upper resp infection

Question 1

viruses that cause colds

Answer 1

usually rhino virus (non-enveloped ssRNA+)
maybe also flu, paraflu, corona, adeno, RSV, enterovirus
(pertussis, chlamydia, mycoplasma)

Question 2

complications of cold

Answer 2

sinusitis, OM, pneumonia (.5-2%). hard to tell the difference in symptoms but consider if symptoms worsen over time or new onset fever occurs.

Question 3

typical length of cold. treatment.

Answer 3

7 days

treat with NSAIDs, decongestants

Question 4

Pathophysiology of cold

Answer 4

viral attachment protein VP1 attaches to cellular receptor ICAM1. Infected cells release IL-8 (important) which cuases an infilux of PMNs and increased vascular permeability, swelling, secretions.

Question 5

pharyngitis: etiology

Answer 5

flu, cold, enterovirus, EBV, CMV, HIV, HSV, group A strep, groups C and G strep, archano bacteria, secondary syphilis, diptheria, gonorrhea

Question 6

flu and pharyngits

Answer 6

may involve fever, cough, headache

Question 7

enteroviruses and pharyngitis

Answer 7

coxsachie, echovirus, enterovirus. fecal/oral route but no GI symptoms. may show throat and vesicular lesions. hand, foot and mouth disease

Question 8

EBV pharyngitis

Answer 8

large tonsils, exudate, fever, cervical lymphadenopathy

splenomegaly, hepatitis, thrombocytopenia.

Question 9

STIs and pharyngitis

Answer 9

primary HIV infection: fever, sore throat, difuse lymphadenpathy and diffuse rash
HSV: primary. also see vesicles and ulcers.
syphilis and gonorrhea- consider based on sexual history. be specific about asking for oral sex history.

Question 10

features of group A strep infection

Answer 10

younger than 15 and older than 3
fever 
anterior cerival adenopathy
tonsillar swelling and exudates
no cough

Question 11

archanobacteria

Answer 11

look like strep and cause scarltiniform rash but doesn’t desquamate. seen in teens.

Question 12

diphtheria pharyngitis

Answer 12

sore throat, fever, LAN, grey and white spots in throat and maybe MEMBRANE FORMATION

Question 13

features of rheumatic fever

Answer 13

Hx of group A strep

carditis, polyarthritis, chorea, erythema marginatum, subcunateous nodules

Question 14

treatment for rheumatic fever

Answer 14

aspirin and prednisone pluse monthly IM penicillin

Question 15

Sequelae of group A strep

Answer 15

TSS, glomerulonephritis, scarlet fever, necrotizing fascitis, impetigo

Question 16

parapharyngeal space infection: involved structures

Answer 16

deep to lateral wall of phayrnx. includes carotid artery, internal jugular veins, cervical sympathetic chain, parts of CNIX-XII, opens to posterior mediastinum

Question 17

features of parapharyngeal space infection

Answer 17

polymicrobial, unilateral sore throat, muffled voice, fever. most common deep neck infection in kids and teens.

Question 18

treatment of parapharyngeal space infection

Answer 18

airway management, drainage of fluid collections, IV antibiotics

Question 19

Lemierre’s disease

Answer 19

septic thrombophebitis of the internal jugular vein caused by anaerobes or mixed bacterial pictures. may be copuled with spetic pulmonary embolit and can extend along the carotid sheat and to the posterior mediastinum/erode the carotid artery. requires IV antibitics and surgical drainage and a thrombolytic

Question 20

sinusitis presentation

Answer 20

usually, what matters is length of symptoms. if more than 10 days, give antibiotics. (fever facial pain, headaches, thick/purulent nasal drainage

Question 21

baceria of sinusitis

Answer 21

strep pneumo, H. flu, moraxella cattarrhalis

in hospitals, consider MRSA, pesudomonas, kelbsiella

Question 22

fungal sinusitis

Answer 22

mucormycosis and aspergillis. mucomycosis can cause rapidly progressive necrotizing infection esp. in immunocompromised and diabetics. fungi can eat bone and brain

Question 23

comlications of bacterial sinusitis

Answer 23

thrombosis, orbital cellulis, meningits, epidural abscess, brain absces

Question 24

complications of fungal sinusitis

Answer 24

thrombosis orbital cellulitis, meningitis, epidural and brain abscesses, nasopharyngeal ulcerations, epstaxis, bony erosion, cranial nerve involvement.

Question 25

treatment for fungal sinusitis

Answer 25

antifungals and IMMEDIATE REFERRAL TO ENT