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Clinical Medicine II > URI (quiz 1, exam 1) > Flashcards

URI (quiz 1, exam 1) Flashcards

1
Q

__ most common primary diagnosis in ambulatory visits in 2002

URI

A

3

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2
Q

__ most common acute illness in US

URI

A

1

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3
Q

URI

majority are __ in etiology

A

viral

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4
Q

URI

difficult to differentiate between viral and bacterial illness due to __

A

overlap of signs and symptoms

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5
Q

URI

leading diagnosis for prescribing __ on an outpatient basis despite mostlly viral in etiology (~__%); this has led to __

A

-antibiotics

~75%

-bacteria resistant to antibiotics

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6
Q

URI

most URIs are self-__ and self-__

A
  • diagnosed
  • treated
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7
Q

common cold: epidemiology

the common cold is the general term for an upper respiratory tract infection (URI) that has __

A

no prominent localizing features (when a specific localizing symptom is present, the diagnosis is made based on location: pharyngitis, sinusitis, bronchitis)

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8
Q

common cold: epidemiology

in an average year, every person in the US has from __ URIs

A

2-4

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9
Q

common cold: epidemiology

incidence peaks during the __ seasons, __ from person to person, and __ with age

A
  • fall and winter
  • varies considerably
  • declines
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10
Q

common cold: epidemiology

URI is a leading reason for __

A

consultation with health care providers and of missed work days (in 1998, 25 million individuals received care for URI and 20 million days were missed from work)

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11
Q

common cold: epidemiology

DESPITE THE FACT TAHT URIs ARE NEARLY ALWAYS CAUSED BY __, APPROX. __% OF MEDICAL PROVIDER VISITS FOR URTIs RESULTS IN AN __ PRESCRIPTION

A
  • viruses
  • 30%
  • antibiotic
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12
Q

common cold: pathophysiology

URIs are nearly always caused by __ infection of the __

A
  • viral
  • anterior nasal mucosa
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13
Q

common cold: pathophysiology

virus reaches nasal __ via __ with infectious secretions on the __

A
  • epithelium
  • aerosol spread or direct contact
  • skin or other surfaces
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14
Q

common cold: pathophysiology

viral replication within __ cells or __ mucosa

A
  • epithelial
  • oral, nasal, and upper respiratory
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15
Q

common cold: pathophysiology

viral replication triggers __ mediated inflammatory reactions leading to __ symptoms

A
  • cytokine
  • typical cold symptoms
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16
Q

common cold: pathophysiology

symptoms begin about __ days after viral __

A
  • 2-8 days
  • inoculation
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17
Q

common cold: microbiology

__ infection is the main cause of URI and peaks in the __ when __% of URI may be caused by this virus

A
  • rhinovirus
  • autumn
  • 80%
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18
Q

common cold: microbiology

the majority of transmission of rhinoviruses occurs via __ and is transferred from __ via the __ to the __, from where the viruses then migrate to the __

A
  • fomites
  • fomites
  • hand
  • nose, eyes, or mouth
  • nasopharynx
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19
Q

common cold: microbiology

experimental infection has demonstrated that __% of individuals who are infected develop symptoms, some as early as __ hours after exposure

A
  • 75%
  • 10 hours
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20
Q

common cold: microbiology

shedding of viral particles peaks __ days after infection, but may continue at low levels for __ weeks

A
  • 2 days
  • 1-3 weeks
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21
Q

viruses ass. with common cold

rhinovirus (>100 serotypes): % of cases and seasonal peak

A
  • 30-50%
  • fall and spring
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22
Q

viruses ass. with the common cold

coronavirus: % of cases and seasonal peaks

A
  • 10-15%
  • mid-winter
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23
Q

viruses ass. with the common cold

influenza: % of cases and seasonal peak

A
  • 5-7%
  • winter
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24
Q

viruses associated with the common cold

RSV: % of cases and seasonal peak

A
  • 5%
  • winter
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25
Q

viruses ass. with the common cold

parainfluenza virus: % of cases and seasonal peaks

A
  • <5%
  • winter
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26
Q

viruses ass. with the common cold

adenovirus: % of cases and seasonal peak

A
  • <5%
  • year round
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27
Q

viruses ass. with the common cold

metapneumovirus: % of cases and seasonal peak

A
  • 5%
  • late winter and early spring
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28
Q

viruses ass. with the common cold

__ to virus are protective against them. But, rhinovirus has __ antigenically different types and adenovirus has __. Therefore, large number of reinfections with them. Influenza has __ serotypes, so reinfection due to __

