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Rosens > 61. Upper respiratory tract infections > Flashcards

61. Upper respiratory tract infections Flashcards

1
Q

Common bacterial causes of pharyngitis

A

Group a strep
Non-Group A strep
Fuso bacterium
Mixed a robes and and robes

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2
Q

What is the Waldeyer ring?

A

Lymphoid tissue in the franks, consisting of the palatine tonsils/tonsils, frenal tonsils (adenoid), two will tonsils surrounding the eustachian tubes and lingual tonsils at the base of the tongue

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3
Q

What general factors are important to consider in pharyngitis

A

Symptom chronicity
Associated completes.
Patient comorbidity.
Patient risk factors

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4
Q

What common symptoms may indicate that a virus is responsible for pharyngitis

A

Rhea
Cough.
Conjunctivitis
Congestion.
Headache.
Usually proceeded by a sore throat inflammation and hypertrophy of the tissue in the waldeyer are common without exudate

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5
Q

What triad does mono usually present with?

A

Fever
Tonsillar pharyngitis. with exit date and hypertrophy, intermittently on the junction of the hard and soft palette
Posterior cervical lymphadenopathy

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6
Q

Mono: what virus causes this and what organ tends to enlarge?

A

EBV.
Splenomegaly

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7
Q

What disease gets a itchy,, morbilliform rash when given beta-lactam?

A

Mono

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8
Q

Influenza as a non-exudative cause of pharyngitis and sore throat – other symptoms?

A

Fever
Chills
Myalgia
Headache

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9
Q

What other symptoms of pharyngitis may occur when HIV is the cause cause?

A

Fever.
Sore throat
Nontender lymphadenopathy.
Diffuse maculopapular rash
Arthralgia
Mucocutaneous ulceration.
Diarrhea

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10
Q

When pharyngitis is caused by HSV what other symptoms might be present?

A

Pallet hyperaemia with sore throat
Odynophagia
Stomatitis
Tender, cervical adenopathy

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11
Q

List eight infectious causes specifically bacterial of pharyngitis

A

Group a haemolytic strep
Group, C and B haemolytic strep
Fusobacterium
Neiseria
Corynebacterium diptheria
Chlamydia
Mycoplasma
Arcano bacterium haemolyticum

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12
Q

Name nine causes of viral infectious pharyngitis

A

Rhinovirus
Coronavirus

ParaInfluenza
Influenza
Adenovirus

HIV.
Ebv
Herpes
CMB

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13
Q

Name, one fungal cause of pharyngitis

A

Candida

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14
Q

Name for serious adjacent infections to infectious causes of pharyngitis

A

Retro pharyngeal abscess.
Parapharyngeal abscess
Epiglottitis
Ludwig angina

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15
Q

Name 10 non-infectious ideologies of pharyngitis

A

Tumor.
Autoimmune disease
Neurogenic pain
Foreign body
Trauma
Medication induced
Steven Johnson syndrome.
Allergic reaction.
Oesophageal reflux
Environmental exposure

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16
Q

Normally, how much faster do group a strep pharyngitis resolve than untreated?

A

16 hours and contagious. Decreases to 24 hours after the start of antibiotics rather than up to one week in untreated patients.

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17
Q

Group A strep: pharyngitis symptoms that are characteristic

A

Rapid onset of sore throat
Odynophagia
Cervical adenopathy.
Fever
Chills.
Next stiffness

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18
Q

GAS pharyngitis: common signs

A

erythema and edema of pharynx
grey white tonsillar exudates
palatal petechiae
tender cerivcal adenoapthy

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19
Q

Suppurtative complications of GAS pharyngitis

A

AOM
mastoiditis
meningits
peritonsilar or retropharyngeal abscess
nec fasc/hem spread
rheumatic fever

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20
Q

What is Lemierre syndrome

A

septic jugular vein thrombophlebitis casued by commonly fusobacterium

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21
Q

arcanobacterium haemolyticum typically involved in what kind of pharyngitis infections?

