Upper respiratory tract Flashcards
1
Q
Common cold etiology
A
- most common pathogens: human rhinoviruses
- in youbng children: RSV, human hetapneumovirus, parainfluenza viruses, adenoviruses, influenza viruses, nonpolio enteroviruses, human coronaviruses
2
Q
Clinical manifestations of common cold
A
- vary by age and virus
- fever is uncommon in older children
- onset 1-3 days after infection
- scratchy throat, nasal obstruction, rhinorrhea
- cough in 2/3
- headache, hoarseness, irritability, difficulty sleeping, decreased appetite
- increased nasal secretion, abnormal middle ear pressure, anterior cervical lymphadenopathy, conjunctival injeciton
3
Q
Laboratory findings in common cold
A
- PCR, culture, antigen detection, serologic methods –> only when antiviral treatment is available, usually not used
- bacterial cultures when group A streptococcus is suspected
4
Q
Treatment of common cold
A
- supportive
- oseltamivir and zanamivir when associated with influenza virus –> has effect on duration of symtpoms
- sometimes antihistamines, antitussices and decongestants
5
Q
Treatment of nasal obstruciton
A
- topical or oral adrenergic agents in older children and adults
- -> xylometazoline, osymetazoline, phylephrine as intranasal sprays
- reduced-strength versions for younger children
- children up to 6 months cannot breath through mouth! –> suck the secrete from nose
6
Q
Treatment of rhinorrhea
A
- first generation antihistamines
7
Q
Normal physiology of sinuses in children
A
- ehtmoidal and maxillary sinuses are present at birth (only ethmoidal are pneumatized)
- maxillary sinuses are not pneumatized until 4 years
- Sphenoidal sinuses are present by 5 years of age
- frontal sinuses start developing at 7-8 years and are done by adolescence
8
Q
Pathogenesis of sinusitis
A
- acute bacterial sinusitis often follows URTI
- viral infection produces viral rhinosinusitis
- nose blowing generates force that porpels nasal secretions into the sinus cavities
- bacteria from the nasopharynx cannot be cleared out because of inflammation and edema
9
Q
Clinical manifestation of sinusitis
A
- nasal congestion, purulent nasal discharge, fever, cough
- bad breath, decreased sense of smell, periorbital edema (less common)
- headache and facial pain rare in children
- maxillary tooth discomfort, pain exacerbated by bending forward
- erythema and swelling of the nasal mucosa with purulent nasal discharge
- sinus tenderness in adolescents
10
Q
How to identify if sinusitis is bacterial?
A
- persistence of nasal congestion
- rhinorrhea and daytime cough over 10 days wihtout improvement
- severe symtpoms and T>39° with purulent nasal discharge > 3 days
- worsening symtpoms after initial improvement
11
Q
Diagnosis of sinusitis
A
- based on history
- sinus aspirate culture is the only accurate mehtod –> not practical for routine use for immunocompetent patients (may be in immunosuppressed pateints with fungal infections)
- radiographic studies: opacification, mucosall thickening, air-fluid level –> cannot tell us what the cause is
12
Q
Differential diagnosis of sinusitis
A
- viral URTI
- allergic rhinitis
- nonallergic rhinitis
- nasal foreign body
13
Q
Treatment of sinusitis
A
- Amoxicillin (oral) for children with uncomplicated mild to moderate severity acute bacterial sinusitis
- Ceftriaxone (iv or im) to children who are vomiting or who are at risk for poor compliance; should be followed by course of oral antibiotics
14
Q
Etiology of acute otitis media
A
- Streptococcus pneumoniae
- nontypeable hemophilius influenzae
- Moraxella catarrhalis
- respiratory viruses can also be present, either alone or together with bacteria –> rhinovirus and RSV
–> go through external ear and aspirate to determine what kind of causative agent
15
Q
Clinical manifestations of acute otitis media
A
- ear pain
- -> irritability
- -> change in sleeping or eating habits
- -> holding or tugging at ear
- -> fever
- systemic symtpoms and symtpoms with URTI occur
16
Q
Treatment of AOM
A
- individual episodes: antibiotics
- myringotomy when:
- -> severe, refractory pain
- -> hyperpyrexia
- -> complications of AOM such as facial paralysis, mastoiditis, labyrinthitis, CNS infection
- -> immunologic compromise
- tympanostopmy tube when AOM ir recurrent