A
  • antibodies
  • >100
  • 47
  • 3
  • rapid mutations on the surface of the virus
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29
Q

viruses ass. with the common cold

rhinovirus spread via __

A

direct contact with infected respiratory secretions: hand-hand, hand-face

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30
Q

viruses ass. with the common cold

viruses that spread through droplets by air include __ (note overlaps)

A
  • adenovirus
  • RSV
  • influenza
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31
Q

viruses ass. with the common cold

__ affects kids; peaks __ after infection with __

A
  • HMPV
  • 1-2 months
  • RSV
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32
Q

viruses ass. with the common cold

viruses found mainly in children include __ and are both in the cateogry of __ viruses

A
  • bocavirus
  • HMPV
  • emerging viruses (HMPV discovered in 2002, bocavirus in 2005)
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33
Q

viruses ass. with the common cold

can have reinfections with virus due to 3 things

A
  1. antigenic shift
  2. incomplete induction of immunity
  3. waning immunity
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34
Q

common cold: clinical features

mild, self-limited illness characterized by 1 or more of the following (7)

A
  1. nasal congestion and discharge - clear to yellow-green
  2. sneezing
  3. coughing
  4. hoarseness or sore throat
  5. headache
  6. sinus pressure
  7. malaise
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35
Q

common cold: clinical features

these symptoms are usually not present (3)

A
  1. myalgias
  2. arthalgias
  3. fever is uncommon in adults
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36
Q

common cold: clinical course

within __ days the sore throat usually __ and the rhinorrhea becomes more __, appearing thick and yellow to green. This change in nasal discharge results from __, and is a natural part of the progressino of a viral URI

A
  • 2-3 days
  • resolves
  • purulent
  • recruitment of leukocytes
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37
Q

common cold: clinical course

purulent sputum and phlegm are __ with bacterial infection/risk for bacterial infection

A

not associated

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38
Q

common cold: clinical course

other associated symptoms include __ (5)

A
  1. headache
  2. hoarse voice
  3. malaise
  4. laryngitis
  5. lethargy
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39
Q

common cold: clinical course

symptoms usually peak withing __ days and resolve over __ days

A
  • 2-3 days
  • 5-10 days
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40
Q

common cold: clinical course

cough may persist for __ weeks after resolution of other symptoms. When this occurs it is usually referred to as __ or a chest cold

A
  • several
  • bronchitis
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41
Q

common cold: clinical course

included in the differential diagnosis of URI is influenza. However, with influenza __(2) are more prominent, and the illness is usually more __

A
  • myalgias and fever
  • severe
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42
Q

common cold: risk factors

T or F: cold exposure increases the risk of URI

A

False

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43
Q

common cold: risk factors

2 risk factors that increase the risk for the development of URI

A
  1. psychological stress
  2. poor hand hygeine (frequent hand washing decreases URI incidence, which makes sense, since fomites are a major source for transmission)
44
Q

common cold: risk factors

smoking: risk for __ infections

A

LOWER respiratory infections

45
Q

common cold: risk factors

T or F: smoking has demonstrated to increase the risk for URIs

46
Q

common cold: risk factors

smoking increases the __ and __ of URI

A
  • duration
  • severity
47
Q

common cold: risk factors

T or F: asthma and emphysema increase the risk for developming URIs

48
Q

common cold: risk factors

URIs can lead to __ of both asthma and emphysema

A

exacerbations

49
Q

common cold: risk factors

prevention is best achieved through __

A

frequent hand washing (its spread via fomites)

