URI Flashcards
(166 cards)
1
Q
most common virology of common cold
A
rhinovirus- 30-50%
2
Q
other virologies of common cold
A
coronavirus, influenza, parainfluenza, RSV) respiratory synctial virus, adenovirus, enterovirus (coxsackie)
3
Q
transmission of cold
A
hands, droplet (sneeze/cough), large particle droplet (close contact), fomites
4
Q
daycare, underlying chronic condition, immunodeficiency, dec sleep/ sleep disorders, malnutrition, exposure to smoke are risk factors for
A
cold
5
Q
RHINORRHEA, NASAL CONGESTION, sore throat, non productive cough, malaise, mild HA, LG fever, self limit in 7-10 days
A
sxs of common cold
6
Q
imp sxs of common cold
A
rhinorrhea, nasal congestion
7
Q
nasal mucosal swelling, nasal discharge (clear/ water/ purulent), conjunctival infxn, pharyngeal erythema (mild), no pulmonary findings/ adenopathy
A
signs of common cold
8
Q
dx of cold based on
A
clinical, reported sxs, observed signs
9
Q
type ___ flue subtypes more dangerous
A
A
10
Q
cold tx
A
self limiting, rest, fluids, handwashing
NO ABX, symptomatic treatment
11
Q
guaifenesin and guaifeniesin with dextromethorphan
A
robitussin and robtiussin DM
expectorants/ antitussives good for common cold
12
Q
acute rhinosinusitis, AOM, acute asthma attack, PNA
A
complications of common cold
13
Q
transmission of flu
A
aeorosolized droplets (cough/sneeze), hand 2 hand contact, incubation 1-4 days
14
Q
imp symptoms of flue
A
abrupt onset, fever, myalgia, sore throat (can be severe)
15
Q
chills, malaise, HA, cough (non-productive), sore throat, nasal discharge, abrupt onset, fever, myalgia,
A
sxs of flu
16
Q
flushing, hot/ dry skin, unremarkable post pharynx, mild cervical LAD, negative chest exam
A
signs of flu
17
Q
people who are over ___ or under ___, but especially under ___ are at high risk of flue
A
over 65, under, 5, especially under 2
18
Q
people at high risk of flu
A
chronic illnesses, immunosuppressed, pregnant/ post -artum, healthcare workers, resident of nursing homes, native americans, BMI 40+
19
Q
flu tests should be done within ___ of illness
A
3-4 days
20
Q
flu screening test- nasal pharyngeal aspirate/swab, 15 minutes for results, SOME can distinguish b/w type A and B
A
RAT
Rapid Antigen Tests
21
Q
flu screening test- nasal swab/washing, 1-4 hours for results, CAN differentiate b/w types A andB
A
immunofluorescence
22
Q
flu screening test- NP swab, 15-30 mins for results, high sensitivity/ specificity, distinguishes b/w type A/B
A
rapid molecular assay
23
Q
flu screening test- NP swab/sputum, 1-8 hours for results, MOST sensitive and specific for flu type/subtype
A
RT- PCR
Reverse transcriptase polymerase chain reaction
24
Q
gold standard for lab diagnosis of flu
A
viral cultures
25
not for initial clinical management of flu but to confirm screening, takes 3-10 days
viral tissue cell culture
26
tonsillar exudates, tender anterior cervical adenopathy, fever by hx, absence of cough
steptococal pharyngitis centor criteria; patients with 3/5 should undergo testing for GAS
27
when should RT-PCR / viral flu cx be ordered if negative
RAT/ immunofluorsecence ab staining + high community flu rates
28
when should RT-PCR / viral flu cx be ordered if positive
RAT/ immunofluorescence + low community influenza rates
29
test pt for RT-PCR / viral cx be ordered if they are exposed to ____ and worry about novel flu ___
pigs/ poultry, flu A
30
acute flu generally improves in
3-7 days
31
cough and malaise with flu may persist for
1-2 weeks
32
when to give an antiviral with flu
hospitalization, progressive/ severe/ complicated illnesses, HIGH RISK OF COMPLICATIONS
