Upper Respiratory Infection Flashcards
Name some specific microbes/viruses that can cause acute bronchitis
influenza, parainfluenza, adeno, rhino, mycoplasma pneumonia and chlamydia pneumonia
Common presentation of acute bronchitis
cough productive of purulent sputum (MOST COMMON) fever malaise rhinorrhea nasal congestion sore throat wheezing dyspnea chest pain myalgias/arthralgias
Typical physical exam findings for acute bronchitis
non-specific and usually UNREMARKABLE
lung exam can show rales, rhonchi, or wheezes occasionally
make sure to note fever, tachypnea, tachycardia, BP abnormalities and to pulse ox in more severe symptoms
Factors more indicative of pneumonia
prolonged fever, tachycardia, tachypnea, hypotension, signs of consolidation on lung exam
What to do to confirm dx if suspecting pneumonia?
chest radiograph
How long does acute bronchitis usually last?
nearly always self limited in otherwise healthy individual
most lasts less than 2 weeks, some cases cough up to 2 months or more
Treatment for acute bronchitis
bronchodilator therapy, antitussives (dextromethorphan and codeine)
antibiotics limited effectiveness
Most common cause of chronic cough in healthy, non smokers with normal chest xray
upper airway cough syndrome (UACS)
encompasses variety of conditions (like allergic rhinitis or bacterial sinusitis)
How to subdivide rhinosinusitis?
acute (12 weeks)
recurrent (4 or more per year with interim resolution of symptoms)
When to think bacterial sinusitis vs viral sinusitis?
viral usually is gone in 7-10 days…
if patient has symptoms that persist longer than this, consider bacterial (>7 adults and>10 for children)
Symptoms of sinusitis
purulent nasal discharge, maxillary tooth/facial pain, unilateral maxillary sinus tenderness, worsening of symptoms after initial improvement + other syptoms similar to other URI
Organisms most commonly responsible for bacterial sinusitis?
s pneumo, h influenza, and moraxella catarrhalis (esp in children)
First line treatment for bacterial acute sinusitis
amoxicillin or trimeth-sulfa 10-14 day regimen
Second line antibiotics for acute sinusitis
augmentin (amox-clauvanic acid), 2/3rd gen cephalosporin), fluroquinolones, second generation macrolides (azithro, clarithrymycin)
What can be used in addition to antibiotics for adjunctive treatment of sinusitis
oral/topical decongestants, NSAIDS all for symptomatic relief
What comprises the majority of etiologies of pharyngitis?
VIRAL, self limited
When someone comes to you with sore throat, what serious conditions to rule out first?
GAS infection (strep throat), peritonsillar abscess, epiglottitis
Some bacterial causes of pharyngitis in teens
mycoplasma pneumoniae, chlamydia pneumoniae, arcanobaacterium haemolyticus
Findings frequently associated with GAS infection
abrupt onset sore throat, cervical lymphadenopathy, absence of cough, fever greater than 100.4, tonsillar exudate (not specific)
think CENTOR criteria
GAS can also cause scarlitinoform rash (red, sandpaper like)
What other virus presents similarly to GAS infection
Epstein barr (infectious mononucleosis)
features of Epstein Barr virus infection
hepatospenomegaly/generalized adenopathy
atypical lymphocytes on blood smear
presdisposition to splenic rupture (tell patients to avoid sports)
stridor, drooling, toxic appearance, patient somtimes leaning forward on outstretched arms (tripod)
epiglottitis
How to treat epiglottitis
emergently secure airway (via intubation/cricothyroidotomy)
swelling, associated tonsil pushed toward the midline with contralateral deviation of uvula
peritonsillar abscess
What is peritonsillar abcess associated with
complication of streptococcal pharyngitis or initial complaint of sore throat with trismus (pain with chewing)
what to do if suspect peritonsillar abscess
immediate referral for surgical drainage of abcess
gold standard for GAS infection diagnosis
throat culture! but can take 24-48 hours to come back
quick way to diagnose GAS
rapid antigen testing (highly specific but lower sensitivity than throat culture)
positive = prompt antibiotic treatment negative = do throat culture
Rare, but serious complications of untreated GAS infection
RHEUMATIC FEVER, glomerulonephritis (poststreptococcal), toxic shock syndrome, peritonsillar abscess, meningitis, bacteremia
T/F: postglomerulornephritis can occur even if patient was given appropriate antibiotic treatment
TRUE
treatment for GAS pharyngitis
PENICILLIN (10 day course) IM or oral
chronic cough, inflammation/hyperactivity of airway, chest tightness, exacerbation by particular triggers, improved with bronchodilators
asthma
cough gets worse in supine position, heartburn, increased symptoms after meals
GERD
how to dx GERD
24 hours esophageal ph monitoring (but clinical diagnosis is more common)
easily overlooked cause of nonproductive cough
ACE-inhibitor related cough
When can ACE inhibitor cough present?
1 week to 6 months after initiation of therapy
how to treat ACE inhibitor cough
discontinue med, check back in 4 weeks at the earliest, may use ARB as alternative
inflamed, swollen external ear canal, exudates/discharge, tympanic membrane may or may not be involved
OTITIS EXTERNA (OE)
pathogens that can cause OE
staph, strept, pseudomonas (“swimmer’s” ear from pools/bathtubs)
What condition puts patients at risk for invasive external otitis (malignant OE) by pseudomonas
DM
How does otitis media usually present?
usually seen in kids
fever, ear pain, tinnitus, vertigo, swollen TM (decreased motility or fluid behind TM is diagnostic), red TM
MOST CASES ACUTE OM RESOLVE SPONTANEOUSLY
bacterial pathogens commonly seen in OM
s pneumo, moraoxella catarrhalis, h influenzae
If patient has prolonged, severe OM, what a/b to give?
amoxicilin!
alt: amoxicillin-clavulanic acid (augmentin), bactrim or cephalosporin
CENTOR criteria = ?
1 point for each
age between 3-14 tonsillar exudate/swelling fever greater than 100.4 absence of cough cervical lymphadenopathy
minus point for age over 45
CENTOR criteria treatment score
0-1 no further testing no antibiotics
2-3 rapid antigen testing or throat culture, if positive treat with antibiotics
4 or more - empirically treat with antibiotics
