Overview of Upper Respiratory Tract Infections - Pawar

Question 1

Name (5) viruses associated with the ‘common cold’. Which is the most common?

Name some common symptoms

Answer 1

Rhinovirus (50%)

Coronavirus

Influenza

RSV

Parainfluenza virus

Symptoms: sore throat, nasal congestion, rhinorrhea, sneezing, cough

Question 2

Describe the pathogenesis of the common cold?

Answer 2

• Virus enters epithelial cells via ICAM-1
• Virus replicates in cell
• Shedding begins around day 2, continues for several weeks
• Results in vasodilation, increased mucus secretion, and epithelial damage

Question 3

Name the (3) most common pathogens associated with otitis media?

Answer 3

Streptococcus pneumoniae, Hemophilus influenza, Morexella catarrhalis

Question 4

Name some risk factors associated with Otitis media in children

Answer 4

Daycare, smoke exposure, lack of breast feeding (?), ethnicity (such as Native American), family history, older siblings, low socioeconomic status, other major health issues (example: Down’s)

Question 5

What is the most common cause of acute otitis media?

What is the most common cause of chronic otitis media?

Answer 5

Streptococcus pneumoniae (40%)

Haemophilus influenza (15%)

Question 6

Describe the purpose of ear tubes in the treatment of otitis media

Describe the indications for insertion of ear tubes.

How long are they left in?

Answer 6

Ear tubes allow the middle ear to ventilate until the eustachian tube matures

Indications: chronic middle ear effusion +/- conductive hearing loss, recurrent suppurative otitis media, atelectasis of the middle ear

6-18 months

Question 7

Name the (4) sets of paranasal sinuses

Answer 7

Ethmoid

Maxillary

Sphenoid

Frontal

Question 8

What is rhino-sinusitis?

In the acute form, what is more common - viral or bacterial?

Answer 8

Inflammation/infection of the nasal passage and paranasal sinuses

Bacterial infection is more common (S. pneumoniae, H. influenza, M. catarhalis)

Question 9

Name several sources of inflammation behind acute sinusitis

Answer 9

Infection (viral, bacterial, fungus)

Environmental allergens and irritants

Mucus

Medications

Question 10

Adherent white plaques on the tongue, buccal mucosa, and hard palate with underlying erythematous mucosa is associated with what?

Answer 10

Pseudomembranous candidiasis (Thrush)

Question 11

Name the two most common AIDS-defining opportunistic infections

Answer 11

Pneumocystis carinii pneumonia

Pseudomembranous candidiasis (thrush)

Question 12

What is the most common form of candidiasis?

Describe its appearance

Answer 12

Erythematous (atrophic) candidiasis

Erythematous inflammation of the mucosa of the tongue and oropharynx

Smooth, swollen, red tongue

Question 13

What is angular chelitis?

Answer 13

soreness, erythema, fissuring, and pooling of saliva at the commissures of the mouth

Caused by a combined bacterial and fungal infection (mostly C. albicans and S. aureus)

Question 14

Define stomatitis

Answer 14

Any inflammatory process affecting the mucous membranes of the mouth and lips

Question 15

Describe the major indications for adenotonsillectomy

Answer 15

• upper airway obstruction (most common)
• recurrent/chronic infection (tonsillitis, peritonsillitis, peri-tonsillar abscess)
• neoplasia

Question 16

Describe the basic treatment algorithm for sore throat

Answer 16

• Assess probability of strep
  
  • low - consider other diagnoses
  • moderate - perform rapid strep test
  • high - perform rapid strep test or consider empiric antibiotics
• If rapid antigen test positive - treat for strep
• If rapid antigen test negative - consider other diagnoses
  
  • if the patient is 10-25 years old, test for mononucleosis
  • if the patient is <10 or >25 years old, order throat culture and treat with any indicated Abx
• Consider ENT referral for unresolved pharyngitis

Question 17

Compare supraglottitis and croup in terms of:

• onset
• symptoms
• stridor
• location
• etiology
• treatment

Answer 17

• supraglottitis
  
  • onset: rapid
  • symptoms: drooling, fevers, sitting up, very sick
  • stridor: inspiratory
  • location: supraglottic
  • etiology: H. influenza (type B)
  • treatment: secure airway, antibiotics
• croup
  
  • onset: gradual
  • symptoms: barking cough, low fevers
  • stridor: biphasic
  • location: subglottic
  • etiology: viral
  • treatment: racemic epi, steroids, humidity

Question 18

Bacterial tracheitis:

• Symptoms
• Imaging
• Etiology
• Treatment

Answer 18

• Symptoms: toxic, cough, stridor, fever
• Imaging: ragged tracheal air column, pseudomembranes lining trachea
• Etiology: S. aureus
• Treatment: IV abx, hydration, bronchoscopy with debridement of tracheal crusts/exudate