Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diagnosis & Mgmt 1 > Upper Respiratory Illnesses > Flashcards

Upper Respiratory Illnesses Flashcards

1
Q

Should antibiotics be used to treat URIs?

A

Rarely!

URIs are mostly viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the main viral culprits of the common cold?

A

Rhino-virus

Coronavirus

Adenovirus

Respiratory Syncytial Virus (RSV)- lower resp. infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the clinical presentation for the common cold?

A

Duration of illness: 5-10days, up to 14 days

Nasal congestion and/or discharge

Sneezing

Sore throat

Cough

Low grade temp

Headache

Malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How will the symptoms of a sore throat differ with viral v. strep?

A

Viral sore throat- worse morning/night and good during day

Strep- persistent sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What will the physical exam look like with a common cold?

A
  • TM is normal, maybe slightly red, some clear fluid

Rhinorrhea, can be green/yellow or clear

Skin, mild scattered erythematous rash

Nasal mucous, swollen and red nasal cavity

Some cervical lymph nodes may be slightly enlarged

lungs are clear bilaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the differential diagnosis for the common cold?

A

Influenza- abrupt onset

Bronchitis- runny nose and rhonchi

Acute bacterial sinusitus- can get bacterial infection at end of viral cold

Allergic rhinitis- pale and boggy turbinates

pertussis- would have significant cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can help with the common cold’s nasal congestion symptom?

A
  • Netti pot, steam shower, normal saline nasal spray
  • Antihistamine to dry things out and help sleep
  • Ipratropium bromide (nasal)- reduces fluid released from nose mucosa
  • Cromolyn sodium (nasal)- reduces allergin triggers
  • Intranasal decongestant like Afrin- opens passages, but can get rebound inflammation. Use 3 days MAX
  • Decongestants- not for kids under 6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can help with the common cold’s cough symptom?

A

Honey

Expectorants like Mucinex

Antitussive like Delsym, the DM in OTC cold medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Otitis Media?

A

inflammatory or infectious process that leaves fluid in the middle ear

Viral, bacterial or fungal by origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risk factors of getting otitis media?

A

young age

Family Hx

Lack of breastfeeding

Tobacco smoke/air pollution

pacifier use

Day care with other kids

lack of access to medical care/ socioeconomic condition

Race/ethnicity

Season

Underlying disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the difference between an acute OM and OM effusion?

A

Acute- fluid is not absorbed and acute inflammation and infection occur

Effusion- build up of fluid behind their TM without inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common microbiota that cause acute otitis media in kids?

A

Strep pneumo- 66%

M. Catarrhalis- 59%

H. Influenzae- 29%

Viral- 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the clinical presentation of acute otitis media?

A

acute onset

May/may no be febrile

Otalgia- ear pain

Vomiting, diarrhea, ear rubbing

Associated with URI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will the physical exam look like with acute otitis media?

A

TM- red, limited mobility, won’t see land marks, bulging, pus

May see URI sym- runny nose, coughing, temp, clear lungs

mastoid bone- non-tender

sinuses- tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is bullous myringitis?

A

development of vesicles in the superficial layers of the TM

look like blisters on the TM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes bullous myringitis?

A

Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What treats bullous myringitis?

A

Macrolide- like azithromax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is acute otitis media treated in children who don’t go to daycare or this is their first infection?

A

Amoxicillin

80-90mg/kg/day in 2 divided doses, 12 hours apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is acute otitis media treated in children who attend daycare or have recurrent infections?

A

Augmentin: Amoxicillin/Clavulante

90mg/kg/day / 6.4mg/kg/day in 2 divided doses 12 hours apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is acute otitis media treated for a child allergic to penicillin?

A

Cefdinir

14mg/kg/day in 1 or 2 doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is mild/moderate AOM treated in adults?

A

Amoxicillin 500mg BID for 7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is severe AOM defined and treated in adults?

A

Meaning: fever and significant hearing loss and severe pain

Tx: augmentin 875mg BID for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is AOM treated in adults with a penicillin allergy?

A

Cefdinir 300mg BID for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can be prescribed to help with the pain of an AOM?

