Respiratory

Question 1

What are the most common viral agent associated with URIs?

Answer 1

Rhinoviruses

Question 2

What is the typical incubation period for URIs?

Answer 2

1-5 days with virus shedding <3 weeks

Question 3

What are typical s/s of viral URIs? When is the s/s peak.

Answer 3

Coryza, pharyngitis, laryngitis, malaise, headache, fever. S/s peak in 3-4 days, improve by day 7 but can last for >10 days. Common viral URIs rarely progress to pna.

Question 4

What are the symptoms of influenza a and b? What. type of patients are at higher risk for development of viral pna and secondary bacterial pneumonia following influenza?

Answer 4

fever, diffuse myalgia, nonproductive cough, headache, sometimes N/V/D. Lack of fever significantly decreases the probability of influenza. Patients with cardiopulmonary disease, asthma, diabetes, elderly, young children, pregnant women, immunocompromised are at higher risk for development of severe illness.

Question 5

What are symptoms of acute rhinosinusitis? What is the duration of the disease?

Answer 5

nonspecific nasal congestion, fatigue, headache, ear fullness, cough, focal sinus pain, purulent nasal discharge, fever. Duration no more than 5-7days

Question 6

What are symptoms of bacterial sinusitis?

Answer 6

symptoms last beyond 10 days w/o improvement; s/s include >39 degrees celsius, purulent nasal discharge, facial pain over a sinus >3 days.

Question 7

What are s/s of allergic sinus disease? What medication is typically used for treatment?

Answer 7

Sinus congestions, itchy/watery eyes, seasonal pattern. Fever, sinus tenderness and purulent nasal discharge is absent UNLESS there is a sinus postal obstruction. Medication: antihistamines

Question 8

What bacteria (2) account for most acute bronchitis cases? What type of individual is at increased risk for developing the disease? What are the symptoms?

Answer 8

Mycoplasma and chlamydia infections. Young adults who live in close proximity are at increased risk. Symptoms include sore throat, headache, low grade fever, dry cough if infection is confined to upper bronchial tree; if cough worsens or dyspnea ensues this is suggestive of the development of pna.

Question 9

Describe the symptoms found in the catarrhal and paroxysmal phases of bordatella pertussis. What is the disease duration? What therapy can shorten the course of illness?

Answer 9

Catarrhal phase is indistinguishable from a viral URI: rhinorrhea, low grade fever, sore throat, mild congestion accompanying a cough that lasts 1-2 weeks.
Paroxysmal phase results from airway injury and produces characteristic severe coughing spells, (20-30 coughs in a row) offend accompanied by posttussive emesis. S/s can be disabling and last for several weeks when untreated. Early antibiotic therapy can shorten the course of the illness.

Question 10

What type of streptococcus infection can lead to rheumatic fever and glomerulonephritis if not treated?

Answer 10

Group A beta-hemolytic streptococcus

Question 11

What are the clinical hallmarks of bacteria pharyngitis? What are typical risk factors?

Answer 11

severe sore throat, difficulty swallowing, exudative pharyngitis, fever >1010, cervical adenopathy, ABSENCE of cough. Very uncommon in persons >45, household contact is primary risk factor.

Question 12

What are the clinical s/s of pneumonia (4 of them)? What does the typical workup include?

Answer 12

S/s: temp>38 degrees celsius, HR>100bpm, RR>24, abnormal findings on chest exam. Workup includes chest imaging and lab testing including CBC, chest x-ray, blood and sputum cultures.

Question 13

What type of medications are the most commonly used decongestants (2 of them)? How do they work? What are the main side effects and what patients should these be avoided in?

Answer 13

alpha-adrenergic agents: pseudoephedrine and phenlypropanolamine. These work by causing generalized vasoconstriction reducing the formation of secretions. As they produce systemic vasoconstriction, this may raise BP, cause urinary retention and worsen closed angle glaucoma. Caution is indicated for patients with inadequately controlled hypertension, ischemic heart disease, symptomatic prostatic hypertrophy and closed-angle glaucoma.

Question 14

What bacteria is the leading cause of atypical pneumonia syndrome (fever, dry cough, nonspecific infiltrate on chest film) and is the leading cause of acute bronchitis in healthy adults?

Answer 14

Mycoplasma pneumonia

Question 15

What are the bacterial causes of pneumonia in patients? (10 of these). What are the nonbacterial causes of pneumonia? (5 of these).

