Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Applied Pathophysiology > Upper Respiratory Tract Infections (URIs) > Flashcards

Upper Respiratory Tract Infections (URIs) Flashcards

1
Q

What is the most common patient physician/emergency department infection?

A

upper respiratory tract infections (URIs)
- Pre-COVID: 25 million visits/year (US)

b/c obstruction of airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antibiotic resistance

A

bacteria that’s now resistant to the things you were treating them with

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are URIs a major driver of?

A

a major driver of bacterial ANTIBIOTIC RESISTANCE due to improper antibiotic prescriptions

b/c most start as viral, therefore a lot of antibiotics are being wrongly prescribed which drives antimicrobial resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 most common URIs?

A
  1. Acute otitis media (ear infections)
  2. Acute rhinosinusitis (sinus infections)
  3. Acute pharyngitis (back of throat infections)
  4. Acute laryngitis (voice box infections)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the upper respiratory tract consist of?

A

nasal cavity, pharynx & larynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

‘oto’ =

A

ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

‘itis’ =

A

inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

‘media’ =

A

middle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Otitis media translates to…

A

middle ear infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 types of Otitis media conditions?

A
  1. Acute otitis media (AOM)
  2. Otitis media with effusion (OME) –> aka “glue ear”
  3. Chronic otitis media (COM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

AOM is normal after what?

A

a viral infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is OME (aka “glue ear”)?

A

hearing impairment (b/c effusion is blocking it), otorrhea but NO inflammation of tympanic membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COM is

A

long term middle ear inflammation causing damage often due to multidrug resistant infections (perhaps b/c if they had AOM before it they most likely have used some antibiotic therapy - therefore higher risk of resistance)
- typically comes if acute OM isn’t treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Out of the >700 million cases of OM worldwide each year where do we see the most cases?

A

50% cases in children <5 yrs old –> results in a high risk of hearing loss (perhaps due to inability to communicate pain & higher risk of more severe infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How come we are recently seeing a downward trend in patient infections <2 yrs of age?

A

due to pneumococcal conjugate vaccine (PCV)-13 use
- costs healthcare system $7 billion in US (so less visits to hospital due to this helps tax payers pay less)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where are we seeing inflammation in OM and where are we seeing fluid build-up?

A

inflammation in the eustachian tube (WBC response)

fluid build-up in the tympanic cavity (causing pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does an AOM look like?

A

inflamed bulging tympanic membrane (catch it here!)
- might see effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Severe AOM

A

perforated tympanic membrane (could req. surgical repair b/c can’t heal itself)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

COM (chronic) vs. OME vs. Severe AOM

A

tissue damage (purple, dark brown & blue), & liquidity b/c bacteria is eating up tissues lining tympanic membrane

  • lead to permanent or long-term

vs. with effusion

vs. severe AOM - perforated tympanic membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 70% of AOM cases/yr caused by?

A

by bacterial infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Streptococcus pneumoniae

gram stain & proportion of AOM

A

positive

1/3

common cause of respiratory infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

non-typeable Haemophilus influenzae (NTHi)

gram stain & proportion of AOM

A

negative

1/3

(non-typeable - more difficult to type)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Moraxella catarrhalis

gram stain & proportion of AOM

A

negative

1/6 (less freq.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do most H. influenzae isolates & nearly all M. catarrhalis URI isolates produces…

A

B-lactamases (enzyme bact. can inherit & produce gives rise to microbial resis), more than half of all S. pneumoniae serotypes are resistant to penicillin
- chews up/degrades many penicillins - loses some effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

AOM clinical presentation

A
  • cases of AOM often follow viral URIs
  • nonverbal children with ear pain might hold, rub, or tug their ear (fussing)
  • infants might cry, be irritable, or have difficulty sleeping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

AOM Signs & Symptoms

A
  • bulging of the tympanic membrane
  • otorrhea (ear discharge/drainage)
  • otalgia (earache)
  • fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Otorrhea is determined by…

A

otoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Otalgia is considered to be…

A

moderate or severe if pain lasts at least 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Fever is considered to be severe if temp is…

A

39 degrees C (102.2 degrees F) or higher
- much more sign. with BACTERIAL infections b/c with fever you can get systematic, therefore more difficult to treat by itself
- but can also be seen with viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

AOM Treatments (antibiotics)

A

Amoxicillin (go to for common infections), 1st-line (oral), if pen. allergy = no

Amoxicillin-clavulanate (used as double wammie/in combo), 1st-line (oral) - if had amox reg. in past 30 days, if pen. allergy = no

Ceftriaxone (1-3 days), 1st-line (IV), yes, if allergy is non-severe

Cefdinir, cefuroxime, cefpodoxime, 2nd-line , yes, if allergy is non-severe

Clindamycin, 2nd-line, yes

*many of the treatments are determined based on how many treatments are coming in & how effective they are (hospitals switch based on effectiveness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