A

RPA

can get a urticarial, maculopapular rash sparing face, palm, handsFranc

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22
Q

What zoonotic gram neg bacillus may cause false pos monospot test and atupical lymphocytes on peripheral smear after drinking contaminated food or water

A

Francisella tularenis

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23
Q

Tx for pharyngitis: options oral - nonpen allergic

A

Penicillin V
Child: 250mg BID or TID daily x10d vs adult 500mg bid 10d

amox 50mg/kg up to 1g daily or 25mg/kg up to 500 bid x10d

Single dose cs dex 0.6mg/kg up to 10mg po

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24
Q

Tx for pharyngitis: options oral - penicillin allergi

A

cephalexin 20mg/kg/dose max 500mg/dose bid x10d

clinda 7mg/kg/dose max 300/dose tid x10d

azithromycin 12/mg/kg max 500 per dose x5d

metronidazole 500mg IV q8h or kids 10-15m/kg max 500
AND
ceftr adult 2g IV q24h, child 50m/kg

or

pip-tazo 3.375g IV q6h, child 100mg/kg of pip q6-8h

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25
Q

Centor criteria for GAS pharyngitis

A

swollen tonsils exudates
tender anterior cervical adenopathy
absent cough
fever

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26
Q

Monospot sn and sp (high vs low)

A

high sp

vvariable sn as false neg early

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27
Q

First line dx test gas pharyngitis?

A

rapid antigen test

high sn and sp when performed correct - bilat tonsils and posterior pharynx

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28
Q

Testing for pharyngitis bugs: how to test for:
arcanobacterium haemolyticum

A

human blood agar

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29
Q

Testing for pharyngitis bugs: how to test for: diphterhia

A

Loeffler medium

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30
Q

Testing for pharyngitis bugs: how to test for:
candida

A

pseudohyphae on gram stain or + KOH stain

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31
Q

Testing for pharyngitis bugs: how to test for:chlamydia or gonorrhea

A

throat swab with naat

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32
Q

Management of mono

A

supportive

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33
Q

Tx of influenza on who?

A

within 2d presentation:

possible on documented or suspected influenza cases in hospitalized patients, children less than 2 years old, adults 65 years and older, preg- nant women and within 2 weeks postpartum, patients with immunosup- pression, and patients with chronic cardiac, pulmonary, hepatic, renal or hematologic disorders.

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34
Q

Diphtheria tx

A

diphtheria antitoxin and penicillin or eryththromycin

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35
Q

Candidal pharyngitis tx

A

topical clotrimazole or nystatin swish and swallow

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36
Q

Laryngitis: ac vs chronic

A

<3 vs >3 weeks

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37
Q

Laryngitis: chr causes

A

gerd
overuse of voice
trauma
thermal/chem burn
irritant
allergic reaction

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38
Q

Laryngitis: chr sensation?

A

globus sens or excess throat clearing

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39
Q

Laryngitis: - when do majority resolve?

A

2 weeks

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40
Q

Laryngitis: tx peds?

A

dex 0.6mg/kg up to 10

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41
Q

Epiglottitis: why is it rarer now?

A

h influ big cause, now vaccinated

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42
Q

Epiglottitis: increased risk?

A

dm
immunocompromised
substance abuse

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43
Q

Causes of Epiglottitis:

A

h influ
strep pneumo
staph

vs
burns, trauma, inhalational injury

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44
Q

Epiglottitis: signficiant geatures

A

sit forward in sitting position
cannot anage secretions
hoarse

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45
Q

Epiglottitis: ddx

A

rpa
anaphylaxis
angioedema
tumor
thyroiditis
chemical/thermal injury
FB

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46
Q

Epiglottitis: diagnostic test?

A

flex laryngoscopy (call ent)

47
Q

Epiglottitis: management

A

abc keep them calm
call ent/anesthesia
iv abx
cs dex 0.6mg/kg to 10
nebulized epi 2.25% racemic epi diluated in ns given q3-4 hours

48
Q

Peritonsillar cellulitis: vs abscess

A

abscess is collection of pus between palatine tonsil capusle and superior constrictor m of palatopharyngeus m
vs
cellulitis no collection

49
Q

Peritonsillar abscess: RF

A

recent strep tonsillitis
mono
obstruction or infection of weber glands
smoking
dental or peridontal disease
antiinlamm meds

50
Q

Peritonsillar abscess: mc bug?

