Upper Respiratory Tract Infections

Question 1

Otitis Media

Answer 1

Fluid in middle years

S/S - ear pain, ear drainage, fever, hearing loss, redness of tympanic membrane

Question 2

Reasons for childhood Predilection

Answer 2

Lack of immunity - loss of maternal antibodies after 6 months

Eustachian Tube is narrow

Question 3

MO responsible for Otitis Media

Answer 3

Streptococcus Pneumonae

Hemophilus Influenzae

Moraxella Catarrhalis

Also Viral - RSV, influenza, adenovirus, and rhinovirs

Some mixed

Question 4

Sinusitis

Answer 4

Inflammation of paranasal sinus.

Viral or bacteria. Sometime allergies.

S/S - sneezing, nasal discharge, rhinorrhea, nasal obstruction, facial puffiness and erythema, headache and fever

X-ray /CT Scan - FLUID in sinus

Question 5

Sinusitis - Pathogenesis

Answer 5

Nose blowing increases pressure - pushing fluid in the sinus

Failure of coilia to move material to ostium

Occlusion of Infundibulum

Organism - Virus *RICRAMP

Bacteria - same as those that cause media

Question 6

Sinusitis - Diagnosis and Treatment

Answer 6

By S/S

Cultures of nasal or throat swabs - useless

Needle aspiration in IC patient

Don’t use antibiotics

Question 7

Pharyngitis - S/S

Answer 7

Sore throat

Odynophagia

Tonsillar enlargment - red with white exudate

Anterior cervial lymphadenopathy

Fever chills headache

Question 8

MO causing pharygitis

Answer 8

Group A strep pyogenes (GAS)

Gonococcla Infection

Respiratory viruses

Infectious mononucleosis

Question 9

GAS

Answer 9

Gram + cocci

B- hemolytic, facultative anaerobe

Virulence factors -

M protein is antiphagocytic . Immune response can cause ARF and acute glomerulonephritis.

Capsule

Streptolysins O and S

Streptokinase - lyses clot

Hyaluronidase - Spreading factor

Lipoteichoic acid - adhesin

Question 10

Virulence Factors of GAS - M protein

Answer 10

Fuzzy on the surface. Becomes dense when it comes in contact with fibrinogen in plasma

2 alpha helical fibrils form coil - N terminus binds fibrinogen to protect it against opsonization. Proximal portion binds complement control protein factor H

Question 11

Strep Pharyngitis

Answer 11

In 2-15 yo

Military recurits

Spread by droplets

Asymptomatic stage - carriers

Self limiting

Antibodies develop and protect against same M protein

Question 12

Strep Pharyngitis

S/S

Answer 12

Sore throat, odynophagia, erythema of pharynx, enlarged erthematous tonsits, white exudates on tonsils, cervical lymphadenopathy, fever

Looks like viral URIs

Rapid Antigen diagnostic test - if negative, then do culture

Tonsillar abscess, otitis media

Can cause ARF and AG

Question 13

Diptheria

Answer 13

Gram postitive rod

non spore forming, non motile, unencapsulated, club shaped

Question 14

Diptheria - Pathogenesis

Answer 14

Incubation period is 2-4 days

Organism produces endotoxin - enters epithelial cells and kills by stopping protein synthesis by inhibiting transfer RNA translocase

Can cause myocarditis, or motor or sensory neuropathies

Question 15

Diptheria S/S

Answer 15

Sore thorat, tonsilitis, cervical lymphadenopathy

Low grade fever, malaise

Formation of membrane on tonsils and pharynx

BULL NECK

pseudomembrane!!

Death by asphyxia