Upper respiratory tract symptoms and conditions Flashcards
what is an upper respiratory tract infection
-non specific term to describe spectrum of acute infections that may involve sinuses, pharynx, larynx and nasal cavity
lower respiratroy tract infections are NOT usually used to describe conditions that affect:
trachea
primary bronchi
lungs
what age group most commonly aquires a URI
*very common in ALL age groups
what can cuase a URI
virus, bacteria and fungi
*viral and bactieral infections can be hard to differentiate -> can have a secondary bacterial in fection on top of the viral
how is viral URIs treated
mainly just symptomatic managemnt
- high risk influenza patients can be treated with antivirals
what causes influenza
virus
aka flu
- exists in type A, B and C, C is the most mild
what causes sinusitis
viruses and bacteria
- Bacterial
- 20-40% of cases
- streptococcus pneumoniae (20-35%)
- Haemophilus influenzae
- moraxella catarrhalis (2-10%)
- Viral
- 80% in context of viral rhinitis
- fungal
- rare
what causes pharyngitis and tonsilitis
often viral but may be bacterial
*more common to see bacterila in childre, but still only 30%
- bacterial
- 5-10% in adults
- 15-30% in children
- typically bc of group A beta hemolytic streptococci
- Viral
- 40% of cases
- adenovrius 20%
- epstein-Barr (mono) 10%
- 40% of cases
- Fungal
- rate
what causes allergic rhinitis
no infectious etiology
caused by allergies
what are th risk factors for aquiring a URI
smoking
close contact with children
medical condition: patients with asthma, allergic rhinitis more liekly to develop URI
immunocompromized (CF, HIV, use of corticosteroids, transplatation, post-splenectromy)
anatomical anormalies (nasal polip)
what are exclusions for self treatment that indicate a possible bacterial infection
- presence of fever for > 72 H
- severe, sudden troat pain (could be pharyngitis)
- prolonged nasal congestion (if doesnt go away after weeks)
- earache (esp in children)
*note these are non urgent
what are the exclusions for self treatment of URI because further evaluation is required?
- chronic cough (above 3 weeks)
- cardiopulmonary diseases
- difficulty breathing/dyspnea, stridor, wheezing, chest pain
- severe headache, neck pain/stiffness, photophobia
- significant dec in food & fluid, dehydration
- dysphagia +/- odynophagia
- frail or immunocompromised patients
- suspected drug-associated cough
- cough assocaitd with vomiting
- concurrent skin rash
exclusions for self treatment for URI in kids
- infants < 6 months with any fever
- infants > 6 months with fever > 72 hours
- symptoms consistent with croup or otitis media
- excesive lethargy or irritability
- concurrent skin rash
- cough ass with vomiting
dehydration signs
describe the pathophysiology of viral uri
- virus infects the epithelial cells of nasal passages -> sore throat and sneezes
- infection of epithelial cells of nasal asages causes
- inflamation of chemical mediators
- blood vessel dialtion -> obstruction of nasal passages
- inc in blood vessel permeability -> edema
- exudation of serum causing rhinorrhea
- airway receptor irritation
- chilinergic stimulation -> broncho constriction -> cough
- inc mucus secretion-> rhinoria
- chilinergic stimulation -> broncho constriction -> cough
- inflamation of chemical mediators
what barriers does the body have to prevent the organism from attaching to the mucosa
- hair lining and mucus that traps pathogens
angle between the pharynx and nose that prevents particles from falling into airways
ciliated cells in the lower airways the transport the pathogens back to the pharynx
*adenoids and tonsils also contrain immunological cells that attack the pathogens
what is the general pathogenesis of URIs
- onset of symptoms usually begins 1-3 days agter exposure, lasts 7-10 days and can persit up to 3 weeks
* mostly inflammation the first week, second week more muscousy
what to consider in the differential diagnoses of URI
- allergic rhinitis
- asthma (cough, dyspnea, wheezing)
- viral rhinitis
COVID19
influenza
pharyngitis
sinusitis
croup (barking cough, fever, rhinitis, dyspnea)
otitis media 9ear pain, fever, fussiness, fever)
- pertussis (rhinorrhea, sneezing, violent & rapid coughing)
compare the nasal discharge and congestion of
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- clear @ 1st then mucopurulent
- nasal congestion is common
- allergic rhinitis
- abundent aqueous clear
- nasal congestion possible
