Upper Respiratory

Question 1

Indications for CXR

Answer 1

• Chronic cough (3 weeks)
• hemoptysis
• suspected COPD or lung cancer (long term smoker)

Question 2

Acute Bronchitis

Answer 2

• Usually acute cough (1-2 weeks) w or w/o sputum, chest discomfort, SOB +/- fever
• Antibiotics unnecessary – usually viral. Give codeine for cough suppression and albuterol PRN

Question 3

Tx cold

Answer 3

• Hydration!
• Rest, analgesics
• Cough suppression (dextromethorphan, codeine)
• Nasal decongestant spray
• Benadryl

Question 4

DDx sore throat

Answer 4

-Most common: viruses (adeno, paraflu, rhino, EBV, HSV)
-Most concerning: beta-hemolytic strep due to possibility of rheumatic fever
-Other:
Chlamydia, mycoplasma
Gonococci (oral sex)
Corynebacterium diphtheriae (pseudomembrane covering pharynx)
Candida (immunocompromised, Abs, severe illness)

Question 5

Tx Strep throat

Answer 5

• PCN 10 days
• Erythromycin if allergic
• Or single dose PCN G IM

Question 6

Centor Score

Answer 6

• Calculates likelihood of bacterial infection in adult pts with sore throat
• One point each for: Hx fever, tonsillar exudates, Tender ant cervical adenopathy, absence of cough.

Modified criteria: +1 for age 45
0-1: low likelihood
2-3: Rapid Strep test. If +, give Penicillin. If -, do a culture (can wait 9 days to Tx with low risk of complications)
4+ : Tx empirically