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Learn these Flashcards > Lecture 22: Upper and Lower RTI (info overload) > Flashcards

Lecture 22: Upper and Lower RTI (info overload) Flashcards

1
Q

Most common reason for anti-biotic prescribing in kids?

A

Otitis media

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2
Q

What is the main pathologies that lead to Otitis media?

A

URI or Allergy –> Congestion of Respiratory Mucosa –> Decreased clearance of middle ear secretions –> fluid accumulation in ME space –> Reflux of OP/NP flora –> Acute Otitis Media (biofilm)

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3
Q

What age group is at highest risk for Otitis media?

A

From birth to 3 years

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4
Q

What percent of kids from birth to age 3 get Otitis media?

A

80-90% of children

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5
Q

Define Otitis media

A

moderate or severe bulging of the TM or new onset otorrhea not due to otitis externa, with acute signs of illness and middle ear inflammation

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6
Q

Environmental factors that predispose to Otitis media

A 
Day care attendance
Tobacco smoke exp
Winter more than summer
Formula feeding (breast feeding > 3 months is protective)
Siblings at home
Lower Socioeconomic status
Pacifier use
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7
Q

Acute Otitis media symptoms in infants include what?

A

Fever, night wakening, poor feeding/anorexia, vomiting, irritability, and diarrhea

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8
Q

Child symptoms of Otitis media include what?

A

Fever, night wakening, poor feeding/anorexia, vomiting, irritability, and diarrhea, + [ear pain (~80%), hearing loss]

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9
Q

What are the complication symptoms in Otitis media?

A

Tinnitus, vertigo, otorrhea (TM perf), nystagmus, swelling

Will see conjunctivitis in some kids with (H. influenzae)

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10
Q

Name the classic Physical exam findings for Otitis media

A

Membrane looks discolored (red, yellow, gray/cloudy) and bulging tympanic membrane. Loss of normal bony landmarks
+ immobile TM pneumatic otoscopy
+ (5%) TM perforation w/ purulent drainage

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11
Q

Name the top bacteria that cause Otitis media

A

Bacteria: TOP one is Strep pneumoniae (50%), Haemophilus influenza (up to 45%),
Moraxella catarrhalis (10%)
(many infections have mixed microbes/viruses)

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12
Q

Name the viruses that typically cause Otitis media?

A

Typical viruses: RSV, flu, enteroviruses, cold viruses, metapneumo

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13
Q

Atypical organisms (uncommon or rare) that may cause Otitis media

A

Mycoplasma, Chlamydia, TB

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14
Q

If a child has an ear infection, what are decongestants good for?

A

Nothing. They’re not good. Have no proven benefit.

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15
Q

For a kid with otitis media pain, what are the 2 main meds to give for relief of pain?

A

Ibuprofen or Tylenol

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16
Q

Antimicrobial therapy for otitis media

A

First target the most common bacterial pathogens,

  1. amoxicillin for 10 days
  2. If suspect resistance to amoxicillin (H. influenzae) use amoxicillin-clavulanate
  3. Kid has an allergy to PCN, use 2nd/3rd gen cephalosporin, macrolide, clindamycin.
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17
Q

When can observation be used?

A

If the age is > 6 mos (some docs say > 2 yrs); not severe & unilateral dz, not immunocompromised, no high fever; 48-72 hr follow-up or “wait-and-see” Rx

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18
Q

Otitis media complications: Extension of infection to contiguous structures can cause what?

A

Mastoiditis

CNS infection

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19
Q

Other complications of otitis media include what?

A
  1. Chronic perforation
  2. Cholesteatoma formation
  3. Hearing loss (conductive)
  4. Delayed language development
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20
Q

What is abnormal, invasive growth of sq epithelium in the ear canal called?

A

It’s called a Cholesteatoma

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21
Q

Sequelae of Acute Otitis Media : Chronic Otitis Media… What is the microbiology, and therapy?

A

Microbiology: often poly-microbial, resistant
Therapy: prolonged antibiotics + ENT referral

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22
Q

Pharyngitis: Most common bacterial cause is what?

A

(25-37% of all) S. pyogenes (Group A Strep&raquo_space; Grp C, G)

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23
Q

What age and time of year is strep throat most common?

A

Affects primarily children 5-15 yrs of age

Higher infection rates in winter months

24
Q

How is strep pharyngitis typically spread?

A

Person-to-person, mainly via respiratory droplets

Also, high carriage rates in asymptomatic individuals facilitates transmission

25
Q

What are the symptoms of Streptococcal pharyngitis?

A 
Acute onset of fever, sore throat
cough and rhinorrhea absent
Pharyngeal/tonsillar edema and erythema
Nonadherent pharyngeal exudate
Tender anterior cervical LAD
associated head ache, Nausea, vomiting and malaise
26
Q

What are the viral pharyngitis symptoms?

A

Sxs of viral infection w/ conjunctivitis, coryza (runny nose), cough, hoarseness, anterior stomatitis, discrete ulcers, viral exanthems +/- diarrhea

27
Q

Causes of viral pharyngitis

A

Common cold, Adenovirus, Herpangina, EBV, (plus other stuff: HSV, HIV, CMV, influenza)

28
Q

Causes of bacterial pharyngitis

A

Anaerobes (Lemierre’s), Arcanobacterium, Mycoplasma, Gonorrhea, and Diphtheria

29
Q

List the complications of Group A Strep pharyngitis

A

Extension to contiguous structures: OM, sinuses, CNS abscess formation, peritonsillar, metastatic,

Nonsuppurative sequelae: rheumatic fever and glomerulonephritis

30
Q

What is the gold standard for diagnosis of strep throat?

