Respiratory infections

Question 1

most frequent diagnosis in sick children at clinic visits (and most common reason for antibiotics)

Answer 1

-otitis media

Question 2

Definition of otitis media

Answer 2

-moderate or severe bulging of the tympanic membrane, or new onset otorrhea (not d/t otitis externa), with acute signs of illness and middle ear inflammation

Question 3

pathogenesis of otitis media

Answer 3

inflammation obstructs the Eustachian tube –> reduction in clearance of middle ear secretions –> fluid accumulation in middle ear/ proliferation of bacteria –> reflux of pharyngeal flora —-> acute otitis media!

Question 4

T/F: breastfeeding is protective for otitis media

Answer 4

True. Formula feeding is a risk factor.

Question 5

clinical presentation of otitis media in infants. (can’t tell you their ear hurts)

Answer 5

• fever
• irritability
• night awakening
• poor feeding
• vomiting/diarrhea
• often happens after an upper respiratory infection - eg cough and runny nose leading up to it.

Question 6

normal tympanic membrane appearance

Answer 6

-gray, clear.

Question 7

tympanic membrane in otitis media

Answer 7

red, vasculature showing. bulging.

Question 8

Most common 3 organisms that cause >90% of otitis media.

Answer 8

• Strep pneumo
• H. influenzae
• moraxella catarrhalis

Question 9

If conjunctivitis (pinkeye) along with otitis media, what organism should you suspect?

Answer 9

H influ

Question 10

first line treatment regimen for acute otitis media

Answer 10

NSAIDs for pain

-amoxicillin for 10 days.

Question 11

what is cholesteatoma?

Answer 11

• complication of otitis media

- abnormal invasive growth of squamous epithelium

Question 12

Treatment for chronic otitis media

Answer 12

prolonged antibiotics, ENT referral.

Question 13

Case: 14 yo female, 3 day history of
-fevers
-chills
-sore throat
-headaches
-malaise
-no runny nose or nasal congestion, no cough. 
Physical exam: 
-pharyngeal erythema, tonsillar exudate, tender cervical lymphadenopathy.

What is the likely diagnosis, and the most likely organism?

Answer 13

• Pharyngitis!!

- most likely org. is Strep pyogenes (group A strep)

Question 14

epidemiology of streptococcal pharyngitis - who and when does it infect?

Answer 14

• primarily 5-15 year olds.
• in winter
• spread through respiratory droplets.

Question 15

what symptoms are present in viral pharyngitis, but not often associated with streptococcal pharyngitis?

Answer 15

cough and rhinorrhea (runny nose) - if these are present think about a viral cause!!

Question 16

pharyngitis with ulcers is associated with

Answer 16

viral pharyngitis due to coxsackievirus

Question 17

Which factors positively impact a pre-test probability for group A strep?

Answer 17

• tender lymph nodes
• tonsillar swelling
• rash
• 5-15 years old
• late fall to early spring
• temp 101-103
• lack of coryza ( runny nose / stuffy nose)

Question 18

complications of group A strep

Answer 18

• acute rheumatic fever

- acute glomerulonephritis.

Question 19

First line treatment for group A strep pharyngitis.

Answer 19

penicillin - 10 days.

Question 20

Define acute rhinosinusitis

Answer 20

-inflammation of the nasal cavity/paranasal sinuses lasting less than 4 weeks.

Question 21

What is the most common cause of community acquired sinusitis?

Answer 21

Viral causes make up the vast majority of infections!!!

bacteria =

Question 22

how to differentiate bacterial vs. viral sinusitis

Answer 22

bacterial more likely if: no improvement after 7-10 days, or high fever/pain, or facial swelling, focused unilateral facial pain, or a current odontogenic source of bacteria (cut in mouth).

Question 23

You see a patient with runny nose and sinus pressure. You are leaning sinusitis. Are any lab exams warranted.

Answer 23

no. sinusitis is a clinical diagnosis.

Question 24

complications of sinusitis

Answer 24

• meningitis
• brain / orbital abscess formation
• venous sinus thrombosis

Question 25

define acute bronchitis

Answer 25

self-limited inflammation of the bronchi, manifest as cough for >5 days, along with possible sputum production.

Question 26

T/F: Acute bronchitis is most often due to viral infection.

Answer 26

True!! however, most who receive care for bronchitis get antibiotics.

Question 27

T/F if there is purulent sputum with coughing/ bronchitis, this indicates a bacterial infection.

Answer 27

False. purulent sputum is present in viral bronchitis

Question 28

Clinical presentation of acute bronchitis

Answer 28

-cough > 5 days
\+/- purulent sputum
-wheezing
-rhonchi which clear with cough
-fever is not usually present
-signs of lung consolidation usually not present.

Question 29

T/F: fever with bronchitis is an indication for antibiotic administration.

Answer 29

False. Fever is not usually associated with bronchitis. If it is present, think about influenza or pneumonia

Question 30

Symptoms in bronchitis which make whooping cough (pertussis) more suspicious

Answer 30

• > 2 weeks cough
• throwing up after coughing
• inspiratory whoop.
• do PCR if suspicious.

Question 31

How to differentiate between bronchitis and pneumonia

Answer 31

**Abnormal vital signs (fever / RR / pulse) - suggest pneumonia

• purulent sputum - happens in both
• rales: clear w/ cough in bronchitisk, don’t clear in pneumonia.
• hypoxemia: suggestive of pneumonia
• CXR shows infiltrate: pneumonia

Question 32

definition of pneumonia

Answer 32

infection of the pulmonary parenchyma

Question 33

risk factors for complicated course of pneumonia

Answer 33

• age >65
• COPD/ lung disease
• RR>30, dBP 125
• low or high WBCs

Question 34

most common 3 organisms for pneumonia

Answer 34

• -strep pneumo*
• mycoplasma
• chlamydia

Question 35

Who can you treat for pneumonia as an outpatient?

Answer 35

-younger, non-productive cough, no lobar infiltrate

Question 36

50 yo man, alcoholic, 1 month of:

• fever
• night sweats
• cough, productive of sputum,
• 10 lb wt loss
• crackles in RLLobe
• dullness to percussion
• cavitary lesion in lung on XRay

Diagnosis

Answer 36

-aspiration pneumonia (alcoholic –> unconscious aspiration)

Pace of illness: slow onset, wt loss, anemia.
-also could be TB

Question 37

therapy for hospitalized patient with pneumonia

Answer 37

cephalosporin + macrolide