Upper Respiratory Tract Infection Flashcards
What are UTIs?
Rhinitis Pharyngitis/tonsillitis Laryngitis/tracheobronchitis *Otitis media Sinusitis
What are causes of the common cold?
rhinovirus >50% of identified organisms respiratory syncytial virus parainfluenza virus corona viruses Adenovirus Metapneumovirus
What are complications of the common cold?
sinusitis - adults 0.5%
otitis media - children 5%
What is the duration of the common cold?
median symptom duration 7 to 13 days, 20 days if age >40
duration and severity of rhinovirus infection increases with age
What is phenylephrine used for?
reducing in congestion and sneezing
Whats the contraindication of phenylephrine?
use with caution in hypertensives; are contraindicated in patients on MAO inhibitors within 14 days
What are some topical decongestants and what are their role?
Oxymetazoline, Phenylephrine–> provides temp. congestion relief
What can be decreased by the use of nasal ipatropium?
rhinorrhea
In which UTI instances is antibiotic indicated?
Group A Strep pyogenes –> pharyngitis [penicillin]
Sinusitis
Epiglottitis
Retropharyngeal or submandibular space infections
Peritonsillar abscess (less rare, less dangerous)
Why is it important to treat pharyngitis?
to prevent:
- rheumatic fever (increasingly a historical concern and more doubtful indication here)
What is a complication of RA?
300,000 develop carditis—rheumatic valvular disease is a major health problem in low income countries
Which group has a very low risk to get RA?
Rheumatic fever extra rare < 3 years of age, or first episode > +/- 25 years
What is the epidemiology of Group A Strep Pharyngitis?
age (most 5-15)
season (winter and spring)
presence of Group A Strep in family or community
What are some symptoms to rule in Group A Strep Pharyngitis?
sudden onset fever systemic symptoms (headache, nausea) tonsillopharyngeal erythema +/- exudate, tender increase tonsillar lymph nodes
What are some symptoms to rule out Group A Strep Pharyngitis?
conjunctivitis, coryza hoarseness cough mucosal ulceration, non-scarlet fever rash
How to diagnose Group Strep A pharyngitis?
ONLY do these is epi data of patient matches criteria:
- Culture–> identifies carriers
- GAS antigen detection rapid test –> identifies carriers
Where does sinusitis affect?
Maxillary, frontal, ethmoid, sphenoid
ciliated pseudostratified epithelium with a mucus blanket
What is the most common cause of sinusitis?
respiratory viruses
What bacteria can cause sinusitis?
- S. pneumoniae (20-35%)
- H influenzae (6-26%)
- Anaerobes, S. aureus less common
What are symptoms of sinusitis?
Maxillary toothache
Purulent secretion
Poor response to decongestants
Abnormal transillumination
T or F: Sinusitis sufficiently likely to warrant consideration of antimicrobial treatment
T
When to prescribe antibiotic for sinusitis?
- 10 days symptoms not getting better
- 3-4 days of severe symptoms
- Worsening of symptoms by the onset of a viral UTI
T or F: antibiotics is always required for sinusitis
F:
most patients recover within 2 weeks
Whats the first choice antibiotic for sinusitis?
1st choice: amoxycillin/clavulanate
5-7 days
Does a patient suffering with bronchitis but otherwise healthy lung require antibiotic?
NO