A

Throat culture, ~90% sensitivity

However, a 24-48 hr delay for results

31
Q

What is it called when using agglutination or ELISA assay to detect a streptococcal wall antigen from a throat swab

A

“Rapid Strep” tests (RADS), 70-90% sensitivity, > 95% specific
If found to be negative, continue to do a culture

*Neither can differentiate acute infection from asymptomatic carriers with intercurrent viral pharyngitis

32
Q

How do you treat strep throat?

A

Antibiotics: Penicillin is the drug of choice (for 10 days)/ (If found allergy use Cephalosporin, Clinda, Macrolide)

Acute illness is usually limited, but therapy shortens severity, duration of Sxs, lowers risk of Rheumatic fever, and lower chances of transmission

33
Q

Define Acute Rhinosinusitis

A

“Symptomatic inflammation of the nasal cavity/paranasal sinuses”

34
Q

Bacterial sinusitis risks to think about

A

Venous drainage of sinus to intracranial and orbital compartments confers risk of complications at those sites if there is a sinus infection w/bacteria

35
Q

What is the most common cause of community acquired sinusitis? Virus or Bacteria?

A

Viral: vast majority (rhino-, flu/parainfluenza)
Majority resolve spontaneously
Bact. infections complicate 0.5-2%

36
Q

List the 4 common bacteria that cause sinusitis

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
+ Anaerobes (esp if contiguous to dental infx)

37
Q

What features distinguish bacterial sinusitis from viral infection?

A

Bacteria quality, duration, progression of sx’s:
No improvement after 7-10 days and/or worsens after initial improvement
Severe sx’s: early high fever, Pain
Physical Exam: facial erythema/swelling, focused/ unilateral facial pain, fever >38°C, concurrent odontogenic source

38
Q

When to seek imaging and/or ENT consultation?

A
  1. CT scan if complicated, lack of response

2. Sinus aspirate by ENT if non-response and/or immunocompromised

39
Q

List the complications of sinusitis

A

Intracranial: Meningitis, Abscess formation, Epidural/ or Subdural infection, Venous sinus thrombosis

Peroorbital/orbital - Periorbital (preseptal) cellulitis, Orbital cellulitis, Orbital abscess

40
Q

What are the symptoms/indicators of bronchitis?

A

Cough longer than 5 days (10-20 days typically)
Purulent sputum (50%) (not equivalent to bacterial cause)
Wheezing 2nd bronchospasm
Rhonchi which often clear w/ cough
Fever: atypical (if so, consider influenza or pneumonia)
Absence of consolidative signs/hypoxemia
CXR: normal or thickened bronchial walls

41
Q

Bacterial causes of bronchitis (3 main ones)

A

Mycoplasma pneumoniae
Chlamydia pneumonia
Bordetella pertussis

42
Q

Viral causes of bronchitis (4 main ones)

A

Cold viruses
RSV
Influenza*/Para-flu
Human metapneumovirus

43
Q

What leads to higher risk for post infectious pneumonia and bronchospasm?

A

Virus action: post viral pneumonia caused because of impaired barrier defense and virus specific damage to bronchial epithelium with denudation

44
Q

What is the main clinical treatment of bronchitis if it is caused by influenza?

A

Symptomatic tx of URI, cough, pain
CXR if suspect pneumonia
Only treat with antivirals for patients at risk for complications

If pertussis suspected: NP PCR; tx if confirmed
Consider microscopic eval. if outbreak suspected

45
Q

Abnormal vitals, rales that don’t clear with cough, hypoxemia, CXR shows inflitration - Typical for pneumonia or bronchitis?

A

Typically seen in pneumonia

Bronchitis presents with rales that clear w/ cough, rarely abnormal vitals, and clear CXR

46
Q

What are the risk factors of complication for Community Acquired Pneumonia (CAP)?

A 
Age over 65
COPD, malignancies
RR ≥ 30, dBP ≤ 60, P ≥ 125
Low WBC (30K), high BUN
Hypoxemia, anemia, coagulopathy
47
Q

Name 5 CAP commonly seen organisms

A 
S. pneumoniae
Mycoplasma/Chlamydia
H. influenzae (smokers, COPD)
S. aureus (post influenza)
Legionella
48
Q

Aspiration pneumonia is associated with

A

altered mental status (may be episodic) and poor dentition

49
Q

aspiration pneumonia complications, name two

A

Complications: lung abscess, empyema

50
Q

What kinds of organisms are associated with aspiration pneumonia?

A

polymicrobial, including anaerobes

51
Q

Name 3 hospital associated pneumonia organisms

A

Enteric gram negative bacilli
Pseudomonas aeruginosa + other GNR
S. aureus (incl MRSA)
(often seen in ventilated patients)

52
Q

How do you initially treat community accquired pneumonia?

A

Outpatient CAP: Rx with Macrolides, doxycycline, (Floroquinolones or beta-lactams and macrolides)

53
Q

How do you treat hospitalized CAP?

A

General Med Ward: 3rd G. cephalosporin + macrolide or Floroquinolones

ICU: 3rd G. cephalosporin + macrolide or 3rd G. cephalosporin + Floroquinolones

54
Q

How do you treat Healthcare associated or ventilator associated pneumonia?

A

Give MRSA agent (eg Vancomycin) + GNR agents (eg Cefepime/Pip-Tazo + 2nd antibiotics)

also consider Legionella testing

55
Q

What are the advantages of pathogen specific therapy?

A

Narrow antibiotic spectrum
Less antimicrobial pressure on normal flora

To determine: use gram stain (sputum), cultures (sputum, blood), and immunoassays (eg urine Ag tests)

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