A

Tylenol Kids: 15mg/kg Q4h

Tylenol Adult: 500-1000 mg Q6h

Ibuprofen Kids >6mo: 10mg/kg Q6h

Ibuprofen Adult: 600-800 mg Q8h

Antipyrine/benzocaine (auralgan) 2-4gtt TID-QID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When would you refer for AOM?

A

persistent OME or AOM

More than 4 episodes in 6 months or 6 episodes in a year

hearing loss

cholesteatoma

acute mastoiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is recurrent AOM?

A

three or more episodes of acute otitis media within six to 18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is herpes zoster oticus? AKA Ramsey Hunt Syndrome

A

Triad of:
1- herpes vesicles in auricle/canal

2- facial paralysis

3- ear pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is herpes zoster oticus treated?

A 
prednisone 1mg/kg/day for 7 days
OR
Famciclovir 500mg po tid for 7 days 
OR
Valacyclovir 1gm po tid for 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is mastoiditis?

A

Inflammation of mastoid air cells of temporal bone inside the mastoid process, usually as a complication of acute otitis media

Usually caused by Step. pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does mastoiditis present?

A

Tenderness, swelling of mastoid

Displaced ear

Fever

AOM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is OME?

A

Otitis Media with Effusion:

effusion in the middle ear without evidence of infection persists after the AOM or related to allergic rhinitis due to dysfunction of the Eustachian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the clinical presentation of OME?

A

Afebrile, no otalgia or otorrhea

HEENT: TM with visible landmarks, TM maybe pearly grey, mildly erythematous, serous fluid behind TM, no bulging

Signs of URI maybe present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the differential diagnosis for OME?

A

AOM

MEE- middle ear effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how do you treat OME?

A

watchful waiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is tympanosclerosis? What causes it?

A

white scarring from T-tubes

incidental finding-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is cholesteatoma?

A

an abnormal accumulation of keratin producing squamous cells in the middle ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What causes cholesteatoma?

A

congenital OR

Acquired due to persistent, recurrent AOM that result in chronic prolonged negative pressure or perforation, which pulls in squamous epithelial cells into the middle ear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the clinical presentation of cholesteatoma?

A

Hearing loss (conductive), tinnitus, persistent ear infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is found on physical exam with cholesteatoma?

A

White cyst usually in the posterior or anterior superior quadrant of the TM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the treatment for cholesteatoma?

A

refer to ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is otitis externa?

A

Inflammation of the external canal that may extend to the auricle

often called ‘swimmers ear’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the most common pathogens for otitis externa?

A

S. Aureus

P. Aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does otitis externa present?

A

As acute presentation : pruritus, mild to moderate discomfort, and erythema

As progresses: edema, otorrhea (ear discharge), and conductive hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What does otitis externa look like on physical exam?

A

Pain and tenderness on palpation of tragus or auricle.

Canal is usually erythematous with exudate.

TM may or may not be visible.

Cellulitis may extend to the auricle.

In severe cases you may have hearing loss as well as cervical lymphadenopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the differential diagnosis for otitis externa?

A

Cerumen impaction- esp if older

Forign body

Malignant otitis externa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for Otitis externa?

A

Aural toilet

Topical antibiotics with steroid and coverage for P. aeruginosa and S. pneumonia for 7 days

Pain tx with NSAID

Severe occlusion- place wick and change 1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When should otitis externa be referred?

A

Malignant otitis externa

Grossly inflamed or prolonged infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How is otitis externa treated with a perforated TM?

A

Ciprofloxacin 0.3%/ dexamethasone 0.1% (Ciprodex) BID

OR

Ofloxacin 0.3% BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How is otitis extra treated if the TM is intact?

A

Neomycin/polymyxin B/ hydrocortisone, solution or suspension TID or QID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is ceruminosis?

A

build up or cerumen in ear canal

may block canal resulting full sensation, decreased hearing, pain or infection (otitis externa)

If hearing is decreased, it is usually very gradual so patient isn’t aware of it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is ceruminosis treated?

A

Irrigation- always direct stream along canal, not directly at TM. Can get messy. Important water is body temperature—not hot or cold

Rare pain—stop

Do not attempt if known or suspected tm perforation or tympanostomy tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How can ceruminosis be treated if the TM is perforated?

