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pathophysiology > Upper respiratory tract > Flashcards

Upper respiratory tract Flashcards

1
Q

4 most common URIs

A

1) Acute otitis media
2) acute rhinosinusitis
3) acute pharyngitis
4) acute laryngitis

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2
Q

TYPES OF OTITIS MEDIA AND THEIR diagnosis/symptoms

A

Caused by bacterial infection, which followed a viral infection

1) acute otitis media: causes an inflamed bulging of tympanic membrane which can rip. - also otorrhea ( ear discharge), otalgia (earache) (if lasts more than 48 hours is severe) and fever ( 39 degrees celsius or higher) is more common with bacterial infection

2) Otitis media with effusion(ome) : causes a heating impairment, otorrhea (ear discharge) but no inflammation of tympanic membrane; a lot of effusion(leaking)
- fluid build up in tympanic cavity

3) chronic otitis media (com): long term middle ear inflammation which causes damage due to multidrug resistant infections and having ome for long.

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3
Q

Antibiotic resistance relating to AOM

A
  • h. influenzae (NTHi) and m. catarrhalis produce beta- lactamases which leads to antibacterial resistance
  • more than half of s. pneumoniae are resistant to penicillin.
    these 3 are the most common causes of AOM bacterial infections.
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4
Q

clinical representation of AOM

A

non verbal children: hold ear with pain, rub or tug their ear
infants may cry, be irritable or have difficult sleeping

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5
Q

AOM treatment

A

antibiotics
first line of treatment if no penicillin allergy: amoxicillin (1) and amoxicillin- clavulanate (2) (oral)
first line of treatment if penicillin allergy is non severe : IV for ceftriaxone (1-3 days) (3)
second line of treatment after first do not work : cefdinir, cefuroxime, cefpodoxime ( if penicillin allergy is not severe)(4). if severe then clindamycin(5)

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6
Q

why dont all antibiotics work for AOM and we have to use different ones?

A

s.pneumoniae, H.influenzae and M.catarrhalis have resistance to beta lactam antibiotics because of the presence of Beta-lactamase enzyme or penicillin binding protein (PBP). beta lactamase degrades peptidoglycan so penicillin can’t bind.

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7
Q

what is Tympanocentesis and what to do if occurs often

A
  • is done after antibiotic treatment fails or AOm persists
  • puncture the tympanic membrane with a needle to remove fluid/let it leak out
  • relieves pressure and pain and keeps cavity from ripping
  • the fluid can be used to figure out the causative agent
  • if occurs often, then you can put in tympanostomy tubes to have drainage all the time
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8
Q

what is a recommendation from doctors for children to avoid getting AOM

A

to get their pneumococcal conjugate vaccine-13 (PCV 13) and annual influenza shot.

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9
Q

what is Rhinosinusitis and what types?

A
  • inflammation of the sinuses and nasal cavity mucosa
  • there are two types, acute viral rhinosinusitis and acute bacterial rhinosinusitis
  • the common cold is a rhinovirus
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10
Q

Acute Rhinosinusitis risk and when it happens most

A
  • often seasonal and increased risk in children, caregivers and asthamatics
  • AR viruses are due to global seasonal patterns.
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11
Q

Acute Rhinosinusitis risk and when it happens most

A
  • often seasonal and increased risk in children, caregivers and asthamatics
  • AR viruses are due to global seasonal patterns.
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12
Q

Clinical presentation, signs and symptoms for acute rhinosinusitis

A

symptoms: pus nasal discharge, nasal obstruction/congestion and facial pain, pressure, headache, dental pain, fever, ear pain, halitosis (disruption of microorganisms)
presentation: presistant, severe/worsening symptoms, or double sickening (improves then worsens)
IF SYMPTOMS STAY FOR LONGER THAN 10 DAYS, OR GET WORSE AFTER 10 DAYS THEN BACTERIAL
OTHERWISE VIRAL

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13
Q

what causes ABR (ETIOLOGY)

