Sore throat week 2 Flashcards
Common cold:
-Viral infection of upper respiratory tract w/ inflammation
-Peaks in winter months
-Symptoms usually worst 2-3 days then resolve in 7-10 days
-Cough may last 2-3 weeks
-Can be caused by many viruses
-Rhinoviruses are the most common cause: grows optimally at temperatures near 32.8 degrees Celsius: the temp inside the human nose
-Other viruses: coronavirus, adenovirus, parainfluenza virus, respiratory syncytial virus
Common cold clinical presentations:
-Nasal congestion
-Sore throat, cough
-Slight body aches
-Mild headache
-Afebrile or low-grade fever
-Malaise
-May have conjunctivitis, sinus symptoms
-Chest exam is normal: no signs if lower respiratory tract infection
Common cold complications:
-Asthma/COPD exacerbation
Secondary infection:
-Acute otitis media
-Acute sinusitis
-Other infections: pneumonia, streptococcal pharyngitis, croup, bronchiolitis, bronchitis
Common cold treatment/management:
-Self limiting. no antibiotics unless secondary bacterial infection
-Analgesics/antipyretics
-Ensure hydration
-Steam inhalation
-Soothing, warm fluids
-Lozenges
-Saline nasal rinse
other supportive therapies: https://www.aafp.org/afp/2019/0901/p281.html
Common cold prevention:
-Avoid sick contacts
-Respiratory etiquette: cough/sneeze into tissues
-Proper hygiene: hand washing
Influenza:
-Infection by influenza A or B
-Peaks in winter months
-Symptoms appear 1-4 days after exposure to virus
-Contagious period: 1 day before symptoms to 5 days after symptoms
Influenza clinical presentation:
-Acute onset
-Fever
-Cough
-Myalgia
-Other common symptoms: headache, chills, fatigue, loss of appetite, sore throat, nasal congestion, rhinorrhea, diarrhea, nausea, vomiting
Allergy vs. URI vs. Flu
Coronavirus vs. cold vs. Flu
Likelihood ratio for flu:
Conductive hearing loss:
-Hearing loss due to dysfunction in one or more parts of the auditory pathway from the external ear to the middle ear
-For example, can result from dysfunction of external ear canal, tympanic membrane, and/or ossicles
Sensorineural hearing loss:
-Hearing loss due to dysfunction in one or more parts of the auditory pathway between the inner ear and auditory cortex
-For example, can result from dysfunction of cochlea, auditory nerve, and/or auditory processing pathway in the central nervous system
Weber and Rinne test findings:
Otitis externa:
“swimmers ear”
-Inflammation or infection of the external ear canal
-Most commonly a bacterial infection: pseudomonas species or staphylococcus aureus
-Camn be a fungal infection (<10%): Candida albicans, aspergillus niger
-Most common in adolescents
Otitis externa risk factors:
-Swimming or repeating water immersion
-Mechanical trauma
-Narrow ear canals
-Cerumen obstruction
-Skin conditions like eczema and psoriasis
Otitis externa typical presentation:
-Otalgia, pruritis, or fullness
-Possible otorrhea
-Hearing impairment: findings consistent with conductive hearing loss
-Periauricular lymphadenopathy
-Pain on movement of the auricle or tragus
-Erythematous, edematous, inflamed external auditory canal
Acute otitis media:
-Acute middle ear inflammation secondary to infection
-Most common in children (peak incidence 6-24 months of age): susceptibility due to developing immune system and shorter, more horizontal eustachian tube that more easily accumulates fluid
-Viral upper respiratory infection => edema and inflammation of nasopharynx and eustachian tube => collection of fluid in middle ear cavity => infection by bacteria
-Most common bacterial causes: Streptococcus pneumoniae, Haemophiles influenzae, Moraxella catarrhalis
Risk factors for acute otitis media in children:
Otitis media is a multifactorial disease.
Specific host an environment factors put children at risk for otitis media through various mechanisms.
To reduce risk of otitis media, public health innervations may need to be prioritized differently for various at-risk populations and geographical regions.
Acute otitis media typical representation:
-Otalgia (rubbing, tugging, holding the ear)
-Fever, irritability
-Possible otorrhea
-Anorexia
-Sometimes vomiting or lethargy
-Hearing impairment: findings consistent w/ conductive hearing loss
-Bulging, inflamed, cloudy/erythematous, immobile tympanic membrane w/ obscured landmarks
Acute otitis media management:
-Symptomatic management of ear pain and fever with analgesics
-80% of children, AOM resolves without antibiotics
In children with uncomplicated, non-severe AOM who are not at increased risk of complications, recommend:
-Watchful waiting: careful monitoring by caregivers, instructed to return in the case of persistent symptoms or worsening of the child’s condition
or
-Delayed antibiotic prescription: prescription given to patient by only filed when symptoms of AOM persist for 48-72 hours
Antibiotics for acute otitis media:
-Benefits are modest and offset by adverse effects
-Do not result in early resolution of pain but decrease pain by day 2 to 3 (NNT=20)
-Side effects of antibiotic therapy: vomiting, diarrhea, rash (NNH=14)
-Severe complications like mastoiditis are rare (NNT= 5000)
Amoxicillin is the antibiotic therapy of choice:
-10-day duration for children <2 years old or with severe symptoms
-5-7 days for children 2-5 years old with mild to moderate AOM
-5 days for children > or equal to 6 years old w/ mild or moderate AOM
Complications of acute otitis media:
-Perforation of the tympanic membrane
Supportive (pus-forming) complications of AOM:
-Acute mastoiditis
-Meningitis
-Brain abscesses
Rare given the high incidence of AOM but potentially serious.
Common cold is:
Viral infection of the upper respiratory tract
Infections of the respiratory tract:
Alarm symptoms associated with cough:
Alarm symptoms associated with sore throat:
