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Clin Med I > URI > Flashcards

URI Flashcards

1
Q

Common cold Virology/timing

A

Usually Rhinovirus

coronavirus, influenza, parunfluenza, respiratory syncytial virus, adenovirus, enterovirus

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2
Q

Common Cold timing

A

Fall and late spring: rhino virus and parinfluenza
Winter/spring: RSV and coronavirus
Summer- enterovirus
adeno virus has no timing

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3
Q

Common Cold Sx

A 
Peak shedding 2-3 with peak sx  
Rhinorrhea 
nasal congestion
sore throat/ scratcy
non productive cough
malaise 
low grade fever (usually in kids)
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4
Q

Common Cold signs

A

nasal swelling, nasal discharge ( clear or purulent), conjuctive injection, usually no pulmonary findings and no adenopathy

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5
Q

Cold dx/ complications

A

clinical and based on observed signs

- acute rhinosinitius, Acute otitis media, asthma attack, pneumonia

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6
Q

Cold Tx

A 
self limitng and supportive care
- NSAIDs, Chloraseptic 
Antihist:
- peudoephed/ Diphenhydramine 
Expectorants/antiussives 
- Guaifenesin (robitussin)
- guaifenesin with dextromethorphan
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7
Q

Influenza etiology

A

influenza A and B
Risks
>65 years
COPD, DM, CVD, immunocomp

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8
Q

Influenza Sx

A

Peak shedding 48hrs
Common: abrupt onset, fever, myalgia, sore throat
Other: chills, malaise, HA, cough, nasal discharge

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9
Q

Influenza Signs

A

flushing, hot dry, pharynx wont look red even if sore, lymphadepathy, chest exam negative

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10
Q

Who do we test for influenza

A

Outpatient: routine is not recommended
- consider testing is sx when no known outbreak
- immuno competent pt after a hospital visit
- high risk
- influenza sx in healthcare workers or visitors to an instituion
Inpt.: any pt with sx upon admissions or during their stay

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11
Q

Dx FLue

A 
- must be testes in first 3-4 days 
Rapid influenza dectection test: 
- low sensitivity/specificity 
- <15min 
Rapid Molecular Assay 
- diff types A/B
-45 min
- high sens/ specif
Reverse- transcriptase polymerase chain raction
- preferred by CDC
- influenza type and subtype 
-NP swab 1-8 hrs 
- hgh sensitivity/specificty
Viral Culture:
3-10 days 
very high sensitivity specificty 
* mostly to confirm
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12
Q

Neuraminidase inhibitors- flu tx

A 
cover A/B
-Oseltamivir (tamiflu) 75mg po bid x5d 
- Zanamivir(relenza) 10mg bid x5d 
Peramivir(rapivab)- 600mg IV  x1 
Baloxavir - 40mg po or 80mg (>80kg) 
- category C for pregnancy but better to take that risk than have the woman get the flu
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13
Q

Who gets flu vaccine

A

Everyone over 6mo

  • usually given in october
  • two weeks till the antibodies develop
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14
Q

Contrindications for vaccination

A

current moderate to severe illness

  • hx of guillain barre syndome within 6wks
  • hx of allergic reaction to flue vaccine
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15
Q

18-64
65
6mo-8yr
vaccines

A
  • standard dose
  • older get high dose
  • live virus 2-49 yo not pregneacny though
    6mo-8yr get 2 doses > 4wks apart
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16
Q

Pharyngitis etiology

A
  • usually a viral illnes
  • may occur as common cold
  • if bacterial it is group A step
  • non infectious causes: trauma, vocal strain, smoking, GERD
    virus: rhinovirus, RSV, adenovirus, coronavirus, parainfluenza, influenza
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17
Q

Phayngitis- mononucelosis

A 
Epstein barr virus 
- sore throat, erythems, exudates 
- large enlarged cervical lymph nodes
- fatugue 
-fever
splenomegaly 
Dx: monospot, CBC with diff  (increases atypical lymphocytes 
Sx: supportive and no contact sports
18
Q

Pharyngitis- bacterial diptheriae

A

Diptheriae
- rare now but will cause gray exudate tightly adherant to throat, nasal passagemway. Midful of the unvaccinated pt with recent travel
Tx: diphtheria anti-toxin+toxin or erythromycin

19
Q

Pharyngitis- mycoplasma pneumoniae and Neisseria gonorrhoeae

A

Associated with LRI and HA
Tx: azithromycin

Neisseria gonorrhoeae;
- ^MSM and associated with oral sex
- pharyngitis with exidates and cervical LAD
Tx: ceftriaxone 250 mg IM x 1

20
Q

Group A strep Pharyngitis Sx

A

Sx: sore throat, odynophagia, fever, mailas, anorexia, arthragials, N/V/ swollen glands
Signs: erythema, tonsilar hypertrophy, purulent exudate, tender and lager anterior cerv lymph, palatal petechiae

21
Q

Strep Criteria

A

Symptoms- tonsillar exudatea, tender anterior cervical adenpathy, fever by history, abscense of a cough
* if 3 of 4 then do a rapid antigen detection test

22
Q

Strep managment

A

First line therapy GAS pharyngitis (adult
- Pen G IM dose
-Pen V 500mg po TID x 10days
- Amoxicillin 500mg BID x 10 days
- Cephalexin 500 mg PO BID 10 days
Second line or Allergy :
- azithromycin 500mg po day 1 followed by 250 mg po days 2-5
- clindamycin 300 mg po tid x 10 days
** supportive care! lozenges, NSAIDs, acetaminophen