A

strep pyogenes

recurrent can have fusobacterium

51
Q

Peritonsillar abscess: complication

A

rupture into airway
spread into adj peritonsillar space

52
Q

Peritonsillar abscess: features

A

unilateral sore throat
odynophagia
dysphagia
fever
malaise
drooling
muffled voice
trismus
ipsilateral otalgia

once abscess formed = uvula deviation towards contralateral tonsil

53
Q

Epiglottis top 5 bugs in a normal host

A

h influ
strep pneumo
gas
staph
neisseria

54
Q

Epiglottis top 5 bugs in a normal host - can tx with what abx?

A

amp sulbactam or ceftr and vanco or clinda/ cefepime or puptazo
and
vanco

55
Q

Epiglottis additional 2 bugs immunocompromised to consider

A

pasteurella
aspergillis

56
Q

RPA/PTA/peritonsilar abscess/Ludwig angina common 5 community bugs

A

gas
staph
strep milleri
aracnobacterium hemolyticum
mixed oral flora

57
Q

RPA/PTA/peritonsilar abscess/Ludwig angina common 5 community bugs - tx

A

vanco
amp sulbactam
OR
clinda and levo

58
Q

RPA/PTA/peritonsilar abscess/Ludwig angina if immunocompromised tx with?

A

cefepime and metronidazole
OR pip tazo and vanco

59
Q

RPA/PTA/peritonsilar abscess/Ludwig angina - if MRSA risk add what 2 abx options?

A

vanco
linezolid

60
Q

DDX of suppurative pharyngeal infection

A

retroph cellulits or abscess
parapharyngeal abscess
peritonsilar abscess
retropharyngeal tumor
tendinits of longus colli m
meningitis
hematoma secondary to trauma
carotid a aneurysm

61
Q

Dx testing for RPA/PTA/peritonsilar abscess/Ludwig angina

A

CT contrast enhanced

62
Q

RPA/PTA/peritonsilar abscess/Ludwig angina -larger abscess management?

A

drainage via needle aspiration via u/s guided to watch for carotid a

spray with topical lido/benzocaine

63
Q

RPA/PTA/peritonsilar abscess/Ludwig angina - when to consider admission?

A

toxic appearing
require iv hydration and analgesia
signs of parapharyngeal ext on ct
immunocompromised with mult comorbidities

64
Q

Ludwig angina: what is this?

A

rapidly progressive, bilatreal, gangrenuous cellulitis of submandibular spaces

65
Q

Ludwig angina: why is this a bilateral process?

A

communication among open posterior aspect of submandibular spaces

66
Q

Ludwig angina: mc causes?

A

mandibuldar molars dental origin
- these end up right under mylohyoid m of mandible and have a thin osseous structure

other: mandibular #, oral trauma, secondary infection from oral malignancy, suppurative parotitis, adj head nad neck infection

67
Q

Ludwig angina: RF

A

immunocomprised and diabetic

68
Q

Ludwig angina: clinical features key

A

recent dental infection or procedure with dysphagia, odynophagia, drooling, swelling of fx of mouth, neck stiffness, muffled voice, tongue displacement or protrustion
trismus

tense brawny neck edema

69
Q

Ludwig angina: ddx

A

rpa
pta
parotid/submandibular gland abscess
oropharyngeal tumor
sublingual hematoma
glossal or posterior oropharyngeal angioedema
laryngeal diphtheria

70
Q

Ludwig angina: management

A

airway!!!! - ent or anesthesia for flexible bronch vs surgical airway if no time

abx once airway secured

71
Q

RPA - what is this?

A

infection of deep neck behind hypoharynx and esophagus in midline of neck, anterior to danger and prevertebral spaces extending to diaphragm and coccyx

72
Q

RPA -mc what age?

A

<5 male as LN present here that drain nasal cavity, paranasal sinu, oropharynx, hypopharynx space, middle ear, eustachian tube

73
Q

RPA - when do these go away

A

puberty

74
Q

RPA - adult causes more likely from?

