Upper Respiratory Tract Infection

Question 1

Raprio model of URTI

Answer 1

● Reassure
● Advise
● Prescribe
● Refer
● Investigate
● Observe
● (Prevent)

Question 2

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

Answer 2

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

Question 3

how does URTI incidence change with age

Answer 3

incidence declines with age.

Question 4

compare these traits betwen bacterial and viral URTI

Answer 4

Question 5

Usually, the RAPRIO model is fine for things you think of as colds. What comorbidities would cause you to have more suspicions?

Answer 5

Question 6

T/F vitamine C, vitamin D and echinacea have all been extensively shown to prevent the common cold/rhinovirus

Answer 6

false. they all have crummy data; all studies funded by businesses that make those products.

Question 7

prevention of common cold:

Answer 7

handwashing

for child studies: zinc sulfate

maybe probiotics.

unclear benefit; gargling, ginseng, exercise, garlic.

Question 8

treatment of common cold

Answer 8

NSAIDS over acetominophen

• intranasal ipratropium– helps for runny nose but not congestion
• decongestants + antihistamine. Watch for these as it can cause dependence.

Question 9

t/f: antihistamine monotherapy can help treat the common cold

Answer 9

false. no benegit. must pair with a decongestant combo

Question 10

T/F cough syrup can help reduce the cold recovery time

Answer 10

false.

Question 11

oral decongestants

Answer 11

phenylephrine and pseodoephedrine

Question 12

nasal decongestants

Answer 12

xylometazoline, phenylephrine

Question 13

aromatics

Answer 13

menthol, eucalyptus

Question 14

non pharmacologic treatments for urti for children

Answer 14

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

Question 15

what demographic should you be concerned for nasopharyngeal cancer if someone shows up with a nasal blockage

Answer 15

SE asian, male, with ear pain, blockage.

Question 16

• Sore throat – esp if older, smoker,
consider ___ cancer

Answer 16

• Sore throat – esp if older, smoker,
consider laryngeal cancer

Question 17

Chronic symptoms – double take

• Cough – think allergy, ___•

Answer 17

Cough – think allergy, GERD

Question 18

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)

Answer 18

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)

Question 19

really broad ddx for rhinitis/rhinosinusitis

Answer 19

● Acute viral rhinosinusitis
● Acute bacterial rhinosinusitis
○ Complicated vs Uncomplicated

● Chronic rhinosinusitis
● Allergies

Question 20

Duration of symptoms for acute viral vs bacterial rhinosinusitis

Answer 20

biral = 7-10 days. should resolve quickly. if hasn’t, consider bascterial causes.

Question 21

4 key features that might indicate a bacterial rhinosinusitis

Answer 21

1. temp of >39
2. sinus tenderness (esp unilateral)-
3. purulent discharge
4. lasts more than 10 days

Question 22

general antibiotics for bacterial rhinosinusitis and what is the next imaging to do if theres complications?

Answer 22

amoxicillin 5-7 days, CT if there are complicatison. NOT AN XRAY

Question 23

2 main causes of viral pharungitis

Answer 23

EBV, mono. viral pharyngitis accounts for 90% of the cases

Question 24

causes of bacterial pharyngitis

Answer 24

BP is less common thatn VP/

strep, rheymatic fever, less common stuff like chalmydia, gonorrhea, diptheria.

Question 25

red flags for someone who you think has pharyngitis

Answer 25

secretions, drooling, dysphoria, muffled “hot potatoe” voice, or neck swelling–> all could indicate epiglotittis, peritonislar abscess, submandibular space infections, retropharyngeal space infections.

Question 26

outline the modified centor criteria for determining strep throat

Answer 26

Question 27

T/f strep throat causes cough

Answer 27

false. absence of cough actually scores points on the modified centor criteria

Question 28

Answer 28

Question 29

ddx and treatment?

Answer 29

dx: otitis media.

in 80-85% of children with acute otitis media, the fever and pain resolve within 2-3 days.

• treat with analgesia.
• if it doesn’t resolve within 3 days, provide antimicrobial OR if theres a high fever over 39, systemically unwell or if tehe is a perforation or discharge.
• amoxicillin by 10 days <2 yo, older children x 5 days.
• if a child has otitis media and you suspect you may lose them to folow up, consider already giving them a prescription/lowering the threshold for antibiotic use.

Question 30

T/f administration of antibiotics after 3 days after AOM can help prevent complications of AOM, such as mastoiditis or meningitis

Answer 30

false. these are complications seen in develoepd countries. adminsitration of antibiotics does not prevent these compications.