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Pulm > URT infections > Flashcards

URT infections Flashcards

1
Q

URT anatomy and defenses

A
  • Everything above the trachea
  • Waldeyer’s ring is a circle of lymphatic tissue in pharynx, includes adenoids (pharyngeal), palatine, lingual and tubal tonsils
  • These tissues are NALT: nasal associated lymphoid tissue
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2
Q

Pharyngitis

A
  • Inflammation/infection of the mucous membranes and underlying parts of the pharynx
  • Sx: throat pain, pain on swallowing, fever, headache, malaise, mouth breathing, snoring, sleep apnea
  • Signs: eythema, exudates, vesicles/ulcerations, tonsillar enlargement, peritonsillar swelling, deviation of uvula
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3
Q

Examples of pharyngitis Dx

A
  • Small vesicles in posterior pharynx should suggest herpangina due to cox-sackie (enterovirus)
  • Pharyngitis w/ conjunctivitis (pharyngoconjunctival fever) suggests adenovirus
  • Erythema and/or exudates suggests step pyogenes or EBV
  • Diffuse LAD with pharyngitis suggests EBV or CMV
  • Sarlatiniform rash suggests scarlet fever from strep pyogenes
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4
Q

Viral URTI

A
  • Commonly found in children, those in close living quarters, they are highly transmissible via fomites/droplets
  • They inoculate mucosal surfaces and spread over them causing local and systemic inflammation
  • SxL rhinitis, congestion, malaise, myalgia, arthralgia, pharyngitis, cough, fever
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5
Q

Examples of URTI Dx

A
  • Croup suggests parainfluenza
  • Herpangina suggests coxsackie or other enteroviruses
  • Conjunctivitis suggests adenoviruses
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6
Q

Sinusitis

A
  • Risk factors: septal deviation, atopic disease, immunodeficiency
  • Acute sinusitis can result from URI causing obstruction to sinus drainage
  • Leading causes: Strep pneumo, H influenza, moraxella catarrhalis, staph aureus, strep pyogenes
  • In immunocompromised patients think mucormycosis for DM/neutropenic patients and aspergillus in neutropenic patients
  • Sx of sinusitis: facial pain, fever, strange smell/taste, post-nasal drip
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7
Q

Rx of sinusitis

A
  • Irrigation, analgesics and decongestants
  • Antibios: amoxicillin (+/- clavulanate) for first line
  • Steroids can be considered
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8
Q

Complications of sinusitis

A
  • Asthma exacerbations
  • Erosion of bony walls into adjacent structures/spaces
  • This can cause orbital cellulitis, subdural empyema, potts puffy tumor, brain abscess
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9
Q

Otitis media

A
  • Inflammation of the middle ear, organisms enter usually thru eustachian tube to infect middle ear mucosa
  • Pts w/ impaired mucocilliary clearance due to obstruction (think children w/ not fully developed eustachian tubes)
  • Other risk factors: URTIs, smoking
  • Sx in infant: fever, vomiting, fussiness, poor feeding
  • Sx in older child: ear pain and similar Sx
  • Dx by otoscopy: dullness, absent light reflex, bulging/retraction of tympanic membrane
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10
Q

Microbiology of otitis media

A
  • Strep pneumo is most common
  • Followed by H flu, moraxella catarrhalis
  • Rx would be amoxicillin (+/- clavulanate), cephalosporins, azithromycin
  • Clavulanate does not overcome pneumococcal penicillin resistance
  • Complications: chronic serous otitis media, hearing loss, learning problems, mastoiditis, brain abscess, meningitis, bacteremia, sinus thrombosis
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11
Q

Mastoiditis

A
  • Infection of the mastoid air cells
  • Sx: fever, ear/posterior ear pain, swelling, tenderness, fluctuance over mastoid, subperiosteal abscess
  • In older children mass is felt behind ear and pushes pinna up and out
  • In infants its felt above the ear, pushing pinna down and out
  • Principle causes: strep pneumo/pyogenes, also consider: staph aureus
  • In chronic cases think anaerobes and pseudomonas
  • Rx is surgical management
  • Complications: sinus thrombosis, subdural empyema, brain abscess, bacteremia, periosteal abscess, epidural abscess, osteomyelitis of skull
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12
Q

