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Clin Med I Exam #2 > L3: Upper Respiratory Infections > Flashcards

L3: Upper Respiratory Infections Flashcards

1
Q

Main Virology of Common Cold

A

Rhinovirus (30-50%)

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2
Q

Two main symptoms of common cold?

A

Rhinorrhea, nasal congestion

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3
Q

Is a low grade-fever common with the common cold?

A

Only in children! Uncommon in adults

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4
Q

Clinical signs of common cold

A

nasal mucosal swelling and discharge (clear, watery, or purulent), pharyngeal erythema, conjunctival injection

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5
Q

Complications of common cold?

A

Acute rhinosinusitis, AOM, may precipitate asthmatic attack, pneumonia (rare)

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6
Q

Treatment of common cold?

A

Ab’s no value!! Can use analgesics (NSAIDS), antihistamines/ decongestants (Pseudoephedrine (Sudafed) or Diphenhydramine (Benadryl)), expectorants (Robitussin (Guaifenesin) or Robitussin DM)

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7
Q

Influenza etiology?

A

Influenza A and B

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8
Q

Common symptoms and signs of Influenza?

A

Symptoms: Abrupt onset, fever, myalgia, sore throat

Signs: flushing, hot dry skin, pharynx unremarkable, mild cervical LAD, chest exam usually neg.

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9
Q

Common cause of death for Influenza?

A

Those immunocompromised who can get pneumonia

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10
Q

How do you diagnose Influenza?

A

Testing should be done w/in 3-4 first days of illness. Can do:

  • RIDTs (in office). Can distinguish btwn A/B. Low sensitivity, high specificity
  • Rapid molecular assay (more specific and can differentiate types A/B, in lab)
  • Reverse-transcriptase polymerase chain reaction (done in-patient)
  • Viral culture (GOLD STANDARD FOR LAB DIAGNOSIS). Not for initial clinical management but to confirm screening
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11
Q

How to treat influenza? What if a female is pregnant with influenza?

A

Can treat with antivirals (if at high risk) within 48hrs of onset of symptoms!! Supportive care (if uncomplicated, low risk).

Neuraminidiase Inhibitors:

  • Oseltamivir (tamiflu) x 5d
  • Zanamivir (Relenza) x 5d, contraindicated in patients with asthma/resp conditions/ mild protein allergy
  • Peramivir (Rapivab) x 1d
  • Baloxavir (Xofluza) x 1 d

If pregnant with influenza A, need to give antiviral (Cat C)

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12
Q

For the common cold which virus is most common in summer? which virus has no seasonal pattern?

A

Summer- enterovirus

No seasonal pattern- Adenovirus

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13
Q

What age group is most at risk for influenza?

A

Adults >65yrs and children <5 yrs ESPECIALLY <2years

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14
Q

Is the influenza vaccine recommended for pregnant women?

A

Yes!

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15
Q

What age groups are the following vaccines for?

  • Standard dose inactivated influenza vaccine
  • High dose trivalent inactivated
  • Live, attenuated vaccine
A
  • standard dose= 18-64 yrs old
  • high dose trivalent= >65
  • Live attenuated= >2-49, NOT in pregnancy or immunocompromised
  • Children (6mo-8yr) get 2 dosages >4 weeks apart 1st flu season
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16
Q

Is pharyngitis viral, bacterial, or noninfectious?

A

Can be any of them! 80% is viral.

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17
Q

Most common etiology of bacterial pharyngitis?

A

Group A Streptococcus (GAS). Strep. progenes

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18
Q

What are some respiratory viruses that cause Pharyngitis?

A

-HSV1/ HSV2, Coxackie, Cytomegalovirus, HIV, Epstein-Barr Virus (Mono), Rhinovirus, Respiratory Syncytial virus, Adenovirus, Coronavirus, Parainfluenza, influenza

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19
Q

How can you tell between a virus and bacterial pharyngitis infection?

A

Viruses are less likely to cause pharyngeal exudate (white/liquidy substance). TWO EXCEPTIONS to this are adenovirus and mononucleosis, they can both cause exudate

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20
Q

How to treat pharyngitis?

