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Flashcards in Upper Respiratory Infection Deck (45):
1

Name some specific microbes/viruses that can cause acute bronchitis

influenza, parainfluenza, adeno, rhino, mycoplasma pneumonia and chlamydia pneumonia

2

Common presentation of acute bronchitis

cough productive of purulent sputum (MOST COMMON)
fever
malaise
rhinorrhea
nasal congestion
sore throat
wheezing
dyspnea
chest pain
myalgias/arthralgias

3

Typical physical exam findings for acute bronchitis

non-specific and usually UNREMARKABLE

lung exam can show rales, rhonchi, or wheezes occasionally

make sure to note fever, tachypnea, tachycardia, BP abnormalities and to pulse ox in more severe symptoms

4

Factors more indicative of pneumonia

prolonged fever, tachycardia, tachypnea, hypotension, signs of consolidation on lung exam

5

What to do to confirm dx if suspecting pneumonia?

chest radiograph

6

How long does acute bronchitis usually last?

nearly always self limited in otherwise healthy individual

most lasts less than 2 weeks, some cases cough up to 2 months or more

7

Treatment for acute bronchitis

bronchodilator therapy, antitussives (dextromethorphan and codeine)

antibiotics limited effectiveness

8

Most common cause of chronic cough in healthy, non smokers with normal chest xray

upper airway cough syndrome (UACS)

encompasses variety of conditions (like allergic rhinitis or bacterial sinusitis)

9

How to subdivide rhinosinusitis?

acute (12 weeks)
recurrent (4 or more per year with interim resolution of symptoms)

10

When to think bacterial sinusitis vs viral sinusitis?

viral usually is gone in 7-10 days...
if patient has symptoms that persist longer than this, consider bacterial (>7 adults and>10 for children)

11

Symptoms of sinusitis

purulent nasal discharge, maxillary tooth/facial pain, unilateral maxillary sinus tenderness, worsening of symptoms after initial improvement + other syptoms similar to other URI

12

Organisms most commonly responsible for bacterial sinusitis?

s pneumo, h influenza, and moraxella catarrhalis (esp in children)

13

First line treatment for bacterial acute sinusitis

amoxicillin or trimeth-sulfa 10-14 day regimen

14

Second line antibiotics for acute sinusitis

augmentin (amox-clauvanic acid), 2/3rd gen cephalosporin), fluroquinolones, second generation macrolides (azithro, clarithrymycin)

15

What can be used in addition to antibiotics for adjunctive treatment of sinusitis

oral/topical decongestants, NSAIDS all for symptomatic relief

16

What comprises the majority of etiologies of pharyngitis?

VIRAL, self limited

17

When someone comes to you with sore throat, what serious conditions to rule out first?

GAS infection (strep throat), peritonsillar abscess, epiglottitis

18

Some bacterial causes of pharyngitis in teens

mycoplasma pneumoniae, chlamydia pneumoniae, arcanobaacterium haemolyticus

19

Findings frequently associated with GAS infection

abrupt onset sore throat, cervical lymphadenopathy, absence of cough, fever greater than 100.4, tonsillar exudate (not specific)

think CENTOR criteria

GAS can also cause scarlitinoform rash (red, sandpaper like)

20

What other virus presents similarly to GAS infection

Epstein barr (infectious mononucleosis)

21

features of Epstein Barr virus infection

hepatospenomegaly/generalized adenopathy
atypical lymphocytes on blood smear
presdisposition to splenic rupture (tell patients to avoid sports)

22

stridor, drooling, toxic appearance, patient somtimes leaning forward on outstretched arms (tripod)

epiglottitis

23

How to treat epiglottitis

emergently secure airway (via intubation/cricothyroidotomy)

24

swelling, associated tonsil pushed toward the midline with contralateral deviation of uvula

peritonsillar abscess

25

What is peritonsillar abcess associated with

complication of streptococcal pharyngitis or initial complaint of sore throat with trismus (pain with chewing)

26

what to do if suspect peritonsillar abscess

immediate referral for surgical drainage of abcess

27

gold standard for GAS infection diagnosis

throat culture! but can take 24-48 hours to come back

28

quick way to diagnose GAS

rapid antigen testing (highly specific but lower sensitivity than throat culture)

positive = prompt antibiotic treatment
negative = do throat culture

29

Rare, but serious complications of untreated GAS infection

RHEUMATIC FEVER, glomerulonephritis (poststreptococcal), toxic shock syndrome, peritonsillar abscess, meningitis, bacteremia

30

T/F: postglomerulornephritis can occur even if patient was given appropriate antibiotic treatment

TRUE

31

treatment for GAS pharyngitis

PENICILLIN (10 day course) IM or oral

32

chronic cough, inflammation/hyperactivity of airway, chest tightness, exacerbation by particular triggers, improved with bronchodilators

asthma

33

cough gets worse in supine position, heartburn, increased symptoms after meals

GERD

34

how to dx GERD

24 hours esophageal ph monitoring (but clinical diagnosis is more common)

35

easily overlooked cause of nonproductive cough

ACE-inhibitor related cough

36

When can ACE inhibitor cough present?

1 week to 6 months after initiation of therapy

37

how to treat ACE inhibitor cough

discontinue med, check back in 4 weeks at the earliest, may use ARB as alternative

38

inflamed, swollen external ear canal, exudates/discharge, tympanic membrane may or may not be involved

OTITIS EXTERNA (OE)

39

pathogens that can cause OE

staph, strept, pseudomonas ("swimmer's" ear from pools/bathtubs)

40

What condition puts patients at risk for invasive external otitis (malignant OE) by pseudomonas

DM

41

How does otitis media usually present?

usually seen in kids
fever, ear pain, tinnitus, vertigo, swollen TM (decreased motility or fluid behind TM is diagnostic), red TM

MOST CASES ACUTE OM RESOLVE SPONTANEOUSLY

42

bacterial pathogens commonly seen in OM

s pneumo, moraoxella catarrhalis, h influenzae

43

If patient has prolonged, severe OM, what a/b to give?

amoxicilin!

alt: amoxicillin-clavulanic acid (augmentin), bactrim or cephalosporin

44

CENTOR criteria = ?

1 point for each

age between 3-14
tonsillar exudate/swelling
fever greater than 100.4
absence of cough
cervical lymphadenopathy

minus point for age over 45

45

CENTOR criteria treatment score

0-1 no further testing no antibiotics
2-3 rapid antigen testing or throat culture, if positive treat with antibiotics
4 or more - empirically treat with antibiotics