HEENT URI Flashcards
primary organism that causes the common cold? How is it transferred?
- rhinovirus 30-50%
- transmission-droplets, hand contact, viruses can remain viable on human skin up to 2 hrs
treatment for the common cold
symptomatic
etiology of influenza
influenza virus, type A and B
- type A subtypes: most extensive and severe
- hemagglutinins H1, H2, H3
- neuraminidases N1, N2
clinical presentation
- fever is rare
- HA is rare
- minimal general aches and pain
- sneezing, runny/stuffy nose and sore throat
- mild to moderate chest discomfort and coughing
cold
clinical presentation
- fever: 100-102F that comes on quickly and lasts 3-4 days
- prominent HA
- general aches, pains
- fatigue and weakness
- chest discomfort and coughing
- can have sneezing, runny/stuffy nose
influenza
diagnostics for influenza
- gold standard for lab diagnosis: viral culture 48-72 hrs
- rapid antigen test (RAT): nasal swab: negative results does not exclude flu: 15 min for test result
treatment for influenza
- antiviral medication within 24-48 hrs from onset of symptoms
- neuraminidase inhibitors: Tamiflu 75 mg po bid x 5 days;
- if pregnant: use Relenza 2 inhalations BID x 5 days
adverse effects of influenza treatment options: tamiflu and relenza
relenza: bronchospasm, decreased respiratory function
tamiflu: self-injury and delirium, N/V
prevention of influenza
influenza vaccine
- 50-80% protection
- need to be older > 6 months
- 2 weeks before antibodies develop
what organisms are the primary cause of acute pharyngitis
- viruses 50%
- Group A streptococci 15%
clinical presentation
- sore throat
- fever
- HA
- mailaise
- “swollen glands”
- URI symptoms
- PE: pharyngeal erythema; tonsillar hypertrophy; purulent exudate; tender and/or enlarged anterior cervical lymph nodes; palatal petichiae
pharyngitis
what are the Centor Criteria symptom complex that carriers a 40-60% predictive value for group A step pharyngitis
- pharyngeal exudates
- cervical adenopathy
- fever
- lack of cough/rhinorrhea
***3/4 criteria: test for GAS
Testing for Group A strep pharyngitis
- rapid antigen detection test
- if negative; throat culture
non-group A strep pharyngitis treatment
- viral: supportive
- HSV: acyclovir
- gonorrhea: ceftriaxone
- Candida: Nystatin troches
group A step pharyngitis treatment
- PCN 500 mg po BID-TID x 10 days
- Amoxicillin 500 mg BID x 10 days
- PCN G benzathine IM single dose: used in ER
- if PCN allergy: use Macrolides (e.g. erythromycin)
complications of group A strep pharyngitis
- acute rheumatic fever
- bacteremia
- scarlet fever
when is acute pharyngitis emergent
- epiglottitis
- peritonisillar abscess
- submandibular space infections: protruding tongue, “double chin”
- retropharyngeal space infection: difficulty swallowing/breathing
when do refer a patient for tonsillectomy
- at least 7 episodes of pharyngitis in the last year OR at least 5 in each of the past 2 years OR at least 3 in each of the past 3 years
- tonsillar exudate OR cervical adenopathy OR culture confirmed group A beta-hemolytic streptococcal
predominant species that causes peritonsillar abscess
Group A step, staphylococcus aureus, occasionally haemophilus influenza
clinical presentation
- severe sore throat-usually unilateral
- “hot potato” muffled voice
- drooling
- trismus (2/3 of patients) = spasm of internal pterygoid muscle
- fever
- neck swelling and pain
- ipsilateral ear pain
- PE: swollen, fluctuant tonsil with deviation of uvula to opposite side; cervical lymphadenopathy
peritonsilar abscess
treatment for peritonsillar abscess
- drainage
- injection: ampicillin sulbactam or clindamycin
- oral: amoxicillin-clavulanate (Augmentin) or clindamycin x 14 days
infectious etiology of acute laryngitis
- respiratory viruses (e.g. rhinovirus, influenza)
- bacterial respiratory infections (e.g. streptococcus)
noninfectious etiology of acute laryngitis
- vocal abuse
- intubation/trauma
- GERD
- carcinoma of vocal cords
clincal presentation
- hoarsenss
- URI symptoms
- direct laryngoscopy can reveal laryngeal erythema and edema, vascular ingorgement of vocal cords, nodules, or ulcerations
acute laryngitis
treatment for acute laryngitis
- humidification
- voice rest
- hydration
- avoid smoking
- usually resolves in 1-3 weeks, if not, consider ENT eval
etiology of acute rhinosinusitis
- viral: rhinovirus, influenza
- bacterial: only in 0.5-2% of cases: haemophilus influenza
pathophysiology of acute rhinosinusitis
viral infection followed by secondary bacterial infection
clinical presentation
- nasal congestion
- purulent nasal discharge
- facial pain/pressure
- fever
- fatigue
- cough
- maxillary tooth discomfort
- ear pressure or fullness
- headache
acute rhinosinusitis
what are red flags when considering acute rhinosinusitis?
