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Thera VII > 26 Upper Respiratory Tract Infections Wong-Beringer > Flashcards

26 Upper Respiratory Tract Infections Wong-Beringer Flashcards

1
Q

What are URIs?

A

Nonspecific term to describe acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, bronchi. “Common Cold”: virus. No infiltrate in the chest X-Ray

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2
Q

What are the majority of URIs caused by?

A

Mostly caused by viruses (i.e. Rhinovirus, Influenza virus, etc.)

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3
Q

What are some bacterial causes of URIs?

A

Group A Strep, H. influenza, Moraxella, Pertussis, Mycoplasma, Chlamydiae

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4
Q

What are the most common bacterial superinfections of viral acute sinusitis?

A

H. influenza. Moraxella

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5
Q

What are the 3 most common causes of URIs?

A

Strep. pneumoniae, H. influenza, Moraxella

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6
Q

What are the S/Sxs of Pharyngitis?

A

Throat pain, fever +/-, visible exudates (+/-)

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7
Q

What is the Center Criteria for Strep Pharyngitis?

A

Fever, Absence of cough, Pharyngeal exudate, Tender anterior cervical lymphadenopathy. If meet 0-1 criteria: no abx. If meet 2-3 criteria: if positive rapid Strep Antigen Test, give abx. If meet all 4: give abx, +/- rapid test

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8
Q

Why is Abx treatment used for Streptococcal Pharyngitis?

A

Abx decrease Sx duration by 1-2 days if started w/in 2-3 days of onset; decrease acute rheumatic fever, decrease peritonsillar abscess

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9
Q

What is the DOC for Streptococcal pharyngitis?

A

PCN

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10
Q

What are the first line choices for treatment of Streptococcal Pharyngitis (after PCN)?

A

Benzathine PCN 1.2 MU IM x1 (one dose, very long lasting). Pen VK 500mg BID-TID x10 days

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11
Q

What are the second line choices for treatment of Streptococcal Pharyngitis?

A

Cefuroxime, Cefprozil, Cefdinir. Clarithromycin, Azithromycin (resistance increasingly common)

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12
Q

What is some supportive treatment for Streptococcal Pharyngitis?

A

Analgesics, Saline gargle

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13
Q

What is Acute Rhinosinusitis?

A

Inflammation of the nasal mucosa and paranasal sinus mucosa, lasting < 4 weeks

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14
Q

What are the predisposing factors for Acute Rhinosinusitis?

A

Viral URI. Allergic rhinitis - more associated w/ chronic rhinosinusitis (Sxs > 12 weeks) or recurrent acute rhinosinusitis (2-4 episodes in a year) nasal obstruction. NG tubes (hospitalized patients)

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15
Q

What are the S/Sxs of Acute Rhinosinusitis?

A

Purulent nasal discharge, post-nasal discharge. Unilateral maxillary sinus tenderness, maxillary toothache or facial pain (esp. unilateral). Sore throat, nasal congestion, HA, partial loss of smell, bad breath

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16
Q

What is the etiology of Acute Rhinosinusitis?

A

Viral mostly. Bacteria: Sxs persist x10 days or more, initial improvement but worsening after 5-7 days (S. pneumoniae, H. influenza, Moraxella)

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17
Q

What is the etiology of Chronic Rhinosinusitis?

A

Same bacteriology as Acute + anaerobes and S. aureus

18
Q

What is the etiology of Hospitalized Rhinosinusitis?

A

Nosocomial sinusitis: enteric GNR +/- staph (especially in pts with NG tubes or mechanical ventilation)

19
Q

What are the treatment options for Sinusitis?

A

Supportive (decongestants, analgesics, topical nasal steroids). Duration of Sxs > 10 days or severe symptoms –> oral Abx 10 days plus supportive therapy. Surgery - complicated cases

20
Q

What is the first line abx for sinusitis (w/ no recent abx use)?

A

Amoxicillin (1.5-4g/d): 500-1g TID-QID

21
Q

What is the second line abx for sinusitis (allergies, failed first line, abx use in past month)?

A

Amox/Clav, Cefuroxime, Cefdinir, Cefpodoxime, TMP/SMX, Doxycycline; Clarithromycin, Azithromycin

22
Q

What is Acute Bronchitis?

A

Inflammation of the bronchus (infectious or non-infectious)

23
Q

What are Sxs of Acute Bronchitis?

A

Low grade fever (T102 x < 3d), respiratory wheezes. Non-productive cough (can last 10-21 days before resolving). Runny nose, difficulty sleeping, sore throat

24
Q

What is the etiology of Acute Bronchitis (bacteria)?

A

Chlamydia, Mycoplasma, Bordatella

25
Q

What do you treat Acute Bronchitis with?

A

Macrolides (Chlamydia, Mycoplasma, Bordatella)

26
Q

What is Bordatella Pertussis (Acute Bronchitis)?

A

Prolonged > 2 weeks dry cough, paroxysms of cough or post-tussive emesis preceded by mild illness with rhinorhea, fever and coryza

27
Q

What are the symptoms of Acute Exacerbation of Chronic Bronchitis (AECB)?

A

Sputum production for > 3 months in 2 consecutive years. Part of symptoms of COPD, associated w/ cigarette smoking. Acute exacerbations –> increase: dyspnea, sputum volume, sputum purulence, cough

28
Q

What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group I?

A

NO comorbid conditions. < 3 exacerbations/year. FEV1 > 50%

29
Q

What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group II?

A

Renal/heart/hepatic comorbid conditions. 4+ exacerbations/year. FEV1 35-50%

30
Q

What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group III?

A

Comorbid, STEROIDS. 4+ exacerbations/year. FEV1 < 35%

31
Q

What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group I?

A

H. influenzae, S. pneumoniae, M. catarrhalis

32
Q

What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group II?

A

Group I + S. aureus, Kleb pneum, other GNR

33
Q

What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group III?

A

Group I/II + Pseudomonas, multi-R-GNR

34
Q

What is the drug selection for AECB Group I?

A

Amoxicillin, Macrolides, Doxycycline

35
Q

What is the drug selection for AECB Group II?

A

Amox/Clav, new gen oral CEPHs (Cefpodoxime, Cefdinir); respiratory FQ

36
Q

What is the drug selection for AECB Group III?

A

High-dose Amox/Clav, Antipseudomonal FQs (Cipro, Levo)

37
Q

What is AECB adjunctive therapy?

A

Removal of irritants (environmental). Oxygen therapy. Hydration. Systemic corticosteroid. Chest physiotherapy

38
Q

What is supportive therapy for AECB?

A

Use of humidifier to moisten the air. Adequate fluid intake. Avoid smoking or exposure or 2nd hand smoke. Symptomatic relief

39
Q

What is done for symptomatic relief of AECB?

A

Cough (Dextromethorphan/Guaifenesin. Antitissives). Pharyngitis (saline gargle). APAP, NSAID. Nasal decongestant. Antihistamines

40
Q

When is the Tdap vaccine recommended?

A

Age 19-64, single dose to replace Td booster immunization if last dose of Td > 10 years ago. Adults anticipated close contact with infant aged < 12 months. Health care personnel with direct patient care

Thera VII (37 decks)

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