A

Use a Curette— Requires training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is labryinthitis?

A

Acute unilateral labyrinthine dysfunction caused by viral inflammation of the vestibular nerve, bacteria or an AOM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How does labrynthitis present?

A

Vertigo

Nausea/vomiting

Tinnitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What clinical findings are expected with labrynthitis?

A

HEENT: without findings

Hearing test: may find decreased hearing on affected side or no hearing loss

Assess Romberg and cranial nerves to evaluate for possible neurological cause of vertigo

56
Q

What are the differential diagnosis for labrynthitis?

A

Benign paroxysmal positional vertigo

Meniere’s Disease

Migrainous vertigo

Multiple Sclerosis

Toxins

Head Trauma

57
Q

How is labrynthitis treated?

A

Depends on symptoms:

Corticosteroids can be prescribed-Methylprednisolone tapering dose

Meclizine 25-50mg, used to treat vertigo and motion sickness

Anti-emetics-ondansetron

Re-assurance

58
Q

What is Meniere’s Disease? What is the clinical presentation?

A

Don’t know what causes it

Episodic vertigo for 20min to several hours.

Sensorineural hearing loss

Tinnitus

Unilateral ear pressure

59
Q

How is Meniere’s disease treated?

A

refer to ENT

60
Q

What is Rhinosinusitis?

A

Inflammation of the mucosal surface of the paranasal sinuses

61
Q

What causes rhinosinusitis?

A

98% viral, such as rhinovirus, parainfluenza, or influenza virus

2% bacterial, such as Step pneumo, H.influenza, M. Catarrhalis

62
Q

What is the clinical presentation of rhinosinusitis?

A

Nasal congestion and obstruction

Purulent nasal discharge

Maxillary tooth discomfort

Otalgia

Facial pain

Cough

Fever low grade

Headache

Halitosis

63
Q

What is clinical findings are expected with rhinosinusitis?

A

HEENT: presence of allergic shiner; turbinates diffusely swollen, copious amounts of rhinorrhea or purulent discharge, erythematous turbinates; pharynx post nasal drip, mild erythema

Voice may be nasal

Check neck for signs of meningitis

64
Q

how is rhinosinusisits diagnosis made?

A

Usually dx made empirically

65
Q

What are the differential diagnosis for rhinosinusitis?

A

Dental abscess

Common cold

Trigeminal neuralgia

Optic neuritis

Atrophic, allergic, idiopathic rhinitis

Migraine or cluster headache

Foreign body (especially children)

66
Q

What criteria needs to be met to treat rhinosinusitis?

A

1/3 need to be met:

  • symptoms for 10+ days without improvement
  • Severe symptoms, fever 39 C (102 F) purulent nasal discharge, facial pain lasting 3-4 days
  • Double sickness: Onset of worsening symptoms, new onset fever, headache, increased nasal discharge following URI that lasted 5-6 days and was initially improving
67
Q

What is the initial empirical treatment for rhinosinusitis in adults ?

A

Augmentin 500mg/125mg PO TID for 5-7 days

68
Q

What is the secondary empirical treatment for rhinosinusitis in adults?

A

Augmentin 2000mg/125mg PO BID for 7-10 days

69
Q

What is the initial empirical treatment for rhino sinusitis in children?

A

Augmentin 45mg/kg/day split BID for 5-7 days

70
Q

What is the secondary empirical treatment for rhinosinusitis in children?

A

Augmentin 90mg/kg/day splity BID for 7-10 days

71
Q

What are some supportive measures for sinusitis?

A

Nasal steroids–modest improvement

Saline nasal spray/flush

Decongestants & antihistamine

Mucolytic/expectorants

Hydration

Analgesics prn

Re-eval in 72 hours if symptoms not improving or worsening

72
Q

What is allergic rhinitis?

A

Immunoglobulin E-mediated disease thought to occur after exposure to indoor or outdoor allergens —can be seasonal or perennial

73
Q

What is the clinical presentation of allergic rhinitis?