23
Q

Strep Complications

A
  1. Acute rheumatic fever - may cause cardiac valve abnormalities
  2. Post step glomerulonephritis
    - can progress to acute renal failure
  3. step toxic shock syndrome
    - shock and organ failure
    Scarlet fever
    other: abscess in tonsils, otitis media, rhinosinusitis, bacteremia, pneummonia
24
Q

Peritonsillar cellulitis/abscess/epiglotiiis

A

etiologiy: S. pyogenes s. aureus
Cellulitis: infection between platine tonsil capsul and pharynx muscles . no pus collection
Abscess: collection of pus, requires drainage

25
Q

Peritonsillar abscess Presentation

A

Sx: severe sore through
drooling, trismus. fever, neck swelling, ipsilateral ear pain, fatigue, anxiety, irritability
Signs: swelling with push tonisl with deviation of oppositice side. Fullnes of posterior of solft palate, cervical LAD, hot potato muffled voice

26
Q

PTA dx

A

Labs: CBC, electroytes, throat culture, culture/gram stain of the abscess of fluid
Imaging
- CT with IV contrast- if unable to diagnose clinically
> r/o spread of infection to parapharyngeal space
* will disstinguidhe cellulitis from abscess
- US helpful an d good for needle guidance during aspiration

27
Q

PTA managment Drainage

A 
- needle aspiration ED/OR 
Antimicrobial therapy adults 
-Ampicillin 3gm q6hrs
-clindamycin 600mg q8hrs
-vancomycin if ^ mRSA
Oral: 
Augmentin 875mg q 12hrs 
clindamycin 300 mg q6hrs 
\+ supportive care and fluids
28
Q

Epiglottitis

A

h. influenzae
- consider unvaccinated children or older aldult
Sx: drooling, stridor (resp distress- squeeking sounds ), severe sore throat, toxi appearance
- danger of airway obstruction, rapid course
- if suspect do not exam oropharynx if patient is in resp distress
Imaging: X ray ( lateral neck x-ray) , thumb sign CT/MRI
Managment: hospitalizaions, intubation, antibiotics

29
Q

Laryngitis etilogy

A

Virus is the MOST common
Bacterial- step, moraxella catarrhalis, influenza
Non infect: vocal abuse, intubation, toxi exposure, GERD, vocal cord coduels or laryngeal polyps, cancer, neuo disfucntion

30
Q

Laryngitis Presentation

A

Hoarsness- key***
dysphnia
URI sx:rhinorrhea, nasal congestion, cough, sore throat
Signs:
if URI related: nasal edema, congestion, benign post parync
Direct laryngoscopy: erythema, edema, vascular engorgment of voca cords, nodes or ulcerations

31
Q

ARS sx

A
  • purulent nasal drainage and nasal obstruction and or facial pain with pressure or fullness
    Sx: fever, congestion, cough, maxillary tooth discomfort, ear pressure, HA
    Digns
  • purulent drainage in nose or post pharynx, nasal mucosal edema, tenderness to percussion of upper teeth, sinus tendernessto palpation
32
Q

Acute viral RHinosinisitis (ARVC) Dx;

A

often rhinovirus, influenza, parainfluenza
clinically
< 10 days od sx with sx of ARS that are not worsening
- radiography is not indicated
limited use of plaing sinus fims
cultures not indicated

33
Q

ARVC managment

A

supportive care 98%

- analgesics, salin irrigation, mucolytics, intranasal decongestants , intranasal glucocorticoids

34
Q

Acute Bacterial Rhinosisnusitis (ABRS) Dx

A

strep, h ful, moraxella catarrhalis
persisitant sx >10days with no improvement or
onset with severe sx >102 purulent nasal discharge facial pain, lasting 3-4 consecutive days
or
viral URI for 5-6 dyas that was initally imprving followed by severe Sx “ double worsening”

35
Q

Pt considered at high risk for abx resistance

A

> 65, severe infection temp >102

recent hospitalization, immunocomp, comorbidities, recent antimicrobial use

36
Q

ABRS tx 1st line

A 
First:
Amoxicillin-clavulanate 875/125mg BID 
doxycyline 100mg BID 
levofloxacin 500mg qd
moxifloxacin 400mg qd 
5-7 days
37
Q

ABRS 2nd line

A 
if no repsonse or worsening of sx 
Amox-clav0 2000mg/125mg bid 
Levofloxacin 500mg qd
Moxifloxacin 400mg qd 
Doxycycline 100mg bid 
7-10 days
38
Q

Complications of ABRS

A

extension of infection
- osteomyelitis, menegitis, brain or epidual abscess, presptal or orbital cellulitis

  • Use CT or MRI is suspected complicated ABRS
    • Sinus aspirate culture is gold standard**
39
Q

Chronic RHinosinisitis risks

A 
a;;ergic rhinitis hx
chronic exp to envior irritants 
defects in muco clearance 
presence of mmuno def 
anatomocal ab
latrogenic ( sinus surgeries )
40
Q

CRS presentation

A 
Adults 
- mucopurulent nasal discharge 
- nasal obstruction and congestion
- facial pain, pressure, fullness
- reduction or loss of smell 
Children may also have a cough not a disturbance sense of smell
41
Q

CRS Dx

A

2-4 cardincal sx and infection lasting > 12wks
Recurrent RS
- non contrast CT and ENT referall
Tx: nasal saline lavage, intranasal corticosteroids, oral corticosteroids, antihistamines, topical antifungals

42
Q

Laryngitis Dx/TX

A

Based on Hx and PE
hoarsnss > 2wks in absence of URI sx
Tx: Treat undlerlying cause / managment of systemic disease
-coice rest/humidifyers

Clin Med I (14 decks)

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