URIs Flashcards
What is the next step in treatment of acute bronchitis ( inflammation of the tracheobronchial tree)?
- Bronchodilators
- Analgesics
- Antitussives
What are common etiologies of cough?
- Asthma
- COPD
- Malignancy
- Post nasal drip
- GERD
- Medication side effect
- Congestive heart failure
What type of respiratory illness is pneumonia?
- Lower respiratory infection
What are indications of chest xray in bronchitis?
- Dullness to percussion
- History of fever
- Clinical suspicion of pneumonia
What viruses commonly cause bronchitis?
- Influenza, parainfluenza, adenovirus, rhinovirus
What bacteria can cause bronchitis?
- Chlamydia pneumoniae and Mycoplasma pneumoniae
What is the most common symptom in bronchitis?
- Cough productive of purulent sputum; color of sputum is not diagnostic of bacterial infection
What signs may help point towards a diagnosis of bacterial vs. viral (rhino) sinusitis?
- Viral 7 days in adults; 10 days in children
- purulent nasal discharge
- maxillary tooth or facial pain
- unilateral maxillary sinus tenderness
What organisms are most commonly responsible for bacterial sinusitis in adults?
- Streptococcus pneumoniae
- Haemophilus influenzae
What organisms are most commonly responsible for bacterial sinusitis in children?
- H. influenzae
- Strep. pneumoniae
- Moraxella catarrhalis
- Anaerobic organisms more common in chronic sinusitis
What are the treatments for bacterial sinusitis?
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
What is the etiology of most pharyngitis in adults?
- Viral
What is pharyngitis?
- inflammation or irritation of the pharynx and/or tonsils
What is (rhino)sinusitis?
- inflammation/infection of the nasal mucosa and of 1+ of the paranasal sinuses
What are common bacterial causes of pharyngitis in teens and young adults?
- Mycoplasma pneumonia
- Chlarmydia pneumonia
- Arcanobacterium haemolyticus
What is the impact of Group A Strep in adult and pediatric cases of pharyngitis?
- 15% of all adult cases of pharyngitis
- 30% of all pediatric cases of pharyngitis
What is the most likely origin/etiology of pharyngitis with sore throat, cough, and rhinorrhea?
- Viral
What are the common symptoms of GAS infection?
- Abrupt onset of sore throat and fever
- Tonsillar and/or palatal petechia
- Tender cervical adenopathy
- No cough
- Erythematous, sandpaper rash
What infection is hard to discriminate from GAS?
- EBV mononucleosis
- exudative pharyngitis is prominent
- retrocervical or generalized adenopathy
- Hepatosplenomegaly
- Atypical lymphocytes on blod smear
What symptoms indicate epiglottitis?
- Stridor
- Drooling
- Toxic appearance
- Leaning forward on outstretched arms
- often due to H. influenza B
What diagnostic test should be done after a negative rapid antigen test for GAS?
- Throat culture (can take 24-48hrs)
What sequelae are associated with untreated GAS infection?
- rheumatic fever
- glomerulonephritis (can occur even with abx treatment)
- toxic shock
- peritonsillar abscess
- meningitis
- bacteremia
How should GAS infection be treated?
- Penicillin
What bacteria is often responsible for “swimmer’s ear” or otitis externa?
- Pseudomonas aeruginosa
How is otitis externa treated?
- Topical abx
- steroid
- patients with diabetes are at higher risk for invasive external otitis (surgical debridement and IV abx)
What are common symptoms of otitis media?
- Fever
- Ear pain
- Diminished hearing
- Vertigo
- Tinnitus
- Erythematous tympanic membrane
- Middle ear effusion (fluid behind ear) or decreased membrane mobility are NECESSARY for diagnosis
What are the most common pathogens for otitis media?
- S. pneumoniae
- H. influenzae
- M catarrhalis
What is the treatment for otitis media?
- Most cases of otitis media remit on their own
- Tx should be given in severe cases, cases of reccurence, prolonged cases, and in children
What are the potential complications of pneumonia?
- bacteremia
- sepsis
- parapneumonic pleural effusion
- empyema
What clues would indicate the severity of a URI?
- toxic appearance
- using accessory muscles to breath
- low oxygen saturation
What signs/symptoms might indicate that a patient with a respiratory illness should be hospitalized?
- tachycardia
- hypotension
- altered mentation
A patient in respiratory distress should have what lab quickly checked?
- Arterial blood gases
What is the gold standard for diagnosis of pneumonia?
- Chest x ray
What might a consolidation not appear in a patient with pneumonia?
- dehydration
What are the most common causes of community acquired pneumonia?
- Streptococcus pneumonia ( rust colored sputum with quick onset)
- Haemophilus influenzae ( often in patients with underlying COPD)
- Moraxella catarrhalis
What organisms are generally responsible for atypical/walking pneumonia?
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella pneumophila
- Viruses
- More common in adolescent and young adults
How might an atypical pneumonia present differently on x ray than typical pneumonia?
- Atypical pneumonia => bilateral, diffuse infiltrates
- Typical => focal, lobar infiltrates
What are the risk factors for hospital acquired pneumonia?
- intubation
- nasogastric tube feeding
- preexisting lung disease
- multisystem failure
What organisms are typically involved in hospital acquired pneumonia?
- CAP organisms
- aerobic gram negatives: Pseudomonas, Klebsiella, Acinetobacter and Staphylococcus aureus
What organism also causes diarrheal as well as pneumonia symptoms?
- Legionella
What is a common cause of post influenza pneumonia?
- Staph. aureus
Interpret the following signs in pneumonia:
- Egophony (E->A change)
- Dullness to percussion
- Egophony (E->A change) => sign of focal lung consolidation
- Dullness to percussion => pulmonary effusion
A ground glass appearance of the lungs on chest x ray like points to what organism in what patient population?
- Pneumocystis jiroveci, often in AIDS patients
What would normally be seen on xray in aspiration pneumonia?
- Aspiration pneumonia of GI contents would be seen in the right lower lobe
What respiratory infection demonstrates apical consolidation?
- TB (requires more O2 to grow)
What is the recommended empiric therapy for CAP?
- Macrolide (clarithromycin or azithromycin) or doxycycline
What is the empiric therapy for hospitalized patients who do NOT require ICU treatment?
- IV beta lactam (cephalosporin or amipicillin-sulbactam)
AND - IV macrolide (erythromycin, azithromycin)
When should an outpatient with pneumonia return to be assessed?
- 3-4 days
What is the next step for the presence of empyema in pneumonia?
- drainage with a chest tube or surgical procedure
Who is recommended to get the pneumococcal vaccine?
- 65+
- All adults with cardiopulmonary diseases
- All immunocompromised persons
What patients may require re-vaccination?
- Low antibody titers => nephritic syndrome or renal failure
- Asplenic patients
