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Clinical Medicine 2 Flashcards

1
Q

Etiology of acute sinusitis (rhino sinusitis)

A

Viral infection associated with common cold (URI). Few are bacterial related

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2
Q

Clinical presentation of acute sinusitis

A
  1. Nasal congestion/obstruction
  2. Purulent discharge (Bilateral viral, unilateral bacterial)
  3. Maxillary tooth pain (Bilateral is viral, unilateral is bacterial)
  4. Facial pain or pressure
  5. fever, fatigue cough
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3
Q

DX workup of acute sinusitis

A

Based on clinical symptoms. Purulent drainage. Must try and figure out if its viral or bacterial. Usually bacterial is secondary to the viral URI

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4
Q

Management of acute sinusitis

A
  1. If viral - goes away in 10 days
  2. Analgesics (NSAIDS)
  3. Saline irrigation
  4. Intranasal steroids
  5. Intranasal decongestants
  6. Amoxicillin
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5
Q

Complications of acute sinusitis

A
  1. Dental infections
  2. Intracranial involvement (abscess)
  3. Orbital cellulitis
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6
Q

Etiology of chronic sinusitis

A

Inflammatory condition involving the paranasal sinuses and lining of nasal passages that last longer than 12 weeks “untreated rhino sinusitis”

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7
Q

Clinical presentation of chronic sinusitis

A
  1. A/P nasal purulent drainage
  2. Nasal obstruction
  3. Facial pain/pressure
  4. Reduction or loss of sense of smell
  5. Mucosal thickening with polyps
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8
Q

DX workup of chronic sinusitis

A
  1. Rhinoscopy

2. CT/MRI

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9
Q

Complications of chronic sinusitis

A

High fever, double vision, proptosis, epistaxis - may indicate more severe conditions

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10
Q

Rhinocerebral mucormycosis

A

Fungal infection of the nasal cavity. Often seen in immunocompromised and diabetic pts

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11
Q

Causes of mucormycosis

A

From the fungal group rhizopus which are found in decaying soil. Airborne transmission

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12
Q

Clinical presentation of mucormycosis

A
  1. Acute sinusitis with fever
  2. Nasal congestion
  3. Clear discharge
  4. Spread to other structures
  5. Necrosis of the palate
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13
Q

Chlamydia

A

Most frequently reported infectious disease

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14
Q

URI

A

Viral induced infection of the upper respiratory tract (nose, mouth, upper lungs)
“common cold”

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15
Q

Types of URI infections

A
  1. Bronchitis
  2. Pertussis
  3. Acute rhinosinusitis
  4. Acute pharyngitis
  5. Acute otitis media
  6. Diptheria
  7. Infectious mononucleosis
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16
Q

Nasal vestibulitis

A

Staph aureus which may create folliculitis of the hairs. Often as a result of hair trimming

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17
Q

Clinical presentation of vestibulitis

A

Inflammation of the nasal vestibule, present with furuncle`

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18
Q

DX workup fro nasal vestibulitis

A

Nasal exam

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19
Q

Management of nasal vestibulitis

A

Drain furuncle, ABX - dicloxacillin. Topical - bacitracin

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20
Q

Common cold (URI) clinical presentation

A

nasal congestion, discharge, cough, sneezing, fever (low grade)

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21
Q

DX of URI

A

symptoms last

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22
Q

Management of URI

A

NO ABX!! Unless it is bacterial induced which is very rare.
Saline irrigation
Oxymetazoline - nasal anithistamine

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23
Q

Influenza A/B

A

Virus infection that comes from avian host

24
Q

Clinical presentation of influenza

A
  1. Fever/chills/malaise
  2. Rhinitis
  3. Cough
  4. Congestion
  5. Sore throat
  6. NVD
25
Q

DX of influenza

A

Rapid flu test, some PCR testing

26
Q

Management of influenza

A

Analgesics, cough suppressant, rest, antiviral therapy, susceptible strains - neuraminidase inhibitors

27
Q

H1N1

A

Complex flu strain that has 4 mutant viruses: human, bird, and 2 swine flu viruses

28
Q

Clinical presentation of H1N1

A

Common flu symptoms plus GI symptoms and respiratory symptoms (pneumonia)