50
Q

common cold: risk factors

T or F: zinc, Echinecea, garlic, and vitamin C decrease the risk of developing URIs

A

False: no adequately blinded studies supports a prophylactic effect of popular supplements for the prevention of URIs

51
Q

common cold

there are minimal findings of PE but they include __

A
  1. nasal congestion, secretions in nasal cavity
  2. oral respiration
  3. mild tonsillar and pharyngeal injeciton without exudate
52
Q

common cold

__ labs are done and treatment is __

A
  • no
  • symptomatic
53
Q

common cold: complications

the most common complication of URI is __

A

exacerbation of underlying asthma or COPD

54
Q

common cold: complications

very rarely (__% of cases) do URIs progress to bacterial infection in adults (usually bacterial __ or __)

A
  • <2%
  • sinusitis
  • otitis media
55
Q

common cold: complications

development of __ are suggestive of bacterial sinusitis and otitis media

A

-fever and/or symptoms of otitis media or sinusitis after initital improvement (purulent nasal secretions alone do not suggest bacterial super infection)

56
Q

common cold: complications

T or F: there is evidence to support use of antibiotics for URI to reduce duration, severity, or risk of complications

A

False (the most significant potential adverse outcome of having a URI is inappropriately receiving antibiotics)

57
Q

common cold: complications

antibiotic prescribing does have 2 direct negative effects on pts

A
  1. adverse drug effects
  2. selection of resistant bacateria among an individual’s colonizing flora, increasing the risk of a future infection with antibiotic resistant bacteria
58
Q

common cold: over-prescribing of antibiotics

surveys of physicians evaluating clinical perceptions towards use of antibiotics for URI have identified the following as pt characteristics leading to prescribing antibiotics

A
  1. current tobacco use
  2. green or yellow nasal discharge or phlegm
  3. tonsillar exudates

(none of these symptoms are specific to bacterial infection and all can occur with viral URI)

59
Q

common cold: over-prescribing of antibiotics

pt __ also play an important role in clinical prescribing practices; in 1 survey, over __% of adults surveyed believed that antibiotics were effective against viral infection

A
  • expectations
  • 50%
60
Q

URI: management

current therapy of URI is based on __

A

symptomatic management

61
Q

URI: managment

recommendation made to a pt should focus of the major symptoms, which include:

A
  1. nasal congestion and sinus pressure/pain
  2. cough
  3. sore throat
62
Q

URI: nasal congestion and sinus pressure/pain managment

oral decongestants: purpose, duration of benefits, examples

A
  • relieves rhinorrhea and nasal congestion
  • hours
    1. phenylephrine (Neo-Synephrine and other brand names)
    2. pseudoephedrine (Sudafed)
63
Q

URI: nasal congestion and sinus pressure/pain management

topical nasal decongestants: purpose, duration of benefit, comments, examples

A
  • relieves rhinorrhea and nasal congestion
  • hours
  • benefit varies by pt
    1. ipratropium nasal spray (Atrovent Nasal)
    2. oxymetazoline nasal spray (Afrin): use for as little as 3 days may lead to rebound nasal congestion (rhinitis medicamentosa), so it should be recommended with caution
64
Q

URI: nasal congestion and sinus pressure/pain management

first generation histamines: purpose, duratin of benefits, comments, examples

A
  • reduces mucus produciton, rhinorrhea, and sneezing
  • hours
  • 1st generation antihistamines are more effective in reducing rhinorrhea and sneezing than 2nd generation antihistamines, due to their greater anticholinergic properties (but they make you more drowsy and than 2nd generation antihistamines)
    1. diphenhydramine
65
Q

URI: nasal congestion and sinus pressure/pain managment

Second-generation antihistamines: purpose, duration of benefits, comments, examples

A
  • reduce mucus production, rhinorrhea, and sneezing
  • hours
  • are less effective in reducing sneezing and rhinorrhea, but also causes less drowsiness, when compared to 1st generation antihistamines (2nd generation has lesser anticholinergic properties)
    1. loratadine
    2. fexofenadine
66
Q

