Upper Respiratory Tract Infection

Question 1

What are UTIs?

Answer 1

Rhinitis
Pharyngitis/tonsillitis
Laryngitis/tracheobronchitis
*Otitis media
Sinusitis

Question 2

What are causes of the common cold?

Answer 2

rhinovirus >50% of identified organisms
respiratory syncytial virus
parainfluenza virus
corona viruses
Adenovirus
Metapneumovirus

Question 3

What are complications of the common cold?

Answer 3

sinusitis - adults 0.5%

otitis media - children 5%

Question 4

What is the duration of the common cold?

Answer 4

median symptom duration 7 to 13 days, 20 days if age >40

duration and severity of rhinovirus infection increases with age

Question 5

What is phenylephrine used for?

Answer 5

reducing in congestion and sneezing

Question 6

Whats the contraindication of phenylephrine?

Answer 6

use with caution in hypertensives; are contraindicated in patients on MAO inhibitors within 14 days

Question 7

What are some topical decongestants and what are their role?

Answer 7

Oxymetazoline, Phenylephrine–> provides temp. congestion relief

Question 8

What can be decreased by the use of nasal ipatropium?

Answer 8

rhinorrhea

Question 9

In which UTI instances is antibiotic indicated?

Answer 9

Group A Strep pyogenes –> pharyngitis [penicillin]
Sinusitis
Epiglottitis
Retropharyngeal or submandibular space infections
Peritonsillar abscess (less rare, less dangerous)

Question 10

Why is it important to treat pharyngitis?

Answer 10

to prevent:

- rheumatic fever (increasingly a historical concern and more doubtful indication here)

Question 11

What is a complication of RA?

Answer 11

300,000 develop carditis—rheumatic valvular disease is a major health problem in low income countries

Question 12

Which group has a very low risk to get RA?

Answer 12

Rheumatic fever extra rare < 3 years of age, or first episode > +/- 25 years

Question 13

What is the epidemiology of Group A Strep Pharyngitis?

Answer 13

age (most 5-15)
season (winter and spring)
presence of Group A Strep in family or community

Question 14

What are some symptoms to rule in Group A Strep Pharyngitis?

Answer 14

sudden onset
fever
systemic symptoms (headache, nausea)  
tonsillopharyngeal erythema +/-  exudate, 
tender increase  tonsillar lymph nodes

Question 15

What are some symptoms to rule out Group A Strep Pharyngitis?

Answer 15

conjunctivitis,
coryza
hoarseness 
cough 
mucosal ulceration, 
non-scarlet fever rash

Question 16

How to diagnose Group Strep A pharyngitis?

Answer 16

ONLY do these is epi data of patient matches criteria:

• Culture–> identifies carriers
• GAS antigen detection rapid test –> identifies carriers

Question 17

Where does sinusitis affect?

Answer 17

Maxillary, frontal, ethmoid, sphenoid

ciliated pseudostratified epithelium with a mucus blanket

Question 18

What is the most common cause of sinusitis?

Answer 18

respiratory viruses

Question 19

What bacteria can cause sinusitis?

Answer 19

• S. pneumoniae (20-35%)
• H influenzae (6-26%)
• Anaerobes, S. aureus less common

Question 20

What are symptoms of sinusitis?

Answer 20

Maxillary toothache
Purulent secretion
Poor response to decongestants
Abnormal transillumination

Question 21

T or F: Sinusitis sufficiently likely to warrant consideration of antimicrobial treatment

Answer 21

T

Question 22

When to prescribe antibiotic for sinusitis?

Answer 22

1. 10 days symptoms not getting better
2. 3-4 days of severe symptoms
3. Worsening of symptoms by the onset of a viral UTI

Question 23

T or F: antibiotics is always required for sinusitis

Answer 23

F:

most patients recover within 2 weeks

Question 24

Whats the first choice antibiotic for sinusitis?

Answer 24

1st choice: amoxycillin/clavulanate

5-7 days

Question 25

Does a patient suffering with bronchitis but otherwise healthy lung require antibiotic?

Answer 25

NO