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Unit 2- Clin Med > URI > Flashcards

URI Flashcards

1
Q

most common virology of common cold

A

rhinovirus- 30-50%

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2
Q

other virologies of common cold

A

coronavirus, influenza, parainfluenza, RSV) respiratory synctial virus, adenovirus, enterovirus (coxsackie)

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3
Q

transmission of cold

A

hands, droplet (sneeze/cough), large particle droplet (close contact), fomites

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4
Q

daycare, underlying chronic condition, immunodeficiency, dec sleep/ sleep disorders, malnutrition, exposure to smoke are risk factors for

A

cold

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5
Q

RHINORRHEA, NASAL CONGESTION, sore throat, non productive cough, malaise, mild HA, LG fever, self limit in 7-10 days

A

sxs of common cold

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6
Q

imp sxs of common cold

A

rhinorrhea, nasal congestion

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7
Q

nasal mucosal swelling, nasal discharge (clear/ water/ purulent), conjunctival infxn, pharyngeal erythema (mild), no pulmonary findings/ adenopathy

A

signs of common cold

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8
Q

dx of cold based on

A

clinical, reported sxs, observed signs

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9
Q

type ___ flue subtypes more dangerous

A

A

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10
Q

cold tx

A

self limiting, rest, fluids, handwashing

NO ABX, symptomatic treatment

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11
Q

guaifenesin and guaifeniesin with dextromethorphan

A

robitussin and robtiussin DM

expectorants/ antitussives good for common cold

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12
Q

acute rhinosinusitis, AOM, acute asthma attack, PNA

A

complications of common cold

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13
Q

transmission of flu

A

aeorosolized droplets (cough/sneeze), hand 2 hand contact, incubation 1-4 days

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14
Q

imp symptoms of flue

A

abrupt onset, fever, myalgia, sore throat (can be severe)

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15
Q

chills, malaise, HA, cough (non-productive), sore throat, nasal discharge, abrupt onset, fever, myalgia,

A

sxs of flu

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16
Q

flushing, hot/ dry skin, unremarkable post pharynx, mild cervical LAD, negative chest exam

A

signs of flu

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17
Q

people who are over ___ or under ___, but especially under ___ are at high risk of flue

A

over 65, under, 5, especially under 2

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18
Q

people at high risk of flu

A

chronic illnesses, immunosuppressed, pregnant/ post -artum, healthcare workers, resident of nursing homes, native americans, BMI 40+

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19
Q

flu tests should be done within ___ of illness

A

3-4 days

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20
Q

flu screening test- nasal pharyngeal aspirate/swab, 15 minutes for results, SOME can distinguish b/w type A and B

A

RAT

Rapid Antigen Tests

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21
Q

flu screening test- nasal swab/washing, 1-4 hours for results, CAN differentiate b/w types A andB

A

immunofluorescence

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22
Q

flu screening test- NP swab, 15-30 mins for results, high sensitivity/ specificity, distinguishes b/w type A/B

A

rapid molecular assay

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23
Q

flu screening test- NP swab/sputum, 1-8 hours for results, MOST sensitive and specific for flu type/subtype

A

RT- PCR

Reverse transcriptase polymerase chain reaction

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24
Q

gold standard for lab diagnosis of flu

A

viral cultures

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25
Q

not for initial clinical management of flu but to confirm screening, takes 3-10 days

A

viral tissue cell culture

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26
Q

tonsillar exudates, tender anterior cervical adenopathy, fever by hx, absence of cough

A

steptococal pharyngitis centor criteria; patients with 3/5 should undergo testing for GAS

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27
Q

when should RT-PCR / viral flu cx be ordered if negative

A

RAT/ immunofluorsecence ab staining + high community flu rates

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28
Q

when should RT-PCR / viral flu cx be ordered if positive

A

RAT/ immunofluorescence + low community influenza rates

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29
Q

test pt for RT-PCR / viral cx be ordered if they are exposed to ____ and worry about novel flu ___

A

pigs/ poultry, flu A

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30
Q

acute flu generally improves in

A

3-7 days

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31
Q

cough and malaise with flu may persist for

A

1-2 weeks

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32
Q

when to give an antiviral with flu

A

hospitalization, progressive/ severe/ complicated illnesses, HIGH RISK OF COMPLICATIONS

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33
Q

administer antiviral for flu within ___, it shortens course by ___

A

24-30 hours, 1-2 days

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34
Q

pharm tx for influenza A/B

A

oseltamivir, zanamivir, peramivir (all are neuraminidase inhibitors)

