Exam 2 URI Flashcards
Pt. comes in with low fever, watery d/x, congestion, sneezing, sore throat and a non productive cough.. ddx? tx?
URI or Influenza. Most likely URI (rhinovirus) bc no malaise, abrupt onset of fever, prominent HA etc. Tx = none bc resolves in a week or so, but push fluid, maybe analgesics for fever but not ASA, chloraseptic for throat, antihist for d/c, sudafed (decongestant), robitussin (expectorant)
What are the defining sx of the flu? how to dx? Tx? risks?
caused by influenza virus
- abrupt onset high fever, pharyngeal erythema, LAD, prominent HA, myalgia/confusion/weakness in elderly, length of illlness, SEVERE sx
dx: history, CBC, electrolytes and glucose, chest xray, viral culture
tx: antipyretic ie rimantadine, zanamivir
risk: secondary bacterial pneumonia
Pt has low fever, sore throat, myalgia, malaise, conjunctivitis… dx, tx?
dx: viral pharyngitis (rhinovirus usually)
tx: support, hydration, antipyretic
note: awareness of other viral processes - herpangina (cox A, B), HIV infection
8 year old pt comes in with severe pain on swallowing, LAD, a funny rash, but no cough or fever. You take a look in their throat and notice pharyngeal exudates. What is your next step
scoring system (fever, absence of cough, LAD, tonsillar swelling, age) –> confirm high risk of strep pharyngitis –> rapid strep test
- gold standard = throat culture
ddx: mono
how would you normally treat strep pharyngitis? what if pt has PCN allergy? Any complications of strep pharyngitis?
treat with PCN or Keflex
if allergy… azithromycin, clarithromycin, erythromycin, clindamycin
avoid aspirin
complications: rheumatic fever, flomerulonephritis, peritonsillar abscess, OM, sinusitis, cellulitis, scarlet fever, toxic shockis
You notice your friend is speaking with a “hot potato voice” and is inappropriately drooling all over. You, being a PA, ask to look in his mouth and notice a deviated uvula. Dx? causative agent? Tx?
dx: peritonsillar abscess (possible complication from tonsillitis/pharyngitis, cellulitis, mono,)
agent: strep pneumo, H flu
tx: surgical drainage, possibly PCN antibiotic
a young teen comes in with malaise, sore throat and oral ulcers with pharyngeal erythema and edema. Ddx? how to confirm dx? tx?
ddx: mono, HIV, pharyngitis
dx: monospot for EBV.. feel for enlarged spleen!
tx: support; educate that EB virus is contagious for 6 or more months
You are sad bc the concert you bought tickets to was cancelled due to the lead singer having hoarseness, dysphonia, and an irritative cough. Likely dx for this musician? Etiology of condition? tx?
dx: laryngitis
Etiology: often viral (rhinovirus), possibly bacterial (streptococci, H flu, moraxella), but likely vocal abuse or nodes in this case
Tx: hydration, rest, stop smoking… If lasts longer than 3weeks then ENT referral
If the lead singer actually did not have laryngitis as suspected, what are some other potential dxs?
Ddx… Epiglotitis (hib, h flu) - typically drooling, fever, no cough. Risk for obstruction! Hospitalize, intubation, antibiotics
Croup (parainfluenza virus) but would have inspiratory stridor and barking cough
Halitosis, dental pain, congestion, purulent discharge, PND… Dx? Potential etiologies?
Dx is SINUSITIS
Etiologies: previous URI (rhinovirus), bacterial (strep pneumo, h flu, moraxella…), fungal (if immunocompromised), other (allergies, tumors, polyps, nosocomial infection (staph aureus, pseudomonas)
You determine a pt has bacterial sinusitis. What is your tx plan?
Antibiotics for ten days
AM-CL-ER, amoxicillin, cefdinir
If PCN ALLERGY… Levaquin
If pt is sick longer than two weeks then try augmentin, azithromycin, clarithromycin
Gold standard for sinusitis dx is
Sinus aspirate culture
*slide also says CT scan is choice
One pt has frontal sinusitis, the other, ethmoidal.. What are potential concerns to be aware of?
Frontal- osteomyelitis (notice doughy edema, HA)
Ethmoidal - orbital cellulitis (fever, eyelid edema, ptosis, potentially decreased EOM or vision loss due to CN II compression)
Other concerns.. Meningitis, thrombosis
If a pt does not have bacterial sinusitis what else could you do for tx?
Hydration, humidification, saline nasal spray, decongestant (topical = phenylephrine, oxymetazoline (Afrin) or systemic = pseudoephedrine (Sudafed), NSAIDS
ENT referral maybe
Note that antihistamines tend to thicken nasal secretions so would not be the best option
Pt is suffering from continued nasal congestion, HA, sinus pressure, purulent dc and drainage. It has been ongoing for 3 months they say, so you order a plain film that shows bony erosion and a ct that indicates mucosal thickening. Dx, cause, tx?
Dx: chronic sinusitis
Cause: s aureus, strep pneumo, h flu, pseudomonas, anaerobes
Tx: systemic decongestants (Sudafed), saline nasal irrigation, inhalation steroids eg Flonase
ENT referral, possible surgery
