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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
Q

What do you treat Neisseria gonorrhoeae with?

Common symptoms?

A

Ceftriazone (rocephine) x 1

Sxs: associated w/ oral sex. Pharyngitis with exudates

26
Q

Differences between Pharyngitis group A and group C/G Streptococcus? (bacterial)

A

Group A more common, can lead to Local invasion AND immune mediated responses.
Group C/G NOT associated with immune mediated responses.

27
Q

Centor criteria for Streptococcal pharyngitis?

A

Tonsillar exudates, Tender anterior cervical adenopathy, fever by hx, absence of cough.
If 3/4–> undergo test for GAS (group A strep)

28
Q

Diagnostic studies for pharyngitis? What to do if patient meets centor criteria w/ negative test?

A
  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
Q

How do you treat streptococcal pharyngitis 1st line?

A

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
Q

How do you treat streptococcal pharyngitis 2nd line?

A

If allergy or 2nd line- Azithromycin PO x 3-6 days, Clindamycin PO TID x 10 days

31
Q

Complications of Streptococcal pharyngitis?

A

Acute Rheumatic fever (rare), Post-Streptococcal glomerulonephritis (rare), streptococcal toxic shock syndrome (rare), Scarlet Fever

32
Q

Etiology of Peritonsillar Abscess (PTA)

A

S. pyogenes (GAS) and s. aureus (including MRSA)

33
Q

Main difference btwn peritonsillar cellulitis vs. abscess?

A

Cellulitis- infection/inflammation of tissue. No discrete puss collection
Abscess- collection of pus btwn capsule of tonsil and pharyngeal muscles

34
Q

Common symptoms of peritonsilar abscess?

A

Trismus (spasm of pterygoid muscle), fever, “hot potato” voice, bilateral abscess rare, ipsilateral ear pain, swelling pushing tonsil w/ deviation of uvula

35
Q

How to dx Peritonsillar abscess?

A

Labs, throat culture, CT w/ IV contrast (distinguishes cellulitis vs. abscess) , US helpful in aspiration

36
Q

How to treat PTA?

A

Drainage (aspiration), Supportive care, +/- hospitalization, Antibiotic therapy

37
Q

Antibiotics used for PTA?

A

Parental (IV)- Ampicillin, Clindamycin, Vancomycin if high rates of MRSA
Oral (14 day course)- Amoxicillin, Clindamycin

38
Q

Etiology of Epiglottitis?

A

H. Influenzae

39
Q

Signs and diagnosis of Epiglottitis?

A

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
Q

Treatment of Epiglottitis?

A

Hospitalization, intubation, Ab

41
Q

Etiology of Laryngitis?

A
  • Viruses most common (associated with URI symptoms)
  • Bacterial etiologies include Stretococci, moraxella catarrhalis, H. influenza.
  • Many noninfectious causes as well
42
Q

Symptoms of Laryngitis?

A

Hoarseness!! Dysphonia, URI sypmtoms.

Laryngoscopy revelas laryngeal erythema/edema, engorgement of vocal cords

43
Q

Difference between acute and chronic laryngitis?

A
  1. Acute- Bacterial/viral. Irritant exposure. Acute epiglottitis
  2. Chronic- head/neck cancer, GERD, vocal nodule
44
Q

How to dx Laryngitis?

A

Hoarseness >2 weeks in absence of URI symptoms! Requires ENT referral for laryngoscopy… especially w/ hx of tobacco or alch use.

45
Q

How to manage laryngitis?

A

Treat underlying cause, voice rest, humidification, hydration, no Ab’s unless bacterial infection

46
Q

What is Rhinosinusitis?

A

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
Q

Etiology of acute Rhinosinusitis? (ARS)

A

Most common- Viral- Rhinovirus, influenza, parainfluenza.

Rare- bacterial- Strep pneumoniae, H. Influenzae, Moraxella catarrhalis

48
Q

How to classify acute from chronic rhinosinusitis?

A

Acute <4 weeks.
Subacute 4-12 weeks
Chronic >12 weeks
Reccurent acute- 4 or more episodes of ARVS/ year

49
Q

ARS presentation?

A

Will vary based on sinus affected and viral/bacterial etiology?

50
Q

Diagnosis and treatment of ARVS?

A

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
Q

What is acute bacterial rhinosinusitis?

A

Viral infection followed by secondary bacterial infection

52
Q

How to Dx acute bacterial rhinosinusitis?

A
  • 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
Q

First line treatment of Acute bacterial rhinosinusitis?

A

First line Ab management-
Amoxicillin 875/125mg, Doxycycline 100mg, Levofloxacin 500mg, Moxifloxacin 400mg
for 5-7 days!!!

54
Q

Second line treatment for Acute bacterial rhinosinusitis?

A

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
Q

Complications of ABRS?

A

Extension of infection from parental sinuses to CNS, orbits, or surrounding tissues. If suspected complication, can do CT scan w/ contrast!! Or MRI

56
Q

What is the gold standard lab for diagnosing a complication with ABRS?

A

Sinus aspirate culture!

If positive, admit to hospital, URGENT ENT/ID CONSULT

57
Q

What are the four cardinal symptoms in adults for chronic rhinosinusitis (CRS)?

A
  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
Q

How to dx CRS?

A

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
Q

Dx and management for CRS?

A

Dx: Non contrast CT, Refer to ENT

Tx: Nasal saline lavage, intranasal/oral corticosteroids, oral antimicrobials, antihistamines

60
Q

What are symptoms of Scarlet fever?

A

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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