33
administer antiviral for flu within ___, it shortens course by ___
24-30 hours, 1-2 days
34
pharm tx for influenza A/B
oseltamivir, zanamivir, peramivir (all are neuraminidase inhibitors)
35
dose for oseltamivir
75 mg po BID x 5 days
36
dose for zanamivir
10 mg (2 inhalations) BID x 5 days
37
dose for peramivir
600 mg IV x 1
38
flu drugs are ___ but you give if
Category C (so you dont give to pregnant), but you give if suspect flu A
39
zanamivir is contraindicated in patients with
asthma/ chronic respiratory conditions
40
PNA, rhinosinusitis, OM, myositis, rhabdomyolysis, CNS involvement, cardiac are complications of
flu
41
flu vaccines are indicated for everyone ___ months old
over 6
42
IM trivalent inactivated flu vaccine protects against
A H1N1, A H3N2, flu B
43
IM quadrivalent flu vaccine protects against
A H1N1, A H3N2, flu B and another flu B
44
takes ___ after vaccine for antibodies to develop
2 weeks
45
for ages 18-49 give ___ flu vaccine
standard dose inactivated (trivalent/ quadrivalent)
46
for age 65+ give ___ flu vaccine
high dose trivalent
47
give live attenuated vaccine to
not pregnant b/w 2 and 49
48
best month to give vaccine
october
49
contraindications of flu vaccine
current illness/ hx of guillain barre (w/in 6 weeks of prev flu vaccine)/ hx of allergic rxn to vaccine
50
most common viral origins of pharyngitis
rhinovirus, adenovirus, parainfluenza, influenza
51
pharyngitis may occur as ___ with ___
common cold with rhinorrhea and cough
52
viruses are ___ likely to cause pharyngeal exudate
less; exceptions- adenovirus/ mononucleosis
53
tx for viral pharyngitis
hydration, antipyretics/ anaglesics, rest, "magic mouthwash"
54
tx for HSV pharyngitis
acyclovir, famiclovir
55
tx for HIV pharyngitis
referral to infectious disease specialist for retroviral therapies
56
group A stretocococcus (GAS) bacterial pharyngitis causes
5-15% adults, 20-30% of kids
57
C trachomatis (bacterial pharyngitis) associated with
oral sex
58
N. gonorrhea (bacterial pharyngitis) associated with
oral sex
59
M. pneumoniae (bacterial pharyngitis) associated with
lower resp infxn and HA
60
H. influenza (bacterial pharyngitis) associated with
pediatric age group
61
C. diphtheriae (bacterial pharyngitis) is recognized by
diphtheria (gray exudate tightly adherent to throat, nasal passageway)
62
(creamy, white/ yellow plaques) are seen with pharyngitis
oral candidasis
63
sore throat, odynophagia, fever, malaise, anorexia, arthralgias, myalgias, nausea, vomitting, swollen glands
streptococcal pharyngitis sxs
64
pharyngeal erythema, tonsillar hypertrophy, purulent exudate, tender and/ or enlarged anterior cervical lymph nodes, palatal petechiae
streptococcal pharyngitis signs
65
steptococal pharyngitis centor criteria
tonsillar exudates, tender anterior cervical adenopathy, fever by hx, absence of cough; patients with 3/5 should undergo testing for GAS
66
gold standard for pharyngitis dx
throat cx
67
throat culture for pharyngitis can be ___ or ___
bacterial or viral
68
pharyngitis dx for group A strep
rapid antigen detection test
69
if pt meets centor criteria (w/ negative RADT) treat ____
empirically while waiting cx
70
first line tx for GAS pharyngisits
- penicillin V 500 mg PO TID x 10 days
- amoxicillin 500 mg BID x 10 days
- pencillin G benzathine 1.2 million units IM
- cephalexin 500 mg PO BID x 10 days
71
tx for pharyngitis if pt has a penicillin allergy
azithromycin, clindamycin, clarthromycin
72
in addition to abx, treat pharyngitis with
supportive care, lozenges, NSAIDs, acetaminophen
73