A

Rhinorrhea

Nasal congestion

Nasal obstruction

Pruritus

Sneezing

Post nasal drip

Cough

Fatigue

74
Q

What are the risk factors for allergic rhinitis?

A

Family history of atopy (ie, the genetic predisposition to develop allergic diseases)

Male sex

Birth during the pollen season

Firstborn status

Early use of antibiotics

Maternal smoking exposure in the first year of life

Exposure to indoor allergens, such as dust mite allergen

Serum IgE >100 IU/mL before age six
Presence of allergen specific IgE

75
Q

What is expected on physical exam for allergic rhinitis?

A

Allergic salute

Allergic shiners

Allergic facies

Nasal mucosa: pale bluish or pale, turbinates swollen, polyps

Cobblestoning of the posterior pharynx

Serous fluid behind TM

76
Q

How is allergic rhinitis treated?

A

Antihistamine

Intranasal corticosteroids

Intranasal antihistamines

Decongestants

Intranasal cromolyn

Leukotriene receptor against

Immunotherapy, slicks is a sublingual immunotherapy

77
Q

What is conjunctivitis?

A

Inflammation of the conjunctivae of the eye.

Usually viral, but can be bacterial or allergic

78
Q

What does bacterial conjunctivitis presentation look like?

A

Hyperemia- increase in blood vessels

Purulent discharge; eyes glued shut

Pruritus

79
Q

What does viral conjunctivitis prevention look like?

A

Hx of recent URI

Excessive watery discharge

Itching, photophobia

Starts in one spreads to another

Herpes: vesicular lesions- send to Eye Dr.

80
Q

What does allergic conjunctivitis look like?

A

Cobblestoning on conjunctiva

Associated with an allergic reaction

Itching severe at times

Clear or stringy discharge (cord like)

81
Q

How is viral conjunctivitis treated?

A

self-limiting

cool compress

hand washing

OTC antihistamine/decongestant drops- 2ggt 4x/day for 2-3 weeks

82
Q

How is bacterial conjunctivitis treated?

A

Topical antibiotic drops: Erythromycin 2ggt 4x/day for 5-7 days

Oral antibiotic if H. Influenza, GC/CT suspected

83
Q

How is allergic conjunctivitis treated?

A

Avoid allergen

Cool compresses

Topical/oral antihistamine

OTC antihistamine/decongestant drops- 2ggt 4x/day for 2-3 weeks

84
Q

When should a referral be given for conjunctivitis?

A

GC/Herpes

Pain

Vision loss

Corneal involvement

Recent injury

Treatment failure

85
Q

What is a corneal abrasion?

A

break in the epithelium usually due from trauma, can be chemical

86
Q

How does a corneal abrasion present?

A

eye pain or feeling like there is sand in the eye, blurred vision, tearing

87
Q

What are some causes of epistaxis?

A

Trauma, epistaxis digitorum (nose picking), foreign bodies

Meds or irritants—topical steroids, cig. Smoke

Intranasal polyps, neoplasm, or septal deviation

Hemophilia, leukemia

Liver disease/disorders cassock w/ thrombocytopenia

Meds affecting platelets/coag: ASA, warfarin, NSAIDS

88
Q

How is epistaxis treated?

A

Prevention is key: No “digitorum”, lubricate nares or humidify air

Compression works well if done correctly. Continuous, direct pressure 5-20 minutes with head forward!

89
Q

What is pharyngitis?

A

Inflammation of the tonsils, pharynx and larynx

90
Q

What is the clinical presentation of pharyngitis?

A

Very painful swallowing

91
Q

What is expected on physical exam of viral pharyngitis?

A

red swollen tonsils

Red throat, cobble stoning

92
Q

What is expected on physical exam of bacterial pharyngitis?

A

swollen uvula with white spots

Red swollen tonsils

Red throat

Gray furry tongue

Bad breath

93
Q

How is viral pharyngitis treated?

A

Adequate analgesics

If “no relief”, get detailed hx of use

Salt or warm water gargles

Hydrate, lozenges, sprays

Voice rest prn

94
Q

What are the three signs of Mononucleosis?

A

Fever

Pharyngitis

lymphaenopathy

95
Q

What is mononucleosis caused by?

