URI & Pneumonia Flashcards
Common Cold
Symptoms PE Duration Etiology At risk Transmission & replication Diagnosis Treatment - Nasal diagnostic - Sore throat - Cough - Systemic symptoms - Decongestion Complications
Symptoms • Rhinorrhea • Sore throat • Nonproductive cough • Postnasal drip on day 4-5 PE • Inflamed nares • Mucus on through • >1 degree elevation Duration • 1 week • 3 days longer for smokers Etiology • Rhinovirus (HRV) - Early spring/mid-spring • Coronavirus & RSV - Winter At risk • Children & their families Transmission & replication • Hand transmission & fomites - RSV • Aerosol – Flu, parainfluenza, adenovirus & Coxsakie • RSV replicates in nasal epithelium with minimal cellular destruction • Stress aggravator Diagnosis • Clinical • R/o Strep throat Treatment • Symptomatic Nasal - Ipratropium bromide (parasympatholytic) Sore Throat - NSAIDs Cough - Dextromethorphan - Guaifenesin - Codeine Systemic symptoms - Bed rest - Ibuprofen Decongestants - Pseudoephedrine - Intranasal phenylephrine Complications • Sinusitis • Otitis media • Lower respiratory tract disease
Group A Strep
Symptoms PE At risk Diagnosis Culture DDx Treatment
Symptoms • Acute onset • Sore throat • Dysphagia • Systemic illness • Nasal congestion or cough in 50% PE • 100-104 F • Bright red pharynx • Tonsillar exudate • Enlarge lymph nodes At risk • 20-30% of childhood pharyngitis • 5-15% of adult Diagnosis • 3 keys - T > 100 F - Cervical lymph node tenderness - Tonsillar exudates • Culture - Sheep blood agar (B hemolytic) - Latex agglutination assay - Rapid enzyme immunoassay DDx • EBC Adenovirus: conjunctivitis + summer • Peritonsillar abscess • Epiglottitis • Group C & G strep Treatment • Oral penicillin V • Erythromycin • Benzathin penicillin • If treatment is started with 9 days there is 10 fold decrease in R. fever • Acetaminophen
Influenza
Symptoms PE Causes Transmission Diagnosis Treatment Prevention
Symptoms • Abrupt onset • Systemic symptoms > pharyngitis PE • Febrile • Minimal pharyngitis • Small tender cervical adenopathy Etiology • Influenza A & B – Orthomyxidae Transmission • Aerosol • Viral shedding 1 day prior to onset of sx & 5-10 days after fever • Replicates in columnar epithelium • IFN immune response Diagnosis • Clinical • Elisa of nasopharyngeal aspirate • Culture Treatment • Supportive • Symptom reduction - Amantadine - Rimantadine - CNS toxicity - Influenza A only Prevention • Vaccine - 80-90% efficacy - 65> - Children at risk of Reyes syndrome • Antiviral - 75-90
Antigenic drift
- Minor changes
- HA & NA
Antigenic shift
- Major changes in HA and/or NA leading to new viruses
Varients of influenza
- A: Annual variation
- B: Less frequent
- C: Never changes
Acute bronchitis
• Acute inflammation of tracheobronchial tree without involvement of lung parenchyma
Acute vs chronic bronchitis
- Chronic bronchitis: Significant sputum > 3months of 2 consecutive years
- Acute exacerbations of chronic bronchitis
Acute Bronchitis
Symptoms
PE
Diagnosis
Treatment
Symptoms
• Cough for days-weeks (dry then wet)
• +/- sputum or fevers
PE
Crackles/wheezes with ought evidence of consolidation
Diagnosis
• Serum IgM for M. pneumonia
• R/o pneumonia with chest X-ray (no lung parenchyma infiltration with bronchitis)
• R/o cold – more severe chough in bronchitis
• R/o chronic bronchitis – length & acute presentation
Treatment
• Antitussives: Dextromethorphan or codeine
• Wheezing – Albuterol or rapid taper of stereos
• Antibiotics: Documented (IgM) bacterial infection, erythromycin
3 main causes of bronchitis
Etiology • Mycoplasma pneumoniae - 3 week incubation - Highly infectious amongst close contacts - Dry hacking cough (initially) - Green or yellow (purulent sputum) - Rhonchi & rales - :low grade fever - Inducible wheeze in atopics • Chlamydia pneumonia • Bordetella pertussis
Acute sinusitis
• Infection or paranasal sinuses
Causes of acute sinusitis
- S. pneumoniae
- H. influenza
- M. catarrhalis
- S. pyogens
- S. aureus
Causes of chronic bronchitis
S. aureus
In what age group is acute sinusitis
Less likely in children under 1
Acute sinusistis
Symptoms PE Classification Pathophysiology Diagnosis
Symptoms • URI • Cough • Purulent discharge • Facial pain • Positional changes • Headache • Chronic – malodorous breath PE • Purulent nasal discharge • Pain on palpitation of sinuses • Diminish transnasal illumination Classification • Viral URI – asymptomatic • Acute bacterial sinusitis • Chronic sinusitis Pathophysiology • Symptomatic - Obstruction of ostia - Allergic rhinitis - Polyps of adenoids - CF - Sarcoid - Wegener’s granulomatosis - Immunocompromised
3 classifications of acute sinusitis
- Viral URI – asymptomatic
- Acute bacterial sinusitis
- Chronic sinusitis
3 complications of acute sinusitis
- Acute bacterial sinusitis
- Meningitis (S. pyogens)
- Chronic sinusitis
Treatment for acute sinusitis
- Which antibiotic and for how long
- For symptom relief
- What sort of surgical intervention might be needed
• Antibiotics - 10 days URI symptoms - Need to coverage B-lactamase production of H. influenza o amoxicillin-clavulanate o Cefuroxime o Cefpodoxime; o Quinolones (moxifloxacin) • Symptoms: Antihistamines • Surgical drainage
Pneumonia
Risk fators
Risk Factors • Immunocompromised • Aspirations • Anatomical variation • CF • Alcoholism • Emphysema • Inadequate salvation
Pneumonia
Symptoms
PE
Diagnosis
Symptoms
• Fatigue
• Cough
• Myalgia
• Fever
• Dyspnea
• Pleurisy
PE
• Fever, hypotension, tachycardia or hypoxia
• Lungs: Crackles, dullness to percussion , egophony or pectoriloquy
• Elderly: Altered mentation, respiratory compromise or shock
Diagnosis
• Chest x-ray: Infiltration, abscess & empyema
• Sputum gram stain
Community acquired pneumonia organisms
- Mycoplasma, legionella (ICU for immunocompromised) or chlamydia
- S. pneumonia or virus
VERY BAD CAP - S. aureus
Nosocomial & ventilators associated pneumonia
- MRSA
- Gram - rods
Aspiration pneumonia
CAP & Anaerobes
Pneumonia tratment
- Atypicals – Azithromycin
- Cefuroxime
- Metronidazole
- Vancomycin (MRSA)
- metronidazole’s
