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clinical med exam 2 > HEENT URI > Flashcards

HEENT URI Flashcards

1
Q

primary organism that causes the common cold? How is it transferred?

A
  • rhinovirus 30-50%
  • transmission-droplets, hand contact, viruses can remain viable on human skin up to 2 hrs
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2
Q

treatment for the common cold

A

symptomatic

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3
Q

etiology of influenza

A

influenza virus, type A and B

  • type A subtypes: most extensive and severe
  • hemagglutinins H1, H2, H3
  • neuraminidases N1, N2
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4
Q

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
A

cold

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5
Q

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
A

influenza

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6
Q

diagnostics for influenza

A
  • 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
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7
Q

treatment for influenza

A
  1. 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
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8
Q

adverse effects of influenza treatment options: tamiflu and relenza

A

relenza: bronchospasm, decreased respiratory function
tamiflu: self-injury and delirium, N/V

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9
Q

prevention of influenza

A

influenza vaccine

  • 50-80% protection
  • need to be older > 6 months
  • 2 weeks before antibodies develop
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10
Q

what organisms are the primary cause of acute pharyngitis

A
  • viruses 50%
  • Group A streptococci 15%
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11
Q

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
A

pharyngitis

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12
Q

what are the Centor Criteria symptom complex that carriers a 40-60% predictive value for group A step pharyngitis

A
  • pharyngeal exudates
  • cervical adenopathy
  • fever
  • lack of cough/rhinorrhea

***3/4 criteria: test for GAS

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13
Q

Testing for Group A strep pharyngitis

A
  1. rapid antigen detection test
  2. if negative; throat culture
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14
Q

non-group A strep pharyngitis treatment

A
  • viral: supportive
  • HSV: acyclovir
  • gonorrhea: ceftriaxone
  • Candida: Nystatin troches
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15
Q

group A step pharyngitis treatment

A
  1. PCN 500 mg po BID-TID x 10 days
  2. Amoxicillin 500 mg BID x 10 days
  3. PCN G benzathine IM single dose: used in ER
  4. if PCN allergy: use Macrolides (e.g. erythromycin)
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16
Q

complications of group A strep pharyngitis

A
  • acute rheumatic fever
  • bacteremia
  • scarlet fever
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17
Q

when is acute pharyngitis emergent

A
  • epiglottitis
  • peritonisillar abscess
  • submandibular space infections: protruding tongue, “double chin”
  • retropharyngeal space infection: difficulty swallowing/breathing
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18
Q

when do refer a patient for tonsillectomy

A
  1. 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
  2. tonsillar exudate OR cervical adenopathy OR culture confirmed group A beta-hemolytic streptococcal
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19
Q

predominant species that causes peritonsillar abscess

A

Group A step, staphylococcus aureus, occasionally haemophilus influenza

20
Q

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
A

peritonsilar abscess

21
Q

treatment for peritonsillar abscess

A
  • drainage
  • injection: ampicillin sulbactam or clindamycin
  • oral: amoxicillin-clavulanate (Augmentin) or clindamycin x 14 days
22
Q

infectious etiology of acute laryngitis

A
  • respiratory viruses (e.g. rhinovirus, influenza)
  • bacterial respiratory infections (e.g. streptococcus)
23
Q

noninfectious etiology of acute laryngitis

A
  • vocal abuse
  • intubation/trauma
  • GERD
  • carcinoma of vocal cords
24
Q

clincal presentation

  • hoarsenss
  • URI symptoms
  • direct laryngoscopy can reveal laryngeal erythema and edema, vascular ingorgement of vocal cords, nodules, or ulcerations
A

acute laryngitis

25
Q

treatment for acute laryngitis

A
  • humidification
  • voice rest
  • hydration
  • avoid smoking
  • usually resolves in 1-3 weeks, if not, consider ENT eval
26
Q

etiology of acute rhinosinusitis

A
  • viral: rhinovirus, influenza
  • bacterial: only in 0.5-2% of cases: haemophilus influenza
27
Q

pathophysiology of acute rhinosinusitis

A

viral infection followed by secondary bacterial infection

28
Q

clinical presentation

  • nasal congestion
  • purulent nasal discharge
  • facial pain/pressure
  • fever
  • fatigue
  • cough
  • maxillary tooth discomfort
  • ear pressure or fullness
  • headache
A

acute rhinosinusitis

29
Q

what are red flags when considering acute rhinosinusitis?

A
  • fever > 102
  • severe HA
  • abnormal vision
  • change in mental status
  • periorbital edema

***if any of these are present, get CT with contrast

30
Q

how can you diagnose recurrent or treatment resistant acute rhinosinusitis

A

sinus aspirate culture

31
Q

treatment of acute rhinosinusitis

A
  • 98% viral source -> supportive
32
Q

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?

A

assume acute bacterial rhinosinusitis

  • augmentin 875/125 mg BID
  • if PCN allergy: doxycycline 100mg BID x 5-7 days
33
Q

complications of acute rhinosinusitis

A
  1. periorbital cellulitis
  2. meningitis
  3. osteitis of sinus bones
34
Q

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
A

chronic rhinosinusitis

35
Q

diagnostic criteria for chronic rhinosinusitis

A
  • at least 2/4 cardinal symptoms
  • illness lasting > 12 weeks with medical management
  • sinus mucosal disease evident on CT
  • direct visualization of mucosal inflammation
36
Q

treatment of chronic rhinosinusitis

A
  • nasal saline lavage
  • intranasal corticosteroids
  • oral corticosteroids
37
Q

pathology of infectious mononucleosis

A

epstein-barr virus (EBV)

38
Q

clinical presentation

  • 1-2 week prodrome: fever, malaise
  • cervical, general lymphadenopathy
  • fever
  • pharyngitis-exudative, petechiae on soft palate
  • splenomegaly (52%)
A

infectious mononucleosis

39
Q

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?

A

infectious mononucleosis

40
Q

what is the difference between using the heterophile antibody test (monospot) during week 1 of infection and week 2

A
  • week 1: 25% false negative; 40% positive
  • week 2: 50-80% will test positive

**if patient is negative, proceed to antibody/antigen testing

41
Q

how long will heterophile antibodies (monospot) be present

A

6-12 months

42
Q

what specific Epstein barr virus antibodies can you test for? how long are they present

A
  • 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
43
Q

what antibody testing indicates an acute infectious mononucleosis infection

A

presence of IgM VCA and absence of IgG EBNA indicates acute infection

44
Q

treatment for infectious mononucleosis

A
  • supportive: acetaminophen, NSAID
  • sports restriction
45
Q

complications of infectious mononucleosis

A
  • airway obstruction
  • splenic rupture
  • association with malignancy : hodgkin’s; Burkitt’s; nasopharyngeal CA
  • fatigue lasting > 6 months

clinical med exam 2 (6 decks)

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