A

Epistein Barr virus
OR

cytomegalovirus

96
Q

How is Mononucleosis spread? What is the incubation period

A

through saliva

incubates for 4-7 weeks

97
Q

What is the clinical presentation of Mono?

A

fever

erythematous tonsils w/ exudate

often very toxic w/ malaise

headache

Anorexia

N/V

98
Q

What is a clinical feature of Mono that helps distinguish it from other diseases?

A

Significant cervical lymphadenopathy may help distinguish from other pharyngitis @ early stages

99
Q

How is Mono diagnosed?

A

Reaction to PCNs

Labs—EBV IgG and IgM , CMV IgG and IgM, CBC with differential

Serum—10% or > atypical lymphocytes support dx

100
Q

What are the differential diagnosis of Mono?

A

Strep

CMV

Acute HIV

Toxoplasma infection

101
Q

How is Mono treated?

A

Adequate analgesics

If “no relief”, get detailed hx of use

Salt or warm water gargles

Hydrate, lozenges, sprays

Voice rest pen

Maybe corticosteroid- controversial b/c immunosuppression and steroid ADE

102
Q

What are some potential complications of Mono?

A

spleen rupture- if contact sports played because splenomegaly

If given penicillin- ab will develop a maculopapular rash

Oral Hairy Leukoplakia on tongue- White painless plaques, cannot be scraped from the surface. (Associated with intense EBV replication)

103
Q

What is the most common causes of bacterial pharyngitis?

A

Most common: GABHS

Others:
Gonococcal- sexually transmitted

Diphtheria pharyngitis

104
Q

What is Gonococcal look like?

A

Greenish exudate + fever, severe ST, dysuria

105
Q

What does diphtheria pharyngitis?

A

“Pseudo-membrane”

“bull neck”- soft tissue swelling of the neck

106
Q

What is the common cause of bacterial pharyngitis?

A

GABHS- Group A Beta Hemolytic Strep

Peak season: late winter/early spring

107
Q

When is GABHS pharyngitis contagious?

A

Incubation 24-72 hours

If treated- no longer contagious after 16 hours of starting antibiotics; OK return to school/work 24 h. after

If untreated—continues to be contagious for up to 10 days after symptom resolution

108
Q

What are the presenting symptoms of the GABHS pharyngitis?

A

Fever, chills, headache, fatigue, malaise,

myalgia’s

Sudden onset of sore throat, painful swallowing: marked erythema of the throat, and tonsils (tonsillar enlargement)

“hot potato voice”

Tonsillar exudates

Uvular edema/erythema (red beefy)

anterior cervical adenopathy

palatal petechiae

n/v, abd pain—often assoc. w/ fever

s/s usually resolve without treatment

Complications w/o treatment

109
Q

How is GABHS pharyngitis diagnosed?

A

Rapid Strep Test- allows for early detection

Throat culture- gold standard

110
Q

Why treat GABHS pharyngitis?

A

Reduce contagiousness from 1-2 wks post-infections down to 1 day after starts antibiotic

Reduces sequellae of other symptoms

111
Q

What are potential GABHS sequellae if it goes untreated?

A

Peritonsillar abscess

Acute rheumatic fever:
systemic disease affecting the peri- arteriolar connective tissue and can occur after an untreated group A streptococcal pharyngeal infection;

rheumatic heart disease—valve damage d/t rheumatic fever

Glomerulonephritis—post-streptococcal; only certain strains

112
Q

What is the treatment for GABHS?

A

PCN V 500mg bid for 10 days

Amoxicillin in children as it tastes better 45mg/kg bid

113
Q

What is the treatment of GABHS if the patient has an PCN allergy?

A

Cefurdroxil 30mg/kg children OR

500mg bid or 1g per day in adults

114
Q

When should GABHS be referred?

A

Referred to ENT if > 6 episodes of documented severe throat infections in one year

Temp > 101

Enlarged and tender lymph nodes

White spots on tonsils

Positive strep test

115
Q

What is PANDAS?