URI: treatment

acetaminophen: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits

A
  • oral analgesic
  • relieves pain
  • rhinosinusitis
  • hours
67
Q

URI: treatment

ibuprofen: type of drug, purpose, symptomatic treatment for what symptom, duration of benefit

A
  • oral analgesic
  • relieves pain
  • rhinosinusitis
  • hours
68
Q

URI: treatment

diphenhydramine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefit, comments

A
  • 1st generation antihistamine
  • reduces mucous production, sneezing, and rhinorrhea
  • rhinosinusitis
  • hours
  • works better than 2nd generation due to ther greater anticholinergic properties
69
Q

URI: treatment

loratadine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments

A
  • 2nd generation antihistamine
  • reduces mucous production, sneezing, and rhinorrhea
  • rhinosinusitis
  • hours
  • works worse than 1st generation due to there lesser anticholinergic properties
70
Q

URI: treatment

fexofenadine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments

A
  • 2nd generation antihistamine
  • reduces mucous production, sneezing, and rhinorrhea
  • rhinosinusitis
  • hours
  • works worse than 1st generation due to there lesser anticholinergic properties
71
Q

URI: treatment

phenylephrine (Neo-Synephrine): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits

A
  • oral decongestant
  • relieve rhinorrhea and nasal congestion
  • rhinosinusitis
  • hours
72
Q

URI: treatment

pseudoephedrine (Sudafed): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits

A
  • oral decongestant
  • relieve rhinorrhea and nasal congestion
  • rhinosinusitis
  • hours
73
Q

URI: treatment

ipratropium nasal spray (Atrovent Nasal): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments

A
  • topical nasal decongestant
  • relieves rhinorrhea and nasal congestion
  • rhinosinusitis
  • hours
  • benefit varies by pt
74
Q

URI: treatment

oxymetazoline nasal spray (Afrin): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments

A
  • topical nasal decongestant
  • relieves rhinorrhea and nasal congestion
  • rhinosinusitis
  • hours
  • benefit varies by pt; use for as little as 3 days may lead to rebound nasal congestion (rhinitis medicamentosa), so it should be recommended with caution
75
Q

URI: treatment

nasal saline lavage/irrigation (Neti pot, etc.): purpose, symptomatic treatment for what symptom, duration of benefits, comments

A
  • nasal passage irrigation
  • rhinosinusitis
  • none
  • no evidence of reduced duration or symptoms;may provide symptom relief for some; cleaning pot and boiling water important to avoid introducing bacterial infection
76
Q

URI: treatment

nasal steroid spray: symptomatic treatment for what symptom, duration of benefits, comments

A
  • rhinosinusitis
  • temporary
  • conflicting evidence of benefit
77
Q

URI: treatment

saline spray: symptomatic treatment for what symptom, duration of benefits, comments

A
  • rhinosinusitis
  • none
  • no clinical evidence of benefit
78
Q

URI: cough management

symptomatic relif by

A

keeping the throat moist (by drinking wamr liquids and sucking on cough drops)

79
Q

URI: cough management

nocturnal cough, when occuring in association with a URI, may be the result of

A

post-nasal drip

80
Q

URI: cough managment

reducing mucus drainage through the use of __ and __

A
  • antihistamines
  • nasal decongestants (such as phenylephrine and pseuoephedrine)
81
Q

URI: cough management

over-the-counter cough syrups containing __ may also provide relief, including supressing __ cough

A
  • dextromethorphan
  • nocturnal
82
Q

URI: treatment

stop smoking/avoid second-hand smoke: symptomatic treatment for what symptom, duration of benefits