29
Q

DX workup for H1N1

A

Rapid flu test (nasal swab 60-80%)

30
Q

Management of H1N1

A

Oseltamivir, zanamivir (if resistant to oseltamivir)

31
Q

Causes of acute bronchitis

A
  1. Mostly due to viruses (flu, rhinovirus) that attack the bronchial tree.
  2. However, there are a few that are bacterial (mycoplasma, chlamydia, bordetella)
32
Q

Clinical presentation of acute bronchitis

A
  1. Cough that lasts longer than 5 days
  2. Sputum production
  3. no fever (more indicative of pneumonia)
  4. Chest wall tenderness
  5. Wheezing
33
Q

DX workup of acute bronchitis

A
  1. wheezing during exam
  2. 5 day cough
  3. No CXR needed (not dx)
34
Q

Management of acute bronchitis

A

NO ABX!! Will clear on its own in 10 days. But may give aspirin or acetaminophen for inflammation

35
Q

Pertussis (whooping cough)

A

Caused by the organism bordetella pertussis. Transmitted through droplets. Seen in

36
Q

Clinical presentation of pertussis

A

Malaise, cough, rhinitis, anorexia, whoop

37
Q

DX work up of pertussis

A
  1. Nasopharyngeal culture

2. Lymphocytosis (pcr)

38
Q

Management of pertussis

A

Erythromycin, azithromycin, clarithromycin

39
Q

Viral pharyngitis causes

A

EBV, CMV, resp viruses, enteroviruses, HSV

40
Q

Clinical presentation of viral pharyngitis

A
  1. Conjunctivitis
  2. Runny nose
  3. Cough
  4. Hoarsness - never seen with bacterial infections
41
Q

Management of viral pharyngitis

A

Because it is viral, no ABX. In adults it is almost never streptococcus related. Treat with pain relievers, antipyretics, gargling

42
Q

Group A beta-hemolytic streptococcal pharyngitis

A

Caused by group A strep, non group A strep, arcanobacterium

43
Q

Clinical presentation of strep A pharyngitis

A
  1. Fever
  2. Headace
  3. Tonsillar inflammation
  4. Age 5-15!!!
44
Q

Management of strep A pharyngitis

A

PENICILLIN or cephalosporin. If allergic they can be given a macrolide

45
Q

Causes of diptheria

A

Corynebacterium (exotoxins). Organism attacks respiratory tract, mucous membranes, and skin wounds

46
Q

Clinical presentation of diptheria

A
  1. Tenacious gray membrane - gray impossible to remove plaque at the back of throat
  2. Sore throat
  3. Rhinorrhea
  4. Fever, malaise
47
Q

Complications of strep A pharyngitis

A

glomerulonephritis and rheumatic fever

48
Q

Complications of diptheria

A

Myocarditis and neuropathy

49
Q

Management of diptheria

A

Horse serum antitoxin + penicillin or erythromycin (z-pak)

50
Q

Causes of mono

A

EBV. Common in 10-35 yr olds

51
Q

Clinical presentation of mono

A
  1. Fever
  2. Sore throat
  3. Malaise
  4. Fatigue!!!!!
  5. Abd px from inflammation of the liver and spleen
52
Q

Workup for mono

A

Monospot positive within 4 weeks. CBC shows atypical lymphocytes

53
Q

Management of mono

A

supportive. secondary bacterial pharyngitis main be present. avoid contact sports because of possible spleen rupture

54
Q

What is the best thing to give pts with strep A in order to prevent glomerulonephritis and rheumatic fever

A

IM penicillin

55
Q

Indications for tonsillectomy

A
  1. Obstruction of airway by tonsils
  2. Tonsillar obstruction that interferes with swallowing
  3. Malignant tumor on tonsil
  4. Uncontrollable hemorrhage
56
Q

Condition indications for tonsillectomy

A
  1. Recurrent throat infections
  2. Chronic tonsillitis
  3. Halitosis
  4. Tonsillar abscess
57
Q

What happens if you give a patient with mono ampicillin/amoxicillin

A

They can break out in a mobilliform rash. The ABX interacts inappropriately with the virus. This is NOT an allergy

AII Week 3 (5 decks)

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