Upper Respiratory Tract Infection Flashcards
Raprio model of URTI
● Reassure
● Advise
● Prescribe
● Refer
● Investigate
● Observe
● (Prevent)
Inflammation in nasal cavity → vessels become ___ there, causing fluid to exude into the nasal tissue → snot aka. ___
Inflammation in the pharynx → activates ___ → Sore throat
Inflammation in the pharynx → activates ___ sensors → Cough
Inflammation in the body → release of ___ and other active agents into blood → acts on ___ centers in ____ → Fever
Inflammation in nasal cavity → vessels become leaky there, causing fluid to exude into the nasal tissue → snot aka. Rhinorrhea
Inflammation in the pharynx → activates nociceptors → Sore throat
Inflammation in the pharynx → activates vagal sensors → Cough
Inflammation in the body → release of cytokines and other active agents into blood → acts on thermoregulation centers in hypothalamus → Fever
how does URTI incidence change with age
incidence declines with age.
compare these traits betwen bacterial and viral URTI
Usually, the RAPRIO model is fine for things you think of as colds. What comorbidities would cause you to have more suspicions?
T/F vitamine C, vitamin D and echinacea have all been extensively shown to prevent the common cold/rhinovirus
false. they all have crummy data; all studies funded by businesses that make those products.
prevention of common cold:
handwashing
for child studies: zinc sulfate
maybe probiotics.
unclear benefit; gargling, ginseng, exercise, garlic.
treatment of common cold
NSAIDS over acetominophen
- intranasal ipratropium– helps for runny nose but not congestion
- decongestants + antihistamine. Watch for these as it can cause dependence.
t/f: antihistamine monotherapy can help treat the common cold
false. no benegit. must pair with a decongestant combo
T/F cough syrup can help reduce the cold recovery time
false.
oral decongestants
phenylephrine and pseodoephedrine
nasal decongestants
xylometazoline, phenylephrine
aromatics
menthol, eucalyptus
non pharmacologic treatments for urti for children
single night time dose of honey for children.
- zinc for adults (s/e bad taste and nausea. not for hcildren)
- no benefit from vitamin C
what demographic should you be concerned for nasopharyngeal cancer if someone shows up with a nasal blockage
SE asian, male, with ear pain, blockage.
• Sore throat – esp if older, smoker,
consider ___ cancer
• Sore throat – esp if older, smoker,
consider laryngeal cancer
Chronic symptoms – double take
• Cough – think allergy, ___•
Cough – think allergy, GERD
Influenza
• Fever, malaise
- Flu: beware kids (___) or > ___ or ___, ___
- Anti-virals: costly, side-effects and generally not recommended (some sub-groups e.g. pregnancy, more data required)
Influenza
• Fever, malaise
- Flu: beware kids (< 2yo) or > 65 or pregnant, immunosuppressed
- Anti-virals: costly, side-effects and generally not recommended (some sub-groups e.g. pregnancy, more data required)
really broad ddx for rhinitis/rhinosinusitis
● Acute viral rhinosinusitis
● Acute bacterial rhinosinusitis
○ Complicated vs Uncomplicated
● Chronic rhinosinusitis
● Allergies
Duration of symptoms for acute viral vs bacterial rhinosinusitis
biral = 7-10 days. should resolve quickly. if hasn’t, consider bascterial causes.
4 key features that might indicate a bacterial rhinosinusitis
- temp of >39
- sinus tenderness (esp unilateral)-
- purulent discharge
- lasts more than 10 days
general antibiotics for bacterial rhinosinusitis and what is the next imaging to do if theres complications?
amoxicillin 5-7 days, CT if there are complicatison. NOT AN XRAY
2 main causes of viral pharungitis
EBV, mono. viral pharyngitis accounts for 90% of the cases
causes of bacterial pharyngitis
BP is less common thatn VP/
strep, rheymatic fever, less common stuff like chalmydia, gonorrhea, diptheria.
