100. Upper Respiratory Tract Infection (35%)

Question 1

Distinguez les situations où la vie est en danger des affections bénignes.

Nommez des DDX dangereux

Answer 1

• épiglottite
• abcès rétropharyngé

Question 2

Posez le diagnostic d’une sinusite bactérienne après une anamnèse et un examen physique détaillé. Prescrivez l’antibiothérapie appropriée (antibiotique de première ligne, posologie adaptée).

Question 3

En présence de symptômes des voies respiratoires supérieures,
* Différenciez une infection virale d’une infection bactérienne (par l’anamnèse et l’examen physique).
* Posez le diagnostic d’une infection des voies respiratoires supérieures (IVRS) d’origine virale (par l’anamnèse et l’examen physique).
* Instaurez le traitement approprié (p. ex. ne prescrivez pas d’antibiotiques à moins d’une indication claire).

Question 4

Devant une anamnèse compatible avec une otite moyenne, différenciez-la de quoi ?

Answer 4

• otite externe
• mastoïdite

Question 5

Chez les patients à haut risque qui présentent une IVRS, recherchez activement les complications et offrez un suivi plus serré.

Nommez les patients à haut risque (3)

Answer 5

• VIH
• MPOC
• Cancer

Question 6

En présence d’une pharyngite, recherchez quoi?

Answer 6

une mononucléose.

Question 7

Dans les groupes à haut risque, adoptez des mesures préventives.

Nommez des examples (2)

Answer 7

vaccins contre l’influenza et le pneumocoque

Question 8

Dans les groupes à haut risque, traitez précocement afin de diminuer l’impact de la maladie sur les individus et la population.

Nommez des tx anti-viraux

Answer 8

• Tamiflu
• Amantadine

Question 9

How to PREVENT common cold ?

Answer 9

• Handwashing
• Zinc sulfate

Question 10

Name acute sinusitis sx (4)

Answer 10

• Facial pain, pressure or fullness
• Nasal obstruction
• Discoloured discharge
• Lack of smell

Question 11

Name common bugs for sinusitis

Answer 11

THINK OF EAR BUGS
* H. influenza
* S.pneumoniae
* M.catarrhalis

Question 12

Name sinusitis alarm features (refer)

Answer 12

• Persistant fever > 39
• Periorbital edema
• Cranial nere palsies
• Abnormal extraocular movements
• Proptosis
• Vision changes
• Severe headache
• Altered menta status
• Meningeal signs

Question 13

Describe tx : Sinusitis

Answer 13

• Amox, macrolide if allergic
• Tx 5-7 dx
• Nasal rince
• Intranasal steroids
• Decongestants
• Analgesics
• AINS

Question 14

Name sx : Mononucleosis

Answer 14

• Lymphadénopathie
• Fièvre
• Pharyngite
• Malaise
• Fatigue
• Maux de tête

Question 15

Name labs : Mono

Answer 15

• Numération lymphocytaire
• AST, ALT sériques
• Monotest

Question 16

Describe tx : Mono

Answer 16

• No ATBs or antivirals
• F/U and handwashing/contact
• Steroids MAY help ONLY if airway obstruction

Question 17

Describe the spleen in mono

Answer 17

• Splenomegaly in 50%
• Rupture in 1-2 per 1000
• NO CONTACT SPORTS for at least 3 weks
• Can last up to 8 wks

Question 18

Describe influenza antivirals

Answer 18

• Tamiflu, Relenza for Influenza B
• If HIGH RISK
• Goal = Start within 12 hrs of sx
• If > 48 hrs, consider if severe illness / high risk

Question 19

What to R/O in common cold ? (2)

Answer 19

• Sinusitis (PODS)
• Acute Bronchitis (Persistent cough >3 weeks)

Question 20

In acute bronchitis, consider ATB when ? (4)

Answer 20

• 1. ≥ 75 years
• > 3 weeks or suspect B. pertussis (Whooping cough, >3 weeks, vomiting (related to coughing)
• exposure to pertussis
• not vaccinated

Question 22

Describe symptomatic therapy for common cold ? (5)

Answer 22

• Analgesics (Acetaminophen/NSAIDs)
• Combination products (Antihistamine, decongestant, analgesics)
• Consider Zinc lozenges 75mg PO daily, Pleragonium sidoides, Andrographis paniculata
• Nasal sx tx
• Cough suppressant

Question 23

Risk of what in intranasal zinc preparations ?

Answer 23

Risk of irreversible anosmia

Question 24

How to tx nasal sx in common cold ? (3)

Answer 24

• Nasal saline irrigation (poor evidence)
• Intranasal cromolyn sodium (Cromolyn) 1 spray (5.2mg) in each nostril q2h PRN x 2 days then 4 times daily x 5 days
• Intranasal ipratropium bromide (Atrovent) 0.06% solution two sprays (42mcg/spray) in each nostril 3-4 times daily PRN x 4 days

Question 25

Name Cough suppressants (3)

Answer 25

* Brompheniramine plus sustained-release pseudoephedrine * Ipratropium bromide inhaled (Atrovent) * Dextromethorphan 30mg PO q6-8h PRN

Question 26

Name prevention : Common cold (4)

Answer 26

* **Handwashing** * Flu vaccine (6mo-5yo, ≥65yo, chronic disease, pregnancy/postpartum, healthcare worker, frequent contact with above) * Pneumococcal 23-valent (≥65 years old, or if specific risk factors) * No evidence for antibiotics, echinacea, intranasal corticosteroids

Question 27

Seasonal Influenza caused by what ? (2)

Answer 27

Caused by influenza A or B viruses, mainly during winter

Question 28

How effective is tx of seasonal influenza ?

Answer 28

Treatment may reduce symptoms from 0.5-3 days (**if started within 48h**)

Question 29

Describe tx : Seasonal Influenza (3)

Answer 29

* Zanamivir (Relenza) two inhalations (10mg) PO BID x 5d or oseltamivir **(Tamiflu) 75mg PO BID x 5d** * Amantadine not first-line due to high rates of resistance * May extend therapy in severely ill patients

Question 31

In influenza, tx with antiviral should be considered when ? (3)

Answer 31

* Severe disease (requiring hospitalization or evidence of lower respiratory tract infection, eg. dyspnea, tachypnea, oxygen desaturation) * High risk for complications (pregnancy) * Most efficacious within first 48h of illness, but indicated to treat if severe illness or pregnancy

Question 32

Name : Indications to consider X-ray in influenza (5)

Answer 32

* Hemoptysis * Pleuritic chest pain * Dyspnea * Systemic symptoms (fever, tachycardia >100, tachypnea>24) * Abnormal physical exam (crackles, decreased breath sounds, bronchial breathing)

Question 33

Describe : Antibiotic Stewardship (8)

Answer 33

* Compassionate communications * Describe infection as viral illness * Discuss expected course of illness and cough duration (**2-3w**) * **Explain antibiotics do not shorten illness duration, and may cause adverse effects and antibiotic resistance** * Treatment plan including symptom management (analgesia, antiinflammatory) * Consider - Delayed prescription strategies (agree on time frame, eg. 1 week that symptoms should improve - and only to use prescription after the specified time) - Immediate prescribing if suspect pneumonia or high-risk (immunosuppressed)