A

ACUTE bacterial Rhinosinusitis
caused by same bacteria as AOM
- s.pneumoniae, H.influenzae cause the most cases while m. catarrhalis cause the next batch
- less detected ones are gram negative bacilli, staphylococcus aureus (opportunistic bacteria) , streptococcus pyogenes and anaerobes

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14
Q

what are the symptoms / sings of ABR (PATHOPHYSIOLOGY)

A
  • often caused as viral respiratory tract infection that causes mucosal inflammation
  • leads to obstruction of sinus ostia which drain sinus
  • maxillary and ethmoid sinuses are the most frequently affected in ABR because bacteria stays in one area while viral goes everywhere
  • swabs tend to be inconclusive so usually not taken
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15
Q

acute rhinosinutsis treatments

A

if bacterial, symptomatic control and antibiotics ( same as aom)— refer to specialist if immunosuppressive illness, unusually severe symptoms and recurrent abr
if viral, symptomatic control and pain management

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16
Q

Gold standard for ABR diagnosis?

A

sinus puncture, with recovery of bacteria in high density = 10^4 colony forming units or greater.
it is invasive costly and painful, and not routinely done

17
Q

how is ABr disagnosed?

A

hard to diagnose since no simple and diagnostic test
- gold standard used- sinus puncture if emergency

18
Q

What is acute pharyngitis? (AP)

A

acute infection of the oropharynx or nasopharynx

19
Q

what causes AP?

A

Viral infections are most common cause, esp rhinovirus

if bacterial, infections are caused by group A beta-hemolytic streptococcus , causing strep throat. (GABHS)

20
Q

why are children at higher risk of getting AP?

A

GABHS is part of their natural flora

21
Q

what are the signs and symptoms of Acute pharyngitis?

A

a sore throat, red swollen, throat redness for both

if viral: a fever, will resolve in about 3-5 days or 5-10 days
if bacterial: a lot more inflammation and pus— swollen uvula, white spots, grey furry tongue
signs are similar for viral, and bacterial

22
Q

what are some suggestive signs of viral AP?

A
  • conjunctivitis, coryza (acute inflammation of mucous membrane of nasal cavities) and cough(not present in GABHS)
23
Q

how is AP transmitted?

A

by coughing or sneezing
person touches contaminated object and then touches mouth.

24
Q

how is bacterial AP determined?

A

for GABHS, throat swab is taken and used for
Rapid antigen-detection test (RADT)–> point of care test detects GABHS antigens (can’t detect viral AP)
and
microbiological culture (GOLD STANDARD of bacterial and viral)

25
Q

what are some viral AP treatments?

A

prevent transmission to close contacts
prevent acute rheumatic fever and treat symptoms
- antipyretic medications
- non prescription cough drops and sprays that contain menthol to numb pain
- topical anesthetics for temporary pain relief

26
Q

What are some GABHS AP treatments? (strep)

A
  • it has resistance to penicillin
  • 10 day oral treatment with first line antibiotics: amoxicillin, penicillin V, penicillin G benzathine (1 dose only)

if penicillin allergy: cephalexin, cefadroxil, clindamycin, azithromycin and clarithromycin

27
Q

what is acute laryngitis

A

caused by inflammation of the larynx
- mild and self limiting condition– lasts 3-7 days
- if lasts over 3 weeks then it is chronic laryngitis

28
Q

what is acute laryngitis caused by?

A

caused by viral organisms
- in kids, it includes croup

29
Q

what is croup? and how to treat it

A

it is laryngotracheobronchitis caused by parainfluenza virus
- ass corticosteroid treatment to bring swelling down

30
Q

what are the signs and symptoms for AL?

A
  • voice change (horse or raspy voice), aphonia, dry cough, pain swallowing, dryness of throat, malaise and fever
    risk factors are similar to AR/AP but gostroesophageal reflux disease (GERD) can commonly occur
31
Q

what causes AL?

A

caused by viruses, same as AVR, due to where the sinus are draining
- bacterial are less common but same as ABR

32
Q

what is the diagnosis for AL and the treatment?

A

diagnosed using a laryngoscope
- treated by resting voice and similar supportive care as AVR unless bacterial suspected

if bacterial then similar to AOM
treat GERD if present

pathophysiology (9 decks)

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