Herpangina

A
  • Due to coxsackie enterovirus, generally occurs in young children
  • Characerized by sudden fever, malaise, dysphagia, refusal to eat
  • Exam: discrete painful small vesicles surrounded by erythema in posterior oropharynx, may ulcerate to yellow-gray ulcers
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13
Q

Strep throat

A
  • Strep pyogenes pharyngitis: erythematous pharynx w/ patchy white exudates on tonsils and posterior pharynx, eden of uvula, tender enlarged cervical LNs
  • Rx w/ antibios (PCNs, macrolides, cephs) will reduce morbidity and prevent rheumatic fever
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14
Q

Scarlet fever

A
  • Cause by strep pyogenes (beta-complete-hemolysis) exotoxin

- Characterized by erythematous sand paper rash, strawberry tongue, pallor around mouth, red (pastia’s) lines

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15
Q

Peritonsillar infections

A
  • Quinsy= abscess in peritonsillar tissue
  • Manifestations: includes fever, severe throat pain, hot potato voice
  • Signs: peritonsillar swelling/edema, deviation of uvula to contralateral side, trismus (lockjaw), inability to fully open mouth
  • Causes: strep pyogenes, strep viridans, staph aureus, oral anaerobes
  • More common in adolescents, while parapharyngeal and retropharyngeal infections more common in childhood
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16
Q

Parapharyngeal and retropharyngeal infections

A
  • More common in younger children, similar etiologies w/ peritonsillar infections
  • These infections can teach down neck spaces to the thorax
17
Q

Deep neck space abscess

A
  • Puss btwn fascial planes of the neck
  • Manifestations: fever, sore throat, neck pain, torticollis (stiff bent neck), swelling, erythema, difficulty breathing, stridor
18
Q

Lemierre’s syndrome

A
  • Septic jugular thrombophelbitis associated w/ pharyngotonsillitis
  • Bacteria cross from pharynx into perivascular space
  • Manifestations: fever, lateral neck pain, erythema, tenderness, swelling, septic emboli
  • Usually due to fusobacterium necrophorum (anaerobic)
  • Rx: antibacterial w/ surgery to resect/ligate infected vein
19
Q

EBV

A
  • Mononucleosis: fever, malaise, fatigue, pharyngitis, LAD, hepatosplenomegaly/hepatitis, abnormal B cells on smear
  • Can Dx w/ rapid monospot test and Ab to IgM to viral capsid Ag (indicates acute infection)
  • Complications: respiratory compromise, autoimmune disease (guillain barre syndrome), splenic rupture w/ trauma, malignancy (burkitt’s nasopharyngeal CA, B cell lymphoma)
20
Q

Corynebacterium diphtheriae

A
  • Club-shaped GP bacillus, highly contagious (requires strict isolation)
  • Causes superficial mucosal and cutaneous infection
  • Manifestations: sore throat, low grade fever, hoarseness, shallow ulcers of nares and upper lip, dysphagia, grayish pseudomembrane in oropharynx, neck swelling, adenopathy
  • Palatal and hypopharyngeal paralysis causes suffocation
  • Can cause neuropathies, myocarditis is number one cause of death in diphtheria pts
  • Rx is antitoxin (diphtheria makes necrotic exotoxin) and antibacterial
21
Q

Croup

A
  • Refers to laryngotracheobronchitis: inflammation of the larynx and associated structures
  • Usually a condition of young children due to narrower airway
  • Caused by viral URIs, usually from parainfluenza which causes swelling of tissues or larynx and sublottic trachea
  • Results in airway narrowing
  • Manifests as barky cough, stridor
  • Usually benign and self-limited, but can cause respiratory arrest
  • Rx is supportive, things that improve Sx: cool mist/air, shower steam, racemic epinephrine and O2, single dose dexamethasone now
22
Q

Epiglottitis

A
  • A medical emergency because a swollen epiglottis can cause sudden airway obstruction, which can be induced by placing the pt in supine position
  • Manifestations: high fever, toxicity, stridor, guarded appearance, drooling, dysphagia, respiratory distress, pts assume characteristic posture of sitting upright w/ neck held in slight extension
  • Dx by appearance/Sx, and later CXR shows thumb sign of the epiglottis
  • Was caused by H flu type B, so incidence has gone down due to vaccine
  • Staph aureus, strep pneumo are now most common causes
  • Need to get pt a tracheostomy

Pulm (30 decks)

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