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Respiratory 1 > Common URT Infections > Flashcards

Common URT Infections Flashcards

1
Q

Rhinosinusitis (common cold)

A

-self limiting viral inf of URT

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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
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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
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4
Q

Adults URT:

A
  • 2-4colds/yr
  • duration 5-7days
  • nasal congestion
  • WITHOUT FEVER
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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)
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6
Q

COLD with labs and radiology:

A

-NOT USEFUL!

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7
Q

rhinosinusitis complications:

A
  • uncommon
  • acute otitis media (secondary to eustachian tube dysf
  • asthma exacerbation
  • LRT infections (pneumonia, bronchiolitis)
  • sinusitis - super rare
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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!!!!!!
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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
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10
Q

Sinusitis epidemiology:

A
  • inflammation of paranasal sinuses
  • Alergic; bacterial; fungal; viral
  • Usually as complication of viral URI
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11
Q

Sinusitis categories:

A

1) Acute:

- >10-14 days but 90 days

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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
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13
Q

Acute bacterial sinusitis - the pathogens:

A
  • strep pneumo
  • moraxella catarrhalis
  • haemophilus influenzae
  • staph aureus (and MRSA)
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14
Q

Pathophys of sinusitis

A

-ciliary dysf and inc secretions = sinus obstruction

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15
Q

Clinical symptoms of sinusitis:

A
  • nasal discharge
  • cough
  • facial pain
  • headache
  • painless eye swelling
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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
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17
Q

complications of sinusitis:

A
  • meningitis
  • brain abscess
  • cavernous venous thrombosis
  • orbital cellulitis (abscess)
  • osteomyelitis
  • epidural/subepidural empyema
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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
Q

Do not treat pharyngitis unless:

Drug of choice?

A
  • proven group A strep!! (usually viral)

- penicillin for strep pharngitis

26
Q

complications of pharyngitis?

A
  • rare!
  • peritonsillar abscess
  • acute otitis media
  • acute sinusitis
  • acute rheumatic fever
  • acute glomulonephritis
27
Q

Otitis media:

A
  • 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
Q

Diagnosis of acute otitis media:

A

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
Q

***If kid doesnt have/had fever or pain with otitis media then..

A

not treating with antibiotics = watchful waiting!!**

30
Q

Risk factors for acute otitis media:

A
  • immunodef
  • craniofacial abn (cleft, down)
  • recent resp tract inf
  • family hisotry
  • siblings
  • daycare
  • lack of breastfeeding
  • passive smoke exposure
  • pacifier use
31
Q

Peak age incidence for acute otitis media?

A

-6-12 months

32
Q

**Pathogens for acute otitis media:

A

1) Viral
- RSV
- influenza
2) bacterial
- S pneumo
- H influenzae
- M catarrhalis

33
Q

Tx for acute otitis media?

A
  • Wait it out
  • pain resolves in <2 yo
  • analgesics for symptmatic relief
  • antibiotics see #35
34
Q

Prevention of acute otitis media:

A
  • conjugate pneumococcal vaccine
  • influenza vaccine
  • reduce risk factors (stop pacifier, stop smoking exposure)
35
Q

antibiotics for acute ottiis media if

A
  • no improvement 48 hours
  • perforation of TM
  • high risk of complications
  • children <2yo with bilateral AOM
36
Q

**on test dont pick which antibiotics???

A

IF ITS NOT AMOXICILLIN OR PENICILLIN DONT PICK IT!!!!

37
Q

Antibiotic selection for acute otitis media:

A
  • 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
Q

What doesnt work for acute otitis media?

A
  • antihistamines
  • decongestants
  • myringotom y
39
Q

common complication for acute OM?

A

-mastoiditis*

-others;
facial palsy, menigitis
intracranial abscess…

40
Q

recurrent acute otitis media defined as:

A

-3 episodes in 6 mo
OR
-4 episodes in 12 months

41
Q

management of recurrent acute otitis media:

A
  • prophylactic antibiotics-ok
  • tympanostomy tubes-ok
  • adenoidectomy - NOT HELPFUL! SO WHY ARE WE EVEN MENTIONING IT IN CLASS HERE…
42
Q

otitis media with effusion:

A
  • 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
Q

most common form of otitis media?

A

-otitis media with effusion

44
Q

Tx otitis media with effusion_

A

-most cases resolve on own within 3 months

Respiratory 1 (9 decks)

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