Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sem2: MDSA30160: Cardiorespiratory Disease > L24 Upper Respiratory Tract Infections > Flashcards

L24 Upper Respiratory Tract Infections Flashcards

1
Q

___________________ are the most common acute illness seen in outpatient care. They are typically _____________

A

Upper respiratory tract infections are the most common cute illness seen in outpatient care. They are typically VIRAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Pharyngitis

TRIAD of symptoms?

Causative Pathogens?

Demographics?

A

Acute Pharyngitis

TRIAD: Sore Throat, Fever, Pharyngeal Inflammation (Characterized by Erthymea and edema)

Cuases:

Typically viral and self limiting (25% to 45% of cases)– rhinovirus** and **coronavirus most common

Most common bacterial cause is S. pyogenes (Group A Strep)

5-18 y/o is the greatest prevalence of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Pharyngitis

TRIAD of symptoms?

Causative Pathogens?

Demographics?

A

Acute Pharyngitis

TRIAD: Sore Throat, Fever, Pharyngeal Inflammation (Characterized by Erthymea and edema)

Cuases:

Typically viral and self limiting (25% to 45% of cases)– rhinovirus** and **coronavirus most common

Most common bacterial cause is S. pyogenes (Group A Strep)

5-18 y/o is the greatest prevalence of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differentiating Viral and Bacterial Causes of Pharyngitis?

A

Viral Cause

Mild pharyngeal symptoms with:

Rhinorrhea (runny nose)

Cough

Conjunctivitis

oral ulcers (HSV, coxsackievirus)

Streptococcus pyogenes (GAS): most common and important bacterial cause of Acute Pharyngitis

History: sudden onset with temperature >38.3°C, marked pharyngeal pain and odynophagia

Signs:

intense pharyngeal erythema

enlarged tonsils

grey-white exudate covering posterior pharynx and tonsillar pillars

pronounced oedema of uvula

petechiae sometimes seen on soft palate (Pinpoint Hemorrhaging)

tender anterior cervical lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

_____________________

  • 0.5-2.5% of bacterial pharyngitis
  • highest frequency in adolescents and young adults
  • exudative pharyngitis, clinically similar to GAS pharyngitis
  • generalized maculopapular rash – most prominent on extremities
A

Arcanobacterium haemolyticum

  • 0.5-2.5% of bacterial pharyngitis
  • highest frequency in adolescents and young adults
  • exudative pharyngitis, clinically similar to GAS pharyngitis
  • generalized maculopapular rash – most prominent on extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

________________

• mild pharyngeal discomfort characterized as soreness, scratchiness or irritation

• pharynx appear normal or mild oedema and erythema

  • Sneezing, nasal discharge/congestion) precede throat symptoms
  • non-productive cough usually present

NOT SEEN?

A

Common Cold

• mild pharyngeal discomfort characterized as soreness, scratchiness or irritation

• pharynx appear normal or mild oedema and erythema

  • Sneezing, nasal discharge/congestion) precede throat symptoms
  • non-productive cough usually present

NOT SEEN:

systemic complaints (fever, chills, myalgia)

exudates and painful lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_________________:

  • 25% of cases of Acute Pharyngitis in children and 3% of adults
  • thick and white exudates
  • What can it progress to?
A

Adenovirus

  • 25% of cases in children and 3% of adults
  • thick and white exudates

• Pharyngoconjunctival Fever

– outbreaks and history of swimming pool exposure

– conjunctivitis, pharyngitis, lymphadenopathy and systemic features (myalgia, chills)

– highly contagious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Epstein-Barr virus (EBV)

  • infectious mononucleosis defined by triad of ___________, _____________,________________
  • adolescents and young adults
  • pharyngitis subacute in onset with moderate to marked:

enlargement of tonsils

exudates

palatal petechiae

• painful anterior and posterior cervical lymphadenopathy

What happens when given ampicillin?