A

penetrating trauma
fb
iatrogenic instrumentation
adj infection
hematologic spread of infection or spine infection

75
Q

RPA - RF

A

immunosuppressiion
chronic steroid
dm
HIV

76
Q

RPA - complications

A

abscess rupture and aspiration
airway compromise
involvement of carotid sheath - aneusym, arterial erosion, Lemierre syndrome, palsy of CN 9-12, mediastinitis

77
Q

RPA - PE

A

tender cervical LN
new swelling
torticollis
fever

78
Q

RPA - preferred diagnostic test

A

ct contrast enhanced

79
Q

RPA - ct findings

A

fluid collection with central hypodensity and complete ring enh with scalloping

fat stranding and edema characterized by low density thickening without peripheral enhancement may be early

80
Q

RPA - lateral neck radiograph + ?

A

rpa space from anteroinf aspect of second vertebral body to posterior pharyngeal wall >7mm or retrotracheal space at 6th vb >14mm child vs 22mm adult - abnormal!!

81
Q

RPA - management

A

airway stabilization
abx
dex

82
Q

Parapharyngeal abscess: what is in close proximity?

A

airway
carotid sheath
mediastinum

either side of neck and extends from skull base to stulogloggus m at angle of mandible

83
Q

Parapharyngeal abscess: usually come from what prior infection?

A

dental

84
Q

Parapharyngeal abscess: possible complications

A

airwau obstuction from edema
neck or mediastinal spread
vascular involvement
nerve compromise
abscess rupture can lead to pneumonia, lung abscess or empyema
ipsilateral Horner syndrome and neuropathies of CN 9-12
rupture of carotid aneyrm or erosion of close
Lemierre syndrome
Cavernous sinus thrombosis - what is this?

85
Q

Cavernous sinus thrombosis: when to expect this?

A

proptosis, impaired EOM, pupillary changes - spread of infection through opthalmic venous system

86
Q

Parapharyngeal abscess: pain with ? can be characteristic

A

mastication

87
Q

Parapharyngeal abscess: preferred diagnostic test?

A

contrast enh ct

88
Q

Parapharyngeal abscess: management

A

airway
dex
abx
ent

89
Q

Rhinosinusitis: what is this?

A

inflamm of upper airways and paranasal sinuses assoc with nasal discharge, facial pain or pressure, nasal blockade and sense of fullness

90
Q

Acute rhinosinusitis classification < than _ weeks

A

4

91
Q

Acute rhinosinusitis viral vs bacterial typical couse

A

Viral etiologies tend to have symptoms that peak and resolve in a few days, whereas bacterial etiol- ogies tend to last longer than 10 days with persistent symptoms or will worsen after a period of improving symptom

92
Q

What structural abnormalities predispose someone to rhinosinusistis?

A

nasal septal deviation
infraorbital ethmoid air cells > 3mm
acessory ostia
conchae bullosa
oroantral fistula
maxillary dental disease

93
Q

Chronic rhinosinusitis > _ weeks

A

12

94
Q

Complications of rhinosinusitis:

A

cellulitis
meningitis
orbital or intracranial abscess

95
Q

Symptoms of rhinosinusitis:

A

purulent nasal discharge
facial pain or pressure
posterior nasal drip
decreased sn of smell

all with headache/fatigue/malaise, fever

96
Q

DDX rhinosinusitis

A

allergic rhinitis
dental infection
headache syndromes
tumor
IC abscess

97
Q

Diagnostic criteria of rhinosinusitis: clinical 3

A
  1. at least 10d of ongoing sx no improvement
  2. 3-4d severe sx including fever >39 with nasal discharge or facial pain without improvement
  3. onset progressive sx with worsening sx after initially improved
98
Q

Management rhinosinusitis: acute

A

self resolving
management on sx and pt education

acetaminophen
ibuprofen
nasal irrig saline 1-2 spray ea nostril q4h
IN CS 2 sprays ea nostril once daily

99
Q

Only use abx if meet rhinosinusitis defn:

abx to use?

A

amox 500mg PO TID or amox clav BID x5d

100
Q

Rhinosinusitis: Amox clav when to use - RF

A

pt smokes
diabetes
recent abx
older >65
HC worker

101
Q

Rhinosinusitis: if allergic to pen use?

