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AII Week 3 > Clinical Medicine 2 > Flashcards

Clinical Medicine 2 Flashcards

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1
Q

Etiology of acute sinusitis (rhino sinusitis)

A

Viral infection associated with common cold (URI). Few are bacterial related

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2
Q

Clinical presentation of acute sinusitis

A
  1. Nasal congestion/obstruction
  2. Purulent discharge (Bilateral viral, unilateral bacterial)
  3. Maxillary tooth pain (Bilateral is viral, unilateral is bacterial)
  4. Facial pain or pressure
  5. fever, fatigue cough
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3
Q

DX workup of acute sinusitis

A

Based on clinical symptoms. Purulent drainage. Must try and figure out if its viral or bacterial. Usually bacterial is secondary to the viral URI

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4
Q

Management of acute sinusitis

A
  1. If viral - goes away in 10 days
  2. Analgesics (NSAIDS)
  3. Saline irrigation
  4. Intranasal steroids
  5. Intranasal decongestants
  6. Amoxicillin
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5
Q

Complications of acute sinusitis

A
  1. Dental infections
  2. Intracranial involvement (abscess)
  3. Orbital cellulitis
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6
Q

Etiology of chronic sinusitis

A

Inflammatory condition involving the paranasal sinuses and lining of nasal passages that last longer than 12 weeks “untreated rhino sinusitis”

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7
Q

Clinical presentation of chronic sinusitis

A
  1. A/P nasal purulent drainage
  2. Nasal obstruction
  3. Facial pain/pressure
  4. Reduction or loss of sense of smell
  5. Mucosal thickening with polyps
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8
Q

DX workup of chronic sinusitis

A
  1. Rhinoscopy

2. CT/MRI

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9
Q

Complications of chronic sinusitis

A

High fever, double vision, proptosis, epistaxis - may indicate more severe conditions

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10
Q

Rhinocerebral mucormycosis

A

Fungal infection of the nasal cavity. Often seen in immunocompromised and diabetic pts

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11
Q

Causes of mucormycosis

A

From the fungal group rhizopus which are found in decaying soil. Airborne transmission

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12
Q

Clinical presentation of mucormycosis

A
  1. Acute sinusitis with fever
  2. Nasal congestion
  3. Clear discharge
  4. Spread to other structures
  5. Necrosis of the palate
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13
Q

Chlamydia

A

Most frequently reported infectious disease

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14
Q

URI

A

Viral induced infection of the upper respiratory tract (nose, mouth, upper lungs)
“common cold”

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15
Q

Types of URI infections

A
  1. Bronchitis
  2. Pertussis
  3. Acute rhinosinusitis
  4. Acute pharyngitis
  5. Acute otitis media
  6. Diptheria
  7. Infectious mononucleosis
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16
Q

Nasal vestibulitis

A

Staph aureus which may create folliculitis of the hairs. Often as a result of hair trimming

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17
Q

Clinical presentation of vestibulitis

A

Inflammation of the nasal vestibule, present with furuncle`

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18
Q

DX workup fro nasal vestibulitis

A

Nasal exam

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19
Q

Management of nasal vestibulitis

A

Drain furuncle, ABX - dicloxacillin. Topical - bacitracin

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20
Q

Common cold (URI) clinical presentation

A

nasal congestion, discharge, cough, sneezing, fever (low grade)

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21
Q

DX of URI

A

symptoms last

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22
Q

Management of URI

A

NO ABX!! Unless it is bacterial induced which is very rare.
Saline irrigation
Oxymetazoline - nasal anithistamine