S. pneumoniae, H. influenzae, & M. catarrhalis can all possess resistance determinants to…

A

B-lactam antibiotics due to the presence of a beta-lactamase (respons. for this - degrades PG) enzymes &/or PENICILLIN BINDING PROTEIN (PBP) (binds to PG’s formation)

(this is why we may have to move to other microbials that have more side effects & long term damage b/c these present will degrade PG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tympanocentesis

A

is considered after treatment failures or for persistent AOM (if seen patient multiple times, if severe/has gone to hospital)
- puncture of the tympanic membrane with a small gauge needle to aspirate fluids
- relieves pain & pressure –> (sunction fluid) can be used to collect fluid to identify the causative agent (used to examine cultures to identify & treat properly)
- with recurrent episodes, may offer tympanostomy tubes (T tubes) rather than prophylaxis (allows continued drainage to heal swelling by inserting tube in tympanic membrane - b/c body wants to heal so sometimes puncture won’t help so this can help by keeping it open more to prevent permanent hearing loss - given to children with chronic ear infections or multiple AOM infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can be done to try prevent tympanocentesis for AOM from happening in the 1st place?

A

strong recommendation for children to receive pneumococcal conjugate vaccine-13 (PCV-13) & annual seasonal influenza vaccinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Acute rhinosinusitis (AR)

A

is inflammation of the sinuses & nasal cavity mucosa (symptom of “the cold”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the 2 types of Acute rhinosinusitis (AR)

A
  1. Acute VIRAL rhinosinusitis (AVR)
  2. Acute BACTERIAL rhinosinusitis (ABR)
36
Q

Majority of acute rhinosinusitis (AR) infections are…

A

VIRAL –> “COMMON COLD” (rhinovirus)

37
Q

Acute rhinosinusitis (AR)

Pre-COVID:

A

bacterial rhinosinusitis is freq. over-diagnosed & treated with antibiotics
- 30 million ABR cases/yr US

(many ppl thought they had a bacterial inf. when majority had a viral infection which normally doesn’t lead to severe bacterial inf. if healthy it’ll clear)

38
Q

How many work days/yr does adult rhinosinusitis cases result in?

A

at least 1-2

39
Q

What age groups are susceptible for AR?

A

AR is often seasonal

Risks increase in children, caregivers, & asthmatics

40
Q

Why are viruses more susceptible to being seasonal than bacteria is?

A

many pathogenic bacteria want to be with ppl; therefore less likely to survive the delivery
- but some are spores that can travel with weather patterns but tend to be more localized, whereas viruses are much smaller so can divide easier

41
Q

What are the 3 categories of symptoms of acute rhinosinusitis AR?

A
  1. Purulent (pus) nasal discharge
  2. Nasal obstruction/congestion
  3. Facial pain, pressure, headache, dental pain (b/c sinuses can drain & can feel it in jaw), fever, ear pain, halitosis (bad breath)
42
Q

What are the 3 clinical presentations of acute rhinosinusitis (AR)?

A
  1. PERSISTENT symptoms for more than 10 days
  2. SEVERE/worsening symptoms (fever) over 10 days
  3. “DOUBLE SICKENING” initially improves after 10 days, then worsens

*don’t treat with antimicrobial within the 10 day window (i.e. don’t want to make antimicrobial resis. worse)

43
Q

If signs & symptoms of AR is persistent, severe/worsening, “double sickening” over 10 days worsens/gets better than…

A

if YES it’ll be ABR (bacterial)

if NO it’ll be AVR (viral)

44
Q

Acute bacterial rhinosinusitis (ABR) is caused by the same bacteria implicated in…

A

AOM

  • S. pneumoniae & H.influenzae (50-70% of adult & child cases)
  • M. catarrhalis (8-16% of adults & child cases)
  • Less freq. detected: gram-negative bacilli, anaerobes, Streptococcus pyrogenes (strept throat), Staphylococcus aureus (many are fecal-oral - opportunist infections)
    (military bunkers, daycare, dorms, cruise ships –> b/c outbreak related)
45
Q

What is Acute bacterial rhinosinusitis (ABR) are often preceded by?

A

a VIRAL RESPIRATORY TRACT INFECTION that causes mucosal inflammation (ABR is a severe form b/c harder to treat b/c many are becoming more resis)
- leads to obstruction of the SINUS OSTIA which drain sinuses
- maxillary & ethmoid (LOWER) sinuses are most freq. inflammed in ABR
- swabs are not taken as they are freq. inconclusive (due to other bact. & flora there)

46
Q

Why would swabs be inconclusive for ABR?