A

doxy

levo and moxi but reserved for pt without other options

102
Q

Rhinosinusitis: if treating bacterial sinusitis, how long to tx for?

A

5-14d (initially try 5d)
child 10d

103
Q

Rhinosinusitis: when to refer to ent?

A

more than 4 episodes per year of distinct ea episodes

104
Q

A previously well 18-year-old male presents with throat pain and fever to 39 °C for the past 2 days. He denies vomiting, diarrhea, cough, or rhinorrhea. He is not sexually active. Physical exam is notable for tender anterior cervical lymphadenopathy and symmet- rically swollen and erythematous palatine tonsils with a gray-white tonsillar exudate. The remainder of his neck and physical exam is benign. What is the most appropriate next step?
a. Empirically prescribe amoxicillin for 10 days
b. Obtain a complete blood count with differential
c. Obtain an intraoral tonsillar ultrasound
d. Perform a rapid strep antigen test and prescribe antibiotics only
if there is a positive result

A

d

104
Q

A 34-year-old male presents with complaints of high fever, left- sided face pain, and purulent nasal discharge for 10 days. He has been attempting symptom management with nasal saline irrigation and intranasal corticosteroids, but after initial improvement reports worsening symptoms. What is the next step in treatment?
a. CT scan of his face to evaluate for complications of rhinosinus- itis
b. Obtain bacterial culture via sinus puncture
c. Prescribe a 5-day course of amoxicillin
d. Supportive care with antiinflammatory medications, rest, and
continued nasal saline irrigation

A

c

105
Q
  1. A 19-year-old female patient presents to the emergency department
    with vision changes and headaches. She reports a sore throat 10 days ago started to improve, but never completely resolved. For the past 3 days she noted increasing left-sided neck pain and fevers. On exam she appears uncomfortable with a fever and mild tachycardia. She is warm and diaphoretic with a dry forehead on the left. Her left eyelid is slightly lower than the right and her left pupil is 3 mm smaller than the right. Her extraocular movements are intact, and her intraoral exam shows symmetric tonsils with mild erythema and a midline uvula. She has mild trismus. What is most likely caus- ing her symptoms?
    a. Parapharyngeal abscess with invasion of the carotid sheath
    b. Peritonsillar abscess with compression of the carotid sheath
    c. Spread of infection into the cavernous sinus causing thrombosis
    and intracranial abscess
    d. Submandibular space infection and spread into retropharynx
A

A

106
Q
  1. Patients presenting with symptoms concerning for a retropharyn-
    geal abscess are best evaluated using what modality? a. Contrast-enhancedCT
    b. Intraoral ultrasound
    c. Lateralneckx-ray
    d. Visualization with a fiberoptic scope
A

A

107
Q
  1. This bacterium is frequently implicated in non-GAS pharyngi- tis and is also most commonly implicated in suppurative jugular thrombophlebitis:
    a. Arcanobacteriumhaemolyticum
    b. Fusobacterium necrophorum
    c. Haemophilus influenzae type B
    d. Methicillin-resistant Staphylococcus aureus
A

B

108
Q

When to consider diptheria?

A

unimm pt with travel to endemic area

109
Q

Diptheria syndromes

A

looks like strep - pharyngeal/tonsillar - grey white spots –> worry systemic tox

nasal diptheria also plausible - crusting/upper lip infection –> worry systemic tox

laryngeal diphtheria: looks like bronchiolitis/laryngitis ish - hoarse voice, cough

cutaenous dipheria: chronic ulcer somewhere - less systemic toxic than systemi

110
Q

Systemic toxin complications of diptheria

A

myocarditis
neuritis (CN palate, eyes; systemic- paralysis)
renal failure

111
Q

Treatment of diptheria:

A

droplet precautions
abx: pen, macrolides
antixtoxin if severe- ID on call
Reporting for probable case and call PH

112
Q

Liverpool PTA score: 5 variables

A

unilateral sore throat
trismus
male
pharyngeal voice change
uvular deviation

113
Q

when to drain an abscess - what general size?

A

1cm

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