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35
Q

dose for oseltamivir

A

75 mg po BID x 5 days

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36
Q

dose for zanamivir

A

10 mg (2 inhalations) BID x 5 days

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37
Q

dose for peramivir

A

600 mg IV x 1

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38
Q

flu drugs are ___ but you give if

A

Category C (so you dont give to pregnant), but you give if suspect flu A

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39
Q

zanamivir is contraindicated in patients with

A

asthma/ chronic respiratory conditions

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40
Q

PNA, rhinosinusitis, OM, myositis, rhabdomyolysis, CNS involvement, cardiac are complications of

A

flu

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41
Q

flu vaccines are indicated for everyone ___ months old

A

over 6

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42
Q

IM trivalent inactivated flu vaccine protects against

A

A H1N1, A H3N2, flu B

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43
Q

IM quadrivalent flu vaccine protects against

A

A H1N1, A H3N2, flu B and another flu B

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44
Q

takes ___ after vaccine for antibodies to develop

A

2 weeks

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45
Q

for ages 18-49 give ___ flu vaccine

A

standard dose inactivated (trivalent/ quadrivalent)

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46
Q

for age 65+ give ___ flu vaccine

A

high dose trivalent

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47
Q

give live attenuated vaccine to

A

not pregnant b/w 2 and 49

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48
Q

best month to give vaccine

A

october

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49
Q

contraindications of flu vaccine

A

current illness/ hx of guillain barre (w/in 6 weeks of prev flu vaccine)/ hx of allergic rxn to vaccine

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50
Q

most common viral origins of pharyngitis

A

rhinovirus, adenovirus, parainfluenza, influenza

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51
Q

pharyngitis may occur as ___ with ___

A

common cold with rhinorrhea and cough

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52
Q

viruses are ___ likely to cause pharyngeal exudate

A

less; exceptions- adenovirus/ mononucleosis

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53
Q

tx for viral pharyngitis

A

hydration, antipyretics/ anaglesics, rest, “magic mouthwash”

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54
Q

tx for HSV pharyngitis

A

acyclovir, famiclovir

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55
Q

tx for HIV pharyngitis

A

referral to infectious disease specialist for retroviral therapies

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56
Q

group A stretocococcus (GAS) bacterial pharyngitis causes

A

5-15% adults, 20-30% of kids

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57
Q

C trachomatis (bacterial pharyngitis) associated with

A

oral sex

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58
Q

N. gonorrhea (bacterial pharyngitis) associated with

A

oral sex

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59
Q

M. pneumoniae (bacterial pharyngitis) associated with

A

lower resp infxn and HA

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60
Q

H. influenza (bacterial pharyngitis) associated with

A

pediatric age group

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61
Q

C. diphtheriae (bacterial pharyngitis) is recognized by

A

diphtheria (gray exudate tightly adherent to throat, nasal passageway)

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62
Q

(creamy, white/ yellow plaques) are seen with pharyngitis

A

oral candidasis

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63
Q

sore throat, odynophagia, fever, malaise, anorexia, arthralgias, myalgias, nausea, vomitting, swollen glands

A

streptococcal pharyngitis sxs

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64
Q

pharyngeal erythema, tonsillar hypertrophy, purulent exudate, tender and/ or enlarged anterior cervical lymph nodes, palatal petechiae

A

streptococcal pharyngitis signs

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65
Q

steptococal pharyngitis centor criteria

A

tonsillar exudates, tender anterior cervical adenopathy, fever by hx, absence of cough; patients with 3/5 should undergo testing for GAS

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66
Q

gold standard for pharyngitis dx

A

throat cx

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67
Q

throat culture for pharyngitis can be ___ or ___

A

bacterial or viral

68
Q

pharyngitis dx for group A strep

A

rapid antigen detection test

69
Q

if pt meets centor criteria (w/ negative RADT) treat ____

A

empirically while waiting cx

70
Q

first line tx for GAS pharyngisits

A
  • penicillin V 500 mg PO TID x 10 days
  • amoxicillin 500 mg BID x 10 days
  • pencillin G benzathine 1.2 million units IM
  • cephalexin 500 mg PO BID x 10 days
71
Q

tx for pharyngitis if pt has a penicillin allergy

A

azithromycin, clindamycin, clarthromycin

72
Q

in addition to abx, treat pharyngitis with

A

supportive care, lozenges, NSAIDs, acetaminophen

73
Q

acute rheumatic fever, post-strep glomerulonephritis, peritonsillar abscess, OM, rhinosinusitis, bacteremia, PNA, toxic shock syndrome, SCARLET FEVER