A

Supportive care! Includes hydration, analgesics, “Magic Mouthwash”, if HIV antivirals

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21
Q

How to treat Pharyngitis if cause is HSV1 or HSV2?

A

Acyclovir, famciclovir, supportive care

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22
Q

How to diagnose and treat pharyngitis if cause is Mono (EBV)?

A

Dx: Monospot, CBC w. Diff
Mangement: Supportive, avoid contact sports (bc splenomegaly), contagious up to 3 months

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23
Q

What do you treat Corynebacterium diphtheriae with? What is a common symptom associated with this strain?

A

Tx: Diptheria anti-toxin + PCN OR Erythromycin (EES)

Sxs: Grey exudate tightly adherent to throat or nasal passageway

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24
Q

What do you treat Mycoplasma pneumoniae with? Common symptoms?

A

Tx: Azithromycin

Sxs: Low res infection & HA

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25
What do you treat Neisseria gonorrhoeae with? | Common symptoms?
Ceftriazone (rocephine) x 1 Sxs: associated w/ oral sex. Pharyngitis with exudates
26
Differences between Pharyngitis group A and group C/G Streptococcus? (bacterial)
Group A more common, can lead to Local invasion AND immune mediated responses. Group C/G NOT associated with immune mediated responses.
27
Centor criteria for Streptococcal pharyngitis?
Tonsillar exudates, Tender anterior cervical adenopathy, fever by hx, absence of cough. If 3/4--> undergo test for GAS (group A strep)
28
Diagnostic studies for pharyngitis? What to do if patient meets centor criteria w/ negative test?
1. Rapid antigen detection test (RADT)- for group A strep 2. If patient meets centor criteria w/ negative RADT, order culture for child, treat w/o culture for adult!! Use best judgement 3. Throat culture- can order bacterial/viral
29
How do you treat streptococcal pharyngitis 1st line?
1st line therapy (adult)- PCN G Benzathine IM, PCN PO TID x 10 days, Amoxicillin BID x 10days, Keflex BID x 10days and supportive care!
30
How do you treat streptococcal pharyngitis 2nd line?
If allergy or 2nd line- Azithromycin PO x 3-6 days, Clindamycin PO TID x 10 days
31
Complications of Streptococcal pharyngitis?
Acute Rheumatic fever (rare), Post-Streptococcal glomerulonephritis (rare), streptococcal toxic shock syndrome (rare), Scarlet Fever
32
Etiology of Peritonsillar Abscess (PTA)
S. pyogenes (GAS) and s. aureus (including MRSA)
33
Main difference btwn peritonsillar cellulitis vs. abscess?
Cellulitis- infection/inflammation of tissue. No discrete puss collection Abscess- collection of pus btwn capsule of tonsil and pharyngeal muscles
34
Common symptoms of peritonsilar abscess?
Trismus (spasm of pterygoid muscle), fever, "hot potato" voice, bilateral abscess rare, ipsilateral ear pain, swelling pushing tonsil w/ deviation of uvula
35
How to dx Peritonsillar abscess?
Labs, throat culture, CT w/ IV contrast (distinguishes cellulitis vs. abscess) , US helpful in aspiration
36
How to treat PTA?
Drainage (aspiration), Supportive care, +/- hospitalization, Antibiotic therapy
37
Antibiotics used for PTA?
Parental (IV)- Ampicillin, Clindamycin, Vancomycin if high rates of MRSA Oral (14 day course)- Amoxicillin, Clindamycin
38
Etiology of Epiglottitis?
H. Influenzae
39
Signs and diagnosis of Epiglottitis?
Signs: Drooling, Stridor, sore throat, danger of airway obstruction (don't do oropharynx exam if patient in distress) Dx : Lateral neck x-ray : "thumb sign". OR CT/MRI
40
Treatment of Epiglottitis?
Hospitalization, intubation, Ab
41
Etiology of Laryngitis?
