526 URTI Flashcards
hyposmia is ____
unable to less able to smell
Acute sinusitis is a duration of
< 4 weeks
what is 1st line treatment for bacterial sinusitis
amox/clav
what is the most common bacterial pathogen that causes sinusitis
s. pneumoniae
Decongestants can be used for symptom management in sinusitis but should not be used for longer than ____ to prevent ____
3 days
rebound congestion
true or false: oral corticosteroids may be helpful in treating sinusitis
false, only intranasal steroids like mometasone have been found to be helpful
true or false: antihistamines may help with symptom management in sinusitis
false, antihistamines have been shown to be of no use unless the cause if allergic
OTC cold medication should not be used in children younger than ____
4 years
what intranasal medication may help reduce coughing from the common cold
ipratropium (atrovent)
what medication may be of use in helping with symptom management of the common cold in older adults
Lactobacillus casei
should intranasal corticosteroids be used in the common cold
no, they have shown no benefit
what are the 4 cardinal symptoms of chronic rhinosinusitis
purulent nasal drainage
nasal obstruction
facial pain or pressure
decrease or loss of smell
what are the 3 cardinal symptoms of acute bacterial rhinosinusitis
mucopurulent discharge
nasal obstruction
facial pain or pressure
in patients presenting with sinusitis symptoms with fever and headache what is a “red flag” assessment that should not be missed
assess for any meningeal irritation (Kernig and Brudzinski sign)
what would transillumination of the sinuses tell you
if sinuses are able to be transilluminated, they are likely not filled with fluid
what medication may help with congestion and pain associated with sinusitis
NSAIDs
saline
topical decongnestants
topical nasal steroids
what are the most common pathogens in bacterial sinusitis
S. pneumonia
M. catarrhalis
H. influenzae
what is first line and second line abx treatment for bacterial sinusitis
first = amoxi/clav
second = doxycycline
hyper, hypo, or isotonic saline should be used for nasal rinse?
isotonic or hypertonic
what type of reaction if allergic rhinitis
type 1 hypersensitivity reaction
the nasal mucosa color is usually ____ in allergic rhinitis
pale
what is an allergic salute
a crease across the nose from manipulation of the tip of the nose
what is first line pharmacological treatment for allergic rhinitis
intranasal steroids
how long should nasal corticosteroids be used for allergic rhinitis
2-4 weeks of continued use is necessary to see reults
what is first line treatment of allergic rhinitis in a patient with narrow angle glaucoma or BPH.
oral second generation antihistamines
what is intranasal cromolyn used for and why might it not be chosen
inhibits mast cell degranulation in allergic rhinitis
good safety profile but has to be used 4 times a day
what comorbidities would cue you to use a leukotrine inhibitor in allergic rhinitis? what is an example of a leukotrine inhibitors
Montelukast is a leukotrine inhibitor
it is used for patients who need multimodal therapy
good for patients with asthma
what is rhinitis medicamentosa and how is it treated
rebound congestion from chronic use of sympatholytic meds, NSAIDs, or topical decongestants
treated by stopping the drug and can also give a 1-2 week course or nasal steroids during this time
Can pregnant women use oral decongestants
not in the first trimester or when breastfeeding
what might lead you to suspect street drug use in rhinitis symptoms
cocaine-induced midline destructive lesions or destruction of the nasal, palatal and pharyngeal tissue
how long after use of intranasal steroids until effectiveness is seen
6-8 hours after doses
what are the most common side effects of intranasal steroids
nasal burning
stinging
dryness
headaches
epistaxis
pharyngitis
what is gustatory rhinitis and skiers rhinitis and what is an effective treatment
gustatory = with meals only
skiers = with exercise
intranasal ipratropium used before exposure can be helpful
what medical history would increase the likelyhood of developing nasal polyps (6 items)
ASA and NSAID sensitivity
Primarily ciliary diskinesia
cystic fibrosis
frequent asthma exacerbation
chronic sinusitis
season allergies
what diagnostics are used for nasal polyps
nasal endoscopy or CT
what is the treatment for nasal polyps
nasal steroids or surgery if steroids are ineffective
what is the atopic triag
allergic rhinitis
asthma
atopic dermatitis
what might you suspect in a immunocompromised patient with high grade fever and dark necrotic ulcers on face
fungal rhinosinusitis
what would you suspect with drooling, tender neck swelling, inspiratory stridor and difficulty swallowing
epiglottis or retropharyngeal abscess
what URTI would also have a scarlatiniform rash and palatal petechiae
pharyngitis
when might you suspect EBV mono
adolescent or young adult with sore throat, fever, malaise, lymphadenopathy and pharyngitis
what will you do with a CENTOR score of
</=1
2-3
4
1 - viral pharyngitis
2-3 rapid strep, if negative send a culture
4 treat for bacterial, no diagnostics needed
what is first line and second line treatment for bacterial pharyngitis
first line = amoxicillin
second = azithromycin
what are complications of untreated bacterial pharyngitis
abscesses
rheumatic fever
when would post-strep golmerulonephritis show
1-2 weeks after infection
what symptoms would suggest a post strep glamerulonephritis
hematuria
oliguria
HTN
edema
proteinuria
what are complications of untreated bacterial rhinosinusitis
AOM
meningitis
osteomyelitis
abscesses
when would antivirals like oseltamivir be effective
confirmed influenza with symptoms that started less than 48 hours ago
what is nirmatrelvir and ritonavir and when is it used
antivirals used for COVID 19 in high risk populations
tripoding is a symptom of what specific URTI
epiglottitis
what bacteria causes scarlet fever
group A strep
an intercapillary hemolysis rash and sandpaper tongue is indicative of what
scarlet fever
what does the acronym JONES stand for and what is it used for
for symptoms of acute rheumatic fever
Joint inflammation
Heart damage
nodules (elbows, knees, forearm)
Erythema marginatum (rash with thick red margin(
Sydenhams chorea (rapid involuntary movement of dace and hands
What would you suspect with facial edema and dark red urine that occurs 2 weeks after a GAS infection
post strep glomerulonephritis
what virus most commonly causes mononucleosis
epstein barr virus
which lymph nodes are swollen in mono
posterior cervical chain
severe fatigue with hepatomegaly and splenomegaly is characteristic of what disease
mono
why is splenomegaly such a concerning finding
more susceptible to splenic rupture which could cause death
what is the difference between an amoxil rash and a mono rash
both are pink patchy macules but mono is non itchy and amoxil rash is itchy
how is mono diagnosed
peripheral blood smear with atypical lymphocytes
positive monospot test
when would a monospot test be falsely negative
early in disease or children under 4
why should contact sports be avoided for 3-4 weeks post mono infection
to avoid splenic rupture
true or false: infection with EBV increased risk of developing cancer
true
a pericardial friction rub might be from what complication after a GAS infection
rheumatic fever
post strep glomerulonephritis usuall infects (adults or children) and is usually (mild or severe)
usually affects children and is usually mild and resolves spontaneously
what pathogen can cause conjunctivitis, pharyngitis, urethritis, epidimytis, and prostatitis
gonorrhoeae and chlamydia
pharyngitis ghonorrea requires retesting after treatment at what intervals
7-14 days and again at 12 weeks
for pregnant women with GC&C, which abx is safe to use: azithromycin or doxycycline
azithromycin