A

complications of pharyngitis

74
Q

rash, desquamation, pastia’s lines, facial flushing w/ circumoral pallor, “strawberry tongue”, can predispose for acute rheumatic fever

A

scarlet fever

75
Q

scarlet fever can predispose for

A

acute rheumatic fever

76
Q

strep pharyngitis is no longer contagious after ___ and clinical sxs improve after ___ after initiating abx tx and may return to work/school/daycare

A

3-4 days, 24 hours

77
Q

most common deep neck infx in children and adolescents

A

peritonsillar abscess

78
Q

polymicrobial etiology, mainly S. pyrogenes (GAS), S. aureus, mixed respiratory anaerobes and H. influenzae

A

peritonsillar abscess etiology

79
Q

in ____ there is tissue infxn b/w palatine tonsil capsule and pharyngeal muscles with no pus; in ___ there is pus b/w tonsil capsule and pharyngeal muscles and it progresses to ___

A

in CELLULITIS there is tissue infxn b/w palatine tonsil capsule and pharyngeal muscles with no pus; in ABSCESS there is pus b/w tonsil capsule and pharyngeal muscles and it progresses to CELLULITIS

80
Q

unilateral severe sore throat, drooling, trismus, fever, neck swelling/pain, ipsilateral ear pain, fatigue, anxiety, irritability, decrease PO intake

A

peritonsillar abscess sxs

81
Q

trismus

A

spasm of internal pterygoid muscle

82
Q

deviated uvula pushed to the opposite side of swollen tonsil, fullness of soft palate with palpable fluctuance, cervical lymphadenopathy, bilateral peritonsillar abxcess if uvula displaced anteriorly, hot potato/ muffled voice

A

peritonsillar abscess signs

83
Q

dx for peritonsillar abscess

A
  • clinical
  • labs (CBC, electrolytes, throat cx)
  • can get a CT to r/o infxn to danger zone but must use contrast
84
Q

tx for peritonsillar abscess (non-abx)

A
  • monitor airway
  • drain (aspirate, tonsillectomy, OR)
  • supportive care (FLUIDS, pain control)
  • +/- glucocorticoids
85
Q

parenteral abx tx for peritonsillar abscess

A

ampicillin-sulbactam or clindamycin (consider vanco if high rates of MRSA)

86
Q

oral abx tx for peritonsillar abscess

A

amoxiciiln-clavulanate or clindamycin x 14 days

87
Q

etiology of epiglottitis

A

H. influenzae

88
Q

drooling, stidor, severe sore throat, no cough, toxic appearance

A

epiglottitis

89
Q

consider ___ in unvaccinated kids and older adults

A

epiglottitis

90
Q

___ is a danger of airway obstruction, rapid course

A

epiglottitis

91
Q

epiglottitis tx

A

hospitalization, intubation, antibiotics

92
Q

imaging of epiglottits

A

lateral neck x-ray: “thumb sign”, CT/MRI

93
Q

etiology of severe tonsillopharyngitis

A

EBV, HSV1/2, coxsackie virus, adenovirus, C. diphtheria, N. gonorrhea

94
Q

pharyngeal edema, exudates, tonsillar hypertrophy

A

severe tonsillopharyngitis

95
Q

dx for severe tonsillopharyngitis

A

monospot and viral/bacterial cx, CT w contrast/MRI

96
Q

tx for severe tonsillopharyngitis

A

based on etiology

97
Q

trauma (chicken bone), recent instrumentation with secondary bac infxn

A

retropharyngeal abscess/ cellulitis

98
Q

prominent neck stiffness, minimal peritonsillar findings, trismus is rare

A

retropharyngeal abscess/ cellulitis

99
Q

extremely serious, can extend to the mediastinum

A

retropharyngeal abscess/ cellulitis

100
Q

dx and tx of retropharyngeal abscess/ cellulitis

A

CT/MRI w/ contrast, airway managment, abx, image guided aspiration of abscesses

101
Q

ludwigs angina

A

submandibular space infxn

102
Q

due to odontogenic infxn

A

submandibular space infxn

103
Q

no trismus, elevated tender oropharynx, “woody” indurated submandibular area w/ possible crepitus