A

many not be able to find due to other bacteria & flora - difficult to find causitative agent

47
Q

Viral infections infect ____ sinuses; bacterial infections infect _____ sinuses typically

A

ALL (b/c systemic; go everywhere)

LOWER (b/c of gravity & where they are located they stay - follow drainage)

48
Q

How do viral & bacterial infections tend to differ in where they infect?

A

viral infection infect ALL sinuses, bact. infect LOWER sinuses (b/c of gravity - where they are located they stay)

49
Q

Acute bacterial rhinosinusitis (ABR) treatments:

A

Symptomatic control + ANTIBIOTIC TREATMENTS (limit when possible)
- involves the same antibiotic treatment as AOM (b/c same pathogens)

50
Q

Acute viral rhinosinusitis (AVR) treatments:

A

Symptomatic control + PAIN management (b/c viral infections will self-resolve with good immune system)
- decongestant usage: oral or nasal spray

(could treat with antiviral but not common b/c resistance to antivirals is growing)

51
Q

When should you referral to specialist for acute bacterial rhinosinusitis (ABR)?

A
  • mental/visual status changes
  • immunosuppressive illness (ex: cancer)
  • anatomical obstructing defects (more susceptible if scar tissue)
  • recent surgery (in sinus cavities & URT regions)
  • unusually severe symptoms
  • recurrent ABR (sinuses always having problems)
52
Q

Why is ABR treatment hindered?

A

due to the lack of a simple & accurate diagnostic test (not financially feasible)
- the gold standard for ABR diagnosis is SINUS PUNCTURE with recovery of bacteria in high density = 10^4 colony-forming units/ml [10^7 cfu/L] or greater (looking for highest density of bact.)
- SINUS PUNCTURE is invasive, costly, & painful, & not routinely done (reserved for ER/severe cases or in other countries)

53
Q

Acute pharyngitis (AP)

A

pharyngitis is an acute infection of the OROpharynx or NASOpharynx

(back of throat)

54
Q

Acute pharyngitis (AP) accounts for…

A

15 million healthcare visits/yr,
- cost of $539 million/year in pediatric visits

55
Q

What are VIRAL infections the most common cause of?

A

Acute pharyngitis (AP)
- but if it becomes bacterial than GABHS is concerning

56
Q

Group A B-hemolytic Streptococcus (GABHS; aka S. pyogenes) is the…

A

primary BACTERIAL cause = “STEP THROAT”

(RBC rupturing - has toxins lysing RBCs & infecting you)

57
Q

What age groups are susceptible for Acute pharyngitis (AP)?

A

all age groups are susceptible, BUT INCREASED RISK for:
- CHILDREN 5 to 15 ys old
- Parents of school-age children
- Those who work with children

(bacteria changes throughout our lifetime; start of life is not same as end of life)

58
Q

What causes the majority of Acute pharyngitis (AP) cases?

A

VIRUSES

59
Q

Rhinovirus

A

20% of Acute pharyngitis (AP) cases (HIGHEST) - b/c so many variants, therefore v. difficult to make a vaccine

High cause of AVR

High cause of AOM

60
Q

Why would we see differences in terms of what viruses are more predominant?

A

b/c of where they’re infecting 1st (diff. receptors) (i.e. where it’s travelling, which receptors it’ll attack)

61
Q

Bacterial causes of Acute pharyngitis (AP) are…

A

less likely (BUT MORE severe (i.e. more inflammation & tissue damage (severe systemic infection) & for strept throat it can cause swelling that can close off pharynx)–> GABHS is the most common cause

62
Q

Bacterial causes of Acute pharyngitis (AP) are less likely. Which is the most common cause?

A

GABHS is the most common cause
- 10%-30% of persons of all ages with pharyngitis in their life
- *GABHS is the only commonly occurring form of AP for which antibiotic therapy is indicated

63
Q

_____ is the only commonly occurring form of AP for which antibiotic therapy is indicated

A

GABHS

64
Q

Acute pharyngitis (AP) signs & symptoms

A
  • a sore throat of sudden onset that is mostly self-limited
  • fever & constitutional symptoms resolving in about 3-5 days (viral)
  • clinical signs & symptoms are similar for GABHS, viral causes, & non-streptococcal bacterial causes (diff. to determine strept/non-strept for ex)
65
Q

Bacterial Acute pharyngitis (AP) signs & symptoms

A
  • SWOLLEN UVULA
  • WHITE SPOTS
  • red swollen tonsils
  • throat redness
  • GREY FURRY TONGUE

(lots of inflammation, stay/target 1 area b/c has good source of food there)

66
Q

Viral Acute pharyngitis (AP) signs & symptoms

A
  • red swollen tonsils
  • throat redness

*redness all over b/c viruses like to be all over

67
Q

Signs & symptoms of VIRAL Acute pharyngitis (AP)

A

• Conjunctivitis = Pink or red color in the white of the eye

• Coryza = acute inflammation of the mucous membrane of the nasal cavities

• Cough (*in GABHS often cough is absent)

(check other places b/c viruses like to be all over)

68
Q

Why is the cough often absent in GABHS?

