Common URT Infections Flashcards
1
Q
Rhinosinusitis (common cold)
A
-self limiting viral inf of URT
2
Q
Rhinosinusitis - pathogens
A
-rhinovirus (most common) (MAR-APR & SEPT)
Others:
- RSV (DEC-FEB)
- influenza (DEC-FEB)
- parainfluenza (Croup) (OCT-NOV)
- adenovirus
- enterovirus (echovirus & Coxsackievirus)
- human metapneumovirus
3
Q
Transmission of rhinovirus:
A
- inh of small particle aerosols
- deposition of large particle droplets on nasal or conjunctival mucosa
- direct- hand to hand contact
- survives up to 2 hours on hands
- several days on surfaces
4
Q
Adults URT:
A
- 2-4colds/yr
- duration 5-7days
- nasal congestion
- WITHOUT FEVER
5
Q
Children URT:
A
- 6-8colds/yr (one/mo Sep-Apr; inc incidence if daycare and fewer with start of primary school)
- duration 7-14days (peak 1-3 days)
- symptoms (colored nasal discharge, FEVER days 1-3, sore throat, cough, irritability, difficulty sleeping, dec appetite)
6
Q
COLD with labs and radiology:
A
-NOT USEFUL!
7
Q
rhinosinusitis complications:
A
- uncommon
- acute otitis media (secondary to eustachian tube dysf
- asthma exacerbation
- LRT infections (pneumonia, bronchiolitis)
- sinusitis - super rare
8
Q
rhinosinusitis Tx:
A
- most patients improve in 14 days
- supportive therapy ( acetaminophen PRN fever; bulb suctioning, saline irrigation)
- NO ANTIBIOTICS
- if symptoms for >10-14days WITHOUT improvement then consider acute bacterial sinusitis (NARROW SPECTRUM - AMOXICILLIN)
- NO OVER THE COUNTER COUGH/COLD MEDS!!!!!!
9
Q
Sinus development:
A
- full dev not complete until late adolescence
- first maxillary and ethmoid
- sphenoid by 5-6 years
- frontal by 7-8 years
10
Q
Sinusitis epidemiology:
A
- inflammation of paranasal sinuses
- Alergic; bacterial; fungal; viral
- Usually as complication of viral URI
11
Q
Sinusitis categories:
A
1) Acute:
- >10-14 days but 90 days
12
Q
Diagnosis of acute bacterial sinusitis:
A
- nasal/postnasal discharge lasting at least 10-14 days without improvement
- with or without daytime cough
- cough worse as night
OR
Ill appearing child with
- temp>102F
- purulent nasal discharge
- 3 consecutive days
13
Q
Acute bacterial sinusitis - the pathogens:
A
- strep pneumo
- moraxella catarrhalis
- haemophilus influenzae
- staph aureus (and MRSA)
14
Q
Pathophys of sinusitis
A
-ciliary dysf and inc secretions = sinus obstruction
15
Q
Clinical symptoms of sinusitis:
A
- nasal discharge
- cough
- facial pain
- headache
- painless eye swelling
16
Q
Sinusitis PE:
A
- periorbital edema
- mucopurulent discharge in nose or pharynx
- nasal mucosa (erythematous(Infectious); boggy (infectious) and pale (allergic))
- tenderness over paranasal sinuses
- malordorous breath
17
Q
complications of sinusitis:
A
- meningitis
- brain abscess
- cavernous venous thrombosis
- orbital cellulitis (abscess)
- osteomyelitis
- epidural/subepidural empyema
18
Q
Labs and radiology for sinusitis?
A
not helpful!
