Habal: Colds, Otitis Media, Sinusitis Flashcards
Which of the three is most commonly prescribed antibiotics in an office visit for children under 15 yo: UTI, Sinusitis, or Otitis Media?
Otitis Media
Which parts include the upper respiratory tract?
Nasal Cavity, Pharynx, Larynx (larynx tends to extend down to lower UT)
What are the more common ailments of the URT?
common cold, pharyngitis and tonsillitis, parotitis*, otitis* and sinusitis, acute epiglottis, oral cavity infections
Which parts include the lower respiratory tract?
Trachea, primary bronchi, lungs
What are the more common ailments of the LRT?
laryngitis* and tracheitis, diphtheria, whooping cough, bronchitis, bronchiolitis, pneumonia
The common cold is most often a _________ infection.
viral. inflammation –> cytokines released.
Common symptoms of the common cold?
nassal congestion, rhinorrhea, cough, fever (kids), last from day to 1-2 weeks
In the pathogenesis of the common cold, what receptors are effected?
HRV (human Rhinovirus) binds to three receptors: ICAM-I (major group), LDLR (minor group), and HRVC (unknown)
What does HRV target in the common cold?
epithelial cells in airways
In the pathogenesis of the common cold, what cytokines and chemokines are released?
cytokines: IFN-b, IFN-gamma, IL-1, IL-6, GM-CSF chemokines: CXCL10/IP-10, CCL5/RANTES, CXCL8/IL-8
In the pathogenesis of the common cold, for airway remodeling ________________ release _______________ which is involved in the breakdown of the extracellular matrix and contributes to remodeling/thickening of airways/thickening of the lamina reticularis.
fibroblasts/myofibroblasts; Matrix proteins (mainly MMP9: Matrix Metalloprotease Protein 9)
What are 4 common cold myths that have no conclusive evidence?
central heating dries out mucosa and you catch a cold; feed a cold/starve a fever; zinc is beneficial for treating/preventing; Vit C is beneficial for treating/preventing
3 main complications of the common cold?
otitis media, acute sinusitis, asthma
Common causes of the common cold?
Rhino Corona Entero Adeno >200 different viruses. 50% due to rhinoviruses and its >100 serotypes. 15-20% due to Coronaviruses (SARS, MERS). 2% due to Enteroviruses. 2% due to Adenoviruses.
What defines acute otitis media and what age group is it most commonly seen in?
acute inflammation of the middle ear resulting in ACCUMULATION OF FLUIDS within the middle ear space. 6-36 months (the eustachian tube is more open in babies)
**Describe the pathogenesis of acute otitis media.
An ANATOMIC or physiologic dysfunction of the auditory tube disrupts the drainage. (shorter and horizontal Eustachian tube in kids; supine position of infants when feeding –> reflux of pharyngeal content) –> FLUID accumulation –> BACTERIAL INFECTION
3 most common pathogens of acute otitis media?
Strep pneumo, H. influenza, Maroxella catarrhalis
Describe how you would diagnose a patient with acute otitis media.
Symptoms: fever, chills, ear pain, ear drainage, irritability. Erythema of tympanic membrane. Fluid on otoscopy. (***if no fluid, it’s NOT otitis media.
How would you manage your patient after giving a diagnosis of acute otitis media?
at ages 6-36 months, you can opt to “observe” and see if it goes away on its own. If no improvement: AMOXICILLIN If not responsive: AUGMENTIN, CEFTRIAXONE (also, topical analgesics, spray/drops)
What is the most commonly effected sinus in acute sinusitis?
Maxillary (due to gravity)
What includes the paranasal sinuses (which are commonly effected in acute sinusitis)?
FEMS: Frontal, Ethmoid, Maxillary, Sphenoid
What is the duration of acute sinusitis? Subacute? Chronic?
10-30d; 30-90d; >90d
What are symptoms of acute sinusitis?
inflammation of paranasal sinuses, congestion, mucus production, facial pain, headache, tooth pain, halitosis (bad breath)
What is the gold standard for diagnosis of sinusitis?
sinus aspiration because it tells you the organisms (unlike xray, etc) BUT infrequently done becuase it has to be done by a specialist, it’s time consuming, invasive, and painful.
