Respiratory Flashcards
What is the common cold?
Viral rhinitis
What are the associated viruses of viral rhinitis?
- Rhinoviruses
- Influenza
- Parainfluenza
- Adenoviruses
Symptoms of viral rhinitis result from inflammation of what?
Upper airways
- Nose
- Sinuses
- Throat
- Often the bronchi
15 y/o male presents to the clinic with nasal and throat irritation, accompanied with sneezing, rhinorrhea, and malaise. What does this patient have?
Viral rhinitis
If a patient has viral rhinitis, how long could a dry cough persist?
1-2 weeks
What bacterial complications may develop from viral rhinitis?
- Sinusitis
- Otitis media
- Bronchitis
If a patient has viral rhinitis, when would a throat culture be performed?
If streptococcal pharyngitis is suspected
What is a rare but serious condition that causes swelling of liver and brain? It effects children / teenagers recovering from viral illnesses associated with ASA use over 2 years old.
Reye’s syndrome
What is another name for thrush?
Oral candidiasis
Who is at increases risk for thrush?
- Infants
- Chronically ill
- Immunocompromised
- Corticosteroid users
- Those receiving antibiotics
Thrush (oral candidiasis) is usually the first manifestation of what disease?
HIV
A patient presents with satellite lesions as well as a creamy-white, exudative patch with erythematous base on the tongue. You scrape off the patches and it leaves a sensitive, bleeding surface. What does this patient have?
Thrush (oral candidiasis)
When testing for oral candida albicans, what will Gram’s stain or KOH show?
Typical yeasts and pseudohyphae
What can be used to treat thrush?
Antifungals, such as nystatin or clitrimazole
What is the prophylactic treatment of candida in AIDs patients?
Oral fluconazole
A patient presents with 102 fever, malaise, joint pain, and headache x 2 days and now complains of sore throat, runny nose, and a nonproductive cough. What does this patient have?
Influenza
What causes influenza?
RNA virus or orthomyxoviridae
What are sequelae of influenza?
- Severe hemorrhagic bronchitis
- Pneumonia
How is influenza diagnosed?
Clinical signs and symptoms are usually sufficient. A definitive diagnosis with serologic tests and viral culture is rarely necessary.
What drugs are used for influenza?
- Tamiflu (Oseltamivir) → PO
- Relenza (Zanamivir) → Inhaler
Which drug used for influenza is associated with delirium and self-harm, especially in teenagers?
Tamiflu (Oseltamivir)
Which drug was used in the early stages of influenza but now there is a high level of resistance against it?
Amantadine
When are influenza vaccinations developed?
Annually
Who should get influenza vaccines?
- 50 years or older
- Health care workers
- People with chronic respiratory or cardiovascular disease
How many people die of influenza annually?
40,000
What is strep throat caused by?
Group A beta-hemolytic streptococci, usually Streptococcus pyogenes
A patient presents with fever, sore throat, and a beefy, red pharynx with tonsillar exudate. On physical exam, there are tender cervical lymph nodes. What does this patient most likely have? What tests will you now perform to confirm diagnose?
- Streptococcal pharyngitis (strep throat)
- Rapid strep antigen detection tests and streptococcal culture
How do you treat strep throat?
- Penicillin
- 1st and 2nd generation cephalosporins
Tonsillitis usually occurs as a result of an infection from what?
- Streptococcal (strep pyogenes)
- Viral infection
A 7 y/o male presents to the clinic. His mother says he hasn’t been eating normally because he can’t swallow his food but his throat doesn’t hurt. She also says that this has happened before. On examination you find red, swollen tonsils with a purulent exudate. You peel away a white, thin membrane which does not bleed. What does this patient most likely have? How will you treat it?
- Tonsillitis
- Tonsillectomy (usually penicillin would be treatment but since he has had this before, he will need it removed)
What is the treatment for tonsillitis?
- Penicillin (for streptococcal infection)
- Rest
- Fluids
- Salt-water gargle
- Humidified air
- Zinc lozenges
What organisms cause peritonsillar abscesses?