acute rheumatic fever, post-strep glomerulonephritis, peritonsillar abscess, OM, rhinosinusitis, bacteremia, PNA, toxic shock syndrome, SCARLET FEVER
complications of pharyngitis
74
rash, desquamation, pastia's lines, facial flushing w/ circumoral pallor, "strawberry tongue", can predispose for acute rheumatic fever
scarlet fever
75
scarlet fever can predispose for
acute rheumatic fever
76
strep pharyngitis is no longer contagious after ___ and clinical sxs improve after ___ after initiating abx tx and may return to work/school/daycare
3-4 days, 24 hours
77
most common deep neck infx in children and adolescents
peritonsillar abscess
78
polymicrobial etiology, mainly S. pyrogenes (GAS), S. aureus, mixed respiratory anaerobes and H. influenzae
peritonsillar abscess etiology
79
in ____ there is tissue infxn b/w palatine tonsil capsule and pharyngeal muscles with no pus; in ___ there is pus b/w tonsil capsule and pharyngeal muscles and it progresses to ___
in CELLULITIS there is tissue infxn b/w palatine tonsil capsule and pharyngeal muscles with no pus; in ABSCESS there is pus b/w tonsil capsule and pharyngeal muscles and it progresses to CELLULITIS
80
unilateral severe sore throat, drooling, trismus, fever, neck swelling/pain, ipsilateral ear pain, fatigue, anxiety, irritability, decrease PO intake
peritonsillar abscess sxs
81
trismus
spasm of internal pterygoid muscle
82
deviated uvula pushed to the opposite side of swollen tonsil, fullness of soft palate with palpable fluctuance, cervical lymphadenopathy, bilateral peritonsillar abxcess if uvula displaced anteriorly, hot potato/ muffled voice
peritonsillar abscess signs
83
dx for peritonsillar abscess
- clinical
- labs (CBC, electrolytes, throat cx)
- can get a CT to r/o infxn to danger zone but must use contrast
84
tx for peritonsillar abscess (non-abx)
- monitor airway
- drain (aspirate, tonsillectomy, OR)
- supportive care (FLUIDS, pain control)
- +/- glucocorticoids
85
parenteral abx tx for peritonsillar abscess
ampicillin-sulbactam or clindamycin (consider vanco if high rates of MRSA)
86
oral abx tx for peritonsillar abscess
amoxiciiln-clavulanate or clindamycin x 14 days
87
etiology of epiglottitis
H. influenzae
88
drooling, stidor, severe sore throat, no cough, toxic appearance
epiglottitis
89
consider ___ in unvaccinated kids and older adults
epiglottitis
90
___ is a danger of airway obstruction, rapid course
epiglottitis
91
epiglottitis tx
hospitalization, intubation, antibiotics
92
imaging of epiglottits
lateral neck x-ray: "thumb sign", CT/MRI
93
etiology of severe tonsillopharyngitis
EBV, HSV1/2, coxsackie virus, adenovirus, C. diphtheria, N. gonorrhea
94
pharyngeal edema, exudates, tonsillar hypertrophy
severe tonsillopharyngitis
95
dx for severe tonsillopharyngitis
monospot and viral/bacterial cx, CT w contrast/MRI
96
tx for severe tonsillopharyngitis
based on etiology
97
trauma (chicken bone), recent instrumentation with secondary bac infxn
retropharyngeal abscess/ cellulitis
98
prominent neck stiffness, minimal peritonsillar findings, trismus is rare
retropharyngeal abscess/ cellulitis
99
extremely serious, can extend to the mediastinum
retropharyngeal abscess/ cellulitis
100
dx and tx of retropharyngeal abscess/ cellulitis
CT/MRI w/ contrast, airway managment, abx, image guided aspiration of abscesses
101
ludwigs angina
submandibular space infxn
102
due to odontogenic infxn
submandibular space infxn
103
no trismus, elevated tender oropharynx, "woody" indurated submandibular area w/ possible crepitus
submandibular space infxn
104
dx and tx of submandibular space infxn
