Upper Resp Tract Inf - 5Qs Flashcards
Differentiate btw the common cold and influenza?
Common cold - occupies upper respiratory tract
Influenza - systemic dx involving upper respiratory tract
Define sinusitis.
Inflammation of the mucosa of the nose and paranasal sinuses
Define acute sinusitis
1 day - 3 weeks
Define chronic sinusitis
> 3 months
What is common predisposing condition for bacterial inf?
Viral infection
What is the most common pathogen that cuz sinusitis?
Viral
- rhinovirus
- influenza
- parainfluenza
RIP
What the other cause of sinusitis?
Bacterial
- community acquired
- nosocomial (nasogastric tube)
What pathogens are resp 4 Community acquired bacterial sinusitis?
H. influenza
S. pneumonia
M. catarrhallis
Mouth anaerobes (dental infections)
What pathogens are resp nosocomial (nasogastric tube) bacterial sinusitis?
Gram tve e.g. S. aureus, S. pneumonia
Gram -ve e.g. Pseudomonas spp
Anaerobic bacteria
Yeast (C. albicans)
What are the clinical manifestations of sinusitis?
Mucopurulent nasal discharge, halitosis
Nasal congestion, fever
Facial pain eps when bending forward
Toothache
How do you diagnose Acute Maxillary Sinusitis?
Sx of sinusitis + 1 major sx or 2minor sx
What’s the gold standard for diagnosis Acute Maxillary Sinusitis?
Sinus puncture
What’s the goal of therapy?
Improve/ restore QOL
How do you treat mild sinusitis?
Usually self-limiting
How do you treat mod-severe sinusitis?
Therapy reserved for this type.
How do you treat sinusitis caused by viral inf?
1st gen antihistamines + NSAID +/ Pseudoepineohrine and/or Dextromethropan
What’s the 1st tx for peds?
Amoxicillin
What’s the 1st tx for peds if penicillin allergy is reported?
Cefuroxime
What’s the 1st tx for peds in amoxicillin failure/ severe dx?
Amoxicillin-Clavulanate
What’s the 1st tx for adults?
Amoxicillin
What’s the 1st tx for adults with mod dx or previous AB in 4-6 wks?
Amoxicillin-Clavulanate
What’s the 1st tx for chronic sinusitis?
ABs that cover s.aureus and anaerobes
Name the atypical m.o. that’s recently indicated for sinusitis?
Chlamidophila pneumoniae
How do you deal with sinusitis of fungal origin?
Surgery intervention may be req
Def pharyngitis.
Inflammation of the pharynx and surrounding tissue
What’s the pathogen of most common that may cuz pharyngitis?
Streptococcus pyogenes (GABHS/GAS)
How do u diagnose bacterial pharyngitis?
Sx in absence of cough, rhinorrhea
Hx of fever > 38.3C (101F)
Tonsillar exudate
Swollen tender anterior cervical nodes
What action do you take if pt has 0-1 of diagnostic criteria?
Nothing
What action do you take if pt has 2-3 of diagnostic criteria?
Culture, treat if tve
What action do you take if pt has all 4 of diagnostic criteria?
Culture and Treat
When is throat culture recommended?
Children 4-15, sore throat, high fever
Close contact of strep pts
Hx of rheumatic fever or heart dx
Epidemic of GABHs or corynebacterium diphtheriae
What’s the preferred culture for sore throat?
Rapid antigen detection test
List complications of GABHS.
Acute rheumatic fever
Glomerulonephritis
What’s 1st line for peds and adults for pharyngitis?
Penicillin V X 10 days ( for all )
Amoxicillin (preferred becuz of taste)
Benzathine penicillin
What’s 2nd line for peds and adults for pharyngitis?
Peds - 2nd gen cephalosporin X 10 days
Adults - 2nd gen cephalosporin X 4-6 days
Name the types of bronchitis? In what age-grp do they occur?
Acute bronchitis - all age grps
Chronic bronchitis - gen in older adults
What’s the main m.o. resp 4 bronchitis?
Viral (majority)
S. pneumoniae, S. aureus, H. influenzae
What other issues may affect bronchitis?
Gastroesophageal reflux
Asthma/COPD
Post-nasal drip
GAP
What’s the routine therapy for acute bronchitis?
No routine role of AB
Use aspirin, acetaminophen, ipratropium, and/or nasal decongestants
What may be used for prolonged atypical dx?
Macrolides
Fluoroquinolones
Doxycycline
How do you treat acute bronchitis.
It’s a viral dx and should not be treated with AB
What may cause Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB)?
Acute exacerbation of chronic bronchitis may be caused by bacteria
How do you define chronic exacerbation?
Coughing up of sputum on most days during at least 3 consecutive months for more than 2 successive years
What factors contribute to chronic bronchitis?
Cigarette smoking
Inhaled dust/ toxins
Infections
What are non-modifiable factors of chronic bronchitis?
Male
>40 yr
What’s the clinical presentation of chronic bronchitis?
Incessant coughing + purulent sputum
Name typical pathogens that cuz chronic bronchitis.
H. influenzae
H. parainfluenzae
S. pneumoniae
M. Catarrhallis
What are the non-pharmacologic ways of handling chronic bronchitis?
Stop smoking
Avoid toxins, dust
What should be considered b4 initiating pharmacotherapy options?
Pt may have had several treated episodes in the past, which may increase level of resistance
When should ABs be given o pts with chronic bronchitis?
Pt with increased dyspnea + increased sputum volume + increased sputum purulence
Pt with increased sputum purulence + 1 other cardinal sx
Pt who req mech ventilation
What factors should be considered b4 starting AB?
Number of occurrences
Previous hx treatment
What AB is the most favored for chronic bronchitis?
Macrolides
What AB should be considered if cost is an issue?
Doxycycline
Bactrim
How do you treat viral bronchitis?
No AB
How do you treat chronic mild bronchitis, FEV1 > 60%, < 60yrs, < 4 exacerbation/year?
Amoxicillin
Macrolide
How do you treat chronic moderate bronchitis + FEV1 59%-40% + diabetes, chronic renal failure, chronic heart failure + at least 4 exacerbation/year?
Respiratory Fluoroquinolones
Amoxicillin/Clavulanate
Macrolides
How do you treat chronic severe bronchitis + FEV1 < 40%
Treat for more resistant pathogens e.g. Pseudomonas, enterobacteriaceae
