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Family Medicine Clerkship- Case files > URIs > Flashcards

URIs Flashcards

1
Q

What is the next step in treatment of acute bronchitis ( inflammation of the tracheobronchial tree)?

A
  • Bronchodilators
  • Analgesics
  • Antitussives
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2
Q

What are common etiologies of cough?

A
  • Asthma
  • COPD
  • Malignancy
  • Post nasal drip
  • GERD
  • Medication side effect
  • Congestive heart failure
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3
Q

What type of respiratory illness is pneumonia?

A
  • Lower respiratory infection
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4
Q

What are indications of chest xray in bronchitis?

A
  • Dullness to percussion
  • History of fever
  • Clinical suspicion of pneumonia
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5
Q

What viruses commonly cause bronchitis?

A
  • Influenza, parainfluenza, adenovirus, rhinovirus
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6
Q

What bacteria can cause bronchitis?

A
  • Chlamydia pneumoniae and Mycoplasma pneumoniae
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7
Q

What is the most common symptom in bronchitis?

A
  • Cough productive of purulent sputum; color of sputum is not diagnostic of bacterial infection
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8
Q

What signs may help point towards a diagnosis of bacterial vs. viral (rhino) sinusitis?

A
  • Viral 7 days in adults; 10 days in children
    • purulent nasal discharge
    • maxillary tooth or facial pain
    • unilateral maxillary sinus tenderness
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9
Q

What organisms are most commonly responsible for bacterial sinusitis in adults?

A
  • Streptococcus pneumoniae

- Haemophilus influenzae

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10
Q

What organisms are most commonly responsible for bacterial sinusitis in children?

A
  • H. influenzae
  • Strep. pneumoniae
  • Moraxella catarrhalis
  • Anaerobic organisms more common in chronic sinusitis
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11
Q

What are the treatments for bacterial sinusitis?

A

1) Amoxicillin and TMP/SMX
2) (fail initial treatment or severe disease) Amoxicillin + clavulanic acid, cephalosporins, fluroquinolones, or macrolides
3) Adjunct therapy: decongestants, NSAIDs, and acetaminophen

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12
Q

What is the etiology of most pharyngitis in adults?

A
  • Viral
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13
Q

What is pharyngitis?

A
  • inflammation or irritation of the pharynx and/or tonsils
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14
Q

What is (rhino)sinusitis?

A
  • inflammation/infection of the nasal mucosa and of 1+ of the paranasal sinuses
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15
Q

What are common bacterial causes of pharyngitis in teens and young adults?

A
  • Mycoplasma pneumonia
  • Chlarmydia pneumonia
  • Arcanobacterium haemolyticus
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16
Q

What is the impact of Group A Strep in adult and pediatric cases of pharyngitis?

A
  • 15% of all adult cases of pharyngitis

- 30% of all pediatric cases of pharyngitis

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17
Q

What is the most likely origin/etiology of pharyngitis with sore throat, cough, and rhinorrhea?

A
  • Viral
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18
Q

What are the common symptoms of GAS infection?

A
  • Abrupt onset of sore throat and fever
  • Tonsillar and/or palatal petechia
  • Tender cervical adenopathy
  • No cough
  • Erythematous, sandpaper rash
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19
Q

What infection is hard to discriminate from GAS?

A
  • EBV mononucleosis
    • exudative pharyngitis is prominent
    • retrocervical or generalized adenopathy
    • Hepatosplenomegaly
    • Atypical lymphocytes on blod smear
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20
Q

What symptoms indicate epiglottitis?

A
  • Stridor
  • Drooling
  • Toxic appearance
  • Leaning forward on outstretched arms
  • often due to H. influenza B
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21
Q

What diagnostic test should be done after a negative rapid antigen test for GAS?

A
  • Throat culture (can take 24-48hrs)
22
Q

What sequelae are associated with untreated GAS infection?

A
  • rheumatic fever
  • glomerulonephritis (can occur even with abx treatment)
  • toxic shock
  • peritonsillar abscess
  • meningitis
  • bacteremia
23
Q

How should GAS infection be treated?

A
  • Penicillin
24
Q

What bacteria is often responsible for “swimmer’s ear” or otitis externa?

A
  • Pseudomonas aeruginosa
25
Q

How is otitis externa treated?

