members of the primary family physician team in Lithuania?

The family physician (šeimos gydytojas) and the community nurse (bendruomenės slaugytojas), complemented by a case manager (atvejo vadybininkas) such as a social worker, advanced practice nurse, lifestyle medicine specialist, midwife, or physiotherapist.

What public health outcomes correlate with a higher density of family physicians according to primary care evidence?

Reduced mortality from cardiovascular diseases, stroke, cancer, and infant mortality, lower rates of low birthweight newborns, better chronic disease control (diabetes, hypertension, depression), and higher preventive screening rates.

According to the Lithuanian Children's Vaccination Schedule, at what ages is the MMR vaccine administered?

At $15\text{--}16\,\text{months}$ of age and at $6\text{--}7\,\text{years}$ of age.

What is the required vaccination coverage threshold to maintain herd immunity against measles?

A vaccination coverage rate of at least $95\%$, corresponding to a basic reproduction number ($R_0$) of $$12\text{--}18$.

What rule governs the minimum time interval when administering two live parenteral vaccines?

Two live parenteral vaccines must be administered either on the exact same day or separated by a minimum interval of 4 weeks.

What are the clinical guidelines for pertussis (Tdap) vaccination in pregnant women?

Tdap is recommended for all pregnant women during every pregnancy, regardless of the interval between pregnancies, ideally administered between 27 and 32 weeks of gestation.

How does maternal influenza vaccination during pregnancy protect the newborn?

It transfers maternal antibodies transplacentally, reducing the risk of influenza-related hospitalization in infants under 6 months of age by $72\%$.

What criteria define a severe adverse event following immunization (AEFI) according to WHO guidelines?

An adverse event that results in death, is life-threatening, requires medical treatment or hospitalization/extended hospital stay, causes persistent or significant disability/incapacity, or results in a congenital anomaly/birth defect.

When can non-live (inactivated) vaccines be administered to cancer patients receiving chemotherapy?

Inactivated vaccines should be given at least 2 weeks prior to initiating chemotherapy or at least 3 months after completing chemotherapy, provided total leukocyte and differential counts have returned to normal.

For oncology patients receiving anti-CD20 or T-cell targeted monoclonal antibody therapy, what are the post-treatment waiting periods for inactivated versus live vaccines?

Inactivated vaccines can be administered 6 months after the last immunosuppressive dose, whereas live vaccines require waiting at least 12 months after treatment completion (provided leukocyte counts are normal).

What are the routine state-funded (VLK) revaccination recommendations for tetanus and diphtheria in adults?

One booster dose of Td vaccine every 10 years for adults over 25 years of age.