A

submandibular space infxn

104
Q

dx and tx of submandibular space infxn

A

CT/MRI w/ contrast, airway managment, abx, abscess drainage

105
Q

most common etiology of laryngitis

A

viruses (often associated with URI)

106
Q

bacterial etiologies of laryngitis

A

Streptococci species, moraxella catarrhalis, H. influenzae

107
Q

vocal abuse (sing/shout), intubation, toxic exposure (smoke, radiation), GERD, vocal cord nodules, laryngeal polys, carcinoma of vocal cords, neurologic dysfxn

A

non infectious causes of laryngitis

108
Q

key symptom of laryngitis

A

hoarseness

109
Q

dysphonia, URI sxs (rhinorrhea, congestion, sore throat, cough), hoarsensess

A

sxs of laryngitis

110
Q

nasal edema, congestion, benign posterior pharynx, laryngeal erythema/ edema, vascular engorgement of vocal cords, nodules, ulcerations

A

signs of laryngitis

111
Q

dx of laryngitis

A
  • based on hx and PE,
  • hoarseness > 2 weeks in abscense of URI then refer to ENT for laryngoscopy
  • hoarseness with URI can last 2-3 weeks
112
Q

tx for laryngitis

A

treat underlying cause, voice rest, humidification, hydration, d/c smoking, refer to ENT prn

113
Q

__ out of __ Americans get rhinosinusitis annually

A

1 out of 7

114
Q

highest incidence of rhinosinusitis

A

45-64 y/o

115
Q

ARS

A

acute rhinosinusitis

116
Q

purulent nasal drainage AND nasal obstruction and or facial pain, pressure, or fullness

A

acute rhinosinusitis

117
Q

acute rhinosinusitis sxs last

A

<4 weeks

118
Q

subactute rhinosinusitis sxs last

A

4-12 weeks

119
Q

chronic rhinosinusitis sxs last

A

> 12 weeks

120
Q

recurrent actue rhinosinusitis is ___ episodes of ARS/ year

A

4 +

121
Q

most common etiology for ARS is

A

viral (AVRS)- rhinovirus, influenza, parainfluenza

122
Q

ABRS (acute bacterial rhinosinusitis) etiology

A

(only 0.5-2% of ARS)

  • strep pneumoniae
  • H. influenzae
  • moraxella catarrhalis
123
Q

beyond infectious causes, ARS can also be associated w/

A

allergies, tumors, polyps, deviated nasal septum, foreign bodies

124
Q

LG fever, congestion/ discharge, facial pain/pressure, fatigue, cough, maxillary tooth discomfort, ear pressure/ fullness, HA

A

sxs of ARS

** degree varies b/w AVRS and ABRS

125
Q

purulent drainage in nose/ post pharynx, nasal mucosal edema, edema over involved cheekbone/ periorbital area, tenderness to percussion of upper teeth, sinus tenderness to palpation, opaque transillumination of frontal or maxillary sinuses

A

signs of ARS

126
Q

radiography is ___ for AVRS diagnosis

A

not indicated

127
Q

cultures are ___ for AVRS

A

not indicated

128
Q

diagnosis of AVRS

A

clinical, < 10 days of sxs that are not worsening, plain sinus films (limited use)

129
Q

tx for AVRS

A

supportive (analgesics, irrigation, mucolytics, intranasal decongestants, glucocorticoids)

130
Q

classic presentation of ABRS is

A

prior hx of URI and AVRS

131
Q

viral infxn leading to mucosal edema and sinus inflammatoin, decreased drainage of thick secretions leading to obstructed sinus ostia

A

leads to entrapment of bacteria and secondary ABRS following AVRS

132
Q

ABRS diagnosis according to infectious disease society of american (IDSA)

A

persistent sxs/ signs > 10 days w/ no improvement OR onset of severe sxs OR viral URI that lasted 5-6 days, was improving then “double worsened”

133
Q

fever > 102, purulent nasal drainage, facial pain lasting at least 3-4 consecutive days at the beginning of illness

