Upper Respiratory Tract Infections Flashcards
What are symptoms of the common cold?
- Sore throat
- Nasal congestion
- Rhinorrhea
- Sneezing
- Cough
What viruses can cause the common cold?
- Rhinovirus (50%)
- Corona virus
- Influenza virus
- Respiratory syncitial virus
- Parainfluenza virus
How is the common cold transmitted?
- Direct contact
- Aerosolized droplets
- Virus enters nose
- Mucociliary clearance to nasopharynx
- How does the virus causing common cold enter epithelial cells?
- What changes does it cause once it enters the cells?
- How does the virus causing common cold enter epithelial cells?
- Via intercellular adhesion molecule-1
- What changes does it cause once it enters the cells?
- Vasodilation, increased mucous secretion, extensive respiratory epithelium damage
What is the first line therapy for Otitis Media?
Amoxicillin
What risk factors are associated with Otitis Media?
- Daycare
- Smoke exposure
- Lack of breast-feeding
- Ethnicity
- Family history
- Older siblings
- Low SES
- Downs syndrome/Cleft palate
- Native American heritage
What are some causes of acute and chronic otitis media?
Which virus is more likely to cause acute? chronic?
- Streptococcus pneumoniae (40% of acute cases)
- Haemophilus influenza (25% of acute; 15% of chronic)
- Moraxella Catarhalis
What types of ear tubes are used in otitis media? What is their purpose?
- Pressure equalizing tubes
- Myringotomy tubes
- Tympanostomy tubes
Allows the middle ear to ventilate until the eustachian tube is mature (usually last 6-18 months)
What are some indications for ear tubes?
- Chronic middle ear effusion ± conductive hearing loss
- Recurrent suppurative otitis media
- Atelectasis of middle ear
What are paranasal sinuses?
Air filled cavities that are found in the bones of teh face/head
What are the 4 sets of sinuses?
- Ethmoid
- Maxillary
- Sphenoid
- Frontal
What is Rhino-sinusitis?
Inflammation/infection of the nasal passage and paranasal sinuses
What are the different types of Rhino-Sinusitis?
- Acute Rhinosinusitis
- Acute bacterial (Strep, Haemophilus, Moraxella)
- Acute viral
- Recurrent acute rhinosinusitis
- Chronic Rhinosinusitis
What is the progression of sinus disease (Cycle)?
Sinus disease → Swelling → Narrowed sinus ostia → Impedes drainage → Mucus fills sinus → Bacteria grow → Sinus infection
What causes inflammation in the sinuses?
- Viral infections
- Environmental allergens
- Environmental irritants
- Mucus
- Medications
- Bacteria
- Fungus
How does pseudomembranous candidiasis appear?
- Thrush
- Adherent white plaques
- Tongue, buccal mucosa, hard palate
- Plaques wipe off and underlying mucosa is erythematous
- Adherent white plaques
What is the second most common AIDS-defining opportunistic infection?
Pseudomembranous candidiasis
Pseudomembranous candidiasis is most common in _____ and ________
infants; immunocompromised
What is the most common form of candidiasis?
What are the subtypes?
- Erythematous candidiasis
- Acute atrophic
- Chronic atrophic
- Angular chelitis
- Median rhomboid glossitis
- Chronic multifocal
- What is Angular chelitis?
- What bacteria cause it?
- In what types of patients is it most commonly seen?
- What is Angular chelitis?
- combination of bacterial and fungal infections
- What bacteria cause it?
- C. albicans and S. aureus
- In what types of patients is it most commonly seen?
- Patients with dentures
How is Candidiasis diagnosed?
- Based on clinical signs/symptoms
- Cytology
- Mucosal biopsy
- Culture
Name the parts of the mouth
What is stomatitis?
The broad term for any infection involving the mouth or lips
What are viral causes of stomatitis?
What are fungal causes of stomatitis?
- Viral
- Measles virus
- Coxsackie virus
- Human papillomavirus
- Herpes simplex virus
- Fungal
- Candida albicans
- Aspergillosis
- Histoplasma capsulatam
- Blastomyces dermatitidis
What is Waldeyer’s ring?
An aggregate of lymphoid tissue in the upper aerodigestive tract
What are the indications for an adenotonsillectomy?
- Upper airway obstruction
- Recurrent/chronic infection
- Neoplasia (lymphoma/carcinoma)
What are the types of upper airway obstructions that would indicate an adenotonsillectomy?
- Adenoids (nasopharynx obstruction)
- Palatine tonsils (oropharynx)
- Lingual tonsils (hypopharynx)
What are the steps in assesing a sore throat?
- Assess probability of strep (Low, Moderate, High)
- If moderate or High - Rapid strep test
- If positive - treat for strep
- If patient does not improve, or worsens, re-evaluate
- If patient is 10-25 years of age test for mononucleosis
- If patient is <10 or >25 years old, order throat culture
- Treat with appropriate antibodies
How do you obtain a throat culture?
- Culture each tonsil and posterior pharyngeal wall
- Twis, rotate swab into tissue
- Avoid touching the tongue
- Immediate transfer to transport medium
What are the cervical lymph nodes and what metastasizes to them?
- Upper jugular chain - metastasis from nasopharynx
- Posterior triangle - metastasis from nasopharynx, posterior skull
- Lower jugular chain area - thyroid, upper esophagus
- Submandibular triangle - anterior two thirds of tongue
- Submental triangle - metastasis from lip cancer
- Midjugular chain - any portion of oral cavity, pharynx or larynx
Supraglottitis
- Onset:
- Symptoms:
- Stridor:
- Etiology:
- Treatment:
Onset: Rapid
Symptoms: Drooling, fevers, sitting up, SICK
Stridor: Inspiratory
Etiology: H. flu (Type B)
Treatment: Secure airway, antibx
Croup
- Onset:
- Symptoms:
- Stridor:
- Etiology:
Onset: Gradual
Symptoms: Barking cough, low fevers
Stridor: Biphasic
Etiology: Viral
What is the characteristic sign of epiglottitis?
Thumb print sign
Bacterial Tracheitis
- Symptoms:
- Etiology:
- Treatment:
Symptoms: Toxic, cough, stridor, fever
Etiology: Usually S. Aureus
Treatment: IV antibiotics, hydration, rigid bronchoscopy
