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PR3151 Finals > URTI > Flashcards

URTI Flashcards

1
Q

What are the 4 types of URTI?

A
  1. Common cold
  2. Influenza
  3. Pharyngitis
  4. Rhinosinusitis
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2
Q

Risk factors for URTI? (6)

A
  • Close contact with children: daycares and schools
  • Lack of personal/ hand hygiene
  • Medical disorder: chronic respiratory disease like asthma and allergic rhinitis
  • Smoking
  • Immunocompromised individuals (cystic fibrosis, HIV, use of corticosteroids, transplantation, post-splenectomy)
  • Anatomical anomalies (facial dysmorphic changes, nasal polyposis)
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3
Q

What are some risk factors of the pt we can manage to prevent URTI? (3)

A
  • Smoking cessation
  • Control asthma
  • Allergic rhinitis
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4
Q

Is common cold a bacterial or viral infection?

A

Viral

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5
Q

What are the clinical presentations of a common cold?

A
  • Low grade temp (~36.9 - 37°C)
  • Rhinorrhea
  • Blocked nose
  • Sneezing
  • Sore throat
  • Productive cough
  • Headache
  • Body ache
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6
Q

What are the likely pathogens of common cold? (2)

A

Rhinovirus, coronavirus

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7
Q

Tx for common cold?

Should we use abx?

A

Symptomatic relief.

DO NOT use abx!

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8
Q

Monitoring for common cold?

When should the pt see a doctor?

A
  • Self-limiting, most recover in 7-10 days
  • Feel better within 3-4 days, but s/sx can linger for few weeks
  • Normal for nasal discharge to change colour
  • Cough may last 2-3 weeks

See doctor if s/sx does not improve after 10 days/ worsen

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9
Q

Clinical presentation for influenza?

What about for elderly?

A
  • Fever
  • Chills
  • Headache
  • Malaise
  • Myalgia
  • Anorexia
  • Sore throat
  • Dry cough
  • Nasal discharge

Elderly may present with confusion

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10
Q

What are the complications that can happen with influenza?

What are the pathogens associated with the bacterial complication?

A
  • Primary viral pneumonia
  • Secondary bacterial pneumonia (most often Staph. aureus, Strep. pneumoniae and H. influenzae)
  • Exacerbation of chronic respiratory disease
  • Myocarditis
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11
Q

What kind of pts are at high risk for complications for influenza?

A
  • Children < 5 y/o
  • Elderly ≥ 65 y/o
  • Pregnancy/ within 2 weeks postpartum
  • Residents of nursing homes/ long-term care facilities
  • Obese individuals with BMI ≥ 40 kg/m2
  • Chronic medical conditions (eg asthma, COPD, HF, DM, CKD, immunocompromised)
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12
Q

When are diagnostics (nasopharyngeal swab or aspirate) for influenza required?

A

For hospitalised pts/ long term care pts.

Not commonly done for outpatient.

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13
Q

What are the likely pathogens for influenza?

Which one causes pandemics and is more common?

A

Human influenza A and B

Influenza A causes pandemics and is more common

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14
Q

What category of pts should we initiate antivirals for influenza ASAP?

When is the best time frame to initiate Tx?

A

Initiate ASAP from s/sx onset → best within first 48h, up to 5 days for:
- Hospitalised
- High-risk for complications
- Severe, complicated/ progressive illness

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15
Q

Is it necessary for outpatients with influenza to initiate Tx?

If so, what is the best time to initiate Tx?

A

Not necessary. Most pts do not need medical care or antiviral drug.

May be considered for outpatients who present within 48h of s/sx

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16
Q

First-line Tx for influenza?

Is dose adjusment needed? If so, what adjustments needed?

A

PO oseltamivir 75mg bid x 5d [Tamiflu]

Dose adjustment in renal impairment (CrCl < 60ml/min)

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17
Q

MOA of oseltamivir for influenza?

Is it active against both influenza A and B?

