Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR3124 FINALS > URTIs > Flashcards

URTIs Flashcards

1
Q

What is pharyngitis?

A

Acute inflammation of the nasopharynx or oropharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical presentation of pharyngitis? (5)

A 
Acute onset of sore throat 
Pain on swallowing
Erythema, with inflammation of the pharynx or tonsils (with or without patchy exudate)
Fever
Tender and swollen lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Viral microbiology of pharyngitis

A

rhinovirus, coronavirus, influenza, parainfluenza, Ebstein-Barr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bacterial microbiology of pharyngitis

A

Group A beta-hemolytic Streptococcus pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which age group has 1 point in the Modified Centor Criteria?

A

3-14 years

children higher prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which complication of Steptococcus pyogenes pharyngitis is prevented by early initiation of effective antibiotics?

A

Acute rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When do complications arise for bacterial pharyngitis? What are they?

A

1-3 weeks later
Acute rheumatic fever (prevented by early initation of effective antibiotics)
Acute glomerulonephritis (not prevented by early initiation of antibiotics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is bacterial pharyngitis diagnosed?

A

Using the Modified Centor Criteria
5 criteria: Age, Absence of cough, fever, swollen lymph nodes, tonsillar exudate

4-5 points: high risk, treat empirically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

First line antibiotics for pharyngitis? What are the alternatives? Treat for how long?

A

First line: Penicillin VK
Alternatives: Amoxicillin, cephalexin, clindamycin, clarithromycin
Treat for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is augmentin not recommended for bacterial pharyngitis?

A

Augmentin covers aneaerobic and gram negaitve coverage, which is not needed. Amoxicillin is good enough (Use narrowest spectrum possible)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is rhinosinusitis

A

Acute inflammation of the paranasal or nasal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is sinusitis diagnosed?

A

> = 2 major symptoms; OR 1 major + >=2 minor symptoms

Major symptoms (7):
Purulent anterior nasal discharge
Purulent or discolored posterior nasal discharge
Nasal congestion/obstruction
Facial congestion/fullness
Facial pressure/pain
Hyposmia/anosmia
Fever 
Minor symptoms (6):
Halitosis, headache, ear pain/pressure/fullness, dental pain, cough, fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Microbiology of sinusitis

A

Viral > bacterial
Viral: adenovirus, rhinovirus, parainfluenza, influenza
Bacterial: H. influenzae and S. pneumoniae most common, Moraxella catarrhalis and S.pyogenes also possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bacterial sinusitis commonly arise from viral URTIs. True or false?

A

True
Inflammation results in sinus obstruction; nasal mucosal secretions are trapped, becomes a medium of bacterial trapping and multiplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is bacterial sinusitis diagnosed?

A

Presence of sinusitis + presence of any ONE criterion:

  • Persistent of symptoms > 10 days AND not improving (viral sinusitis resolves in 7-10 days)
  • Severe symptoms at onset (purulent nasal discharge x 3-4 days or high fever >= 39 degC)
  • “Double sickening” (worsening symptoms after 5-6 days after initial improvement - most likely bacterial sinusitis after viral URTI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for bacterial sinusitis

A

1st line antibiotic: amoxicillin or amoxicillin-clavulanate
Alternatives:
- Respiratory FQs: levofloxacin, moxifloxacin
- Trimethoprim/sulfamethoxazole
-Cefuroxime

Adults: treat for 5-10 days
Children: treat for 10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which antibiotics are NOT suitable for local setting for treatment of bacterial sinusitis?

A

Clarithromycin, azithromycin, doxycycline

18
Q

Which fluoroquinolone is not a respiratory fluoroquinolone? What does it lack activity against?

A

Ciprofloxacin, as it has poor activity against Streptococcus pneumoniae

19
Q

Treatment considerations for S pneumoniae

A

Mutation of Penicillin binding protein which increases the MIC of penicillins
Prefer to use amoxicillin over penicillins due to more favourable PK
Prefer high dose amoxicillin for effective treatment

20
Q

Treatment considerations for H influenzae

A 
Beta-lactamase production 
Inhibited by beta-lactamase inhibitor
Use augmentin over amoxicillin only if:
- recent hospitalisation
- recent antibiotics use 
- failure to improve after 72 hours of antibiotics
21
Q

What is acute otitis media?