A

Pediatric autoimmune neuropsychiatric disorder associated with strep

Meaning: Group A strep in a susceptible person causes and abnormal immune response with resultant central nervous system manifestations
Pediatric onset 3 yr to puberty

Leads to abrupt onset or exacerbation of OCD or tic behavior

116
Q

What does it mean to be a carrier of GABHS?

A

Patients who are chronically colonized with GABHS

Very low risk, if any, for developing suppurative complications

Unlikely to spread GABHS to close contacts.

Most carriers require no medical intervention

117
Q

How should GABHS carriers be treated if they get infected?

A

Clindamycin 20 mg/kg/day in three divided doses (maximum 450 mg/day) x 10 days

118
Q

What is Scarlet Fever?

A

Erythematous eruption due to a toxin produced by beta-hemolytic streptococci…

119
Q

What is the typical presentation of scarlet fever?

A

Starts with fever, pharyngitis

THEN
Scarletiniform rash: fine papular with rough texture…neck-trunk- axillary, groin, extremities.

The skin peels off (desquamation) at the axilla, groin, palms

Begins 7-10 d. after rash resolution

May last up to 6 wks

Proportional to intensity of rash

120
Q

How is scarlet fever treated?

A

PCN V 500mg bid for 10 days

Amoxicillin in children as it tastes better 45mg/kg bid

121
Q

How is scarlet fever treated if the patient has a PCN allergy?

A

Cefurdroxil 30mg/kg children OR

500mg bid or 1g per day in adults

122
Q

What does Kawasaki’s disease look like?

A

strawberry tongue

Rash- circular with red center on trunk/loins

Red swollen hands

123
Q

What is pertitonsillar abscess?

A

accumulation of pus within the peritonsillar tissue

tonsillitis leads to cellulitis which leads to abscess, the body tries to encapsulate the infection.

Associated with GABHS, Staph aureus, H. influenza

124
Q

How does peritonsillar abscess present?

A

Fever, chills, malaise, halitosis, toxic appearing, ‘hot potato” voice, drooling

125
Q

What is expected to be found on physical exam for a peritonsillar abscess?

A

Unilateral erythema edema of the peritonsillar tissue which leads to uvular deviation

Tender cervical nodes

Signs of dehydration

126
Q

How is peritonsillar abscess diagnosed?

A

physical findings

CT scan

CBC with diff and a Chem panel

monospot

127
Q

What are the differential diagnosis for peritonsillar abscess?

A

Mono

Tumor/Leukemia/Lymphoma

Cervical adenitis

Epiglottitis

Dental infection

128
Q

How is peritonsillar abscess treated?

A

Refer to ENT or ED

129
Q

What are Tonsilloliths?

A

Benign collection of collagen/ microorganisms/
food in tonsillar crypts

Patient will have bad breath

130
Q

What is epiglottis?

A

acute usually bacterial inflammation/cellulitis of the epiglottitis

131
Q

What is the clinical presentation of epiglottis?

A

severe odynophagia

dysphagia

fever

drooling

SOB

distress

stridor

132
Q

What is the the clinical presentation of croup?

A

Cough barking sound, worse at night

Usually precedent URI or low grade fever

Hoarseness, stridor, wheeze

133
Q

What is expected upon physical exam of croup?

A

Vital signs: low grade temp, tachycardia, tachypneic, nl pulse ox

Varies from no apparent to distress with barky cough at rest or with crying to nasal flaring, stridor, respiratory distress

HEENT: turbinates swollen, erythematous with mucoid discharge, pharynx may have erythema enlarged tonsils, no exudate or petechial

Neck: shoddy cervical lymphadenopathy, inspiratory stridor

Chest: scattered expiratory wheeze

134
Q

What are the differential diagnosis for croup?

A

Angioedema

Epiglottitis

Peritonsilar abscess

Foreign body

Retropharyngeal abscess

135
Q

What is the treatment of croup?

A

Oral corticosteroid
Dexamethasone po/IV/IM
6mg/kg up to 12mg x1 in office

Effects persist up to 48 hours

Avoid if active TB or varicella

Mist therapy

Racemic Epinephrine- moderate to severe, given in ER, monitored for
4 hours for “rebound phenomenon”

Oxygen therapy

Diagnosis & Mgmt 1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions