Upper RTI Flashcards
Acute Otitis Media
- who gets it
- risk factors
- common in infancy (6-18 mo). More boys than girls
- age, family Hx, day care, lack of breastfeeding, tobacco smoke/air pollution, pacifier use
Acute Otitis media
-etiology
- 2/3 combined viral/bacterial
- Bacterial: S. pnuemoniae, H. influenzae, M. cattarhalis
- Viral: RSV, rhinovirus, picoronaviruses, coronaviruses, influenza virus, adenovirus, human metapneumovirus
Acute otitis media
-pathophysiology
- antecedent viral URTI closes the eustachian tube with inflammation
- middle ear secretions build up
- bacteria gain access to middle ear and grow in secretions
Acute otitis media
-S/S in infants and children
- Infants: nonspecific, maybe fever
- children: otalgia, bulging tympanic membrane, otorrhea
Acute otitis media
-management
- many resolve spontaneously (organism-dependant)
- Usually watchful waiting
- Treat if <6 months, perforated ear drum, day care, previous Ab in last 3 months, unlikely to return
- Amoxicillin (want to cover S. pneumoniae)
Acute otitis media
-how long do children have effusions
50% of children have them at 1 month (do not treat) only 10% have them at 3 months
Acute sinusitis
- epidemiology
- Risk factors
- adults and children, but women more frequent than men
- dental infection, allergies, swimming, obstruction of nose
Acute sinusitis
-etiology
- Viral 200x more common (rhinovirus, influenza virus, parainfluenza virus
- Bacterial: S. pneumoniae, H. influenzae, M. cattarhalis, anaerobes associated with dental disease
Acute sinusitis
-pathophysiology
- common cold spreads to paranasal sinuses (systemic or direct)
- secondary spread of bacteria into nasal cavities
Acute sinusitis
-S/S
- purulent rhinorhea
- nasal congestion
- Cannot differentiate viral vs. bacterial, but bacterial more likely if:
-URTI persist for >10 days, or worsen after 5-7 days AND (above symptoms +pain OR fever and pain)
Acute sinusitis
-Management
- No Ab (even for bacterial sinusitis), no topical steroid
- Analgesics
- Saline irrigation
- Steam inhalation
- Decongestants
-If must use Ab, use Amoxil
Croup
-epidemiology (demographics, season, time of day)
- 6-36 months, rare beyond 6 y.o
- more common in boys
- more common in the fall/winter
- more common in late evening/early morning
Croup
-Etiology
- Parainfluenza virus type 1 (50%)
- RSV
- Adenovirus
- Coronavirus
- Influenza
Croup
-Pathophysiology
- Virus invades respiratory epithelium
- Inflammation of trachea and larynx
- Narrowing trachea –> barking cough
Croup
-S/S
-inspiratory stridor, barking cough, sudden onset and rapid progression
Croup
-management
- no Ab
- systemic or nebulized steroids
- no sedation– have to be awake to breath
Pertussis
-epidemiology (transmission, frequency of outbreaks)
- cyclic epidemics q2-5 yrs
- highly contagious
- respiratory droplet or direct contact
- adults are a reservoir for transmission
Pertussis
-etiology
Bordetella pertussis
Pertussis
-pathophysiology
-various toxins and interference of host-defence (e.g. lives in macrophages)
Pertussis
- S/S
- typical course
-paroxysmal cough, inspiratpry whoop, post-tussive emesis
1) cattarhal phase (runny nose, fever) (1-2 wks, v. contagious)
2) paroxysmal phase (3-6 wks)
3) convalescent phase ( >6 wks)
Pertussis
-diagnosis
- nasopharyngeal swab–> culture and PCR
- clinical signs
Pertussis
-management
- macrolides or TMP-SMX
- give longer if infant, pregnant woman, health care worker, childcare worker
Common cold
-epidemiology (who gets it, what season, transmission, infectivity)
- mostly children
- year round (mostly winter)
- hands +++, droplets +
- incubation: 24/72h
- Infectivity: peaks with symptoms, shedding continues ~3wks
Common cold
-etiology
ALL VIRAL rhinovirus influenzavirus adenovirus enterovirus coronavirus RSV Parainfluenza virus human metapnuemovirus