19
Q
Management of sinusitis:
A
1) antibiotics
-start with narrow spectrum (first line amoxicillin)
-treat until symptom free +7 dats (at least 10-14days)
2) sinus aspiration
-indications:
failuer to respond to antibiots
severe facial pain
orbital intracranail complications
immunocomp patient
20
Q
Pharyngitis:
A
-affects respiratory mucosa of throat
21
Q
clinical features of pharyngitis:
A
- sore throat
- headache
- fever
- malaise
22
Q
Predictors of bacterial pharyngitis:
A
(compared to viral)
- fever >38C
- tonsillar swelling or exudate
- tender cervical lymph
- absence of cough and nasal discharge
23
Q
Tx pharngitis:
A
- resolves on on in 40% cases by 3 days
- resolves in 85% by 1 week
- analgesia
- antibiotics to prevent rare complications
- systemic corticosteroids: severe pain no responding to analgesics=reduce pain 12-24 hrs; tonsillar edema with risk of obstruction
24
Q
Swabbing throat how old?
A
not unless 2-3 years – if younger they prbably dont even have the receptors yet
25
Do not treat pharyngitis unless:
| Drug of choice?
- proven group A strep!! (usually viral)
| - penicillin for strep pharngitis
26
complications of pharyngitis?
- rare!
- peritonsillar abscess
- acute otitis media
- acute sinusitis
- acute rheumatic fever
- acute glomulonephritis
27
Otitis media:
- affect respiratory mucosa of middle ear
- common in children (dec in frequency after age 6 years)
- most common reason for prescribing antibiotics for children in US
28
Diagnosis of acute otitis media:
1) presence of middle ear effusion
- bulging of tympanic membrane
- limited or absent mobility of the tympanic membrane
- air-fluid level behind the tympanic membrane -otorrhea
2) history of recent acute onset
3) signs of inflammation of middle ear
- otalgia
- eryhhematous tympanic membrane
29
***If kid doesnt have/had fever or pain with otitis media then..
not treating with antibiotics = watchful waiting!!****
30
Risk factors for acute otitis media:
- immunodef
- craniofacial abn (cleft, down)
- recent resp tract inf
- family hisotry
- siblings
- daycare
- lack of breastfeeding
- passive smoke exposure
- pacifier use
31
Peak age incidence for acute otitis media?
-6-12 months
32
**Pathogens for acute otitis media:
1) Viral
- RSV
- influenza
2) bacterial
- S pneumo
- H influenzae
- M catarrhalis
33
Tx for acute otitis media?
- Wait it out
- pain resolves in <2 yo
- analgesics for symptmatic relief
- antibiotics see #35
34
Prevention of acute otitis media:
- conjugate pneumococcal vaccine
- influenza vaccine
- reduce risk factors (stop pacifier, stop smoking exposure)
35
antibiotics for acute ottiis media if
- no improvement 48 hours
- perforation of TM
- high risk of complications
- children <2yo with bilateral AOM
36
**on test dont pick which antibiotics???
IF ITS NOT AMOXICILLIN OR PENICILLIN DONT PICK IT!!!!
37
Antibiotic selection for acute otitis media:
- narrow spectrum (amoxicillin)
- treat for 5-7 days
- 10 day course if younger child, underlyying chronic illness (craniofacial issues), perforated TM, chronic or recurrent acute OM.
38
What doesnt work for acute otitis media?
- antihistamines
- decongestants
- myringotom y
39
common complication for acute OM?
-mastoiditis*
-others;
facial palsy, menigitis
intracranial abscess...
40
recurrent acute otitis media defined as:
-3 episodes in 6 mo
OR
-4 episodes in 12 months
41
management of recurrent acute otitis media:
- prophylactic antibiotics-ok
- tympanostomy tubes-ok
- adenoidectomy - NOT HELPFUL! SO WHY ARE WE EVEN MENTIONING IT IN CLASS HERE...
42
otitis media with effusion:
- presence of middle effusion wihtout symptoms of acute infection
- expected 2-3 mo following acute ottiis emdia
- usually asymptomatic but can cause hearing loss
43
most common form of otitis media?
-otitis media with effusion
44
Tx otitis media with effusion_
-most cases resolve on own within 3 months