A
  • cough
  • long-term benefits
83
Q

URI: treatment

oral fluids: symptomatic treatment for what symptom, comments

A
  • cough
  • may reduce thraot irritation and cough
84
Q

URI: treatment

dextromethorpan: type of drug, duration of benefits, comments

A
  • cough suppressant
  • hours
  • may help with symptoms in some pts
85
Q

URI: treatment

carbetapentane: type of drug, duration of benefits, comments

A
  • cough suppressant
  • hours
  • may help with symptoms in some pts
86
Q

URI: treatment

benzonatate: type of drug, duration of benefits, comments

A
  • cough suppressant
  • hours
  • may help with symptoms in some pts
87
Q

URI: treatment

phenylephrine: type of drug, duration of benefits, comments

A
  • oral decongestant (symptomatic treatment for cough)
  • hours
  • may reduce post-nasal drip associated cough
88
Q

URI: treatment

pseudoephedrine: type of drug, duration of benefits, comments

A
  • oral decongestant (symptomatic treatment for cough)
  • hours
  • may reduce post-nasal drip associated cough
89
Q

URI: treatment

cough drops: symptomatic treatment for what symptom, duration of benefit

A
  • cough
  • brief relief
90
Q

URI: treatment

guaifenesin: type of drug, comments

A
  • mucolytics (for treatment of cough)
  • may improve expectoration of mucous build-up (little clincial data of benefit)
91
Q

URI: treatment

air humidifier: symptomatic treatment for what symptom, comments

A
  • cough
  • may help to maintain upper airway moisture and reduce throat irritation
92
Q

URI: treatment

beta-agonist MDI (albuterol): routes, symptomatic treatment for what symptom

A
  • oral, inhalational, IV
  • cough
93
Q

URI: management

non-steroidal anti-inflammatory drugs (NSAIDs) may help with these 3 symptoms

A
  1. sore throat
  2. headache
  3. fever
94
Q

URI: sore throat management

a varieity of supplements and naturopathic prodcuts have been promoted for treatment of URI, includine __ (3), none of which have consistently demonstrated efficacy in blinded studies

A
  1. vitamin C
  2. zinc
  3. Echinacea
95
Q

URI: treatment

acetaminophen/ibuprofen: type of drug, duration of benefits, comments

A
  • oral analgesics (for fever, sore throat)
  • 6 hours
  • Ibuprofen superior in some studies
96
Q

URI: treatment

Demulcents (soothing topical preparations/lozenges usually with menthol, e.g. Cepacol): symptomatic treatment for what symptom, duration of benefits

A
  • sore throat
  • 30 minutes
97
Q

URI: treatment

demulcents with lidocaine/benzocaine: symptomatic treatment of what symtom, duration of beneefits

A
  • sore throat
  • 1+ hours
98
Q

URI: treatment

dexamethasone: dose, symptomatic treatment for what symptom, comments

A
  • 10 mg po qd for 1-3 days
  • sore throat
  • reduces symptom duration in multiple randomized clinical trials; however, potential adverse effects of steroids limit this treatment
99
Q

URI: treatment

zinc lozenges: how long taken, symptomatic treatment for what symptom, comments

A
  • every 2 hours while awake
  • sore throat
  • data suggesting possible benefit with use of zinc lozenges soon after symptom onset; in a recent meta-analysis, 2 of 6 studies included reduction in symptom duration and severity
100
Q

URI: treatment

these 4 treatments show brief duration of benefits when treating sore throat

A
  1. salt water gargle
  2. gargle of cayenne, black pepper, (long list of herbal remedies): no evidence of lasting benefit
  3. drinking wam liquids
  4. tea with honey or whisky: untested (some suggestion that honey may reduce cough)
101
Q

URI: treatment

these 2 treatments for sore throat who no duration/evidence of benefit

A
  1. Echinacea
  2. vitamin C
102
Q

URI: prevention

T or F: vitamin C and Echinacea reduce the risk of infection with a symptomatic URI

103
Q

URI: prevention

__ is the highly efficacious method of reducing URI related illness

A

fastidious hand hygeine

104
Q

URI: prevention

washing hands and keeping them away from eyse and mouth reduces frequency of URI by approx. __%

105
Q

URI: American College of Physicians position statement

__ should not be used to treat nonspecific URIs in previously healthy adults

A

antibiotics

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