A

severe sxs associated with ABRS and indicated by IDSA

134
Q

pts at higher risk for abx resistance

A 
65 y/o +
severe infxn
temp 102 +
recent hospitalization
immunocompromised
comorbidities
recent abx use (in past month)
135
Q

first line tx for ABRS

A

amoxicillin-clavulanate- 500 mg/TID

136
Q

use first line tx for ABRS when patients are/ are not at risk for abx resistance

A

are not

137
Q

tx for ABRS if pt has a penicillin allergy

A
  • doxycycline 100 mg BID
  • levofloxacin 500 mg QD
  • moxifloxacin 400 mg QD
138
Q

duration of tx for 1st line tx recommended for ABRS

A

5-7 days

139
Q

second line tx for ABRS is used when

A

no response/ worsening sxs OR HIGH RISK OF ABRS RESISTANCE

140
Q

second line tx for ABRS

A

amoxicillin-clavulanate - 2000/125 mg BID

141
Q

when high risk of ABRS resistance use

A

second line tx

142
Q

duration of tx for 2nd line tx of ABRS

A

7-10 days

143
Q

complicated ABRS

A

spread of infxn to the CNS/ orbit/ surrounding tissues, may be associated with persistent, high fevers (>102)

144
Q

usually frontal, with doughy edema, severe HA

A

osteomyelitis (complication of ABRS)

145
Q

severe HA, AMS, +/- nuchal rigidity

A

meningitis/ brain abscess/ epidural abscess (complication of ABRS)

146
Q

periorbital edema/ inflammation/ erythema, abnormal extraocular movements, proptosis, vision changes (diplopia/ dec. acuity)

A

periorbital and/or preseptal or orbital cellulitis (complication of ABRS)

147
Q

radiologic studies are indicated w/ ABRS if

A

suspect complicated ABRS

148
Q

radiologic studies ordered w/ ABRS

A

CT w/ contrast & MRI

149
Q

gold standard dx for complicated ABRS

A

sinus aspirate

150
Q

tx for complicated ABRS

A

admit to hospital, URGENT ENT/ID consult

151
Q

relating to ABRS: severe infxn, need urgent endoscopy/cx/surgical biopsy, anatomic defect obstructs, immunocompromised, failure to respond to 1st and 2nd line tx, multiple recurrent episodes, allergic rhinitis leading to ABRS in candidate for immunotherapy, chronic rhinosinusitis

A

are indications for ENT referral/ consult

152
Q

CRS

A

chronic rhinosinusitis

153
Q

risk factors:
allergic rhinitis, chronic irritant exposure, defects in mucocilliary clearance (CF), presence of immunodeficiency/ autoimmune/ inflammatory disease, anatomical abnormality predisposing to sinus obstruction, latrogenic

A

risk factors for CRS

154
Q

latrogenic

A

multiple sinus surgeries

155
Q

4 cardinal sxs of CRS in adults

A
  • mucopurulent nasal drainage
  • nasal obstruction and congestion
  • facial pain/ pressure/ fullness
  • reduction/ loss of sense of smell
156
Q

4 cardinal sxs of CRS in kids

A
  • mucopurulent nasal drainage
  • nasal obstruction and congestion
  • facial pain/ pressure/ fullness
  • cough
157
Q

diagnostic criteria of CRS

A

2/4 of cardinal sxs
AND infection for 12+ weeks
PLUS sinus mucosal disease w/ mucosal thickening and opaque paranasal sinuses OR mucosal inflammation, nasal polyps, edema, and purulent mucus

158
Q

viral pharyngitis with vesicles on erythematous base

A

HSV1 and HSV2

159
Q

to dx viral pharyngitis etiology as HSV1/2

A
  • viral cx, tzanck prep: multinucleated giant cells

- serology: HSV antibodies

160
Q

viral pharyngitis with sore throat, pharyngeal erythema, tonsillar exudates, enlarged cervical lymph noes or diffuse LAD, splenolmegaly

A

Mononucleosis aka Epstein-Barr Virus (EBV)

161
Q

to dx viral pharyngitis etiology as mono

A
  • Monospot

- CBC w/ diff (increased atypical lymphocytes)

162
Q

tx for viral pharyngitis caused by mono

A

supportive, avoid contact sports

163
Q

duration of mono

A

2-4 weeks; contagious up to 3 months!

164
Q

viral pharyngitis with acute gingivitis, painful oropharyngeal ulceration (sharply demarcated), febrile illness like mono, painless generalized lymphadenopathy, not tonsillar enlargement, no pharyngeal exudates, +/- maculopapular rash, fatigue

A

HIV

165
Q

dx for recurrent or treatment resistant rhinosinusitis

A

NON CONTRAST CT, referral to ENT for endoscopy/ sinus aspirate cx

166
Q

nasal saline lavage, intranasal corticosteroids, oral corticosteroids, oral antimicrobials, antihistamines, topical/ systemic antifungals, endoscopic sinus surgery

A

tx for CRS

Unit 2- Clin Med (6 decks)

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