A
  • Topical abx
  • steroid
  • patients with diabetes are at higher risk for invasive external otitis (surgical debridement and IV abx)
26
Q

What are common symptoms of otitis media?

A
  • Fever
  • Ear pain
  • Diminished hearing
  • Vertigo
  • Tinnitus
  • Erythematous tympanic membrane
  • Middle ear effusion (fluid behind ear) or decreased membrane mobility are NECESSARY for diagnosis
27
Q

What are the most common pathogens for otitis media?

A
  • S. pneumoniae
  • H. influenzae
  • M catarrhalis
28
Q

What is the treatment for otitis media?

A
  • Most cases of otitis media remit on their own

- Tx should be given in severe cases, cases of reccurence, prolonged cases, and in children

29
Q

What are the potential complications of pneumonia?

A
  • bacteremia
  • sepsis
  • parapneumonic pleural effusion
  • empyema
30
Q

What clues would indicate the severity of a URI?

A
  • toxic appearance
  • using accessory muscles to breath
  • low oxygen saturation
31
Q

What signs/symptoms might indicate that a patient with a respiratory illness should be hospitalized?

A
  • tachycardia
  • hypotension
  • altered mentation
32
Q

A patient in respiratory distress should have what lab quickly checked?

A
  • Arterial blood gases
33
Q

What is the gold standard for diagnosis of pneumonia?

A
  • Chest x ray
34
Q

What might a consolidation not appear in a patient with pneumonia?

A
  • dehydration
35
Q

What are the most common causes of community acquired pneumonia?

A
  • Streptococcus pneumonia ( rust colored sputum with quick onset)
  • Haemophilus influenzae ( often in patients with underlying COPD)
  • Moraxella catarrhalis
36
Q

What organisms are generally responsible for atypical/walking pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophila
  • Viruses
  • More common in adolescent and young adults
37
Q

How might an atypical pneumonia present differently on x ray than typical pneumonia?

A
  • Atypical pneumonia => bilateral, diffuse infiltrates

- Typical => focal, lobar infiltrates

38
Q

What are the risk factors for hospital acquired pneumonia?

A
  • intubation
  • nasogastric tube feeding
  • preexisting lung disease
  • multisystem failure
39
Q

What organisms are typically involved in hospital acquired pneumonia?

A
  • CAP organisms

- aerobic gram negatives: Pseudomonas, Klebsiella, Acinetobacter and Staphylococcus aureus

40
Q

What organism also causes diarrheal as well as pneumonia symptoms?

A
  • Legionella
41
Q

What is a common cause of post influenza pneumonia?

A
  • Staph. aureus
42
Q

Interpret the following signs in pneumonia:

  • Egophony (E->A change)
  • Dullness to percussion
A
  • Egophony (E->A change) => sign of focal lung consolidation

- Dullness to percussion => pulmonary effusion

43
Q

A ground glass appearance of the lungs on chest x ray like points to what organism in what patient population?

A
  • Pneumocystis jiroveci, often in AIDS patients
44
Q

What would normally be seen on xray in aspiration pneumonia?

A
  • Aspiration pneumonia of GI contents would be seen in the right lower lobe
45
Q

What respiratory infection demonstrates apical consolidation?

A
  • TB (requires more O2 to grow)
46
Q

What is the recommended empiric therapy for CAP?

A
  • Macrolide (clarithromycin or azithromycin) or doxycycline
47
Q

What is the empiric therapy for hospitalized patients who do NOT require ICU treatment?

A
  • IV beta lactam (cephalosporin or amipicillin-sulbactam)
    AND
  • IV macrolide (erythromycin, azithromycin)
48
Q

When should an outpatient with pneumonia return to be assessed?

A
  • 3-4 days
49
Q

What is the next step for the presence of empyema in pneumonia?

A
  • drainage with a chest tube or surgical procedure
50
Q

Who is recommended to get the pneumococcal vaccine?

A
  • 65+
  • All adults with cardiopulmonary diseases
  • All immunocompromised persons
51
Q

What patients may require re-vaccination?

A
  • Low antibody titers => nephritic syndrome or renal failure

- Asplenic patients

Family Medicine Clerkship- Case files (13 decks)

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