- fever > 102
- severe HA
- abnormal vision
- change in mental status
- periorbital edema
***if any of these are present, get CT with contrast
how can you diagnose recurrent or treatment resistant acute rhinosinusitis
sinus aspirate culture
treatment of acute rhinosinusitis
- 98% viral source -> supportive
If patient has rhinosinusitis in which
- symptoms last >10 days OR
- severe symptoms (fever >102, facial pain) 3-4 days
- double sickening
how would you treat?
assume acute bacterial rhinosinusitis
- augmentin 875/125 mg BID
- if PCN allergy: doxycycline 100mg BID x 5-7 days
complications of acute rhinosinusitis
- periorbital cellulitis
- meningitis
- osteitis of sinus bones
clinical presentation
Cardinal symptoms:
Adults:
- mucopurulent nasal drainage, typically white/yellow
- nasal obstruction and congestion
- facial pain, pressure, and fullness
- reduction of loss of sense of smell
Child:
- cough without reduction of smell
chronic rhinosinusitis
diagnostic criteria for chronic rhinosinusitis
- at least 2/4 cardinal symptoms
- illness lasting > 12 weeks with medical management
- sinus mucosal disease evident on CT
- direct visualization of mucosal inflammation
treatment of chronic rhinosinusitis
- nasal saline lavage
- intranasal corticosteroids
- oral corticosteroids
pathology of infectious mononucleosis
epstein-barr virus (EBV)
clinical presentation
- 1-2 week prodrome: fever, malaise
- cervical, general lymphadenopathy
- fever
- pharyngitis-exudative, petechiae on soft palate
- splenomegaly (52%)
infectious mononucleosis
if a patient who has fever, malaise, and pharyngitis is treated with IM ampicillin, amoxicillin, beta-lactam Abx and develops a pruritic, maculopapular rash, what might this patient have?
infectious mononucleosis
what is the difference between using the heterophile antibody test (monospot) during week 1 of infection and week 2
- week 1: 25% false negative; 40% positive
- week 2: 50-80% will test positive
**if patient is negative, proceed to antibody/antigen testing
how long will heterophile antibodies (monospot) be present
6-12 months
what specific Epstein barr virus antibodies can you test for? how long are they present
- IgM VCA: against viral capsid antigen (VCA) wane after 3 months
- IgG VCA persist for life
**both present at onset of clinical illness
- IgG antibodies to EBV nuclear antigen (IgG EBNA)
- expressed 6-12 weeks after onset, persists for life
what antibody testing indicates an acute infectious mononucleosis infection
presence of IgM VCA and absence of IgG EBNA indicates acute infection
treatment for infectious mononucleosis
- supportive: acetaminophen, NSAID
- sports restriction
complications of infectious mononucleosis
- airway obstruction
- splenic rupture
- association with malignancy : hodgkin’s; Burkitt’s; nasopharyngeal CA
- fatigue lasting > 6 months
