Cases- URI (3)-Melissa Flashcards
The absolute contraindication to using ABX for URI treatment + why (2)?
VIRAL INFECTION
- patient safety: ^ likelihood c. diff infection, etc.
- ^ ABX resistance
When do we suspect bronchitis (2)?
What is the most likely etiology of bronchitis?
How do we treat this?
- no fever
- ~nasal congestion, sore throat, cough +/- productive, post nasal drip
- TYPICALLY viral; NO ABX
When do we suspect bacterial sinusitis (3)?
Do we use radiological imaging to make this diagnosis?
How do we treat this?
What are the 4 most common bugs that cause this infection?
- symptoms lasting LONGER than 7 days or getting worse
- common cold sx + sinus drainage, facial tenderness worse when leaning forward
- +/- fever and chills
- DOES NOT require imaging (does not change tx)
- Tx with amoxicillin (penicillins) for 10 days
- 4 bugs: Strep pneumo, Hflu, moroxella, staph aureus
Describe the clinical decision scoring system for sore throats?
What are the 4 criteria and how many points is each worth? How does age factor in?
How is the sore throat managed for : 0, 1, 2, 3, 4 points?
Criteria: ( +1 each)
- absence of cough
- swollen or tender anterior cervical nodes
- temp 100.4+
- Tonsillar exudates or swelling
Age:
3-14 yoa = +1
15-44 yoa = 0
45+yoa = -1
0 points= no testing or abx 1 point = no testing or abx 2 points = culture, abx if + 3 points= culture, abx if + 4 points= admin. emperic abx
Identify 2very strong signs that your patient has sterp and not viral infection:
- exudate on tonsils*
* no cough*
How do we typically treat strep infections?
ABX (amoxicillin; penicillin family) for 10 days
List 4 possible complications of pharyngeal strep infection if not treated:
- rheumatic fever
- post strep glomerulonephritis
- abscess
- meningitis
Most common bacterial cause of acute pharyngitis?
GAS
What is the most common cause of acute bronchitis?
What are two other potential causes?
#1 viral Common bacteria are mycoplasma and chlamydia
What is the clinical definition of acute bronchitis?
- cough longer than 3 days (cough may be productive; phlegm may be green or colorless)
Note: patient if patient has fever it will be low grade; does not typically present with chills, SOB, nausea, vomiting or body aches–these are indicative of other disease processes
Do patients with acute bronchitis get ABX?
NO, not even if bacterial–disease process is self limited and risks outweigh benefits
ABX do NOT shorted duration of illness; they are unfortunately commonly prescribed despite this recommendation
List 3 high yield risks associated with ABX prescription?
- allergic reaction/ GI upset
- abx resistance
- c diff!
32 yom day care employee presents with frontal HA, myalgia, sore throat for 48 hours. No cough. Tender anterior cervical adenopathy. No fever, purulent discharge, or tonsillar exudate. Maxillary sinuses transilluminate. What is the most likely dx?
sinusitis (could also be pharyngitis, but sinusitis is indicated die to the mention of maxillary sinuses)
This question is being challenged because mentioning that the maxillary sinuses transluminates suggests that there is NOT obstruction/ swelling of that area.
25 yof current daily smoker, sore throat, post nasal drip, increases cough, HA, tenderness above cheeks and eyes for 8 days (worse with leaning forward), cheeks tender to palpation, edema in nares and erythematous throat. Lungs clear to auscultation. What is the most likely dx?
rhinosinusitis
24 yom college student with 2 day hx of cough occasionally productive in nature; no fever or chills; no sinus tederness or post nasal drip, lings clear to auscultation, no cervical lymphadenopathy–most likely dx?
bronchitis
