Upper Respiratory Infections, Pharyngitis, Sinusitis

Question 1

etiology of acute viral rhinositis

Answer 1

Rhinovirus (30%); Coronavirus (10-20%); other viruses

aka “common cold”

Question 2

presentation of acute viral rhinositis

Answer 2

clear watery rhinorrhea, conjestion, sneezing; sore throat,mild to moderate non-productive cough; low grade fever(if present), chills; slight malaise, myalgias, headache; nasal and pharyngeal erythema, congested turbinates, sinus tenderness, occasional cervical adenopathy

Question 3

treatment of acute viral rhinositis

Answer 3

rest, fluid, analgesics;antibiotics are of no value - self resolving in 5-7 days
may also use antihistamines (reduce sneezing, discharge), decongestants (decrease nasal symptoms), expectorants (reduce sputum production)

Question 4

etioloty of ‘flu’

Answer 4

influenza a or b

spread by respiratory droplets

Question 5

presentation of ‘flu’

Answer 5

abrupt onset of high fever; myalgias, malaise, extreme weakness, headache; sore throat;clear nasal discharge; non-productive cough; pharyngeal erythema; cervical lymphadenopathy; may see confusion and weakness in the elderly
symptoms are more severe than the common cold

Question 6

diagnositc approach to ‘flu’

Answer 6

thorough history and physical
viral cultures from the nose or pharynx (its a reportable disease)
CBC, CXR(to check for pneumonia complications), electrolytes/glucose (check hydration status), pulse ox

Question 7

treatment of ‘flu’

Answer 7

supportive care: bedrest, fluids, antipyretics,
neuraminidase inhibitors (for types A&B)

most important is prevention through vaccination

Question 8

who is at high risk for getting influenza?

Answer 8

> 50, residence of care facility, hx of pulmonary disease, hx of cardiovascular disease, pregnant women, immunocompromized patients
those around high risk patient should also be vaccinated (healthcare providers, caregivers and family to high risk patients)

Question 9

etiology of pharygitis

Answer 9

80% are viral, usually rhinovirus, adenovirus; (associated with the common cold, herpangina, etc.)
20% are bacterial - group A beta hemolytic strep

Question 10

presentation of streptococcal pharyngitis

Answer 10

fever, painful adenopathy, exudative tonsils, NO cough; sore throat; sandpaper-like rash; arthralgia; nausea, vomiting

Question 11

diagnosis of streptococcal pharyngitis

Answer 11

throat culture=gold standard

rapid strep test, monospot (to make sure it’s not mono)

Question 12

treatment of streptococcal pharyngitis

Answer 12

Penicillin 500mg bid X 10 d
macrolide antibiotics if penicillin allergy (azithromycin, clindamycin, clarithromycin)

no longer contagious after 24 hours of tx

Question 13

etiology of peritonsillar abscess

Answer 13

a complication of tonsillitis, peritonsillar cellulitis, streptococcal pharyngitis, mononucleosis; infection spreads into peritonsillar space

Question 14

presentation of peritonsillar abscess

Answer 14

“hot potato voice,” drooling, trismus(spasm of the jaw muscles, lockjaw), unilateral peritonsillar swelling and shifted uvula

Question 15

treatment of peritonsillar abscess

Answer 15

surgical drainage, +/- antibiotics (penicillin)

Question 16

etiology of mononucleosis

Answer 16

Epstein-Barr Virus

Question 17

presentation of mononucleosis

Answer 17

“strep-like;” malaise, sore throat, low grade fever; oral ulcers; pharyngeal erythema and exudates; cervical adenopathy, splenomegaly; NO cough

Question 18

treatment of mononucleosis

Answer 18

supportive; rest, analgesics, hydration
spleen precautions
can remain contagious for >6mo

Question 19

etiology of laryngitis

Answer 19

Infectious: viruses (most common); bacterial (Strep., H. flu., Staph. aureus)
Non-infectious: vocal abuse, intubation, toxic exposure, GERD, laryngeal polyps, carcinoma

Question 20

presentation of laryngitis

Answer 20

hoarseness, dysphonia (variation in vocal quality); cough, difficulty swallowing (usu. due to URI)
visualization of vocal cords reveals erythema or swelling

Question 21

treatment of laryngitis

Answer 21

Infectious (do CBC) - treat underlying illness, antibiotics only if bacterial infection.
voice rest, humidification, fluids, no smoking
should resolve in 1-3 weeks, if persists >3 weeks, refer to ENT

Question 22

classification of sinusitis

Answer 22

acute: less than 30 days
Subacute: 30-90 days
Chronic: 90 days or more with persistent symptoms

Question 23

etiology of sinusitis

Answer 23

bacterial: step. pneumoniae; H. flu.; Morexella catarrhalis
viral (15-20%)
fungal in immunocompromized patients

Question 24

presentation of sinusitis

Answer 24

hx of URI with improment, followed by relaps; purulent nasal discharge; facial pain/pressure made worse by bending forward or percussing sinuses; low grade fever, nasal congestion, post nasal drip; halitosis; dull or absent light in transillumination of sinus

Question 25

diagnosis of sinusitis

Answer 25

sinus aspirate culture= gold standard
CT scan (coronal view) - test of choice
endoscopy - limited
sinus radiographs - limited use

Question 26

treatment of sinusitis

Answer 26

hydration, humidification, decongestants (promote sinus drainage); topical nasal steroids; antihistamines (if associated with allergy - may thicken mucus as a side effect); analgesics; antibiotics (amoxicillin, augmentin, azithromycin)

refer to ENT if symptoms persist after 2 rounds of antibiotic therapy

Question 27

etiology of osteomyelitis

Answer 27

complication from sinusitis, more commonly in frontal sinus, and in peds

bacterial: step. pneumoniae; H. flu.; Morexella catarrhalis
viral (15-20%)
fungal in immunocompromized patients

Question 28

presentation of osteomyelitis

Answer 28

sinusitis symptoms, fever, headache, doughy edema over the involved area of the bone

Question 29

treatment of osteomyelitis

Answer 29

immediate ENT referral (can be life threatening), hospitalization, IV antibiotics, surgery

Question 30

etiology of orbital cellulitis

Answer 30

inflammation of subcutaneous connective tissue around the eye, often associated with ethmoid sinusitis

Question 31

presentation of orbital cellulitis

Answer 31

febrile, look “sick,” eyelid edema, ptosis(drooping eyelid), proptosis (eye protrusion), and chemosis; decreased extra ocular movements, pressure on CN II may lead to vision loss

Question 32

treatment of orbital cellulitis

Answer 32

immediate referral/admit

hospitalization, IV antibiotics, surgery