URTI Flashcards
Acute otitis media (AOM)
Bulging TM
Middle ear effusion (MEE)
Inflammation
Acute onset of sx
AOM RF
Airborne particle allergies Attend daycare Bottle feeding Craniofacial abnormalities Food allergies Immunodeficiency Low SES Male Nasopharyngeal colonization with bacterial pathogens Native American, Eskimo, Australian ethnicities Pacifier use Predisposition Recent viral illness Sick household member Tobacco smoke exposure Under 2 yo
Anatomy of eustachian tube by age
Adults - 45 degrees
Infants - 10 degrees
Presentation of AOM
MEE with acute sx onset: Fever Irritability Otalgia Pulling ears Rhinorrhea
AOM otoscopic examination
TM appearance
TM changes
AOM TM appearance
Cloudy
Erythematous
Pale yellow
White
AOM TM changes
Fullness
Immobility
Otorrhea
AOM complications
Temporary hearing loss
TM perforation
Brain abscess or meningitis
What delays are seen with hearing loss d/t AOM?
Cognitive abilities
Language
Speech
Common causes of AOM
Bacterial (80%): S pneumonia, H flu, M catarrhalis
Viral: RSV, rhinovirus, influenza, adenovirus
AOM prevention
PCV 13 (3 vaccine series starting at 2 months) Hib (3 vaccine series starting at 2 months) Annual influenza (after 6 months old)
AOM recurrence definition
>/= 3 episodes in 6 months >/= 4 episodes in 12 months
AOM recurrence prevention
Abx (AAP argues against but does not have recommendation)
Tympanostomy tube placement)
Pharyngitis
Inflammation of the mucous membrane of throat
Types of pharyngitis
Nasopharyngitis
Tonsillitis
Tonsillopharyngitis
Pharyngitis general s/sx
Throat pain (not required)
Erythema - required
Exudate - required
Ulceration - required
Pharyngitis causes
Bacterial: s pyogenes (GAS) most common
Viral: adenovirus, CMV, enteroviruses, EBV, HSV, Influenza
Bacterial pharyngitis s/sx
Autumn, winter, spring Ab pain Cervical adenopathy Fever HA Nausea Sore throat Tonsillar exudate Vomiting
Viral pharyngitis s/sx
Summer, Autumn Anterior stomatitis Conjunctivitis Coryza Cough Diarrhea Rash (in children not adults) Ulcerative colitis
Diagnosis of bacterial pharyngitis
Throat culture
Rapid antigen detection test (RADT)
RADT
Never used alone unless positive
If it is positive, it is accurate. Negative does not mean you do not have it.
Treatment of viral pharyngitis
Self-limiting
Sx treatment
Treatment of bacterial pharyngitis
Abx for sx GAS Sx resolution: 3-4 day mark Beta-lactams Clindamycin Macrolides Sx treatment
Beta lactams in pharyngitis
PCN (enteral/IV)
Amox
Duration: 10 days
Clinda in pharyngitis duration of therapy
10 days
Macrolides pharyngitis duration of therapy
5 days
Pharyngitis symptomatic treatment
Treat the pain
Do NOT use antihistamines or decongestants
Rhinosinusitis
Inflammation of the mucous membranes:
Nose
Paranasal area
Rhinosinusitis viral causes
Most common - common cold Rhinovirus Influenza Parainfluenza Respiratory syncytial virus Adenovirus Enterovirus
Rhinosinusitis bacterial causes
Secondary infections
S pneumonia
H influenza
M catarrhallis
Rhinosinusitis duration classifications
< 30 days = acute
30-90 days = subacute
> 90 = chronic
Bacterial sinusitis diagnosis
Persistent illness lasting > 10 days (wait)
Worsening course after implementation (abx)
Severe onset for 3 consecutive days
Bacterial sinusitis: persistent illness lasting > 10 days
Daytime cough
Nasal discharge
Bacterial sinusitis: worsening course after implementation
Daytime cough
Fever
New onset nasal discharge
Bacterial sinusitis: severe onset for 3 consecutive days
Concurrent fever
Purulent nasal discharge
Bacterial sinusitis treatments
Beta-lactams
Clinda + cefiximine
FQ
Sx treatment
Bacterial sinusitis beta-lactam treatment
Amox (dosing lower than in AOM) Augmentin Cefotaxime Ceftriaxone Duration of therapy - 10 days
Bacterial sinusitis clindamycin + cefixime duration of therapy
10 days
Bacterial sinusitis FQ duration of therapy
10 days
Bacterial sinusitis sx treatment
Pain management
Antihistamines/decongestants (only if viral - decreases blood flow of where you want abx to go)
Saline spray/mist/drops are the only recommendation