A

Epstein-Barr virus (EBV)

  • infectious mononucleosis defined by triad of fever, pharyngitis and adenopathy
  • adolescents and young adults
  • pharyngitis subacute in onset with moderate to marked:

enlargement of tonsils

exudates

palatal petechiae

  • painful anterior and posterior cervical lymphadenopathy
  • diffuse pruritic maculopapular eruption in patients given ampicillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Herpangina

  • majority of cases due to _____________
  • primarily in ________
  • severe _______ illness with marked sore throat and dysphagia
  • pharyngeal erythema with discrete multiple vesicles on soft palate, uvula, and anterior tonsillar pillars which rupture to form _____________
A

Herpangina

  • majority of cases due to group A coxsackieviruses
  • primarily in children

severe febrile illness with marked sore throat and dysphagia

• pharyngeal erythema with discrete multiple vesicles on soft palate, uvula, and anterior tonsillar pillars which rupture to form small shallow ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hand-foot-and-mouth Disease

  • due to ___________________
  • characterized by __________________ and ____________ in pharynx
  • vesicles also noted on hands, feet and buttock
A

Hand-foot-and-mouth Disease

  • due to group A coxsackieviruses
  • characterized by erythematous-based vesicles and ulcerations in pharynx
  • vesicles also noted on hands, feet and buttock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Herpes simplex virus

• primary infection causes

– ___________ in young children

– ___________ in adolescents and young adults

  • fever, pharyngeal erythema, exudates and tender cervical adenopathy
  • vesicles and shallow ulcers of mouth, lips or pharynx
A

Herpes simplex virus

• primary infection causes

– gingivostomatitis in young children

– pharyngitis in adolescents and young adults

  • fever, pharyngeal erythema, exudates and tender cervical adenopathy
  • vesicles and shallow ulcers of mouth, lips or pharynx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of Pharyngitis?

A

Suppurative (Pus) Complications:

Peritonsillar abscess (quinsy)

  • typically adolescents and young adults
  • fever, malaise, severe sore throat, odynophagia, drooling and a muffled voice (“hot potato voice”)
  • swelling of anterior tonsillar pillar and soft palate
  • uvula displaced to contralateral side
  • tender cervical adenopathy

Treatment:drainage of purulent material coupled with antibiotics

Retropharyngeal abscess

Sinusitis

otitis media

Mastoiditis

invasive infections (necrotizing fasciitis and toxic shock syndrome with GAS).

Nonsuppurative complications of GAS:

acute rheumatic fever

acute glomerulonephritis

viral pharyngitis may be complicated by a secondary bacterial infection (sinusitis, pneumonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pharyngitis Investigation/Management?

A

Investigation

Rapid antigen detection test (RADT): test for Streptococcus pyogenes (GAS) if cannot rule out on clinical grounds

– positive result is diagnostic

– perform throat culture in children and adolescents with negative test

– timely treatment and reduce over-treatment of viral causes

Management

10-day course of oral penicillin V** or **amoxicillin

Macrolide or cephalosporin for penicillin-allergic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_____________ an acute illness marked by middle ear inflammation that results in middle ear fluid collection and associated local and systemic features.

______________ is middle ear effusion in the absence of acute infection.

______________ is a condition with persistent drainage and perforation lasting longer than 6 weeks

A

acute otitis media (AOM) an acute illness marked by middle ear inflammation that results in middle ear fluid collection and associated local and systemic features.

otitis media with effusion (OME) is middle ear effusion in the absence of acute infection.

chronic suppurative otitis media (CSOM) is a condition with persistent drainage and perforation lasting longer than 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Epidemiology/Risk Factors of Otitis Media

A

Epidemiology

90% of children have at least one episode by 2 years of age.

highest incidence between 6 and 24 months of age

Risk factors include:

daycare attendance

parental smoking

immune dysfunction eg. HIV

congenital orofacial deformities (CLEFT PALLATE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathogenesis/Causes of Otitis Media?

A

Pathogenesis

anatomic or physiologic eustachian tube dysfunction play a critical role in Ottis media

viral URTI => congestion / swelling of nasal mucosa, nasopharynx and eustachian tube

=> obstruction at eustachian tube isthmus (narrowest portion)

=> results in accumulation of middle ear secretions.

