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Flashcards in 04-16 URI Deck (15):
1

CXR findings in pneumonia vs. bronchitis

Pneumonia: CXR w/ infiltrate
Bronchitis: normal or w/ peribronchial cuffing

2

Clinical presentation differences between viral and bacterial sinusitis

bacterial: more severe sx; more localized
viral: less severe sx; less localized (also present w/ or have h/o rhinorrhea, cough, +/- sore throat)

3

Red Flags on pneumonia imaging

—Kerley B lines (LHF)
—higher in lung? abscess? Ghon? (TB)
—multiple abscesses (SBE)

4

Major pathogens that cause acute pharyngitis? What is its clinical presentation of VIRAL pharyngitis? Diagnostics available? Epidemiology of principle cause?

PATHOGENS
—Tons: Rhino most common; 10% are Grp A Strep
—Viral: Rhino, Adeno, Para-flu, Flu, HSV, CoxA, EBV, CMV, HIV RSV (NOT Coronavirus)
—Bacterial: Grp A/C/G Strep, N. gon, Mycoplas, Chla. pneu, Corynebacterium diph, Arcanobacterium haemolyticum

CLINICAL PRESENTATION: Common Cold
—rhinorrhea/obst/sneeze; sore/scratchy throat; non-prod cough w/ Post-nas drip
—throat ery but no exudate; mild or no fever
—avg 1 week, but 25% last 2 wks; add 3 days for smokers

EPIDEMIOLOGY: Common Cold
—Rhino (most common): early fall or mid-spring; hand-to-hand transmission
—Corona (2nd) and RSV: winter;
—Incubation 2-3 days

5

Major pathogens that cause acute bronchitis?
—What is its clinical presentation?
—Epidemiology of principle cause?
—Treatment?

PATHOGENS
—MAJORITY = Viral: Rhino, Adeno, Flu A/B, Human metapnuemovirus, RSV
—Bacterial: Myco. pneu., Chla pneu., H.flu, Strep pneu., Branhamella catarrhalis

PRESENTATION
—cough for days-weeks +/- sputum +/- fevers
—crackles +/ wheezes but NO consolidation
MYCOPLASMA PRESENTATION
—cough: dry → green/yellow
—low-grade fever
—Pulm: rhonchi and coarse rales

EPIDEMIOLOGY
—Mostly viral
—Mycoplasma pneu (long incubation 3 wks w/ lots of sick contacts) and Chlamydia pneu on DDx
—Bordetella pertussis if outbreak

TREATMENT
—Supportive (consider albuterol or rapid roid taper)
—Abx (erythromycin or other macrolide like azithro or clarithro) only if highly-likely (exposure to infx'd person) or documented w/ IgM for M. pneumonia or PCR/culture of B. pertussis

6

Major pathogens that cause acute bacterial sinusitis?
—What is its clinical presentation?
—Diagnostics available?
—Epidemiology of principle cause?
—Treatment?

CAUSES
—Almost always rhino
—can also be acute bacterial (ACABS):
25-30% - Strep pneumo
15-20% - H. flu
15-20% - Moraxella catarrhalis (pedi)
< 5% for Strep pyo and < 5% for S. aureus
—or chronic bacterial:
Above + Staph, anaero Gm+, Gm- bacilli
—fungal in immunocompromised

PRESENTATION OF ACABS
—Usu overlap w/ URI
—Persistent cought, puruent boogers, h/a, FACIAL PAIN exacerbated by positional ∆s
—Bad breath w/ chronic
—Purulent discharge seen w/ otoscope, ‪↓‬ translum, pain w/ palpation

DIAGNOSIS
—Gold Std: aspirate & culture
—r/o allergic
—Bacterial likely if classic sx (F >38°C, facial pain, erythema or swelling) OR if URI not improving after 10d
—CT when suspect chronic

EPIDEMIOLOGY
—40-50% ACABS resolves spontaneously

TREATMENT
—Need to cover b-lactamase-producing H.flu, S.pneumoniae
—Amox-clav, cefuroxime, cefpodoxime; new quinolones (i.e. moxifloxacin)
—Anti-histamines and ibu, yes. Little evid. for Sudafed

7

Major pathogens that cause the common cold?

—30-50% rhinovirus
—10-15% coronavirus
—5-15% Influenza A/B
—5% Parainfluenza
—<5% Adenovirus
—Also: RSV and human metapneumovirus

8

Pathophysiology of bacterial infection w/ acute sinusitis?

invasive, pyogenic infx

9

Pathophysiology post-infectious rheumatic disease?

immune-mediated

10

Pathophysiology of colds?

receptor-mediated release of kinins is the 1° cause of sx in common colds (i.e. those due to rhino)
—40% progress to viral sinusitis, but < 2.5% develop bacterial sinusitis
—triggers ~40% of asthma attacks in adults
—otitis media in kids or eustachian tube dysfxn in adults

11

Ibuprofen vs. APAP vs. ASA for common cold

choose ibuprofen; APAP and ASA may increase nasal s/sx, prolong viral shedding and decr. neutralizing Ab's.

12

What is its clinical presentation of BACTERIAL pharyngitis? Diagnostics available? Epidemiology of principle cause? Treatment?

PRESENTATION
—abrupt onset
—painful swallowing
—systemic illness & malaise
—nasal congestion + cough in only 50%, not prominent
CENTOR SCORE
—Temp 100-104°F? +1
—Tonsillar exudate? +1
—Cervical adenopathy +1
—Absence of cough +1
—< 14 y/o +1

DIAGNOSIS
—Culture
—Rapid enzyme immunoassay (≥96% spec, only 80-90% sens)

EPIDEMIOLOGY
—Grp A Strep causes 5-15% sore throats in adults, and 20-30% in kids

TREATMENT
—P.O. PenV
—Erythromycin or other macrolide (clarith- or azith-romycin) if allergic to Pen
—IM Benzathine Pen x1 when compliance a problem

13

What is its clinical presentation of Infectious Mononucleosis pharyngitis?
—Causative organisms?
—Diagnostics available?
—Epidemiology of principle cause?
—Treatment?

PRESENTATION
—Exudative PHARYNGITIS/laryngitis in 1/2 of EBV-cases
—Systemic sx: FEBRILE, H/A, malaise, fatigue (usu signif)
—Onset: abrupt or w/ several day prodrome
—Cervical +/- systemic adenopathy
—Splenomegaly (50% pts)

CAUSATIVE AGENTS
—Usually EBV
—Also CMV, Toxoplasma gondii, and HIV

DIAGNOSIS
—Lymphocytosis (atypical lymphocytes hallmark but not specific)
—50% thrombocytopenia
—Heterophile Ab's (e.g. monospot)
—EBV-specific Abs

EPIDEMIOLOGY
—Prolly no epidemics
—Intimate contact
—2 age peaks: 0-5 y/o & 2nd decade (teens)

14

Antigenic Drift vs. Shift

shift (i.e. development of H1N1) is bigger ∆ than drift

15

Influenza Rx

—amantadine/rimantadine: reduces Flu A s/sx duration by 50%
—Neuraminidase inhibitors: oseltamivir and zanamivir