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Flashcards in Upper RTI Deck (35):
1

Acute Otitis Media
-who gets it
-risk factors

- common in infancy (6-18 mo). More boys than girls
- age, family Hx, day care, lack of breastfeeding, tobacco smoke/air pollution, pacifier use

2

Acute Otitis media
-etiology

- 2/3 combined viral/bacterial
-Bacterial: S. pnuemoniae, H. influenzae, M. cattarhalis
-Viral: RSV, rhinovirus, picoronaviruses, coronaviruses, influenza virus, adenovirus, human metapneumovirus

3

Acute otitis media
-pathophysiology

- antecedent viral URTI closes the eustachian tube with inflammation
-middle ear secretions build up
-bacteria gain access to middle ear and grow in secretions

4

Acute otitis media
-S/S in infants and children

-Infants: nonspecific, maybe fever
-children: otalgia, bulging tympanic membrane, otorrhea

5

Acute otitis media
-management

- many resolve spontaneously (organism-dependant)
-Usually watchful waiting
-Treat if <6 months, perforated ear drum, day care, previous Ab in last 3 months, unlikely to return
-Amoxicillin (want to cover S. pneumoniae)

6

Acute otitis media
-how long do children have effusions

50% of children have them at 1 month (do not treat) only 10% have them at 3 months

7

Acute sinusitis
-epidemiology
-Risk factors

- adults and children, but women more frequent than men
- dental infection, allergies, swimming, obstruction of nose

8

Acute sinusitis
-etiology

- Viral 200x more common (rhinovirus, influenza virus, parainfluenza virus
-Bacterial: S. pneumoniae, H. influenzae, M. cattarhalis, anaerobes associated with dental disease

9

Acute sinusitis
-pathophysiology

- common cold spreads to paranasal sinuses (systemic or direct)
-secondary spread of bacteria into nasal cavities

10

Acute sinusitis
-S/S

-purulent rhinorhea
-nasal congestion
-Cannot differentiate viral vs. bacterial, but bacterial more likely if:

-URTI persist for >10 days, or worsen after 5-7 days AND (above symptoms +pain OR fever and pain)

11

Acute sinusitis
-Management

- No Ab (even for bacterial sinusitis), no topical steroid
-Analgesics
-Saline irrigation
-Steam inhalation
-Decongestants

-If must use Ab, use Amoxil

12

Croup
-epidemiology (demographics, season, time of day)

-6-36 months, rare beyond 6 y.o
-more common in boys
-more common in the fall/winter
-more common in late evening/early morning

13

Croup
-Etiology

-Parainfluenza virus type 1 (50%)
-RSV
-Adenovirus
-Coronavirus
-Influenza

14

Croup
-Pathophysiology

-Virus invades respiratory epithelium
-Inflammation of trachea and larynx
-Narrowing trachea --> barking cough

15

Croup
-S/S

-inspiratory stridor, barking cough, sudden onset and rapid progression

16

Croup
-management

-no Ab
-systemic or nebulized steroids
-no sedation-- have to be awake to breath

17

Pertussis
-epidemiology (transmission, frequency of outbreaks)

-cyclic epidemics q2-5 yrs
-highly contagious
-respiratory droplet or direct contact
-adults are a reservoir for transmission

18

Pertussis
-etiology

Bordetella pertussis

19

Pertussis
-pathophysiology

-various toxins and interference of host-defence (e.g. lives in macrophages)

20

Pertussis
-S/S
-typical course

-paroxysmal cough, inspiratpry whoop, post-tussive emesis

1) cattarhal phase (runny nose, fever) (1-2 wks, v. contagious)
2) paroxysmal phase (3-6 wks)
3) convalescent phase ( >6 wks)

21

Pertussis
-diagnosis

-nasopharyngeal swab--> culture and PCR
-clinical signs

22

Pertussis
-management

-macrolides or TMP-SMX
-give longer if infant, pregnant woman, health care worker, childcare worker

23

Common cold
-epidemiology (who gets it, what season, transmission, infectivity)

-mostly children
-year round (mostly winter)
-hands +++, droplets +
-incubation: 24/72h
-Infectivity: peaks with symptoms, shedding continues ~3wks

24

Common cold
-etiology

ALL VIRAL
rhinovirus
influenzavirus
adenovirus
enterovirus
coronavirus
RSV
Parainfluenza virus
human metapnuemovirus

25

Common cold
-pathophysiology

virus attaches to conjunctival and nasal mucosa and replicates causing inflammation

26

Common cold
-diagnosis

-rhinorhea, sneezing/congestion, low-grade fever, cough

27

Common cold management

-HANDWASHING
-Saline irrigation
-Steam inhalation
-Decongestants
-No antibiotics

28

Pharyngitis
-epidemiology (who gets it, when)

-school aged kids
-winter/spring

29

Pharyngitis
-etiology

-80-90% viral

adenovirus
RSV
parainfluenzae virus
rhinovirus
influenza virus
coxsackie virus
echovirus
HSV
EBV

-10-20% virus

GAS, GCS, GGS
N. gonorrhea
C. diptheriae
Fusobacterium necrophorium
arcanobacterium hemolyticum

30

Pharygitis
-pathophysiology

GAS resists phagocytosis

31

Pharyngitis
-S/S of viral vs. bacterial

Viral:

Rhinorhea
cough
conjunctivitis
rash
diarrhea

Bacterial

F: fever
A: adenopathy
C: absence of cough
E: exudate on tonsils

32

Pharyngitis
-Daignosis

- Only swab or do RADT on those that don't appear to be viral

33

Pharyngitis
-Management

-Viral: analgesic, antipyretic. NO antispetic or antibiotic

Bacterial: Penicillin (want to prevent rheumatic fever)

34

Signs of infectious mononucleosis

Fever, LAD, pharyngitis

35

Two most common causes of mono

CMV and EBV