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PR3151 Finals > IC15: URTI > Flashcards

IC15: URTI Flashcards

1
Q

Pathophysiology of URTI

A

Transmission through:

  • Droplets containing virus that are expelled when people with URTI cough, sneeze or talk
  • Spread indirectly when a person touches a surface with the virus on it and then touches his nose/mouth
  • When an infected person shares food with others during mealtime without a serving spoon

These particles inhaled into the respiratory tract and invade upper airway mucosa

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2
Q

Innate immunity against URTI includes? (total 5)

A

1) Nostril hair lining traps organisms

2) Mucus traps organisms

3) Angle between the pharynx and nose which prevents particles from falling into the airway

4) Mucocilliary system in the lower airways that transport the pathogens back to the pharynx

5) Adenoids and tonsils also contain immunological cells that attack the pathogens

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3
Q

Risk factors for URTI (6)

A

1) Close contact with children

2) Lack of personal/hand hygiene

3) Medical disorder eg asthma and allergic rhinitis (chronic respiratory disease)

4) Smoking

5) Immunocompromised individuals eg cystic fibrosis, HIV, use of corticosteroids, transplantation and post splenectomy

6) Anatomical anomalies including facial dysmorphic changes or nasal polyposis

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4
Q

What are some ways to prevent URTI? (3)

A

1) Vaccination (influenza, pneumococcal, haemophilus influenzae)

2) Manage known risk factors eg smoking cessation, control asthma and allergic rhinitis

3) Hand/personal hygiene, wearing mask, staying away from sick contact and crowds

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5
Q

Options of symptomatic relief

A

Paracetamol
NSAID
Nasal decongestant
Normal saline nasal irrigation
Antihistamine
Lozenges
Mucolytics
Cough suppressants
Expectorant
Warm water/tea
Honey

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6
Q

Clinical presentation of common cold/viral infection

A
  • Sx: Rhinorrhea, nasal blockage, sneezing, sore throat, productive cough, some headache, body ache
  • Signs: Low grade temperature, normal heart rate and lungs that are clear to auscultation
  • Gradual onset
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7
Q

What are the usual pathogens in common cold/viral infection?

A

Rhinovirus, coronavirus etc

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8
Q

How would you counsel a patient with common cold? (5 points)

(Therapeutic monitoring for common cold/viral infection)

A
  • Feel better in 3-4 days
  • Most will recover in 7-10 days
  • Cough may last 2-3 weeks
  • It is normal for your mucus to change colour (it is a sign of inflammation and not infection)
  • Please see a doctor if your symptoms do not improve after 10 days or if symptoms worsen (may be sign of secondary bacterial infection)
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9
Q

Clinical presentation of influenza

A
  • Abrupt onset
  • Sx: fever, chill, headache, malaise, myalgia, anorexia, sore throat, dry cough, nasal discharge. Sometimes sneezing, common chest discomfort, stuffy nose
  • Elderly may have confusion
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10
Q

Which groups of patients are at high risk for flu complications? (6)

A

1) Children <5yo

2) Elderly ≥ 65yo

3) Women who are pregnant or within 2 weeks postpartum

4) Residents of nursing homes or long term care facilities

5) Obese individuals with BMI > 40kg/m2

6) Individuals with chronic medical conditions eg asthma, COPD, HF, DM, CKD, immunocompromised

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11
Q

What are the usual pathogen(s) that cause influenza?

A

Influenza A (2 proteins on surface of virus. Haemagglutinin and neuraminidase) and B (2 lineages Yamagata and Victoria)

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12
Q

State what is used to treat influenza (including dose and duration), who should be treated with it and when it should be initiated

A

PO Oseltamivir 75mg BD x 5 days. (Requires dose adjustment in renal impaired.)

  • Initiate within 5 days of symptom onset (best within 48h) if individual is hospitalised, has high risk of complication or has severe progressive illness.
  • Initiate within 48h if outpatient
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13
Q

How would you counsel a patient with influenza?

(Therapeutic monitoring/ response of influenza)

A

Self limiting within a week

See doctor if:
- No improvement after 10 days
- Symptoms improve then worsen such as develop new fever, shortness of breath or cough

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14
Q

What is the clinical presentation of pharyngitis

A

Sore throat (worse with swallowing), fever, erythema and inflammation of pharynx and tonsils

Viral: low grade fever, malaise, fatigue, rhinorrhea, cough, hoarseness, oropharyngeal lesion (ulcers or vesicles), conjunctivitis

Bacterial: sore throat with tonsillar exudates, fever and cervical lymphadenopathy

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15
Q

What are the potential pathogens involved in both viral and bacterial pharyngitis?

A

Virus > Bacteria

Virus (e.g rhinovirus, coronavirus, influenza, parainfluenza, epstein-barr)

Bacteria (group A beta hemolytic streptococcus i.e streptococcus pyogenes)

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16
Q

Goal of antibiotic therapy in pharyngitis (4)

A

1) Reducing symptom severity and duration

2) Prevention of acute complications eg otitis media, peritonsillar abscesses or other invasive infections

3) Prevention of delayed complications or immune sequelae, particularly acute rheumatic fever

4) Prevention of spread to others

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17
Q

What are the components of the Modified centor criteria?

