100. Upper Respiratory Tract Infection

Question 1

In a presentation of pharyngitis, look for what ?

Answer 1

mononucleosis

Question 2

In high-risk groups with URTI sx, what to do ? (2)

Answer 2

• Take preventive measures (e.g., use flu and pneumococcal vaccines).
• Treat early to decrease individual and population impact (e.g., with oseltamivir phosphate [Tamiflu], amantadine).

Question 3

What to R/O in common cold ? (2)

Answer 3

• Sinusitis (PODS)
• Acute Bronchitis (Persistent cough >3 weeks)

Question 4

In acute bronchitis, consider ATB when ? (4)

Answer 4

• 1. ≥ 75 years
• > 3 weeks or suspect B. pertussis (Whooping cough, >3 weeks, vomiting (related to coughing)
• exposure to pertussis
• not vaccinated

Question 5

Describe symptomatic therapy for common cold ? (5)

Answer 5

• Analgesics (Acetaminophen/NSAIDs)
• Combination products (Antihistamine, decongestant, analgesics)
• Consider Zinc lozenges 75mg PO daily, Pleragonium sidoides, Andrographis paniculata
• Nasal sx tx
• Cough suppressant

Question 6

Risk of what in intranasal zinc preparations ?

Answer 6

Risk of irreversible anosmia

Question 7

How to tx nasal sx in common cold ? (3)

Answer 7

• Nasal saline irrigation (poor evidence)
• Intranasal cromolyn sodium (Cromolyn) 1 spray (5.2mg) in each nostril q2h PRN x 2 days then 4 times daily x 5 days
• Intranasal ipratropium bromide (Atrovent) 0.06% solution two sprays (42mcg/spray) in each nostril 3-4 times daily PRN x 4 days

Question 8

Name Cough suppressants (3)

Answer 8

• Brompheniramine plus sustained-release pseudoephedrine
• Ipratropium bromide inhaled (Atrovent)
• Dextromethorphan 30mg PO q6-8h PRN

Question 9

Name prevention : Common cold (4)

Answer 9

• Handwashing
• Flu vaccine (6mo-5yo, ≥65yo, chronic disease, pregnancy/postpartum, healthcare worker, frequent contact with above)
• Pneumococcal 23-valent (≥65 years old, or if specific risk factors)
• No evidence for antibiotics, echinacea, intranasal corticosteroids

Question 10

Seasonal Influenza caused by what ? (2)

Answer 10

Caused by influenza A or B viruses, mainly during winter

Question 11

How effective is tx of seasonal influenza ?

Answer 11

Treatment may reduce symptoms from 0.5-3 days (if started within 48h)

Question 12

Describe tx : Seasonal Influenza (3)

Answer 12

• Zanamivir (Relenza) two inhalations (10mg) PO BID x 5d or oseltamivir (Tamiflu) 75mg PO BID x 5d
• Amantadine not first-line due to high rates of resistance
• May extend therapy in severely ill patients

Question 14

In influenza, tx with antiviral should be considered when ? (3)

Answer 14

• Severe disease (requiring hospitalization or evidence of lower respiratory tract infection, eg. dyspnea, tachypnea, oxygen desaturation)
• High risk for complications (pregnancy)
• Most efficacious within first 48h of illness, but indicated to treat if severe illness or pregnancy

Question 15

Name : Indications to consider X-ray in influenza (5)

Answer 15

• Hemoptysis
• Pleuritic chest pain
• Dyspnea
• Systemic symptoms (fever, tachycardia >100, tachypnea>24)
• Abnormal physical exam (crackles, decreased breath sounds, bronchial breathing)

Question 16

Describe : Antibiotic Stewardship (8)

Answer 16

• Compassionate communications
• Describe infection as viral illness
• Discuss expected course of illness and cough duration (2-3w)
• Explain antibiotics do not shorten illness duration, and may cause adverse effects and antibiotic resistance
• Treatment plan including symptom management (analgesia, antiinflammatory)
• Consider
• Delayed prescription strategies (agree on time frame, eg. 1 week that symptoms should improve - and only to use prescription after the specified time)
• Immediate prescribing if suspect pneumonia or high-risk (immunosuppressed)