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23
Q

Influenza A/B

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A

Virus infection that comes from avian host

24
Q

Clinical presentation of influenza

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A
  1. Fever/chills/malaise
  2. Rhinitis
  3. Cough
  4. Congestion
  5. Sore throat
  6. NVD
25
DX of influenza
Rapid flu test, some PCR testing
26
Management of influenza
Analgesics, cough suppressant, rest, antiviral therapy, susceptible strains - neuraminidase inhibitors
27
H1N1
Complex flu strain that has 4 mutant viruses: human, bird, and 2 swine flu viruses
28
Clinical presentation of H1N1
Common flu symptoms plus GI symptoms and respiratory symptoms (pneumonia)
29
DX workup for H1N1
Rapid flu test (nasal swab 60-80%)
30
Management of H1N1
Oseltamivir, zanamivir (if resistant to oseltamivir)
31
Causes of acute bronchitis
1. Mostly due to viruses (flu, rhinovirus) that attack the bronchial tree. 2. However, there are a few that are bacterial (mycoplasma, chlamydia, bordetella)
32
Clinical presentation of acute bronchitis
1. Cough that lasts longer than 5 days 2. Sputum production 3. no fever (more indicative of pneumonia) 4. Chest wall tenderness 5. Wheezing
33
DX workup of acute bronchitis
1. wheezing during exam 2. 5 day cough 3. No CXR needed (not dx)
34
Management of acute bronchitis
NO ABX!! Will clear on its own in 10 days. But may give aspirin or acetaminophen for inflammation
35
Pertussis (whooping cough)
Caused by the organism bordetella pertussis. Transmitted through droplets. Seen in
36
Clinical presentation of pertussis
Malaise, cough, rhinitis, anorexia, whoop
37
DX work up of pertussis
1. Nasopharyngeal culture | 2. Lymphocytosis (pcr)
38
Management of pertussis
Erythromycin, azithromycin, clarithromycin
39
Viral pharyngitis causes
EBV, CMV, resp viruses, enteroviruses, HSV
40
Clinical presentation of viral pharyngitis
1. Conjunctivitis 2. Runny nose 3. Cough 4. Hoarsness - never seen with bacterial infections
41
Management of viral pharyngitis
Because it is viral, no ABX. In adults it is almost never streptococcus related. Treat with pain relievers, antipyretics, gargling
42
Group A beta-hemolytic streptococcal pharyngitis
Caused by group A strep, non group A strep, arcanobacterium
43
Clinical presentation of strep A pharyngitis
1. Fever 2. Headace 3. Tonsillar inflammation 4. Age 5-15!!!
44
Management of strep A pharyngitis
PENICILLIN or cephalosporin. If allergic they can be given a macrolide
45
Causes of diptheria
Corynebacterium (exotoxins). Organism attacks respiratory tract, mucous membranes, and skin wounds
46
Clinical presentation of diptheria
1. Tenacious gray membrane - gray impossible to remove plaque at the back of throat 2. Sore throat 3. Rhinorrhea 4. Fever, malaise
47
Complications of strep A pharyngitis
glomerulonephritis and rheumatic fever
48
Complications of diptheria
Myocarditis and neuropathy
49
Management of diptheria
Horse serum antitoxin + penicillin or erythromycin (z-pak)
50
Causes of mono
EBV. Common in 10-35 yr olds
51
Clinical presentation of mono
1. Fever 2. Sore throat 3. Malaise 4. Fatigue!!!!! 5. Abd px from inflammation of the liver and spleen
52
Workup for mono
Monospot positive within 4 weeks. CBC shows atypical lymphocytes
53
Management of mono
supportive. secondary bacterial pharyngitis main be present. avoid contact sports because of possible spleen rupture
54
What is the best thing to give pts with strep A in order to prevent glomerulonephritis and rheumatic fever
IM penicillin
55
Indications for tonsillectomy
1. Obstruction of airway by tonsils 2. Tonsillar obstruction that interferes with swallowing 3. Malignant tumor on tonsil 4. Uncontrollable hemorrhage
56
Condition indications for tonsillectomy
1. Recurrent throat infections 2. Chronic tonsillitis 3. Halitosis 4. Tonsillar abscess
57
What happens if you give a patient with mono ampicillin/amoxicillin
They can break out in a mobilliform rash. The ABX interacts inappropriately with the virus. This is NOT an allergy

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