- we must keep eustachian tube open by cleaning nose and decongestants
17
Q
Pathology of acute tonsillitis
A
- msot episodes are caused by viruses
- group A ß-hemolytic streptococcus most common cause of bacterial infection in pharynx
18
Q
Pathology of chronic tonsillitis
A
- aerobic species like streptococci and H. infleunzae
- anaerobic species like Peptostreptococcus, Prevotella, Fusobacterium
- tonsillary crypts can accumulate desquamated epithelial cells, lymphocyts, bacteria and other debris –> cryptic tonsillitis
- cryptic plugs can calcify into tonsillar concretions ro tonsillolith
19
Q
Diagnosis of tonsilltis
A
- testing when GABHS suspected –> thorat cultures
- Rapid antigen detection test (RADT) can detect GABHS
- when spread into deep neck structures is suspected –> radiologic imaging using X-ray or CT
- tender cervial lymph nodes and neck stiffness
- consider infectious mononucleosis, when it accompanied by tender cervical, axillary, or inguinal nodes, splenomegaly, lethargy, malaise, low-grade fever
- grey membrane in EBV infection
20
Q
Symtpoms of acute tonsillitis
A
- fever
- sore throat
- foul breath
- dysphagia
- odynophagia
- tender cervical lymph nodes
- dry tongue
- erythematous enlarged tonsils
- tonsillar or pharyngeal exudate
- palatine petechiae
- airway obstruction: mouth breathing, snoring, sleep-disordered breathing, nocturnal breathing pauses, sleep apnea
21
Q
Symtpoms of acute tonsillitis caused by GABHS
A
- odynophagia
- dry throat
- malaise
- fever and chills
- dysphagia
- referred otalgia
- headache
- muscular aches
- enalrged cervical nodes
22
Q
Symtpoms of chronic tonsillitis
A
- halitosis
- chronic sore throats
- foreign-body sensation
- history of expelling foul-tasting cheesy lumps
- tonsils contain copious depris within crypts
- usually not caused by GABHS
23
Q
Treatment of acute tonsillitis
A
- mostly supprtive
- maintaining hydration and caloric intake
- controlling pain and fever
- Corticosteroids in infectious mononucleosis (for fever and pharyngitis)
- in case of GABHS: antiobiotics –> 10 days of penicillin
24
Q
When is tonsillectomy indicated?
A
- more than 6 episodes of streptococcal pharyngitis in 1 year
- five episodes of streptococcal pharyngitis in 2 consecutive years
- three or more infections of the tonsils per year for 3 years
- chronic or recurrent tonsillitis associated with streptococcal carrier state that has not responded to ß-lactamase resistant antibiotics
25
Q
Complications of tonsillitis
A
- GABHS: post-infectious GN, acute rheumatic fever
- peritonsillar infection
- retropharyngeal space infection
26
Q
Etiology of Laryngitis
A
- mostly viruses –> parainfluenza, influenza A and B, adenovirus, RSV
- diphteria can be bacterial cause, rare in industrialized countries
27
Q
Clinical manifestations of laryngitis (croup)
A
- URTI with rhinorrhea, pharyngitis, mild cough, low-grade fever 1-3 days before signs of upper airway obstruction
- barking cough, hoarseness, inpiratory stridor
- edema of the vocal cords and subglottic tissue in laryngoscopy
- symtpoms are worse at night
- agitation and crying aggrevates it
- other family members migth be ill too
- airway obstruction: increasing respiratory rate, nasal flaring, costal retractions, stridor
28
Q
Diagnosis of laryngitis/ croup
A
- does not require radiography (subglotting narrowing)
29
Q
Spasmodic croup
A
- 1-3 years, history of viral prodrome and fever absent
- commonly in evening or night
- sudden onset that may be preceded by mild to moderate coryza and hoarseness
- barking, metallic cough, noisy inspiration and respiratory distress
- anxious and frightened
- next day patient is well except hoarseness and cough
30
Q
Differential diagnosis of croup
A
- bacterial tracheitis
- foreign body
- retropharyngeal or peritonsillar abscess
- angioedema
31
Q
Complicatiosn of laryngitis
A
- extension of the infection to involve other regions (middle ear, terminal bronchioles, lumonary parenchyma)
- bacterial tracheitis
32
Q
Treatment of laryngitis
A
- airway management and treatment of hypoxia is always most important
- Epinephrine (nebulized)
- systemic CCS –> decrease edema in laryngeal mucosa (dexamethasone
- oxygen therapy –> the aim is 94-95% (give 2-3 liters)
