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
