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URT infections Flashcards

1
Q

the common cold

A

rhinovirus vs. coronavirus

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2
Q

the most common agent of the common cold is..

A

rhinovirus THEN coronavirus

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3
Q

ddx allergic rhinitis

A

blue-colored nasal passages
clear, serous fluid-colored rhinorrhea
“nasal salute”
itchy, serous discharge conjunctivitis

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4
Q

ddx purulent rhinitis

A

lasts longer: 14 d (vs. 4-5)
thicker, denser rhinorrhea
caused by Hib
DO NOT USE ABX

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5
Q

coronavirus is enveloped, therefore

A

does not survive as long in the environment (no fomite transfer)

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6
Q

period of incubation is shorter in..

A

Rhinovirus (poss. hrs) vs coronavirus (3 days)

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7
Q

most important Ab for Rhinovirus* viral immunity is

A

IgA2 (but only short term immunity)

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8
Q

rhinovirus uses this as cell surface receptor

A

ICAM-1

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9
Q

is fever seen in rhinovirus or coronavirus?

A

rarely

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10
Q

other viral agents that cause infectious rhinitis

A 
influenza v type C 
adenovirus
RSV
influenza v type A or B
PIV
hMPV
other enteroviruses
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11
Q

bacterial infections that can cause rhinitis

A

Bordetella pertussis
Mycoplasma pneumoniae
Chlamydia pneumoniae

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12
Q

DO NOT want to use ASA in children bc

A

could cause Reye’s syndrome if influenza virus, VZV?

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13
Q

Moraxella catarrhalis

A

G-diplococci, kidney bean, non-encap, non-staining, Ox +
3rd most common cause of AOM
3rd: BAC cause of acute sinusitis
3rd: BAC cause of AE-CB or COPD/emphysema
imp. LRTI (tracheitis–>pneumonia)

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14
Q

viral agents of sinusitis

A

Rhinovirus
Influenza V
PIV

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15
Q

bac agents of sinusitis

A

Strep pneumonia
NTHi
Moraxella catarrhalis (N. or B.)

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16
Q

unique risk factor for sinusitis

A

Prim. ciliary dyskinesia (PCD) aka immotile ciliary syndrome or Kartagener syndrome (KS)

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17
Q

main pathogenic event

A

closure of sinus ostia

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18
Q

most common sinus of sinusitis

A

Maxillary, then ethmoid, frontal, sphenoid (MEFS)

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19
Q

fever with sinusitis?

A

may have low grade fever

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20
Q

purulent nasal discharge in sinusitis implies

A

bac. etiology, GIVE ABX

other bac. signs: sig. pain, prolonged duration (>7-10 d)

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21
Q

acute sinusitis can become a medical emergency if spread to

A

eye
bone
CNS

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22
Q

xray for sinusitis?

A

subj. decision, cannot distinguish btw viral, allergic, bac.

* is a MUST if complications suspected

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23
Q

dx tenderness over CN V…

A

CN V2 for maxillary sinusitis, CN V1 for others

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24
Q

acute sinusitis is tx w/

A

abx: amoxicillin, amoxicillin-clavulanic acid (Augmentin)
*BUT should be w.held for 10-14 d unless sev. symps : use analgesics, decongestants and “watchfully wait”
DO NOT use antihistamines unless allergic rhinitis
Hypertonic saline nasal irrigation (HSNI)

