URI- part 2 Flashcards
Peritonsillar abscess etiology
s. pyrogenes, s. aureus (including MRSA)
cellulitis- infection and inflammation of tissue between palatine tonsil capsule and pharyngeal muscles
No discrete pus collection
Abcess
collection of pus between capsule of tonsil and pharyngeal muscles
-usually a progression of cellulitis
-requires drainage
peritonsillar absces presentation
Symptoms: severe sore throat- uslayy unilateral drooling trismus spasm of internal pterygoid muscle fever neck swelling and pain
Signs:
swellin pushin tonsil with deviation of uvula to opposite side
cervical LAD
bilateral peritonsillar abscess rare, uvula may be displaced anteriorly
“hot patato voice”
Peritonsillar abscess diagnostics
labs: cbc white count electrolytes throat culture culture gram stain of abscess fluid
imaging:
ct with iv contrast
peritonsillar abscess management
Drainage antimicrobial therapy -parenteral- unitl afebrile ampicillin-sulbactam clindimycin vancomycin if high rates of MRSA
-oral 14 days
amoxicillin-clavulanate(augmentin)
clindamycin
fluids, pain control
Epiglottitis etiology
typically H. influenzae
epiglottitis signs and symptoms
consider in unvaccinated children and older adults
drooling (difficulty swallowing)
stridor
severe sore throat
toxic appearance
danger of airway obstruction, rapid course
ACT FAST, CAN BE FATAL
DO NOT exam oropharynx if patient in repiratory distress, secure airway first
Imaging
lateral neck x-ray “thumb sign-swollen epiglottis” CT/MRI
management of epiglottitis
hospitalization, intubation, antibiotics
laryngitis etiology
virus are most common
bacterial etiologies
streptococci species
moraxella catarrhalis
h. influenza
non-infectious vocal abuse intubation toxic exposure smoke inhalation radiation GERD vocal cord nodules or laryngeal polyps carcinoma of vocal folds neurologic dysfunction
laryngitis presentation
sypmptoms: hoarseness is KEY symptom dysphonia vairiation in vocal quality URI symptoms rhinorrhea, congestion, cough, etc
Signs: if URI related nasal edema, congestion, typical benign post pharynx erythema edema nodules ulcerations
laryngitis differentials
acute:
bacterial/viral
irritant exposure
acute epiglottitis (h. influenzae type b)
Chronic:
head neck cancer
GERD
vocal nodule
laryngitis diagnosis
largely based on history and PE
HOARSENESS > 2W IN ABSENCE OF URI SYMPTOMS
requires ENT referral for laryngoscopy, head/neck exam
especially with history of tobacco or alcohol use
Hoarseness from URI can last 2-3 weeks
laryngitis management
TREAT THE UNDERLYING CAUSE removal of offending agents voice rest humidification cool mist increased fluid intake hydration
Acute rhinosinusitis (ARS) etiology
MOST COMMON VIRAL
rhonovirus, influenza, parainfluenza
BACTERIAL only in 0.5-2% acute bacterial rhinosinusitis (ABRS) streptococcus pneumoniae h. influenzae moraxella catarrhalis
Acute rhinosinusits presentation
purulent nasal drainage AND nasal obstruction and/or facial pain, pressure, fullness
can be associated with allergies, tumors, polyps, deviated nasal septum or foreign bodies
acute<4 weeks
subacute 4-12 w
chronic >12 w
recurrent more than 4 episodes per year
Symptoms: fever low grade nasal congestion facial pain fatigue cough
Signs: purulent drainage nose or postnasal nasal mucosal edema tenderness to percussion of upper teeth sinus tenderness
acute viral rhinosinusitis diagnosis
clinically
<10 days of symptoms consistent with symptoms of ARS that are not worsening
Acute viral rhinosinusitis management
supportive care
days 1-9 analgesics saline irrigation mucolytics intranasal decongestants intranasal glucocorticoids
acute bacterial rhinosinusitis diagnosis
persisitent symptoms lasting > 10 days with no clinical improvement
or
onsent with severe symptoms fever> 102 purulent nasal discharge, facial pain lasting at least 3-4 consecutive days at the beginning of illness
or
viral URI that lasted 5-6 days and was initially improving followed by severe symptoms “double worsening”
acute bacterial rhonosinusitis management
1st line pt is NOT high risk for antibiotic resistance
5-7 days tx
amoxicillin-clavulanate (augmentin) 875/125 mg bid
doxycylcine 100 mg
levofloxacin 500 mg qd
moxifloxacin 400 mg qd
WORSENING OR HIGH RISK tx 7-10 amoxicillin-clavulanate (augmentin) 2000mg/125 mg bid doxycycline 100mg bid levofloxacin 500 mg qd moxifloxacin 400 qd
complications of ABRS
osteomyelitis
meningitis
brain or epidural abscess
preseptal or orbital cellulitis
radiologic studies
indicated if suspect complicated ABRS
CT scan with contrast
MRI can be used soft tissue detail
Labs
sinus aspirate culture is GOLD STANDARD
CBC with differential
others based on etiology
management:
admit to hospital
urgent ENT/ID consult
Empiric antibiotics
Chronic rhinosinusitis presentation
FOUR CARDINAL SYMPTOMS IN ADULTS mucopurulent nasal drainage nasal obstruction and congestion facial pain, pressure, fullness reduction/ loss of sense of smell
in children, cough is the fourth symptom
chronic rhinosinusitis diagnosis
the presence of at least 2 of 4 cardinal symptoms
and
infection lasting 12 or more weeks with medical management
plus either
sinus mucosal disease with imaging with mucosal thickening, or partial/complete opacification of the paranasal sinuses
or
direct visualization of mucosal inflammation polyps in the nasal cavity or meatus, and or purulent mucus and edema
chronic rhinosinusitis diagnosis and management
diagnosis for recurrent or treatment resistant: NON-CONTRAST CT referral to ENT nasal endoscopy sinus aspirate culture
Management nasal saline lavage intranasal corticosteroids oral corticosteroids oral antimicrobials antihistimines topical or systemic antifungals endoscopic sinus surgery