A

Infection of the middle ear space resulting in inflammation and fluid accumulation

22
Q

Clinical presentation of AOM

A

Ear pain, ear fullness, ear popping, ear discharge, fever, hearing impairment, dizziness, non-specific in young infants (excessive crying, changes in sleep or behavioral pattern, ear rubbing)

23
Q

Risk factors for AOM

A

Age <5 years old, attending day care, siblings, supine position during feeding, exposure to tobacco smoke at home, pacifier use, winter season

24
Q

Prevention of AOM

A

avoid exposure to tobacco smoke
exclusive breastfeeding for 1st 6 months
minimise pacifier use
vaccinations - influenza, pneumococcal, h influenzae type B vaccine

25
Q

Microbiology of AOM

A

Virus = Bacterial
Virus: adenovirus, rhinovirus, respiratory syncytial virus, parainfluenza virus
Bacteria: S pneumoniae, H influenzae, Moraxella catarrhalis

26
Q

Approaches to antibiotics for AOM

A

Immediate initiation vs observation period

27
Q

When can observation period be considered for patient with AOM?

A
  • > =6 months
  • No otorrhea
  • Lack of severe illness (no fever >=39 deg in the last 48 hours, otalgia >= 48 hours, moderate to severe otalgia)
  • Possible for close follow up
  • Shared decision making with the parent/caregiver
28
Q

Which are candidates for observation period?

A

6 months to 2 years: unilateral AOM with no otorrhea

>= 2 years: bilateral AOM with no otorrhea, unilateral AOM with no otorrhea

29
Q

Under what circumstances would amoxicillin-clavulanate be preferred over amoxicillin in the treatment of AOM?

A

amoxicillin in the last 30 days
history of purulent conjunctivitis
history of AOM non-responsive to amoxicillin

30
Q

Treatment options for AOM

A

1st line: amoxicillin or augmentin
use augmentin if recent amoxicillin use, history of purulent conjunctivitis, history of AOM non-responsive to amoxicillin

alternatives: cefuroxime, ceftriaxone (IM), clindamycin (for severe penicillin allergy, no coverage for h influenzae)

31
Q

What are severe symptoms of AOM?

A

Moderate-to-severe otalgia
otalgia >=48 hours
fever >= 39 degC in the last 48 hours

32
Q

Compared to common cold, what symptoms are more usual in influenza?

A

Chills, body aches, fever, fatigue, body weakness, chest discomfort, cough, headache, acute onset

33
Q

Symptoms more like COVID-19 and more unlike influenza

A

Nausea, vomiting, diarrhea, loss of taste or smell

34
Q

Microbiology of influenza

A

3 strains - influenza A, B and C

35
Q

Complications of influenza

A

Viral pneumonia
post-influenza bacterial pneumonia (esp S. aureus)
respiratory failure
exacerbate underlying pulmonary or cardiac comorbidities
febrile seizures
myocarditis or pericarditis

36
Q

Who are those at “high-risk” for influenza related complications?

A

Children <5 years
Elderly >65 years
Women who are pregnant or within 2 weeks post partum
Residents of nursing homes or long-term care facilities
Obese individuals with BMI >40kg/m2
Individuals with chronic medical conditions

37
Q

What are some prevention strategies for influenza?

A

Good personal hygiene, health lifestyle, vaccination

38
Q

How is influenza diagnosed?

A

molecular tests like reverse-transcriptase polymerase chain reaction (RT-PCR) - only for inpatients, most outpatients are treated empirically

39
Q

For which patients do you need to initiate treatment as soon as possible for suspected or documented influenza?

A

Hospitalised
High risk for complications
Severe, complicated or progressive illness
may be considered for outpatients presenting within 48 hours of symptom onset

40
Q

What is the antiviral used for influenza? What is the mechanism of action?

A

Oseltamivir, a neuraminidase inhibitor which interferes with protein cleavage, inhibiting the release of new virus

41
Q

Which strains of influenza is oseltamivir active against

A

Influenza A and B

42
Q

Does oseltamivir need renal dose adjustment? What is the usual dosing?

A

Yes.

Usual adult dosing is 75mg PO BD for 5 days

PR3124 FINALS (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions