100. Upper Respiratory Tract Infection (35%) Flashcards
Distinguez les situations où la vie est en danger des affections bénignes.
Nommez des DDX dangereux
- épiglottite
- abcès rétropharyngé
Posez le diagnostic d’une sinusite bactérienne après une anamnèse et un examen physique détaillé. Prescrivez l’antibiothérapie appropriée (antibiotique de première ligne, posologie adaptée).
En présence de symptômes des voies respiratoires supérieures,
* Différenciez une infection virale d’une infection bactérienne (par l’anamnèse et l’examen physique).
* Posez le diagnostic d’une infection des voies respiratoires supérieures (IVRS) d’origine virale (par l’anamnèse et l’examen physique).
* Instaurez le traitement approprié (p. ex. ne prescrivez pas d’antibiotiques à moins d’une indication claire).
Devant une anamnèse compatible avec une otite moyenne, différenciez-la de quoi ?
- otite externe
- mastoïdite
Chez les patients à haut risque qui présentent une IVRS, recherchez activement les complications et offrez un suivi plus serré.
Nommez les patients à haut risque (3)
- VIH
- MPOC
- Cancer
En présence d’une pharyngite, recherchez quoi?
une mononucléose.
Dans les groupes à haut risque, adoptez des mesures préventives.
Nommez des examples (2)
vaccins contre l’influenza et le pneumocoque
Dans les groupes à haut risque, traitez précocement afin de diminuer l’impact de la maladie sur les individus et la population.
Nommez des tx anti-viraux
- Tamiflu
- Amantadine
How to PREVENT common cold ?
- Handwashing
- Zinc sulfate
Name acute sinusitis sx (4)
- Facial pain, pressure or fullness
- Nasal obstruction
- Discoloured discharge
- Lack of smell
Name common bugs for sinusitis
THINK OF EAR BUGS
* H. influenza
* S.pneumoniae
* M.catarrhalis
Name sinusitis alarm features (refer)
- Persistant fever > 39
- Periorbital edema
- Cranial nere palsies
- Abnormal extraocular movements
- Proptosis
- Vision changes
- Severe headache
- Altered menta status
- Meningeal signs
Describe tx : Sinusitis
- Amox, macrolide if allergic
- Tx 5-7 dx
- Nasal rince
- Intranasal steroids
- Decongestants
- Analgesics
- AINS
Name sx : Mononucleosis
- Lymphadénopathie
- Fièvre
- Pharyngite
- Malaise
- Fatigue
- Maux de tête
Name labs : Mono
- Numération lymphocytaire
- AST, ALT sériques
- Monotest
Describe tx : Mono
- No ATBs or antivirals
- F/U and handwashing/contact
- Steroids MAY help ONLY if airway obstruction
Describe the spleen in mono
- Splenomegaly in 50%
- Rupture in 1-2 per 1000
- NO CONTACT SPORTS for at least 3 weks
- Can last up to 8 wks
Describe influenza antivirals
- Tamiflu, Relenza for Influenza B
- If HIGH RISK
- Goal = Start within 12 hrs of sx
- If > 48 hrs, consider if severe illness / high risk
What to R/O in common cold ? (2)
- Sinusitis (PODS)
- Acute Bronchitis (Persistent cough >3 weeks)
In acute bronchitis, consider ATB when ? (4)
- ≥ 75 years
- > 3 weeks or suspect B. pertussis (Whooping cough, >3 weeks, vomiting (related to coughing)
- exposure to pertussis
- not vaccinated
Describe symptomatic therapy for common cold ? (5)
- Analgesics (Acetaminophen/NSAIDs)
- Combination products (Antihistamine, decongestant, analgesics)
- Consider Zinc lozenges 75mg PO daily, Pleragonium sidoides, Andrographis paniculata
- Nasal sx tx
- Cough suppressant
Risk of what in intranasal zinc preparations ?
Risk of irreversible anosmia
How to tx nasal sx in common cold ? (3)
- 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
Name Cough suppressants (3)
- Brompheniramine plus sustained-release pseudoephedrine
- Ipratropium bromide inhaled (Atrovent)
- Dextromethorphan 30mg PO q6-8h PRN
Name prevention : Common cold (4)
- 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
Seasonal Influenza caused by what ? (2)
Caused by influenza A or B viruses, mainly during winter
How effective is tx of seasonal influenza ?
Treatment may reduce symptoms from 0.5-3 days (if started within 48h)
Describe tx : Seasonal Influenza (3)
- 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
In influenza, tx with antiviral should be considered when ? (3)
- 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
Name : Indications to consider X-ray in influenza (5)
- Hemoptysis
- Pleuritic chest pain
- Dyspnea
- Systemic symptoms (fever, tachycardia >100, tachypnea>24)
- Abnormal physical exam (crackles, decreased breath sounds, bronchial breathing)
Describe : Antibiotic Stewardship (8)
- 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)