A

1) Fever >38degrees

2) Swollen, tender anterior cervical lymph nodes

3) Tonsillar exudate

4) Absence of cough

5) 3-14yo (if 45yo and above, -1)

18
Q

State the first-line treatment regimen of bacterial pharyngitis (no penicillin allergy)

A

First line:
PO penicillin V 250mg Q6H OR
Amoxicillin 500mg Q12H

Treatment duration: 10 days

19
Q

State the monitoring parameters for pharyngitis

A

Monitor for:
1) Clinical response
- 1-3 days with antibiotics.
- <1week without antibiotics

2) Antibiotic ADR

3) Microbiological test for cure not required

20
Q

Pathogenesis of sinusitis

A

Direct contact with droplets of infected saliva or nasal secretions

Bacterial cases usually preceded by viral URTIs eg common cold, pharyngitis

Inflammation results in sinus obstruction
- Nasal mucosal secretions are trapped
- Medium of bacterial trapping and multiplication

21
Q

Clinical presentation of sinusitis

A

Sx: purulent nasal discharge, facial pain/pressure, fever, nasal congestion and obstruction, reduced sense of taste/smell, headache, cough, ear fullness, bad breath, dental pain

If got CNS infection or orbital cellulitis: limited ocular movements, acute vision changes, confusion, unilateral weakness

22
Q

What are the potential pathogens involved in sinusitis? Name the ones that cause bacterial sinusitis

A

Virus > bacteria

For bacteria caused: Streptococcus pneumoniae, haemophilus influenzae most common

Less common:
- Streptococcus pyogenes,
- moraxella catarrhalis,
- anaerobic bacteria (mostly gram +ve anaerobes present in saliva and on face)

23
Q

Goal of treatment of sinusitis (3)

A

1) Shorten duration of symptoms, faster symptom relief

2) Restore quality of life

3) Prevent complications

24
Q

List both first-line treatment of bacterial sinusitis and state when 1 might be preferred over the other

A

First line:
PO amoxicillin 500mg Q8H, OR
PO augmentin 625mg Q8H

Duration: 5-7 days

If recent antibiotic use before or symptoms are severe, Augmentin will be preferred (concern for H. influenzae resistance through production of beta-lactamase)

25
Q

State how you would monitor therapeutic response for sinusitis

A

Symptoms should improve within 7-10 days.

Seek medical attention (see doctor) if they develop persistent, severe, or worsening symptoms

Monitor for antibiotic ADR if antibiotic given

26
Q

Which influenza type(s) can cause both epidemics and pandemics?

A

Influenza A

27
Q

Which influenza type(s) can cause epidemics?

A

A and B

28
Q

Which influenza does not occur in epidemics?

A

C

29
Q

How many types of influenza are there in total?

A

4 (A-D; D only occur in cattle)

30
Q

What is MOA of Oseltamivir?

A

Neuraminidase inhibitor that interferes with protein cleavage, inhibiting release of new virus.

31
Q

What are the side effects of Oseltamivir?

A

Well tolerated with headache and mild GI discomfort.

32
Q

Which complication of bacterial pharyngitis is not preventable even with antibiotic use?

A

Acute Glomerulonephritis

33
Q

State how you would manage a patient with Centor Criteria score of 0-1

A

Total points: 0 or 1
- No additional testing indicated
- Low risk of S. pyogenes pharyngitis
- Presumed viral
- No antibiotics

34
Q

State how you would manage a patient with Centor Criteria score of 2-3

A

Total points: 2,3
- Test for S. pyogenes pharyngitis and treat with antibiotic if positive

35
Q

State how you would manage a patient with Centor Criteria score of 4-5

A

Total points: 4,5
- Initiate empiric antibiotics due to high risk S. pyogenes pharyngitis

36
Q

State the possible treatment regimens of bacterial pharyngitis (for pt with penicillin V allergy)

A

Non-severe allergy: PO cephalexin 500mg Q12H (NOT to be used if it’s Amoxicillin allergy)

Severe allergy:
- PO azithromycin 500mg once daily OR
- PO clarithromycin 250mg Q12H OR
- PO clindamycin 300mg Q8H (used when resistant to macrolide)

Duration: 10 days treatment (5 days for azithromycin)

37
Q

State possible complications of bacterial pharyngitis

A

1) Acute Rheumatic Fever

2) Acute Glomerulonephritis

38
Q

When is antibiotic treatment of bacterial sinusitis indicated?

A

≥ 1 of the following:
o Symptoms persist for more than 10 days WITHOUT clinical improvement
- Got clinical improvement = NOT persistent

o Symptoms are severe
- Fever >39°C, purulent nasal discharge, or facial pain lasting for > 3 consecutive days

o Symptoms worsen (new-onset fever, headache, or increased nasal discharge) after an initial period of improvement (double sickening) for more than 3 days (5 to 6 days)

39
Q

List alternative treatment regimens for bacterial sinusitis when patient is allergic to penicillin

A

Non-severe allergy:
PO cefuroxime 500mg Q12H (if very ill, can use Ceftriaxone)

Severe allergy:
PO levofloxacin 500mg daily or moxifloxacin 400mg daily

Duration: 5-7 days treatment course for adults

40
Q

Desicion to treat bacterial sinusitis is based on?

A

Clinical presentation. Little to no use of culture or diagnostic to confirm viral or bacterial sinusitis.

PR3151 Finals (9 decks)

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