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Medical Studies 1 > 7.4 Upper Respiratory Tract Infections > Flashcards

7.4 Upper Respiratory Tract Infections Flashcards

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USMLE® Step 1 flashcards
1
Q

How many URTIs does the typical child/adult get in a year?

A

Child: 7
Adult: 2-3

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2
Q

What percentage of missed work days are due to URTIs?

A

40%

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3
Q

What percentage of URTIs are viral/bacterial?

A

75% viral
25% bacterial

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4
Q

What is a syndrome?

A

A group of symptoms

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5
Q

What is the common cold?

A

Syndrome including:
- Rhinorrhoea
- Nasal congestion
- Cough
- Sneezing
- Sore throat
- Etc.

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6
Q

What differentiates common cold from other syndromes?

A

No prominent localisation to one anatomical location

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7
Q

What percentage of common colds are caused by viruses vs bacteria?

A

Bacteria: 0%
Viruses: 100%

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8
Q

What is the most common virus that can cause a cold?

A

Rhinovirus

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9
Q

Describe transmission of the common cold

A
  • Hand-hand contact (fomites)
  • Respiratory particles (droplets/aerosols)
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10
Q

Is antibacterial treatment indicated for common cold?

A

Very rarely

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11
Q

In what percentage of common colds does secondary bacterial infection occur?

A

0.5-2%

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12
Q

What are coryzal symptoms?

A

Cold symptoms

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13
Q

Is pharyngitis predominantly caused by bacteria or viruses?

A

Viruses (in high income countries, bacterial rate is dropping more and more)

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14
Q

Can pharygnitis ever have non-infective aetiology? Provide examples if applicable.

A

Yes:
- GORD
- Chemo
- Allergy

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15
Q

Epstein-Barr virus (glandular fever) can cause pharyngitis. List some additional symptoms caused by this virus

A
  • Tender cervical lymphadenopathy
  • Tonsillar exudate
  • Fever
  • Splenomegaly
  • Weeks/months of fever/malaise
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16
Q

List two bacteria that can cause pharyngitis

A
  • Gonorrhoea
  • Group A streptococcal
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17
Q

Clinical features of peritonsillar abscess

A
  • Voice change
  • Severe unilateral throat pain
  • Fever
  • Dysphagia
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18
Q

Does peritonsillar abscess require hospital admission? Why, or why not?

A
  • Yes
  • May block airway
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19
Q

Complications that can occur alongside pharyngitis (other than peritonsillar abscess/quinsy)

A
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Scarlet fever
20
Q

A patient who is at high risk of rheumatic fever comes in with non-life-threatening pharyngitis. Do you prescribe antibiotics?

A

Yes. Always.

21
Q

Overview: steps of pharyngitis management.

A
  1. Check if life-threatening (airway obstruction, sepsis etc.)
  2. Check if viral/bacterial
22
Q

A patient has coryzal symptoms while concurrently having pharyngitis. Is this more likely to be bacterial or viral?

A

Bacterial

23
Q

What are the four centor criteria for bacterial pharyngitis?

A
  • Fever
  • Tender cervical lymphadenopathy
  • Tonsillar exudate
  • Absence of cough
24
Q

Under what circumstances would you prescribe antibiotics for bacterial pharyngitis?

A
  • Severe symptoms
  • No improvement after 3-7 days
  • Immunosuppression
  • ‘Shared decision making’
25
Q

Is epiglottitis life-threatening?

A
  • Yes
  • Can cause airway obstruction within minutes to hours
26
Q

Symptoms of epiglottitis

A
  • High fever
  • Resp. distress
  • Stridor
  • tripod position
27
Q

Managemment/treatment of epiglottitis

A
  • Priority is securing airway
  • Limit interventions (in kids: IV access)
  • Treated by airway management + IV antibiotics +/- steroids
28
Q

Diagnosis of epiglottitis

A
  • Normally on direct inspection
  • Lateral X-ray can be used
29
Q

What is acute otitis media? Provide a common mechanism

A
  • It is the accumulation of infected fluid/inflammation in the middle ear
  • Often caused by inflammation of eustachain tube leading to fluid accumulation and viral/bacterial colonisation
30
Q

Bacteria and viruses can be found simultaneously in some instances of acute otitis media. Does this happen in a majority or minority of cases?

A

Majority

31
Q

What symptoms do people present with when they have acute otitis media?

A
  • Pain
  • Hearing loss
  • Fever
  • Lethargy
  • Ear discharge (if tympanic membrane ruputed)
32
Q

In which age group is acute otitis media most common?

A

6-24 months

33
Q

How is acute otitis media diagnosed?

A

Otoscopy

34
Q

What proportion of acute otitis media cases self-resolve within 3 days?

A

> 80%

35
Q

Describe acute otitis media with effusion

A
  • Presence of middle ear effusion after resolution of infection
  • If persistent, can cause hearing loss (learning difficulty etc.)
36
Q

Describe chronic suppurative otitis media

A
  • Perforated tympanic membrane and >=6 weeks purulent drainage
37
Q

Describe mastoiditis as a consequence of acute otitis media. How is it treated?

A
  • Spread of infection into mastoid air cells of temporal bone
  • Can lead to postauricular swelling, erythema, systemic illness, and pain
  • Treated with IV antibiotics and possibly surgical intervention
38
Q

What is universal treatment for acute otitis media? What kind of patients would require antibiotics?

A
  • Universal: analgesia

Give antibiotics if:
- <6 months old
- Bilateral infection
- Perforated TM

39
Q

Symptoms of sinusitis?

A
  • Severe nasal congestion
  • Purulent nasal discharge
  • Facial pressure/fullness; often worsened when lying down
  • Maxillary tooth pain
40
Q

Are the vast majority of acute sinusitis cases caused by viruses or bacteria?

A

Viruses

41
Q

Mechanism of sinusitis

A
  • Epithelial inflammation
  • Limiting mucous drainage
  • Pressure buildup
42
Q

How does vigorous nose-blowing increase sinusitis risk?

A
  • Pushing more material into sinuses
  • Increased risk of secondary infection
43
Q

Complications of sinusitis

A
  • Orbital cellulitis (inflammation of eye socket)
  • Frontal bone subperiosteal abscess
  • Intracranial complications (meningitis etc.)
44
Q

Acute sinusitis management (except antibiotics)

A
  • Analgesia
  • Nasal saline/corticosteriods
45
Q

Is purulent nasal discharge a sign of bacterial sinusitis?

A

NO

46
Q

Signs of bacterial sinusitis

A
  • Duration >7-10 days
  • High fever
  • Worsening of symptoms after improvement

Medical Studies 1 (90 decks)

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