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25
most common causes of OE
Pseudomonas*, staphylococci (coag +/-) fungi
26
OE: pus? TM involved? fever?
possibly to all, if TM, no fluid should be behind, if there is -->OE + AOM
27
OE: syst. abx?
NO, local topical abx +/- cortisone
28
AOM agents: ALL BACTERIA
*Streptococcus pneumoniae (G+ lancet diplococci) *NTHi (G- coccobacilli) *Moraxella catarrhalis (G- diplococci) GABHS (S. pyogenes) and S. aureus (coag+) Mycoplasma pneumoniae and Chlamydia pneumoniae *no viral cause, but virus may be present
29
AOM: pus?
YES; bac inf; it is pyogenic
30
OME: pus?
NO; serous fluid, biofilm (chron. bac inf)
31
AOM ddx
``` fever bulging, opaque, immobile TM otorrhea (discharge) if perf. TM worse complications: can lead to OME hearing impairment, TM rupture, Mastoiditis ```
32
OME ddx
NO FEVER TM MAY BE NORMAL serous fluid in middle ear (air bubbles, fluid) otorrhea (serous fluid) if perf. TM
33
AOM: abx?
complicated: 80% resolve spont., otherwise amoxicillin, augmentin if failure - need other meds for pain relief
34
OME: abx?
not unless chronic (>4 mos) | will not help serous effusion
35
AOM: prevention?
yes: 1. Prevenar 7-valent and 13-valent conjugated vaccine - prev. inv. pneumococcal disease, pneumo, mening, bacteremia 2. Influenza trivalent inact. vaccine (TIV), LAIV (live atttnd intranasal vaccine) 3. S. pneumo 23 valent polysacc. vaccine: Pneumovax/Pneu-imune
36
acute myringitis ddx
same bac agents as AOM +/- viral agents TM inflammation may occur ALONE or w/ OE or OME bullous: blisters or hemorrhagic
37
rhinovirus and coronavirus can cause "pharyngitis" but do not
replicate in pharyngeal tissue
38
these viruses can replicate in pharyngitis
Adenovirus and Strep pyogenes
39
the primary agent of pharyngitis (URI) and 3rd most common cause of LRI in children
Adenovirus (non-env.) A-->F (Ad7 *) most commonly affect kids
40
main causes of LRIs
1. RSV 2.PIV 3. Adenovirus* 4.hMPV | * most severe and highest mortality rate (esp. pneumonia)
41
adenovirus: causes fever?
yes, also cause of pharyngoconjunctival fever (PCF): summer, swimming pools
42
adenovirus s/s indistinguishable from
Strep pyogenes infection (GAS) | both: fever, tonsillar exudates, ANT. cerv. lymphadena
43
pharyngitis is more likely to be viral if
temp is lower, coryza and cough are present, no N/V/abd pn | tx: DO NOTHING; self-limiting (3-7 days)
44
adenovirus can cause LRT disease that looks like
Pertussis
45
if adenovirus, will observe these on microscopic observation
mononuclear infiltrates (lymphocytes and monocytic cells)
46
Streptococcus pyogenes
``` G+ cocci in chains aerotolerant anaerobe Catalase neg B-hemolytic (GAS or GABHS) ```
47
S. pneumoniae
a-hemolytic; causes pneumo, mening, OM, sinusitis, septicemia, conjunc.
48
S. agalactiae
B-hemolytic: causes neonatal septicemia w. pneumo and mening
49
S. mutans, S. mitis
a-hemolytic Strep; NF of mouth and l. int, causes dental caries, infective endocarditis
50
GABHS causes suppurative (pus-producing) disease
pharyngitis, OM, sinusitis, mastoiditis, pneumo | -impetigo, ecthyma, erysipelas, cellulitis, necrotizing fasciitis
51
GABHS causes non-suppurative, immunpath-med disease
RF, PSRA, PANDAS, AGN
52
GABHS causes exotoxin-mediated disease (superAgs)
scarlet fever, STSS
53
the most common cause of BACTERIAL pharyngitis
S. pyogenes (GABHS) **still less common than viral pharyngitis (Ad)
54
pharyngitis from GAS: self-limiting? tx??
it IS self-limiting, BUT YOU NEED TO TX: want to prevent spread, reduce duration (NOT throat pain), and **prevent agains RH or AGN by suppressing host's self-limiting imm resp. against GAS (can lead to RH or AGN) tx: PNC V or cephalosporins for hypersn. pts: eryth, linco, clindamycin *also want to treat bac/fungal inf. bc they may not be self-limiting
55
non-suppurative sequelae of GAS
RF: heart (carditis), skin (nodules), joints (arthritis), CNS (chorea), FEVER AGN: follow phary. or integumental inf., TIII hypersn., self-limiting
56
RF tx
bed rest, benzathine penicillin G or procaine penicillin | sympto: salicylates (ASA)
57
PANDAS
ADHD, Tourett's, OCD, tic disorder
58
Scarlet fever caused by
GAS w/ SPEs (strep pyrogenic exotoxins) complication of pharyng. and integumental inf. exanthem: scarlatiniform "sand-paper" rash enanthem: petechia on palate, bleeding, red strawberry tongue tx to prevent RF/AGN
59
Lemierre syndrome
``` thrombophlebitis of IJV-->septic emboli-->lung, brain, joints Fusobacterium necrophorum (G- bacillus, ob. anaerobe) ```
60
Corynebacterium diphtheriae
G+ rods, may be club shaped (diphtheroids) aerobic *non-invasive
61
this is req. for diphtheria ("throat distemper")
exotoxin production: reg by [Fe]: opposite reg inhibits protein synthesis-->cell death via necrosis-->inflammatory reaction-->fibrinous exudate-->pseudomembrane forms, edema ("bull neck")-->non-invasive but **toxemia** (the toxin, not bacteremia) can occur
62
fever in diphtheria?
yes, low grade
63
diphtheria: pseudomembrane
gray-black, not pathognomonic (cerv. adenines, GAS)
64
how to dx diphtheria
clinical findings, Gs ("chinese char." G+rods), Cx, Elek test to demonstrate toxigenic
65
diphteria tx
maintain airways, antitoxin abs, abx (PCN G, eryth) as adjunct
66
Haemophilus influenza
most common cause of *acute epiglottitis*-AE (Hib) | 2nd to S. pneumo for OM, sinusitis (NTHi)
67
H. flu type aegyptius assoc. w/
conjunct, Brazilian purpuric fever
68
H. influenza character
v. small G-coccobacilli, ox + (pleomorph in CSF) anti-phago capsule, type b is most important: strain (PRP) : Hib grows on chocolate agar
69
Hib is a frank pathogen, in contrast to..
NTHi: NF of nasopharynx
70
non-invasive NTHi diseases
OM, sinusitis, conjunc/conjunc-OM synd, bronchitis and pneumo
71
invasive Hib diseases
mening, bacterimia, facial cellulitis, septic arthritis, secondary bacterial pneumo
72
AE: fever?
YES +"air hunger" +insp. stridor + "barking/hot potato voice" + "bull neck"+ "thumb sign" + SUPRAglottic edema + beefy red epiglottis w. purulence
73
AE org dx
FIRST MAINTAIN AIRWAY *med emergency* | -Hib, then pneumococcus, then GAS
74
AE tx
after airway maintained | cefuoxime, cefotaxime, ceftriaxone, TMP-SMX
75
Hib vaccine... | so now use..
are type II-T-independent so: IgM only, no memory (short term imm.), not protective in kidsswitch to sIgA2, induce memory (B cells), rec. @ 2mos *don't bundle w/dTap
76
other causes of sinusitis: fungal
aka Rhinocerebral mucormycosis

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