=> secondary bacterial infection of effusion causes suppuration

Causes

Viral URTI facilitates bacteria to ascend from nasopharynx

most common are:

Streptococcus pneumoniae (30-40%)

Non typeable H. influenzae (20%)

M. catarrhalis (10%)

17
Q

Clinical Presentation/Investigation of Otitis Media?

A

Clinical Presentation

ear pain, ear drainage or decreased hearing is more common in older children.

occasionally vertigo and tinnitus

otoscopic examination reveals erythematous tympanic membrane which may be: Bulging, Retracted, Perforated

Investigation

tympanocentesis (needle aspiration of middle ear effusion)

not recommended unless patient is toxic, has failed multiple courses of antibiotics or immunosuppressed

swab cultures from external auditory canal do not accurately reflect cause

Imaging not helpful in diagnosis

18
Q

Management of Otitis Media?

A

Management

  • antibiotics should not be routinely prescribed initially!!
  • delaying antibiotic therapy: reduces treatment-related costs and side-effects and minimizes emergence of resistant strains.

antibiotics deferred in:

healthy children older than six months of age w/ mild otitis media

in those the diagnosis is uncertain.

antibiotics recommended in

– all children younger than six months

– those between six months and two years if diagnosis is certain

– severe infection (severe otalgia or temperature > 39°C)

amoxicillin for 10 days is recommended first-line therapy

19
Q

Pathogenesis/Clinical Presentation/Complications of Acute Mastoiditis?

A

Pathogenesis

infection in mastoid follows middle ear infection

hyperemia (Increased blood flow) and oedema of mucosal lining of air cells

=> serous and then purulent exudate.

=>blockage of antrum by inflamed mucosa prevents drainage of fluid

=> pressure of purulent exudate on thin bony septa

=> bone necrosis

Clinical

Early on resembles Acute Otitis Media

Later:

erythema, swelling and tenderness over mastoid bone

pinna displaced outward and downward

erythematous, bulging tympanic membrane

Complications

  • hearing loss
  • cranial nerve involvement
  • osteomyelitis
  • abscess formation
  • intracranial extension– meningitis, cerebral abscess, epidural abscess, subdural empyema
20
Q

Investigations/Management of Acute Mastoiditis?

A

Investigations:

plain radiographs may show increased opacification in mastoid region

ear drainage fluid for culture

– fresh pus as it exudes from tympanic membrane

– tympanocentesis if tympanic membrane not perforated

Management: amoxicillin for 10 days is recommended first-line therapy

21
Q

___________ sinusitis more common than _________ sinusitis

A

Viral sinusitis more common than bacterial sinusitis - bacterial sinusitis a complication of viral URTI

22
Q

Pathogenesis/Causes of Sinusitis?

3 key factors?

A

Pathogenesis related to three key factors:

  • narrow sinus ostia => predispose to obstruction
  • dysfunction of ciliary apparatus => structure/function of mucociliary apparatus impaired during viral colds
  • viscous sinus secretions => impair ciliary function

Causes:

majority caused by viral infection

bacterial causes similar to agents that cause AOM

S. pneumoniae (30-40%)

nontypeable H. influenzae (20%)

M. catarrhalis (20%)

less frequently S. pyogenes (S. aureus and anaerobes)

rarely, f_ungal causes in immunocompromised_

23
Q

Clinical Presentation/Predictors of Bacterial/Complications of Sinusitis

A

Clinical

young children– persistent rhinorrhoea (often purulent), Cough, foul breath, fever

older children and adults– symptoms and signs more localised to affected sinus

predictors of bacterial sinusitis include:

– symptoms persist for 10 days or longer

– persistent purulent nasal discharge w/maxillary tooth** or **unilateral facial pain

– unilateral sinus tenderness

– worsening symptoms after initial improvement

Complications

intracranial complications: subdural empyema, epidural abscess, brain abscess, meningitis, venous sinus thrombosis

extracranial complications:

orbital cellulitis: most common serious complication, associated with _ethmoiditis_

Orbital abscess

frontal and maxillary osteomyelitis

subperiosteal abscess

24
Q

Investigations/Management of Sinusitis?