- Viruses most common (associated with URI symptoms) - Bacterial etiologies include Stretococci, moraxella catarrhalis, H. influenza. - Many noninfectious causes as well
42
Symptoms of Laryngitis?
Hoarseness!! Dysphonia, URI sypmtoms. | Laryngoscopy revelas laryngeal erythema/edema, engorgement of vocal cords
43
Difference between acute and chronic laryngitis?
1. Acute- Bacterial/viral. Irritant exposure. Acute epiglottitis 2. Chronic- head/neck cancer, GERD, vocal nodule
44
How to dx Laryngitis?
Hoarseness >2 weeks in absence of URI symptoms! Requires ENT referral for laryngoscopy... especially w/ hx of tobacco or alch use.
45
How to manage laryngitis?
Treat underlying cause, voice rest, humidification, hydration, no Ab's unless bacterial infection
46
What is Rhinosinusitis?
Sinus infection! Purulent nasal drainage AND nasal obstruction and/or facial pain, pressure, or fullness. Can be asstd with allergies, tumors, polyps, deviated nasal septum
47
Etiology of acute Rhinosinusitis? (ARS)
Most common- Viral- Rhinovirus, influenza, parainfluenza. | Rare- bacterial- Strep pneumoniae, H. Influenzae, Moraxella catarrhalis
48
How to classify acute from chronic rhinosinusitis?
Acute <4 weeks. Subacute 4-12 weeks Chronic >12 weeks Reccurent acute- 4 or more episodes of ARVS/ year
49
ARS presentation?
Will vary based on sinus affected and viral/bacterial etiology?
50
Diagnosis and treatment of ARVS?
Dx: <10 days of symptoms that are NOT worsening. Radiography is not indicated. Tx: Supportive care. Days 1-9 analgesics, saline irrigation, intranasal decongestants/ glucocorticoids
51
What is acute bacterial rhinosinusitis?
Viral infection followed by secondary bacterial infection
52
How to Dx acute bacterial rhinosinusitis?
- Persistent symptoms lasting >10 days w/ no improvement OR - Onset w/ severe symtoms, fever >102, purulent nasal drainage lasting 3-4 consecutive days, OR - Viral URI that lasted 5-6 days and was initially improving, followed by severe symptoms "double worsening"
53
First line treatment of Acute bacterial rhinosinusitis?
First line Ab management- Amoxicillin 875/125mg, Doxycycline 100mg, Levofloxacin 500mg, Moxifloxacin 400mg for 5-7 days!!!
54
Second line treatment for Acute bacterial rhinosinusitis?
If no response or worsening symptoms after 1st line AB's OR high risk of Ab resistance- Amoxicillin 2000mg/125mg BID, Levofloxacin 500mg, moxifloxacin 400mg, doxycycline 100mg for 7-10 days!!!
55
Complications of ABRS?
Extension of infection from parental sinuses to CNS, orbits, or surrounding tissues. If suspected complication, can do CT scan w/ contrast!! Or MRI
56
What is the gold standard lab for diagnosing a complication with ABRS?
Sinus aspirate culture! | If positive, admit to hospital, URGENT ENT/ID CONSULT
57
What are the four cardinal symptoms in adults for chronic rhinosinusitis (CRS)?
1. Mucopurulent nasal drainage 2. nasal obstruction and congestion 3. facial pain, pressure, fullness 4. reduction/loss of sense of smell - in children, cough is the fourth symptom!!
58
How to dx CRS?
Presence of 2/4 cardinal symptoms AND infection lasting >12 weeks w/ medical management.. PLUS EITHER--> 1. Sinus mucosal disease w/ Imaging, or opacification of paranasal sinuses OR 2. Direct visualization of mucosal inflammation, polyps in nose, or purulent mucus
59
Dx and management for CRS?
Dx: Non contrast CT, Refer to ENT Tx: Nasal saline lavage, intranasal/oral corticosteroids, oral antimicrobials, antihistamines
60
What are symptoms of Scarlet fever?
pastia's lines, rash, strawberry tongue, facial flushing w/ circumoral pallor, desquamation, can predispose for acute rheumatic fever)

Clin Med I Exam #2 (6 decks)

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