Upper Respiratory Tract Infections

Question 1

What are symptoms of the common cold?

Answer 1

• Sore throat
• Nasal congestion
• Rhinorrhea
• Sneezing
• Cough

Question 2

What viruses can cause the common cold?

Answer 2

• Rhinovirus (50%)
• Corona virus
• Influenza virus
• Respiratory syncitial virus
• Parainfluenza virus

Question 3

How is the common cold transmitted?

Answer 3

• Direct contact
• Aerosolized droplets
• Virus enters nose
• Mucociliary clearance to nasopharynx

Question 4

• How does the virus causing common cold enter epithelial cells?
• What changes does it cause once it enters the cells?

Answer 4

• How does the virus causing common cold enter epithelial cells?
  
  • Via intercellular adhesion molecule-1
• What changes does it cause once it enters the cells?
  
  • Vasodilation, increased mucous secretion, extensive respiratory epithelium damage

Question 5

What is the first line therapy for Otitis Media?

Answer 5

Amoxicillin

Question 6

What risk factors are associated with Otitis Media?

Answer 6

• Daycare
• Smoke exposure
• Lack of breast-feeding
• Ethnicity
• Family history
• Older siblings
• Low SES
• Downs syndrome/Cleft palate
• Native American heritage

Question 7

What are some causes of acute and chronic otitis media?

Which virus is more likely to cause acute? chronic?

Answer 7

• Streptococcus pneumoniae (40% of acute cases)
• Haemophilus influenza (25% of acute; 15% of chronic)
• Moraxella Catarhalis

Question 8

What types of ear tubes are used in otitis media? What is their purpose?

Answer 8

• Pressure equalizing tubes
• Myringotomy tubes
• Tympanostomy tubes

Allows the middle ear to ventilate until the eustachian tube is mature (usually last 6-18 months)

Question 9

What are some indications for ear tubes?

Answer 9

• Chronic middle ear effusion ± conductive hearing loss
• Recurrent suppurative otitis media
• Atelectasis of middle ear

Question 10

What are paranasal sinuses?

Answer 10

Air filled cavities that are found in the bones of teh face/head

Question 11

What are the 4 sets of sinuses?

Answer 11

• Ethmoid
• Maxillary
• Sphenoid
• Frontal

Question 12

What is Rhino-sinusitis?

Answer 12

Inflammation/infection of the nasal passage and paranasal sinuses

Question 13

What are the different types of Rhino-Sinusitis?

Answer 13

• Acute Rhinosinusitis
  
  • Acute bacterial (Strep, Haemophilus, Moraxella)
  • Acute viral
• Recurrent acute rhinosinusitis
• Chronic Rhinosinusitis

Question 14

What is the progression of sinus disease (Cycle)?

Answer 14

Sinus disease → Swelling → Narrowed sinus ostia → Impedes drainage → Mucus fills sinus → Bacteria grow → Sinus infection

Question 15

What causes inflammation in the sinuses?

Answer 15

• Viral infections
• Environmental allergens
• Environmental irritants
• Mucus
• Medications
• Bacteria
• Fungus

Question 16

How does pseudomembranous candidiasis appear?

Answer 16

• Thrush
  
  • Adherent white plaques
    
    • Tongue, buccal mucosa, hard palate
    • Plaques wipe off and underlying mucosa is erythematous

Question 17

What is the second most common AIDS-defining opportunistic infection?

Answer 17

Pseudomembranous candidiasis

Question 18

Pseudomembranous candidiasis is most common in _____ and ________

Answer 18

infants; immunocompromised

Question 19

What is the most common form of candidiasis?

What are the subtypes?

Answer 19

• Erythematous candidiasis
  
  • Acute atrophic
  • Chronic atrophic
  • Angular chelitis
  • Median rhomboid glossitis
  • Chronic multifocal

Question 20

• What is Angular chelitis?
• What bacteria cause it?
• In what types of patients is it most commonly seen?

Answer 20

• What is Angular chelitis?
  
  • combination of bacterial and fungal infections
• What bacteria cause it?
  
  • C. albicans and S. aureus
• In what types of patients is it most commonly seen?
  
  • Patients with dentures

Question 21

How is Candidiasis diagnosed?

Answer 21

• Based on clinical signs/symptoms
• Cytology
• Mucosal biopsy
• Culture

Question 22

Name the parts of the mouth

Answer 22

Question 23

What is stomatitis?

Answer 23

The broad term for any infection involving the mouth or lips

Question 24

What are viral causes of stomatitis?

What are fungal causes of stomatitis?

Answer 24

• Viral
  
  • Measles virus
  • Coxsackie virus
  • Human papillomavirus
  • Herpes simplex virus
• Fungal
  
  • Candida albicans
  • Aspergillosis
  • Histoplasma capsulatam
  • Blastomyces dermatitidis

Question 25

What is Waldeyer's ring?

Answer 25

An aggregate of lymphoid tissue in the upper aerodigestive tract

Question 26

What are the indications for an adenotonsillectomy?

Answer 26

* Upper airway obstruction * Recurrent/chronic infection * Neoplasia (lymphoma/carcinoma)

Question 27

What are the types of upper airway obstructions that would indicate an adenotonsillectomy?

Answer 27

* Adenoids (nasopharynx obstruction) * Palatine tonsils (oropharynx) * Lingual tonsils (hypopharynx)

Question 28

What are the steps in assesing a sore throat?

Answer 28

* Assess probability of strep (Low, Moderate, High) * If moderate or High - Rapid strep test * If positive - treat for strep * If patient does not improve, or worsens, re-evaluate * If patient is 10-25 years of age test for mononucleosis * If patient is \<10 or \>25 years old, order throat culture * Treat with appropriate antibodies

Question 29

How do you obtain a throat culture?

Answer 29

* Culture each tonsil and posterior pharyngeal wall * Twis, rotate swab into tissue * Avoid touching the tongue * Immediate transfer to transport medium

Question 30

What are the cervical lymph nodes and what metastasizes to them?

Answer 30

* Upper jugular chain - metastasis from nasopharynx * Posterior triangle - metastasis from nasopharynx, posterior skull * Lower jugular chain area - thyroid, upper esophagus * Submandibular triangle - anterior two thirds of tongue * Submental triangle - metastasis from lip cancer * Midjugular chain - any portion of oral cavity, pharynx or larynx

Question 31

Supraglottitis * Onset: * Symptoms: * Stridor: * Etiology: * Treatment:

Answer 31

Onset: Rapid Symptoms: Drooling, fevers, sitting up, SICK Stridor: Inspiratory Etiology: H. flu (Type B) Treatment: Secure airway, antibx

Question 32

Croup * Onset: * Symptoms: * Stridor: * Etiology:

Answer 32

Onset: Gradual Symptoms: Barking cough, low fevers Stridor: Biphasic Etiology: Viral

Question 33

What is the characteristic sign of epiglottitis?

Answer 33

Thumb print sign

Question 34

Bacterial Tracheitis * Symptoms: * Etiology: * Treatment:

Answer 34

Symptoms: Toxic, cough, stridor, fever Etiology: Usually S. Aureus Treatment: IV antibiotics, hydration, rigid bronchoscopy