CT/MRI w/ contrast, airway managment, abx, abscess drainage
105
most common etiology of laryngitis
viruses (often associated with URI)
106
bacterial etiologies of laryngitis
Streptococci species, moraxella catarrhalis, H. influenzae
107
vocal abuse (sing/shout), intubation, toxic exposure (smoke, radiation), GERD, vocal cord nodules, laryngeal polys, carcinoma of vocal cords, neurologic dysfxn
non infectious causes of laryngitis
108
key symptom of laryngitis
hoarseness
109
dysphonia, URI sxs (rhinorrhea, congestion, sore throat, cough), hoarsensess
sxs of laryngitis
110
nasal edema, congestion, benign posterior pharynx, laryngeal erythema/ edema, vascular engorgement of vocal cords, nodules, ulcerations
signs of laryngitis
111
dx of laryngitis
- based on hx and PE,
- hoarseness > 2 weeks in abscense of URI then refer to ENT for laryngoscopy
- hoarseness with URI can last 2-3 weeks
112
tx for laryngitis
treat underlying cause, voice rest, humidification, hydration, d/c smoking, refer to ENT prn
113
__ out of __ Americans get rhinosinusitis annually
1 out of 7
114
highest incidence of rhinosinusitis
45-64 y/o
115
ARS
acute rhinosinusitis
116
purulent nasal drainage AND nasal obstruction and or facial pain, pressure, or fullness
acute rhinosinusitis
117
acute rhinosinusitis sxs last
<4 weeks
118
subactute rhinosinusitis sxs last
4-12 weeks
119
chronic rhinosinusitis sxs last
> 12 weeks
120
recurrent actue rhinosinusitis is ___ episodes of ARS/ year
4 +
121
most common etiology for ARS is
viral (AVRS)- rhinovirus, influenza, parainfluenza
122
ABRS (acute bacterial rhinosinusitis) etiology
(only 0.5-2% of ARS)
- strep pneumoniae
- H. influenzae
- moraxella catarrhalis
123
beyond infectious causes, ARS can also be associated w/
allergies, tumors, polyps, deviated nasal septum, foreign bodies
124
LG fever, congestion/ discharge, facial pain/pressure, fatigue, cough, maxillary tooth discomfort, ear pressure/ fullness, HA
sxs of ARS
| ** degree varies b/w AVRS and ABRS
125
purulent drainage in nose/ post pharynx, nasal mucosal edema, edema over involved cheekbone/ periorbital area, tenderness to percussion of upper teeth, sinus tenderness to palpation, opaque transillumination of frontal or maxillary sinuses
signs of ARS
126
radiography is ___ for AVRS diagnosis
not indicated
127
cultures are ___ for AVRS
not indicated
128
diagnosis of AVRS
clinical, < 10 days of sxs that are not worsening, plain sinus films (limited use)
129
tx for AVRS
supportive (analgesics, irrigation, mucolytics, intranasal decongestants, glucocorticoids)
130
classic presentation of ABRS is
prior hx of URI and AVRS
131
viral infxn leading to mucosal edema and sinus inflammatoin, decreased drainage of thick secretions leading to obstructed sinus ostia
leads to entrapment of bacteria and secondary ABRS following AVRS
132
ABRS diagnosis according to infectious disease society of american (IDSA)
persistent sxs/ signs > 10 days w/ no improvement OR onset of severe sxs OR viral URI that lasted 5-6 days, was improving then "double worsened"
133
fever > 102, purulent nasal drainage, facial pain lasting at least 3-4 consecutive days at the beginning of illness
severe sxs associated with ABRS and indicated by IDSA
134
pts at higher risk for abx resistance
```
65 y/o +
severe infxn
temp 102 +
recent hospitalization
immunocompromised
comorbidities
recent abx use (in past month)
```
135
first line tx for ABRS
amoxicillin-clavulanate- 500 mg/TID
136
use first line tx for ABRS when patients are/ are not at risk for abx resistance
are not
137
tx for ABRS if pt has a penicillin allergy
- doxycycline 100 mg BID
- levofloxacin 500 mg QD
- moxifloxacin 400 mg QD
138
duration of tx for 1st line tx recommended for ABRS
5-7 days
139
second line tx for ABRS is used when
no response/ worsening sxs OR HIGH RISK OF ABRS RESISTANCE
140
second line tx for ABRS
amoxicillin-clavulanate - 2000/125 mg BID
141
when high risk of ABRS resistance use
second line tx
142
duration of tx for 2nd line tx of ABRS
7-10 days
143
complicated ABRS
spread of infxn to the CNS/ orbit/ surrounding tissues, may be associated with persistent, high fevers (>102)
144
usually frontal, with doughy edema, severe HA
osteomyelitis (complication of ABRS)
145
severe HA, AMS, +/- nuchal rigidity
meningitis/ brain abscess/ epidural abscess (complication of ABRS)
146
periorbital edema/ inflammation/ erythema, abnormal extraocular movements, proptosis, vision changes (diplopia/ dec. acuity)
periorbital and/or preseptal or orbital cellulitis (complication of ABRS)
147
radiologic studies are indicated w/ ABRS if
suspect complicated ABRS
148
radiologic studies ordered w/ ABRS
CT w/ contrast & MRI
149
gold standard dx for complicated ABRS
sinus aspirate
150
tx for complicated ABRS
admit to hospital, URGENT ENT/ID consult
151
relating to ABRS: severe infxn, need urgent endoscopy/cx/surgical biopsy, anatomic defect obstructs, immunocompromised, failure to respond to 1st and 2nd line tx, multiple recurrent episodes, allergic rhinitis leading to ABRS in candidate for immunotherapy, chronic rhinosinusitis
are indications for ENT referral/ consult
152
CRS
chronic rhinosinusitis
153
risk factors:
allergic rhinitis, chronic irritant exposure, defects in mucocilliary clearance (CF), presence of immunodeficiency/ autoimmune/ inflammatory disease, anatomical abnormality predisposing to sinus obstruction, latrogenic
risk factors for CRS
154
latrogenic
multiple sinus surgeries
155
4 cardinal sxs of CRS in adults
- mucopurulent nasal drainage
- nasal obstruction and congestion
- facial pain/ pressure/ fullness
- reduction/ loss of sense of smell
156
4 cardinal sxs of CRS in kids
- mucopurulent nasal drainage
- nasal obstruction and congestion
- facial pain/ pressure/ fullness
- cough
157
diagnostic criteria of CRS
2/4 of cardinal sxs
AND infection for 12+ weeks
PLUS sinus mucosal disease w/ mucosal thickening and opaque paranasal sinuses OR mucosal inflammation, nasal polyps, edema, and purulent mucus
158
viral pharyngitis with vesicles on erythematous base
HSV1 and HSV2
159
to dx viral pharyngitis etiology as HSV1/2
- viral cx, tzanck prep: multinucleated giant cells
| - serology: HSV antibodies
160
viral pharyngitis with sore throat, pharyngeal erythema, tonsillar exudates, enlarged cervical lymph noes or diffuse LAD, splenolmegaly
Mononucleosis aka Epstein-Barr Virus (EBV)
161
to dx viral pharyngitis etiology as mono
- Monospot
| - CBC w/ diff (increased atypical lymphocytes)
162
tx for viral pharyngitis caused by mono
supportive, avoid contact sports
163
duration of mono
2-4 weeks; contagious up to 3 months!
164
viral pharyngitis with acute gingivitis, painful oropharyngeal ulceration (sharply demarcated), febrile illness like mono, painless generalized lymphadenopathy, not tonsillar enlargement, no pharyngeal exudates, +/- maculopapular rash, fatigue
HIV
165
dx for recurrent or treatment resistant rhinosinusitis
NON CONTRAST CT, referral to ENT for endoscopy/ sinus aspirate cx
166
nasal saline lavage, intranasal corticosteroids, oral corticosteroids, oral antimicrobials, antihistamines, topical/ systemic antifungals, endoscopic sinus surgery
tx for CRS