- influenza
- clear @ 1st -> mucopurulent
- nasal congestion rare
- sinusitis
- peristent purulent rhinorrhea (yellow/green)
- pharyngitis
- rare
compare fever in URI of
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- rare, milkd -> usually only in children
- allergic rhinitis
- N/A
- influenza
- yes, sudden
- sinusitis
- no
- pharyngitis
- Yes
compare sore throat in
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- common
- mild (dry and sctratchy)
- present at beginning, if this develops at day 7 then its something else
- allergic rhinitis
- no
- influenza
- sometimes
- sinusitis
- No
- pharyngitis
- Sudden severe onset
describe cough in
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- mild-mod
- 1st dry -> productive
- allergic rhinitis
- possible via post-nasal drip
- influenza
- common; unproductive
- sinusitis
- possible via post nasal drip
- pharyngitis
- rare
describe headache in
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- Rare
- can happen via sinus congestion
- allergic rhinitis
- via sinus congestion
- influenza
- yes (happens bc of porstaglandin)
- sinusitis
- via sinus congestion
- pharyngitis
- possible
describe general aches and pains in
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- rare, milkd
- allergic rhinitis
- earaches, esp in children
- influenza
- common (myalgia)
- sinusitis
- Rare
- pharyngitis
- Possible
describe other unqiue characteristics of
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- sneezing in 1st couple of days
- allergic rhinitis
- Puritis (palate, nose, eyes, sneezing)
- if itchy prob allergies
- lactrimation
- Puritis (palate, nose, eyes, sneezing)
- influenza
- fatigue, weakness, chilld N/V
- sinusitis
- facial tenderness
- jaw and tooth pain
- pharyngitis
- swollen lymph nodes in neck (big day to differentiate from cold)
what is the duration of
viral rhinitis
allergic rhinitis
influenza
sinusitis
pharyngitis
- viral rhinitis
- 5-7 days
- 25% of cases last 14 days (can go longer with poor self care)
- allergic rhinitis
- as long as exposed to allergen
- influenza
- 10 days (a bit longer then cold)
- sinusitis
- days - weeks
- pharyngitis
- 3 days
in Viral rhinitis: describe presence of
nasal discharge
fever
sore throat
cough
Headache
General aches and pains
other factors
and duration
- nasal discharge
- clear at first then mucopurulent
- nasal comgestion is common
- fever
- rare, mild ( only really in children)
- sore throat
- common, mild (dry and scratchy)
- cough
- mild- moderate
- dry at first then productive
- Headache
- rare but can happen via sinus ifnetion
- General aches and pains
- rare and mild
- other factors
- sneezing in 1st few days
- duration
- 5-7 days, 25% of causes last 14 but can go longer if poor self care
allergic rhinitis for:
nasal discharge
fever
sore throat
cough
Headache
General aches and pains
other factors
and duration
- nasal discharge
- lots, aqeous and clear
- nasal congestion possible
- fever
- no
- sore throat
- no
- cough
- possible via post nasal drop
- Headache
- can happen via sinus infection
- General aches and pains
- earaches can occur in children*
- other factors
- puritis* ithiness
- lactimation
- duration
- as long as exposed to allergen
influenza for:
nasal discharge
fever
sore throat
cough
Headache
General aches and pains
other factors
and duration
- nasal discharge
- clear at first then mucopurulent
- nasla congestion is rare
- fever
- yes sudden onset
- sore throat
- sometimes
- cough
- common and unproductive
- Headache
- Yes
- General aches and pains
- common myalgia (this and HA is bc of prostaglandin)
- other factors
- fatigue, weakness, N/V
- and duration
- 10 days (bit logner than a cold)
Sinusitis for
nasal discharge
fever
sore throat
cough
Headache
General aches and pains
other factors
and duration
- nasal discharge
- *persistent purulent rhinorrhea (yellow/green)
- fever
- no
- sore throat
- no
- cough
- possible via post nasal drip
- Headache
- via sinus congestion
- General aches and pains
- rare
- other factors
- **facial tenderness
- **jaw and tooth pain
- and duration
- days to weeks
pharyngitis for
nasal discharge
fever
sore throat
cough
Headache
General aches and pains
other factors
and duration
- nasal discharge
- rare
- fever
- yes
- sore throat
- sudden, severe onset
- cough
- rare
- Headache
- possible
- General aches and pains
- possible
- other factors
- swollen lymph nodes in neck (main way to tell this from cold)
- and duration
- 3 days