A
  • Active against influenza A and B
  • Neuraminidase inhibitor: interferes with protein cleavage → inhibits release of new virus
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18
Q

ADEs of oseltamivir for influenza?

A
  • Headache
  • GI discomfort (n/v)
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19
Q

When should (out)pts with influenza see a doctor?

What should we counsel them about the duration of the s/sx?

A
  • S/sx does not improve after 10 days
  • S/sx improved then worsened (ie new fevers, worsening dyspnea, cough)

Counsel pts s/sx last for a week

20
Q

What type of people are the influenza vaccine (IM) recommended for?

How long does it take to confer immunity?

A

Recommended for: ALL persons ≥ 6 months old, esp if high risk of complications

Takes 2 weeks to confer immunity

21
Q

Is pharyngitis bacterial or viral?

A

Both

22
Q

What are the general clinical presentations of bacterial and viral pharyngitis? (5)

A
  • Sore throat (worse with swallowing)
  • Fever
  • Erythema
  • Inflammation of pharynx and tonsils (with or without patchy exudates)
  • Tender, swollen lymph nodes
23
Q

Elaborate more on the clinical presentations of bacterial pharyngitis (4)

A
  • Sore throat
  • Tonsillar exudates*
  • Fever
  • Cervical lymphadenopathy without viral s/sx
24
Q

What is the criteria we can use to guide us to see whether there is a need to test for group A streptococcus or initiate abx Tx for bacterial pharyngitis?

A

Modified Centor Criteria

25
Q

State the 5 criterions of the Modified Centor Criteria

A
  1. Fever > 38°C
  2. Swollen, tender anterior cervical lymph nodes
  3. Tonsillar exudate
  4. Absence of cough
  5. Age
    3-14 y/o (1)
    15-44 y/o (0)
    45 y/o and above (-1)
26
Q

State the actions for the number of points for the Modified Centor Criteria

A

0 or 1:
- No additional testing indicated
- Low risk of S. pyogenes pharyngitis
- Presumed viral
- No abx

2 or 3:
- TEST for S. pyogenes pharyngitis
- TREAT with abx

4 or 5:
- HIGH RISK for S. pyogenes pharyngitis
- Initiate empiric abx

27
Q

Is bacterial pharyngitis self-limiting? Or are there complications?

A

Self-limiting/ complications possible

Complications usually occur 1-5 weeks later, usually 2-3 weeks:
- Acute rheumatic fever (preventable with early abx)
- Acute glomerulonephritis (preventable by abx

28
Q

What is the pathogen that causes bacterial pharyngitis?

A

Group A Streptococcus (S. pyogenes)

29
Q

What is the Gold Standard test for S. pyogenes pharyngitis?

A

Throat culture (takes 24 - 48h)

Other: Rapid Antigen Detection Test (RADT) (minutes)

30
Q

Duration of Tx for bacterial pharyngitis?

A

Treat for 10 days (5 days for azithromycin)

31
Q

First-line Tx for bacterial pharyngitis?

If penicillin allergy?
(What is one thing we have to note about the alternative regimen with regards to resistance?)

A
  • PO penicillin 250mg q6h
  • PO amoxicillin 500mg q12h

If penicillin allergy:
- PO Cephalexin 500mg q12h (non-severe)

More serious penicillin allergy:
- PO azithromycin 500mg OD
- PO clarithromycin 250mg q12h
- PO clindamycin 300mg q8h

Note: Increasing resistance to macrolides

32
Q

Goals of Tx for bacterial pharyngitis?

A
  • Reduce s/sx severity and duration
  • Prevent of acute complications (ie otitis media, peritonsillar abscesses, invasive infections)
  • Prevent delayed complications/ immune sequelae (esp rheumatic fever)
  • Prevent spread to others (no longer infectious after 24h on abx)
33
Q

Monitoring for bacterial pharyngitis?

For pts both NOT on abx and on abx

Is microbiological test for cure required?

A
  • Pt not given abx: counsel that sore throat < 1 week, abx not needed as it is likely viral pharyngitis
  • Pts given abx: fever and s/sx usually resolve within 1-3 days of starting Tx
  • Microbiological test for cure NOT required
  • Abx ADRs
34
Q

Elaborate more on the clinical presentations of viral pharyngitis (6)

A
  • Low-grade fever
  • Malaise
  • Fatigue
  • Rhinorrhoea
  • Cough
  • Hoarseness
  • Oropharyngeal lesions (ulcers/ vesicles)
  • Conjunctivitis
35
Q

Is viral pharyngitis self-limiting?

Do we prescribe anything for it?

A

Yes

No need any medications (maybe just symptomatic relief)

36
Q

Likely pathogens for viral pharyngitis?

A
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Parainfluenza
  • Epstein-Barr
37
Q

Define acute rhinosinusitis

A

Acute (within 4w) inflammation and infection of paranasal and nasal mucosa

38
Q

Is acute rhinosinusitis typically bacterial or viral?

If bacterial, what are the pathogens involved? (Hint: most common and others)

A

> 90% viral

Bacterial < 2%
Most common:
- Strep. Pneumoniae
- H. influenzae

Others:
- Strep. pyogenes
- Moraxella catarrhalis
- Anaerobic bacteria

39
Q

Risk factors of acute rhinosinusitis?

A
  • Direct contact with droplets of infected saliva or nasal secretions
  • Viral URTIs may result in bacterial cases
  • Inflammation → sinus obstruction → bacterial multiplication
40
Q

Common s/sx of acute rhinosinusitis?

When should we send pt to ED?

A
  • Purulent nasal discharge
  • Facial pain or pressure
  • Fever
  • Nasal congestion and obstruction
  • Reduced sense of taste or smell (hyposmia or anosmia)
  • Headache
  • Cough
  • Ear fullness/ pressure
  • Bad breath
  • Dental pain

Send to ED if spread of infection to orbits or CNS (ie limited ocular movements, acute vision changes, confusion, unilateral weakness)

41
Q

Most of the time, how does bacterial rhinosinusitis occur?

A

Commonly occurs as a secondary infection from sinus obstruction due to viral URTI

42
Q

When should we treat bacterial sinusitis? (what type of s/sx?)

A

Treat bacterial sinusitis with abx if ≥ 1 of the following:
1. S/sx persist > 10 days, no clinical improvement
2. Severe s/sx (fever > 39°C, purulent nasal discharge, facial pain > 3 consecutive days)
3. S/sx improve then worsen (new onset fever, headache, increase nasal discharge) for > 3 days (5-6 days)

43
Q

Duration of Tx of bacterial sinusitis

A

Treat 5-7 days (adults)

44
Q

First-line Tx for bacterial sinusitis?

If penicillin allergy? (non-severe?)

A
  • PO amoxicillin 500mg q8h
  • PO amoxicillin-clavulanate 625mg q8h

If penicillin allergy:
- Non-severe: PO cefuroxime 500mg q12h
- PO levofloxacin 500mg daily/ PO moxifloxacin 400mg daily (but last line)

45
Q

What type of abx cannot be used for bacterial sinusitis due to increasing resistance?

A

Tetracycline, co-trimoxazole and macrolides not recommended due to increasing resistance

46
Q

Goal of Tx for acute rhinosinusitis?

A
  • Shorten duration of s/sx, faster s/sx relief
  • Restore QoL
  • Prevent complications
47
Q

Monitoring for acute rhinosinusitis? (for pts not given abx and pts given abx)

When does the pt need to see doctor?

A
  • Pts not given abx: counsel that s/sx last 7-10 days, abx not needed as likely having viral or non-severe bacterial pharyngitis
  • Pts given abx: expect s/sx to improve within 7-10 days
  • Abx ADRs

See doctor if pt develops persistent, severe or worsening s/sx

PR3151 Finals (11 decks)

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