Upper Resp Tract Inf - 5Qs

Question 1

Differentiate btw the common cold and influenza?

Answer 1

Common cold - occupies upper respiratory tract

Influenza - systemic dx involving upper respiratory tract

Question 2

Define sinusitis.

Answer 2

Inflammation of the mucosa of the nose and paranasal sinuses

Question 3

Define acute sinusitis

Answer 3

1 day - 3 weeks

Question 4

Define chronic sinusitis

Answer 4

> 3 months

Question 5

What is common predisposing condition for bacterial inf?

Answer 5

Viral infection

Question 6

What is the most common pathogen that cuz sinusitis?

Answer 6

Viral

• rhinovirus
• influenza
• parainfluenza

RIP

Question 7

What the other cause of sinusitis?

Answer 7

Bacterial

• community acquired
• nosocomial (nasogastric tube)

Question 8

What pathogens are resp 4 Community acquired bacterial sinusitis?

Answer 8

H. influenza
S. pneumonia
M. catarrhallis
Mouth anaerobes (dental infections)

Question 9

What pathogens are resp nosocomial (nasogastric tube) bacterial sinusitis?

Answer 9

Gram tve e.g. S. aureus, S. pneumonia

Gram -ve e.g. Pseudomonas spp

Anaerobic bacteria

Yeast (C. albicans)

Question 10

What are the clinical manifestations of sinusitis?

Answer 10

Mucopurulent nasal discharge, halitosis

Nasal congestion, fever

Facial pain eps when bending forward

Toothache

Question 11

How do you diagnose Acute Maxillary Sinusitis?

Answer 11

Sx of sinusitis + 1 major sx or 2minor sx

Question 12

What’s the gold standard for diagnosis Acute Maxillary Sinusitis?

Answer 12

Sinus puncture

Question 13

What’s the goal of therapy?

Answer 13

Improve/ restore QOL

Question 14

How do you treat mild sinusitis?

Answer 14

Usually self-limiting

Question 15

How do you treat mod-severe sinusitis?

Answer 15

Therapy reserved for this type.

Question 16

How do you treat sinusitis caused by viral inf?

Answer 16

1st gen antihistamines + NSAID +/ Pseudoepineohrine and/or Dextromethropan

Question 17

What’s the 1st tx for peds?

Answer 17

Amoxicillin

Question 18

What’s the 1st tx for peds if penicillin allergy is reported?

Answer 18

Cefuroxime

Question 19

What’s the 1st tx for peds in amoxicillin failure/ severe dx?

Answer 19

Amoxicillin-Clavulanate

Question 20

What’s the 1st tx for adults?

Answer 20

Amoxicillin

Question 21

What’s the 1st tx for adults with mod dx or previous AB in 4-6 wks?

Answer 21

Amoxicillin-Clavulanate

Question 22

What’s the 1st tx for chronic sinusitis?

Answer 22

ABs that cover s.aureus and anaerobes

Question 23

Name the atypical m.o. that’s recently indicated for sinusitis?

Answer 23

Chlamidophila pneumoniae

Question 24

How do you deal with sinusitis of fungal origin?

Answer 24

Surgery intervention may be req

Question 25

Def pharyngitis.

Answer 25

Inflammation of the pharynx and surrounding tissue

Question 26

What's the pathogen of most common that may cuz pharyngitis?

Answer 26

Streptococcus pyogenes (GABHS/GAS)

Question 27

How do u diagnose bacterial pharyngitis?

Answer 27

Sx in absence of cough, rhinorrhea Hx of fever > 38.3C (101F) Tonsillar exudate Swollen tender anterior cervical nodes

Question 28

What action do you take if pt has 0-1 of diagnostic criteria?

Answer 28

Nothing

Question 29

What action do you take if pt has 2-3 of diagnostic criteria?

Answer 29

Culture, treat if tve

Question 30

What action do you take if pt has all 4 of diagnostic criteria?

Answer 30

Culture and Treat

Question 31

When is throat culture recommended?

Answer 31

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

Question 32

What's the preferred culture for sore throat?

Answer 32

Rapid antigen detection test

Question 33

List complications of GABHS.

Answer 33

Acute rheumatic fever Glomerulonephritis

Question 34

What's 1st line for peds and adults for pharyngitis?

Answer 34

Penicillin V X 10 days ( for all ) Amoxicillin (preferred becuz of taste) Benzathine penicillin

Question 35

What's 2nd line for peds and adults for pharyngitis?

Answer 35

Peds - 2nd gen cephalosporin X 10 days Adults - 2nd gen cephalosporin X 4-6 days

Question 36

Name the types of bronchitis? In what age-grp do they occur?

Answer 36

Acute bronchitis - all age grps Chronic bronchitis - gen in older adults

Question 37

What's the main m.o. resp 4 bronchitis?

Answer 37

Viral (majority) S. pneumoniae, S. aureus, H. influenzae

Question 38

What other issues may affect bronchitis?

Answer 38

Gastroesophageal reflux Asthma/COPD Post-nasal drip GAP

Question 39

What's the routine therapy for acute bronchitis?

Answer 39

No routine role of AB Use aspirin, acetaminophen, ipratropium, and/or nasal decongestants

Question 40

What may be used for prolonged atypical dx?

Answer 40

Macrolides Fluoroquinolones Doxycycline

Question 41

How do you treat acute bronchitis.

Answer 41

It's a viral dx and should not be treated with AB

Question 42

What may cause Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB)?

Answer 42

Acute exacerbation of chronic bronchitis may be caused by bacteria

Question 43

How do you define chronic exacerbation?

Answer 43

Coughing up of sputum on most days during at least 3 consecutive months for more than 2 successive years

Question 44

What factors contribute to chronic bronchitis?

Answer 44

Cigarette smoking Inhaled dust/ toxins Infections

Question 45

What are non-modifiable factors of chronic bronchitis?

Answer 45

Male | >40 yr

Question 46

What's the clinical presentation of chronic bronchitis?

Answer 46

Incessant coughing + purulent sputum

Question 47

Name typical pathogens that cuz chronic bronchitis.

Answer 47

H. influenzae H. parainfluenzae S. pneumoniae M. Catarrhallis

Question 48

What are the non-pharmacologic ways of handling chronic bronchitis?

Answer 48

Stop smoking Avoid toxins, dust

Question 49

What should be considered b4 initiating pharmacotherapy options?

Answer 49

Pt may have had several treated episodes in the past, which may increase level of resistance

Question 50

When should ABs be given o pts with chronic bronchitis?

Answer 50

Pt with increased dyspnea + increased sputum volume + increased sputum purulence Pt with increased sputum purulence + 1 other cardinal sx Pt who req mech ventilation

Question 51

What factors should be considered b4 starting AB?

Answer 51

Number of occurrences Previous hx treatment

Question 52

What AB is the most favored for chronic bronchitis?

Answer 52

Macrolides

Question 53

What AB should be considered if cost is an issue?

Answer 53

Doxycycline Bactrim

Question 54

How do you treat viral bronchitis?

Answer 54

No AB

Question 55

How do you treat chronic mild bronchitis, FEV1 > 60%, < 60yrs, < 4 exacerbation/year?

Answer 55

Amoxicillin Macrolide

Question 56

How do you treat chronic moderate bronchitis + FEV1 59%-40% + diabetes, chronic renal failure, chronic heart failure + at least 4 exacerbation/year?

Answer 56

Respiratory Fluoroquinolones Amoxicillin/Clavulanate Macrolides

Question 57

How do you treat chronic severe bronchitis + FEV1 < 40%

Answer 57

Treat for more resistant pathogens e.g. Pseudomonas, enterobacteriaceae