Answer 15

Bacterial: streptococcus pneumonia, haemophilius influenza, legionella species, staphylococcus aureus, klebsiella pneumonia, mortadella catarrhalis, streptococcus pyogenes, mycoplasma pneumoniae, chlaymdophila pneumoniae, clamydia psittaci

Nonbacterial: mycobacterium tuberculosis, cosiella brunetii, Viral, pneumocystis carinii, Fungi

Question 16

What does the CURB-65 rule acronym stand for? What is it used for?

Answer 16

Confusion
Uremia (blood urea nitrogen >20 mg/dL)
RR>30 
Blood pressure < 90SBP or 60 DBP
Age 65 or older

used as an algorithm for triage in patients with community-acquire pneumonia. Table 52-2 in text.

Question 17

What is the preferred empiric treatment of acute bronchitis? Alternative treatment?

Answer 17

Empiric: none
Alternative: doxycycline, erythromycin

Table 52-3

Question 18

What is the preferred empiric treatment of acute exacerbation of chronic bronchitis? Alternative treatment?

Answer 18

Empiric: Second generation cephalosporin or amoxicillin-clauvanate

Alternative: second-gen macrolide trimethoprim/sulfamethazole

table 52-3

Question 19

What is the preferred empiric treatment of community acquire pneumonia in healthy, young adults? Alternative treatment?

Answer 19

Empiric: macrolides

Alternative: doxycycline, respiratory fluroqunolones

table 52-3

Question 20

What is the preferred empiric treatment of community-acquired pneumonia for elderly (age >60) or comorbid disease? Alternative treatment?

Answer 20

Empiric: beta-lactam +/- second generation macrolide

Alternative: respiratory fluroquinoloone

table 52-3

Question 21

What is the preferred empiric treatment of community acquired pneumonia for hospitalized patient (non-ICU)? Alternative treatment?

Answer 21

Empiric: third-generation cephalosporin + second generation macrolide

Alternative: respiratory fluroquinolone

table 52-3

Question 22

What are symptoms of bacterial conjunctivitis? What are the most common pathogens that cause the disease?

Answer 22

Mucopurulent discharge unilaterally without per auricular adenopathy. Thick crust on eyelids after a nights sleep. Streptococcus pheumoniae, staphylococcus aureus and Haemophilus influence are the most common pathogens.

Question 23

What are the symptoms of viral conjunctivitis?

Answer 23

watery, sometimes nonpurulent mucoid discharge that begins in one eye and spreads to the other several days lateral. Preauricular adenopathy is common. Associated with fever and pharyngitis especially in children.

Question 24

What is pinguecula? What causes it?

Answer 24

A yellow-white, harmless nodule on the conjunctiva that is usually found on the nasal side and causes mild discoloration. This results from heavy exposure to ultraviolet light.

Question 25

What is keratitis? Symptoms? Causes?

Answer 25

Keratitis is inflammation of the cornea that presents with a perilimbal ciliary flush and is accompanied by tearing and photophobia.

Causes include dry eyes, overuse of contact lenses and ultraviolet keratitis.

Question 26

What is episcleritis? Symptoms?

Answer 26

Benign inflammation of superficial episcleral vessels. In recurrent cases the conductive may manifest areas of circumscribed nodular inflammation with complaints of mildly tender, red eye. Vision/lids are normal. corneas are normal, conductive show local raised areas of redness.

Question 27

What is Uveitis? Clinical presentations?

Answer 27

Inflammation of the uveal tract including the iris, ciliary body and choroid. Iritis (which is anterior uveitis) presents with eye pain, photophobia, redness and pupillary contraction, ciliary flush, decreased vision. May be uni or bilateral. If unilateral the affected pupil may be smaller compared to the other eye.

Question 28

What is Hordeolum? What are the clinical presentations? Internal vs. external?

Answer 28

Acute inflammatory or infectious nodule of the meibomian glands (internal hordeolum), the glands of Zeir or lash follicles (external hordeolum or sty).

Presentation includes red, tender mass near the eyelid margin.

Internal hordeolum may point to either the skin or the conjunctival side of the eyelid.

External hordeolum always points to the skin.

Question 29

What is orbital cellulitis? What are clinical presentations?

Answer 29

Infection that presents as swollen, red eyelids with chemises, exophthalmos, pain, fever and leukocytosis. If it progresses it may lead to paresis of the third, fourth, and sixth cranial nerves.

Question 30

What is acute glaucoma and what are the causes? What are clinical presentations?

Answer 30

Ocular emergency! Patient presents with painful red eye and prominent ciliary flush. The pupil is dilated and fixed and the cornea is cloudy secondary to edema. Intraocular pressure >40mmHg.

Clinical presentations: cloudy vision, closed rings around lights, unilateral headache, N/V.