- Group A beta-hemolytic Streptococcus
- Anaerobes, such as Bacteroides
A 17 y/o female presents to clinic with fever, severe pain on swallowing, and trismus. While she is telling you what’s wrong, it sounds like there is a hot potato in her mouth causing a muffled sound. On examination, the palate is erythematous and the tonsils are asymmetric. What is the most likely diagnosis?
Peritonsillar abscess
True or false: A patient with peritonsillar abscess will have his head tilted away from the affected side and the uvula may be displaced towards the affected side.
False
Head will be tilted toward affected side / Uvula will be displaced to the opposite side
What is the treatment for peritonsillar abscess?
- IV penicillin over 24-48 hours
- When pain goes down, I&D
- Tonsillectomy after acute infection has been resolved (because these abscesses tend to recur)
How long must sinusitis occur to be considered chronic?
More than 12 weeks
Sinusitis is typically precipitated by what two things? What do these cause?
- Allergic rhinitis
- Viral URIs
- They cause mucosal swelling that obstructs sinus drainage
Sinusitis is caused by what organisms?
- Streptococcus pneumoniae
- Haemophilus influenza
- Moraxella catarrhalis
Which sinuses are usually involved in sinusitis?
Maxillary and frontal
A patient presents to the clinic with red and swollen nasal membranes and yellow / green purulent discharge. On examination, there is an inability to transilluminate the sinuses. What is the likely diagnosis?
Sinusitis
What is the gold standard to diagnose sinusitis?
CT (may ID deep inflammation or physical obstruction difficult to detect with endoscope)
How do you treat sinusitis?
- Antibiotics for 2 weeks
- Nasal vasoconstrictors, decongestants, and corticosteroids
- Recurrent or chronic sinusitis may require surgery to remove drainage
What is a spasmodic muscular contraction of the bronchi which usually occurs in the context of asthma?
Bronchospasm
How would a bronchospasm occur in the absence of asthma?
- Occupational dust exposure
- Acute allergic reactions
- Water inhalation
What is described as a whistling sound in the lungs during respiration? What is it commonly caused by?
- Wheezing
- Asthma
Other than asthma, what are causes of wheezing?
- Foreign body obstruction (“asthmatoid wheeze”)
- COPD
- CHF
- Inflammation (pneumonia and bronchitis)
What is a general term describing inflammation of the pleural lining?
Pleurisy (pleuritis)
What are causes of pleurisy?
- Infectious diseases (pneumonia)
- Neoplasms (metastatic cancer)
- Connective tissue disorders (SLE)
Where can pleuritic pain be referred to?
Shoulder as a result of diaphragmatic irritation
What is inflammation of the trachea and bronchi?
Acute bronchitis
In nonsmokers, what is the number one cause of acute bronchitis?
Mycoplasma pneumoniae
What might cause acute bronchitis?
- Acute viral or bacterial URI
- Occupational setting after exposure to dust or respiratory irritants
A patient presents with a productive cough. He states he recently had a URI but his cough has persisted. At first it was a dry cough but now he has purulent sputum with a fever and sore throat. On examination, scattered rhonchi and wheezing were noted. What is the most likely diagnosis? What medication will you prescribe?
- Acute bronchitis
- None, most cases are viral and require only rest, fluids, and analgesics although bacterial cases might be treated with antibiotics… (but this is controversial)
If you suspect a patient has acute bronchitis, a chest x-ray must be done to rule out what?
Pneumonia
What kinds of patients does bronchiectasis usually occur in?
- Cystic fibrosis
- Immunodeficiencies
- Lung infection
- Foreign body aspiration
What percentage of patients with bronchiectasis have CF?
1/3
What percentage of patients with bronchiectasis have hemoptysis?
50-70%
A patient presents to the clinic with dyspnea and hemoptysis. He says his sputum has a foul smell to it and that his cough gets worse when he’s lying down. On examination, moist rales and rhonchi are heard. You also notice clubbing of the fingers. What is the likely diagnosis?
Bronchiectasis
What is bronchial dilation?
Bronchiectasis
What will you see on an x-ray of a patient with bronchiectasis?
- Increased bronchial markings
- “Honeycombing”
- Areas of atelectasis
In what disease would you use Aspergillosis fungus precipitant test, genetic testing for CF, alpha-1 antitripsan blood test, and PPD skin test for TB?
Bronchiectasis
