Upper Respiratory Tract Infection

Question 1

What percentage of sinusitis is viral?

Answer 1

> 90%

Question 2

What percentage of sinusitis is bacterial?

Answer 2

<10%

Question 3

Major nonspecific symptoms of sinusitis

Answer 3

Purulent posterior/anterior nasal discharge
Nasal congestion
Facial congestion
Decreased sense of smell
Fever

Question 4

Minor nonspecific symptoms of sinusitis

Answer 4

Headache
Ear pain
Halitosis
Dental pain
Fatigue
Cough

Question 5

How do you treat viral sinusitis?

Answer 5

Decongestants
Irrigation
Mucolytics

Question 6

How do you treat bacterial sinusitis

Answer 6

No decongestants or antihistamines

Question 7

When do you use ABx for sinusitis?

Answer 7

• Persistent symptoms >10 days w/ no improvement
• Severe symptoms >3-4 days (102 Fever, purulent nasal discharge, facial pain)
• Worsening symptoms ~5days/double sickening (New fever, HA, ^ nasal discharge)

Question 8

ABx treatment for sinusitis

Answer 8

• Augumentin (Amoxicillin/Clavulanate)
• Fluoroquinolones
  -Clindamycin + Cefpodix/Cefurox (Mild)

Question 9

Duration of ABx treatment for Adults

Answer 9

5 - 7 days

Question 10

Duration of ABx treatment for Kids

Answer 10

10 - 14 days

Question 11

Chronic sinusitis pathogens

Answer 11

H. influenzae
S. pneumoniae

***cultures recommended

Question 12

What is the pathogen for viral pharyngitis?

Answer 12

Rhinovirus

Question 13

What is the pathogen for bacterial pharyngitis?

Answer 13

Group A strep

Question 14

Bacterial sinusitis group A strep

Answer 14

Tonsil pharyngeal inflammation
Tender nodes
Scarlatiniform rash
Fever, HA
Age 5 - 15 yrs

Question 15

Symptomatic Adult Diagnosis

Answer 15

RADT Throat -> Negative (Do not treat)
-> Positive (Treat)

Question 16

Symptomatic Kid Diagnosis

Answer 16

RADT Throat > Positive (Treat)
> Negative > Throat culture
>Negative (Do not)
> Positive (Treat)

Question 17

Kid Treatment ABx

Answer 17

Penicillin or Amoxicillin

Question 18

Kid Duration of ABx

Answer 18

10 days

Question 19

If kid had penicillin allergy?

Answer 19

Cephalexin (10 days)
Clindamycin (10 days)
Azithromycin (5 days)

Question 20

Otitis Media bacterial etiology

Answer 20

S. pneumoniae
H. influenzae

Question 21

Otitis Media Background

Answer 21

age 6 mos - 24 mos
acute, w/ effusion, chronic recurrent

Question 22

Otitis media signs and symptoms

Answer 22

Fluid in the middle ear
Inflammation of the mid-ear mucosa
Ear pain, drainage, hearing loss

Question 23

Vaccine in otitis media

Answer 23

PCV7 and Influenza

Question 24

True or False. Only use ABx in acute otitis media.

Answer 24

True

Question 25

Pain management in Otitis Media

Answer 25

PO APAP & Ibuprofen
OTIC Ibuprofen (5-12 years)

Question 26

When should you absolutely give ABx for Otitis Media?

Answer 26

6 mos - 12 mos + mod/severe pain OR temp 102.2
6 mos - 12 mos + nonsevere bilateral acute OM

Question 27

When should you consider giving ABx for Otitis Media?

Answer 27

6 mos - 23 mos + nonsevere unilateral
2 - 12 yrs + acute nonsevere acute OM

Question 28

Many URTI treated empirically with…

Answer 28

Amoxicillin or Augmentin (acute OM)
Augumentin (sinusitis)
Amoxicillin or Penicillin (pharyngitis)

Question 29

COPD ABx treatment

Answer 29

Augumentin
Azithromycin
Doxycycline