A

Investigations

Diagnosis is usually made on clinical grounds

Imaging if: vague symptoms, ambiguous physical findings, symptoms persist despite medical therapy

plain radiograph of sinuses: complete sinus opacification

maxillary sinus aspiration indicated in:

– lack of response to multiple courses of antibiotics

– orbital or intracranial complications

– immunocompromised patients

– nosocomial infection

Management

  • amoxicillin first-line in mild disease and NO day-care**/ **NO previous antibiotic use– 10 to 14 day course
  • amoxicillin-clavulanate or cefuroxime as second-line agents in severe disease, day-care exposure** or **previous antibiotic use.
25
Q

Characteristics/Demographics of Epiglottitis?

A

Above the Glottis: locally invasive bacterial infection of epiglottis supraglottis structures (supraglottitis)

RESPIRATORY EMERGENCY: rapidly progressive (within hours) to severe upper airway obstruction

Most common in children aged 2-6 years with peak incidence in those aged 3 years

26
Q

Causes/Clinical Manifestation of Epiglottitis?

A

Causes

Historically H. influenzae b – decreased dramatically since introduction of Hib vaccine

Now:

Streptococcus pneumoniae

group A or C streptococci

Clinical Manifestation

Abrupt onset of high fever, sore throat and odynophagia

stertor** and a **gurgling noise on inspiration

muffled voice (“hot-potato voice”) but not hoarse

marked tachycardia and tachypnoea

Physical Signs:

sits upright

hands extended behind body in a characteristic tripod position

jaw thrust forward, mouth open, and tongue protruding

Rapidly precedes to: fluctuating levels of consciousness and respiratory arrest

27
Q

Investigation/Management of Epiglottitis?

A

Investigation: Swelling of epiglottis (thumb sign on XRAY)

Management

ensure child kept in upright position

a medical emergency

visualization of epiglottis must be performed with care - respiratory arrest may occur if there is laryngeal spasm while probing the mouth

direct examination should only be performed by trained personnel in a unit where immediate intubation or tracheotomy can be performed

laryngoscope examination reveals a “cherry-red” epiglottis

28
Q

Characteristics/Demographics of Laryngotracheobronchitis( aka. _________)?

A

Laryngotracheobronchitis (Croup)

Bellow the glottis

subglottic inflammation caused by a viral or bacterial infection of larynx, trachea and bronchi.

most often in children aged 6 months to 6 years with peak incidence in second year.

Not expected in children >6 due to larger diameter of trachea and previous immunity

29
Q

Most common infectious cause of obstruction of upper airway (stridor) in young children?

A

Laryngotracheobronchitis (Croup): inflammatory oedema of subglottic larynx and trachea, especially near cricoid cartilage => narrowing and obstruction of airway.

Leads to: stridor** (harsh, high-pitched **musical sound) produced by air flowing through narrowed subglottic area

30
Q

Causes/Clinical Manifestation of Laryngotracheobronchitis (Croup)

A

Causes

Parainfluenza viruses types 1, 2, and 3 are most common causes

RSV
Influenzas A and B

Clinical Manifestation

Starts as nonspecific URTI symptoms

Within 1-2 days hoarseness of voice is followed by paroxysms of brassy or barking, non-productive cough** that ends with a **prominent inspiratory stridor.

In more severe cases: Tachypnoea, use of accessory respiratory muscles

Self-limiting in most children

Sometimes leads to larygeal obstruction/ respiratory failure

31
Q

Diagnosis/Management of Croup?

A

Diagnosis: anterior-posterior and lateral neck X-rays may help to differentiate croup from other causes of stridor.

Lateral neck X-rays show:

ballooning of hypopharynx

subglottic narrowing

normal epiglottitis

Management

  • Minimal handling to avoid worsening symptoms.
  • Keep children with carers to reduce distress.
  • Mild/Moderate croup treated with steroids alone.
  • Severe croup requires nebulized adrenaline** and **steroids.

Sem2: MDSA30160: Cardiorespiratory Disease (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions