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Clinical Medicine I > URI > Flashcards

URI Flashcards

1
Q

Most common cause of common cold

A
  1. rhinovirus (30-50%)
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2
Q

Timing and virology of common cold:

A
  1. fall/late spring: rhinovirus, parainfluenza
  2. winter/spring: RSV/coronavirus
  3. Summer: enterovirus
  4. adenovirus no seasonal pattern
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3
Q

Primary sxs of common cold

A

Rhinorrhea and nasal congestion

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4
Q

What can you find on exam of common cold pt.

A

nasal mucosa swelling
clear, watery, purulent discharge

No pulmonary involvement

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5
Q

What are the best txs for common cold?

A
  1. analgesics
  2. antihistamines and decongestants
  3. expectorants and antitussives
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6
Q

Which populations have increased morbidity/mortality with influenza?

A
  1. over 65
  2. COPD
  3. DM
  4. CVD
  5. Immunocompromise
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7
Q

What are the initial sxs of flu?

A
  1. abrupt onset
  2. fever
  3. myalgia
  4. sore throat
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8
Q

who should be tested for flu?

A
  1. sxs but no known outbreak
  2. immunocompetent after hospital stay
  3. high risk pt. w/ sxs
  4. anybody in institution that is experiencing outbreak
  5. inpatient with sxs of flu
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9
Q

When should influenza testing take place?

A

w/in first 3-4 days of illness

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10
Q

rapid influenza detection test features

A
  1. in-office and results in 15 minutes
  2. low sensitivity high specificity
  3. some distinguish type a and b
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11
Q

rapid molecular assay test features

A
  1. differentiate between a and b
  2. 45 minutes to hours
  3. high sensitivity and specificity
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12
Q

RT PCR test features

A
  1. influenza type and subtype
  2. NP swab/sputum, 1-8 hours
  3. high sensitivity and specificity
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13
Q

Viral culture test features

A
  1. Gold standard for lab diagnosis
  2. takes 3-10 days
  3. high sensitivity/specificity
  4. not for initial mgmt, but to confirm screening
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14
Q

Who gets antiviral tx for flu?

A
  1. severe illness
  2. high risk for complications
  3. high risk household
  4. health care provider w/ high risk pts
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15
Q

What type of antivirals help shorten flu when taken w/in 48 hrs of onset?

A
  1. neruaminidase inhibitors

- tamiflu, relenza, rapivab, xofluza

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16
Q

What vaccine should those 65 and older receive

A

high dose trivalent IM

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17
Q

A pt. is not getting better from flu… what complications should you be aware of?

A
  1. pneumonia
  2. rhinosinusitis
  3. OM
  4. myositis/rhabdo
  5. CNS involvement
  6. cardiac complications
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18
Q

what is the most common cause of pharyngitis?

A
  1. viral is 80%, yet 60% receive abx
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19
Q

In the 20% of cases of pharyngitis that are bacterial, what is the most common pathogen?

A

strep. pyogenes

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20
Q

what are the common pathogens causing viral pharyngitis?

A
  1. rhinovirus
  2. RSV
  3. Adenovirus
  4. Coronavirus
  5. Parainfluenza
  6. Flu
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21
Q

How to treat pharyngitis caused by HSV 1/2

A

acyclovir, famciclovir and supportive care

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22
Q

What are the common features of epstein barr virus:

A
  1. ST, erythema, tonsilar exudates
  2. cervical lympadenopathy
  3. high fever
  4. fatigue
  5. splenomegaly
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23
Q

What tests are ordered to confirm EBV

A

monospot, CBC with Diff

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24
Q

A pt. presents to the clinic with grey exudate tightly bound to throat and nasal passage. The pt. reports recent travel outside of the US. What is the likely cause of his pharyngitis?

A

corynebacterium diptheriae

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25
Q

how do you treat pharyngitis due to corynebacterium diptheriae?

A

diptheria anti-toxin + PCN or erythromycin

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26
Q

A patient is presenting with ST following a lower respiratory infection and headache. What pathogen caused this pharyngitis and how do you treat it?

A

mycoplasma pneumoniae, zithromax

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27
Q

A sexually active gay man presents to the clinic with exudative pharyngitis and cervical LAD on palpation. What pathogen caused this and how do you treat it?

A

neisseria gonorrhoeae, ceftriaxone 250mg IM x 1

28
Q

What is a common cause of bacterial pharyngitis in children and what are some potential complications?

A

group A strep, OM, rhinosinusitis, meningitis, bacteremia

29
Q

What sxs commonly present w/ GAS pharyngitis?

A
  1. ST
  2. odynophagia
  3. fever, malaise, anorexia
  4. arthralgia, myalgia
  5. NV
  6. neck discomfort
30
Q

What signs are commonly present w/ GAS pharyngitis

A
  1. pharyngeal erythema
  2. tonsilar hypertrophy
  3. purulent exudate
  4. tender or enlarged anterior cervical lymph nodes
    5 palatal petechiae
31
Q

Pts w/ 3 or more of what findings should get tested for GAS infection?

A
  1. tonsilar exudates
  2. tender anterior cervical LAD
  3. fever
  4. no cough
32
Q

What tests can be ordered to confirm GAS infection

A
  1. rapid antigen detection (70-90% sensitivity, 95% specificity)
  2. negative RADT, but centor criteria met: Throat culture + empiric abx (90-95% sensitivity/95-99% specificity)
33
Q

1st line therapies for GAS

A
  1. penicillin G: 1.2 millllion units IM x 1
  2. penicillin V 500mg PO TID x 10 days
  3. amoxicillin 500mg PO BID x 10 days
  4. cephalexin 500 mg PO BID x 10 days
34
Q

2nd line or PCN allergy tx for GAS infection

A
  1. zithromax 500mg po x 1, 250mg po q1d days 2-5

2. clindamycin 300mg po tid x 10d

35
Q

Complications from GAS infection:

A
  1. acute rhematic fever
  2. post-strep glomerulonephritis
  3. strep TSS
  4. scarlet fever
36
Q

signs and sxs of scarlet fever:

A
  1. rash, desquamination
  2. pastias lines
  3. strawberry tongue
  4. circumoral pallor
37
Q

what population is at highest risk for developing peritonsilar abscess?

A
  1. adolescents
38
Q

What distinguishes PTA from cellulitis

A

cellulitis:
1. no discrete pus collection

Abscess:

  1. collection of pus btwn tonsil and pharyngeal muscles
  2. progression of cellulitis
  3. requires I & D
39
Q

a patient is complaning of unilateral ST, trismus, drolling, ipsilateral ear pain. On exam you notice hot potato voice, swelling of tonsil with uvular deviation, cervical LAD. What is your presumptive diagnosis

A
  1. PTA
40
Q

What labs do you order for a suspected PTA

A
  1. CBC
  2. electrolytes
  3. throat culture
  4. culture and gram stain of aspirated fluid
41
Q

What imaging would you want to asses for PTA?

A
  1. CT w/ IV contrast in order to visualize soft tissue.

CT definitively distinguishes PTA from cellulitis

42
Q

Surgical interventions for PTA

A
  1. needle aspiration
  2. I & D
  3. Tonsillectomy
43
Q

Antimicrobial therapy for PTA

A

Parenteral options:

  1. unasyn 3gm q6 hrs until afebrile
  2. clinda 600mg q 8hrs until afebrile
  3. vancomycin if high rates of mrsa

PO options:

  1. augmentin 875mg q 12 hrs x 14 days
  2. clindamycin 300mg po q 6hrs x 14 days
44
Q

a pt. presents w/ drooling, stridor and a severe ST. you notice a toxic appearance. what is your suspected diagnosis, what do you want to confirm, and how do you manage? Any precautions?

A
  1. epiglottitis
  2. lateral neck x-ray for thumb sign. DO NOT EXAMINE oropharynx w/out securing airway
  3. hospitalization, ET intubation, abx
45
Q

What is the most common cause of laryngitis?

A

viruses

46
Q

bacterial causes of laryngitis?

A
  1. strep
  2. moraxella
  3. h. flu
47
Q

What signs and sxs would you expect to see in a pt. with laryngitis?

A
  1. hoarseness
  2. dysphonia
  3. URI sxs
  4. nasal edema, congestion, benign post. pharynx
48
Q

what would laryngoscopy reveal in laryngitis?

A
  1. erythema and edema
  2. coval cord enlargement
  3. nodules/ulcerations
49
Q

What is the key diagnostic feature for laryngitis?

A

hoarseness > 2 weeks in absence of URI sxs. Refer to ENT

50
Q

what is the most common etiology of acute rhinosinusitis?

A
  1. viral: rhinovirus, influenza, parainfluenza
51
Q

What should you be looking for if you suspect ARS?

A

Sxs:

  1. low grade fever
  2. nasal congestion and discharge
  3. pressure, headache
  4. tooth discomfort

Signs:

  1. purulent drainage
  2. nasal mucosal edema
  3. tenderness to palpation
  4. tenderness of teeth to percussion
52
Q

Diagnosis of ARS?

A
  1. < 10 days of sxs not worsening
53
Q

Tx of ARS?

A

analgesics, irrication, mucolytics, decongestants, glucocorticoids

54
Q

When to consider abx for rhinosinusitis?

A
  1. persistant sxs lasting > 10 days w/out improvement
  2. onset of severe sxs for 3-4 days
  3. double worsening.
55
Q

Who may need a stronger dose or duration of abx for rhinosinusitis?

A
  1. 65 or older
  2. temp greater than 102
  3. recent hospitalization
  4. immunocompromised
  5. comorbid pts
  6. hx of abx use in last month
56
Q

1st line for acute bacterial rhinosinusitis

A
  1. augmentin 875/125 mg PO BID x 5-7 days
  2. doxycycline 100mg PO BID x 5-7 days
  3. levaquin 500 mg PO qd x 5-7 days
  4. avelox 400mg PO qd x 5-7 days
57
Q

2nd line ABRS tx

A
  1. augmentin 2000mg/125mg bid x 7-10 days
  2. levaquin 500mg qd x 7-10 days
  3. avelox 400mg qd x 7-10 days
  4. doxycycline 100mg bid x 7-10 days
58
Q

What severe complications should you look for with ABRS

A
  1. osteomyelitis
  2. meningitis
  3. brain or epidural abscess
  4. preseptal or orbital cellulitis
59
Q

What radiologic tests do you want to order if complicated ABRS?

A

CT w/ contrast

60
Q

Labs to confirm ABRS?

A
  1. sinus aspirate culture is gold standard

2. CBC w/ diff

61
Q

Management of ABRS w/ complications?

A
  1. hospital admission
  2. urgent ENT/ID consult
  3. empiric abx
62
Q

who is at most risk for chronic rhinosinusitis?

A

adults

63
Q

What risk factors for chronic rhinosinusitis

A
  1. ARS history
  2. tobacco smoke
  3. CF
  4. immunocompromised
  5. obstruction
  6. latrogenic due to sinus surgeries
64
Q

What are the 4 cardinal sxs of CRS in adults?

A
  1. mucopurulent nasal drainage
  2. nasal obstruction/congestion
  3. facial pain, pressure, fullness
  4. reduction of smell (cough in children)
65
Q

Diagnosing CRS

A
  1. 2 of 4 cardinal sxs and infection lasting more than 12 weeks w/ medical mgmt

plus sinus mucosal disease w/ non-contrast CT or direct visualization of mucosal inflamation

66
Q

Tx of CRS

A
  1. saline lavage
  2. IN/PO corticosteroids
  3. PO abx
  4. antihistamines
  5. antifungals
  6. endoscopic sinus surgery

Clinical Medicine I (25 decks)

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