Upper Respiratory Infections, Pharyngitis, Sinusitis Flashcards
etiology of acute viral rhinositis
Rhinovirus (30%); Coronavirus (10-20%); other viruses
aka “common cold”
presentation of acute viral rhinositis
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
treatment of acute viral rhinositis
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)
etioloty of ‘flu’
influenza a or b
spread by respiratory droplets
presentation of ‘flu’
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
diagnositc approach to ‘flu’
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
treatment of ‘flu’
supportive care: bedrest, fluids, antipyretics, neuraminidase inhibitors (for types A&B)
most important is prevention through vaccination
who is at high risk for getting influenza?
> 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)
etiology of pharygitis
80% are viral, usually rhinovirus, adenovirus; (associated with the common cold, herpangina, etc.)
20% are bacterial - group A beta hemolytic strep
presentation of streptococcal pharyngitis
fever, painful adenopathy, exudative tonsils, NO cough; sore throat; sandpaper-like rash; arthralgia; nausea, vomiting
diagnosis of streptococcal pharyngitis
throat culture=gold standard
rapid strep test, monospot (to make sure it’s not mono)
treatment of streptococcal pharyngitis
Penicillin 500mg bid X 10 d
macrolide antibiotics if penicillin allergy (azithromycin, clindamycin, clarithromycin)
no longer contagious after 24 hours of tx
etiology of peritonsillar abscess
a complication of tonsillitis, peritonsillar cellulitis, streptococcal pharyngitis, mononucleosis; infection spreads into peritonsillar space
presentation of peritonsillar abscess
“hot potato voice,” drooling, trismus(spasm of the jaw muscles, lockjaw), unilateral peritonsillar swelling and shifted uvula
treatment of peritonsillar abscess
surgical drainage, +/- antibiotics (penicillin)
etiology of mononucleosis
Epstein-Barr Virus
presentation of mononucleosis
“strep-like;” malaise, sore throat, low grade fever; oral ulcers; pharyngeal erythema and exudates; cervical adenopathy, splenomegaly; NO cough
treatment of mononucleosis
supportive; rest, analgesics, hydration
spleen precautions
can remain contagious for >6mo
etiology of laryngitis
Infectious: viruses (most common); bacterial (Strep., H. flu., Staph. aureus)
Non-infectious: vocal abuse, intubation, toxic exposure, GERD, laryngeal polyps, carcinoma
presentation of laryngitis
hoarseness, dysphonia (variation in vocal quality); cough, difficulty swallowing (usu. due to URI)
visualization of vocal cords reveals erythema or swelling
treatment of laryngitis
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
classification of sinusitis
acute: less than 30 days
Subacute: 30-90 days
Chronic: 90 days or more with persistent symptoms
etiology of sinusitis
bacterial: step. pneumoniae; H. flu.; Morexella catarrhalis
viral (15-20%)
fungal in immunocompromized patients
presentation of sinusitis
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
diagnosis of sinusitis
sinus aspirate culture= gold standard CT scan (coronal view) - test of choice endoscopy - limited sinus radiographs - limited use
treatment of sinusitis
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
etiology of osteomyelitis
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
presentation of osteomyelitis
sinusitis symptoms, fever, headache, doughy edema over the involved area of the bone
treatment of osteomyelitis
immediate ENT referral (can be life threatening), hospitalization, IV antibiotics, surgery
etiology of orbital cellulitis
inflammation of subcutaneous connective tissue around the eye, often associated with ethmoid sinusitis
presentation of orbital cellulitis
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
treatment of orbital cellulitis
immediate referral/admit
hospitalization, IV antibiotics, surgery