A

b/c throat is swelling & hard to swallow

69
Q

How are viruses/bacteria usually spread?

A

Viruses/ bacteria are usually spread by people coughing or sneezing. It can also be spread when a person touches a contaminated object and then touches their mouth or nose.

70
Q

GABHS Acute Pharyngitis (AP) Laboratory Tests

A

Throat swab is taken and used for:
• Rapid antigen-detection test (RADT) → Point of care test that detects GABHS antigens (cannot detect viral AP) *ONLY BACTERIA

• Microbiological culture (gold standard of bacterial or viral AP)
- don’t do unless seeing outbreak to determine causative agent

71
Q

Viral Acute Pharyngitis (AP) treatments

A

prevent transmission to close contacts, and prevent acute rheumatic fever and suppurative complications
• Anti-pyretic (fever) medications
• analgesics, non-prescription lozenges and sprays containing menthol (calming/numbing feeling)
• topical anesthetics for temporary relief of pain (avoid lots for children, typically used for adults)

72
Q

GABHS Acute Pharyngitis (AP) treatments

A

• GABHS has increasing resistance to penicillin treatments (not using penicillin’s b/c of B-lactamase transfer & PBP –> becoming v. drug resis.)

• 10-day oral treatment with First-line antibiotics: (heavy duty penicillins)
• Penicillin V, Penicillin G benzathine* (1 dose only, intramuscular (IM) - injectables, or Amoxicillin (don’t work as much anymore - children exposed to many microbials will probs be less responsive to those antimicrobials esp. depending on source of where infection was from)

• For penicillin allergies: (some extended spectrum B-lactamases b/c diff. allergy levels)
• cephalexin, cefadroxil, clindamycin, azithromycin** (5 day only treatment), clarithromycin (protein inhibiting antimicrobials - higher freq. of resis.)
- drug antimicrobial cocktails are popular now

73
Q

Acute Infectious laryngitis (AL)

A

is caused by inflammation of the (vocal folds & cords of) larynx (hard to talk; raspy during sickness b/c of this)

74
Q

How long does Acute Infectious laryngitis (AL) last & when does it become chronic?

A
  • mild and self-limiting condition that typically lasts for 3 to 7 days
  • If this condition lasts for over 3 weeks, then it is termed as CHRONIC LARYNGITIS
75
Q

How is Acute Infectious laryngitis (AL) most commonly caused by?

A

viral organisms listed for other URIs (AVB, AVP)
- in pediatric (children are at higher risk) AL also includes “CROUP” (laryngotracheobronchitis) caused by PARAINFLUENZA VIRUS

76
Q

Which infection doesn’t have viral cause & is mostly due to bacterial infection?

A

ottis media (ear infection)

77
Q

AOM (ear infection) is commonly caused by…

A

bacterial (refer to earlier)

78
Q

Signs & symptoms of Acute Infectious laryngitis (AL)

A

voice changes (hoarseness or a “raspy” voice), aphonia, or a dry cough, pain swallowing, dryness of throat, malaise, and fever

79
Q

Acute Infectious laryngitis (AL) risk factors:

A

similar to AR/AP but also gastroesophageal reflux disease (GERD) is often a common co-morbidity (a lifestyle change) (& singers/radio hosts)
- esophagus is in close proximity to larynx; acid can spill into trachea (acid reflux can damage larynx too)

80
Q

Acute Infectious laryngitis (AL) etiology

A
  • Most commonly caused by viruses; the same viruses as AVR
  • Bacterial causes are less common; same as ABR
81
Q

Why are bacterial causes less common; but same as ABR? (i.e. why sinuses opposed to pharynx)

A

b/c of where sinuses are draining
- tend to drain further back of pharynx (greater chance of sinus infection getting to larynx than others)

82
Q

Acute Infectious laryngitis (AL) diagnosis & treatment

A

Examination using LARYNGOSCOPE (fiberoptic or mirror scope)
• VOICE REST + similar supportive care (help fever etc.) as AVR unless bacterial etiology is suspected → then similar to AOM
• Treatment of uncontrolled GERD symptoms if present
• For CROUP add corticosteroid treatment (b/c should reduce swelling quickly due to their narrow airways)

83
Q

Which common URI viruses are HIGH causes of AP cases?

A

RHINOVIRUS (20% - HIGH)

84
Q

Which common URI viruses are HIGH causes of AVR cases?

A
  • Rhinovirus
  • Adenovirus
  • Influenza virus
  • Parainfluenza virus
85
Q

Which common URI viruses are HIGH causes of AOM cases?

A
  • Rhinovirus
  • Respiratory syncytial virus (RSV)

Applied Pathophysiology (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions