Urti Flashcards
What are the signs and symptoms of mononucleosis?
Patient will present with fever, malaise, fatigue, nausea, anorexia without vomiting, sore throat.
May have cough, ocular pain, chest pain.
On physical examination, patient will be febrile with live and apathy pharyngitis tonsilla enlargement may have a rash along with hepatus or Megli, tenderness, jaundice
Complications associated with mononucleosis
Speedy rupture.
Airway obstruction due to enlarged tonsils.
Lymphoma
Myocarditis.
Encephalitis
Investigations for mononucleosis
Monospot or EBV,IGM and IGG serology
Elevated WBC.
Elevated ESR
Elevated AST, ALT.
Management of mononucleosis
Treatment is symptomatic.
Patient counselled regarding avoiding sports for three weeks, contact sports for four weeks.
If risk of airway compromise, steroids should be considered.
Monitor WBC’s weekly
What are the alarm signs and symptoms of common cold?
Presence of
Rash, neck stiffness, high-grade, fever, lethargy, sides of chest, pathology, such as crackles or rails, dyspnoea
Complications associated with a common cold
Complications include
acute otitis media
Sinusitis.
Pneumonia.
Exacerbation of asthma.
Exacerbation of COPD
Prevention and treatment of common cold
Prevention: vitamin C, garlic
Treatment:
adults:antipyretics, antitussives, nasal decongestant, zinc, lozenges,echinacea
In children: antipyeretics, honey, if greater than one year of age, can consider, vitamin C, consider humidified air, avoid cough, medicines in children, less than six years of age
What is the difference between acute recurrent and chronic sinusitis?
Sinusitis is inflammation of one or more of the paranasal sinuses.
Acute is less than four weeks
recurrent is more than four episodes in one year each episode lasting for 10 days with no symptoms in between.
Chronic is greater than 12 weeks
Practice for developing sinusitis or rhinosinusitis
Anatomic abnormality like deviated, nasal septum, enlarged adenoids.
Exposure to smoke.
Medical conditions like cystic fibrosis, wegeners granulamatosus, allergic rhinitis
Medication, such as chronic, decongestant use, cocaine.
Trauma
Diagnosis of sinusitis and chronic sinusitis
Sinusitis:
Two or more of
Nasal purulence
Nasal obstruction
Facial pain
Change in smell.
Chronic sinusitis: two or more off
Congestion or fullness
Nasal purulence
Nasal obstruction
Facial pain or pressure
Change in smell.
Red flags of sinusitis
Presents of recurrent nasal crusts
Bleeding from mild trauma.
Irregular surface
Orbital swelling with extra ocular muscle disfunction or decreased visual acuity
Investigations for sinusitis
CT of the parasol sinuses without contrast.
Endoscopy of the sinuses/nasal cavity
Allergy testing
Complications of sinusitis
Peri orbital or orbital cellulitis
Meningitis
Intracranial abscess.
Sepsis
Cerebral Venous thrombosis
Management of acute sinusitis
Tylenol, Advil
Nasal decongestant
Nasal saline rinse
Steam inhalation
Intra nasal steroid for mild to moderate bacterial sinusitis
If no improvement in three days or if worsening symptoms
Start oral antibiotics
IF severe bacterial sinusitis start nasal steroid and oral antibiotics together.
Antibiotics include amoxycillin or Amoxi-clav or cefuroxime clarithromycin, aszithromycin, doxycycline.
Management of chronic sinusitis
No nasal polyp: intra nasal cortical steroid short course of oral steroid, nasal saline, rinse second line antibiotics
With nasal, polyp intranasal cortical, steroid and oral steroids antibiotic for three weeks if signs of bacterial infection present
Can also consider LTRA
Went to Refer patient with sinusitis
No improvement with standard therapy.
Presence of complications.
If anatomical abnormalities like DNS,
if recurrent sinusitis
What are the red flags for a sore throat?
Dysphagia.
Dysphonia.
Drooling.
Stiff neck.
Respiratory distress.
Unstable vitals
Causes of pharyngitis
Viral most common.
Bacterial.
Fungal
What is carrier group a strep?
More than three confirmed group A strep cases per year. Does not increase risk of rheumatic fever.
Throat swab, when patient is not symptomatic.
Characteristic signs of group a strep
Tonsillar enlargement and exude dates.
Scarlet fever, blanching rash with sandpaper feel that spares the palms and souls subsides in 6 to 9 days, followed by desquamation of the palms and soles. Strawberry tongue.
Complications associated with streptococcal pharyngitis
Poststreptococcal glomerulonephritis.
Rheumatic fever.
Pediatric auto immune neuropsychiatric disorder associated with streptococcal infection.
Meningitis.
Acute otitis media.
Endocarditis.
Bacteraemia
What is the centor criteria?
Cervical lymph fluid enlargement.
No cough.
Temperature greater than 38
Oropharyngeal exudates.
Age between three to 14 years
What are the investigations for pharyngitis? And when are they done?
Pharyngitis usually does not require any investigations as it is viral.
If centre score is 0 to 1 supportive management.
If centre score is two then can consider rapid antigen test.
3+ RAT and/or culture. Rx with abx if positive
Consider sending culture even if rat negative in children or immunocompromised, or those were at high risk, such as the indigenous.
Can return to school on day, two of antibiotics, if improved or a febrile 

Treatment of viral pharyngitis
Nsaids and tylenol
Lidocaine and benzocaine mouth rinse
Lozenges
Oral corticosteroids canndecrease odynophagia. Use for 1-2 days
Treatment of group A strep
Only treat with abx if positive rapid test, culture or high risk and rat not available
Pen V
Amox
Cefuroxime
Clarithro, azithro
When is follow up warranted for pharyngitis
In 24 to 48 hrs if worsening
2-7 days post completion of abx if symptomatic
When is referral to ent warranted in pharyngitis/tonsillitis
If greater than 7 episodes in 1 year
Greater than five episodes in two years and
Later than three episodes in three years
Aetiology of croup
Caused by most common, the para influenza type, one and three
Could also be caused by RSV, metapnemo virus, adenovirus, influenza a and b
Usually occurs between six to 36 months of age
narrowing of the subglottic airway
Signs and symptoms of croup
Sudden onset barky cough.
Fever.
Strider on inspiration.
Hoarseness
Respiratory distress
Usually lost 3 to 7 days. Cough usually resolves in 48 hours.
Investigations for croup
Investigations are generally not needed.
Can do an AP and lateral neck x-ray. Will show steepling of the subglottic region.
Management of croup
Supportive treatment with oral hydration, analgesia with Tylenol or Advil
Single oral dose of dexamethasone 0.6 mg per KG up to a maximum of 10 mg. Can consider IM if vomiting or significant respiratory distress 
If severe croup, then refer to ED and add
Blow by oxygen
Nebulized 5ml of 1: 1000 L epinephrine
When should admission be considered for croup
If respiratory compromise persists for more than four hours after treatment with corticosteroids
Additionally, improvement and then worsening
There is stridor at rest
If there is sternal wall indrawing
If no improvement in severe group or group with impendingrespiratory failure contact peds ICU 
Features of mild croup
Occasional barking cough with no strider no drawing no distress no cyanosis
Pictures of moderate croup
Frequent by kickoff with strider addressed, visible, drawing addressed, no agitation or lethargy, and no cyanosis
Features of severe croup
Frequent barky cough, inspiratory, and expiratory, strider, marked retractions, lethargy, no cyanosis. Requires treatment in the ED.
Features of impending respiratory failure in croup
No barky, cough, minimal strider, severe or absent retractions, significant lethargy, cyanosis without oxygen.
Will require treatment in the ED
What are the features of bacteria tracheitis?
Hi grade fever with toxic appearing. With cough and sore throat.
X-ray will show the presence of membrane spanning the trachea. AP x-ray.
Will require supportive care as well as IV antibiotics. 
Cefotaxime or ceftriaxone 
What are the features of epiglottitis?
Supraglottic, edema, resulting in sore throat, fever, drooling, dysphasia, dysphonia, tripod, positioning. Patient will be toxic appearing next line clinical diagnosis however AP x-ray will show the presence of thumb printing sign.
Treatment is with.
What are the features of retro pharyngeal or para phayngeal, or peritonsillar abscess?
Start with high fever, sore throat, neck, pain, will progress to neck swelling, torticollis, drooling, hot potato voice.
Ap xray will show the presence of bulging posterior pharynx greater than 7 cm at the level of C2 and greater than 14 cm at the level of C6.
Investigations include ultrasound, CT
Will require drainage needle, aspiration, or incision and drainage as well as IV antibiotics
Refer to ENT
Aetiology of bronchiolitis in children
Most commonly caused by RSV.
Can also be caused by influenza, rhinovirus, adenovirus or para influenza virus
Risk Factors for bronchiolitis
Most commonly occurs in children less than two years of age
Risk factors include.
Daycare?
Overcrowded homes.
Exposure to smoke.
Sick contacts
Genetic.
Risk Factors for severe bronchiolitis
CHF or chronic lung disease
Premature birth.
Less than three months of age
Respiratory rate greater than 70
Oxygen saturation less than90%
Immune deficiency
Signs and symptoms of bronchitis
Proceeding two to three days of upper respiratory tract infection symptoms followed by.
Cough.
Expiratory wheeze
Crackles.
Increase work of breathing, as seen by nostril flaring, intercostal in drawing, Tapchypnea 
Prevention of bronchiolitis
Palivizumab. In high risk.
What investigations are done for bronchiolitis?
It is a clinical diagnosis.
Can consider chest x-ray if diagnosis unclear?
Can consider bacterial culture if less than two months of age
Management of patients with bronchiolitis
Oxygen if saturation is less than 90%
Ensure hydration either oral or IV
Nebulized epinephrinein the emergency department if needed.
Nasal suctioning
3% hypertonic saline nebulization only in admitted infants
Can consider combined epinephrin and dexamethasone 
Characteristics and treatment of mild bronchiolitis
Normal vitals, no accessory muscle use, normal feeding.
Encourage intake trial nasal saline follow up in 2 days
Characteristics and treatment of moderate bronchiolitis
Increased heart rate, increased respiratory rate, oxygen saturation between 90 to 95%, minor accessory muscle, use, feeding difficulty, minor dehydration.
Encourage and take, trial, nasal saline, follow up in two days.
If needing oxygen or not tolerating food sent to the ER.
If less than three months of age with increased work of breathing, sent to the ER
Characteristics of severe and life-threatening, bronchiolitis and their management
Severe bronchiolitis: increase respiratory rate, increase heart rate, decrease oxygen saturation, less than 90%
Moderate accessory muscle, use, nasal flaring, grunting, unable to feed with dehydration, sweaty and irritable.
Life-threatening bronchiolitis: apnea, cyanosis, decrease respiratory effort.
Treatment give oxygen, sent to the ER where they will get nebulized epinephrinand IV fluids with nasal suctioning.
What is unexplained chronic cough? How is it diagnosed and what is its treatment
Unexplained, chronic cough is when cough is present for more than eight weeks with no cause found on extensive investigations and therapeutic trials.
Can consider doing PFTs, ruling out is eosinophilic bronchitis
Can consider trial of cortical steroids
If normal PFT is then no inhaled, cortical steroids if negative work up for Gerd no PPI 
Treatment is: referral to SLP. Can trial gabapentin 300 mg to 1800 mg per day for six months with reassessment.
What over-the-counter cough suppressant should be used for dry cough and for wet cough
For dry cough: dextromethorphan
For wet cough: guaifenesin
