URI

Question 1

Common cold Virology/timing

Answer 1

Usually Rhinovirus

coronavirus, influenza, parunfluenza, respiratory syncytial virus, adenovirus, enterovirus

Question 2

Common Cold timing

Answer 2

Fall and late spring: rhino virus and parinfluenza
Winter/spring: RSV and coronavirus
Summer- enterovirus
adeno virus has no timing

Question 3

Common Cold Sx

Answer 3

Peak shedding 2-3 with peak sx  
Rhinorrhea 
nasal congestion
sore throat/ scratcy
non productive cough
malaise 
low grade fever (usually in kids)

Question 4

Common Cold signs

Answer 4

nasal swelling, nasal discharge ( clear or purulent), conjuctive injection, usually no pulmonary findings and no adenopathy

Question 5

Cold dx/ complications

Answer 5

clinical and based on observed signs

- acute rhinosinitius, Acute otitis media, asthma attack, pneumonia

Question 6

Cold Tx

Answer 6

self limitng and supportive care
- NSAIDs, Chloraseptic 
Antihist:
- peudoephed/ Diphenhydramine 
Expectorants/antiussives 
- Guaifenesin (robitussin)
- guaifenesin with dextromethorphan

Question 7

Influenza etiology

Answer 7

influenza A and B
Risks
>65 years
COPD, DM, CVD, immunocomp

Question 8

Influenza Sx

Answer 8

Peak shedding 48hrs
Common: abrupt onset, fever, myalgia, sore throat
Other: chills, malaise, HA, cough, nasal discharge

Question 9

Influenza Signs

Answer 9

flushing, hot dry, pharynx wont look red even if sore, lymphadepathy, chest exam negative

Question 10

Who do we test for influenza

Answer 10

Outpatient: routine is not recommended
- consider testing is sx when no known outbreak
- immuno competent pt after a hospital visit
- high risk
- influenza sx in healthcare workers or visitors to an instituion
Inpt.: any pt with sx upon admissions or during their stay

Question 11

Dx FLue

Answer 11

- must be testes in first 3-4 days 
Rapid influenza dectection test: 
- low sensitivity/specificity 
- <15min 
Rapid Molecular Assay 
- diff types A/B
-45 min
- high sens/ specif
Reverse- transcriptase polymerase chain raction
- preferred by CDC
- influenza type and subtype 
-NP swab 1-8 hrs 
- hgh sensitivity/specificty
Viral Culture:
3-10 days 
very high sensitivity specificty 
* mostly to confirm

Question 12

Neuraminidase inhibitors- flu tx

Answer 12

cover A/B
-Oseltamivir (tamiflu) 75mg po bid x5d 
- Zanamivir(relenza) 10mg bid x5d 
Peramivir(rapivab)- 600mg IV  x1 
Baloxavir - 40mg po or 80mg (>80kg) 
- category C for pregnancy but better to take that risk than have the woman get the flu

Question 13

Who gets flu vaccine

Answer 13

Everyone over 6mo

• usually given in october
• two weeks till the antibodies develop

Question 14

Contrindications for vaccination

Answer 14

current moderate to severe illness

• hx of guillain barre syndome within 6wks
• hx of allergic reaction to flue vaccine

Question 15

18-64
65
6mo-8yr
vaccines

Answer 15

• standard dose
• older get high dose
• live virus 2-49 yo not pregneacny though
  6mo-8yr get 2 doses > 4wks apart

Question 16

Pharyngitis etiology

Answer 16

• usually a viral illnes
• may occur as common cold
• if bacterial it is group A step
• non infectious causes: trauma, vocal strain, smoking, GERD
  virus: rhinovirus, RSV, adenovirus, coronavirus, parainfluenza, influenza

Question 17

Phayngitis- mononucelosis

Answer 17

Epstein barr virus 
- sore throat, erythems, exudates 
- large enlarged cervical lymph nodes
- fatugue 
-fever
splenomegaly 
Dx: monospot, CBC with diff  (increases atypical lymphocytes 
Sx: supportive and no contact sports

Question 18

Pharyngitis- bacterial diptheriae

Answer 18

Diptheriae
- rare now but will cause gray exudate tightly adherant to throat, nasal passagemway. Midful of the unvaccinated pt with recent travel
Tx: diphtheria anti-toxin+toxin or erythromycin

Question 19

Pharyngitis- mycoplasma pneumoniae and Neisseria gonorrhoeae

Answer 19

Associated with LRI and HA
Tx: azithromycin

Neisseria gonorrhoeae;
- ^MSM and associated with oral sex
- pharyngitis with exidates and cervical LAD
Tx: ceftriaxone 250 mg IM x 1

Question 20

Group A strep Pharyngitis Sx

Answer 20

Sx: sore throat, odynophagia, fever, mailas, anorexia, arthragials, N/V/ swollen glands
Signs: erythema, tonsilar hypertrophy, purulent exudate, tender and lager anterior cerv lymph, palatal petechiae

Question 21

Strep Criteria

Answer 21

Symptoms- tonsillar exudatea, tender anterior cervical adenpathy, fever by history, abscense of a cough
* if 3 of 4 then do a rapid antigen detection test

Question 22

Strep managment

Answer 22

First line therapy GAS pharyngitis (adult
- Pen G IM dose
-Pen V 500mg po TID x 10days
- Amoxicillin 500mg BID x 10 days
- Cephalexin 500 mg PO BID 10 days
Second line or Allergy :
- azithromycin 500mg po day 1 followed by 250 mg po days 2-5
- clindamycin 300 mg po tid x 10 days
** supportive care! lozenges, NSAIDs, acetaminophen

Question 23

Strep Complications

Answer 23

1. Acute rheumatic fever - may cause cardiac valve abnormalities
2. Post step glomerulonephritis
   - can progress to acute renal failure
3. step toxic shock syndrome
   - shock and organ failure
   Scarlet fever
   other: abscess in tonsils, otitis media, rhinosinusitis, bacteremia, pneummonia

Question 24

Peritonsillar cellulitis/abscess/epiglotiiis

Answer 24

etiologiy: S. pyogenes s. aureus
Cellulitis: infection between platine tonsil capsul and pharynx muscles . no pus collection
Abscess: collection of pus, requires drainage

Question 25

Peritonsillar abscess Presentation

Answer 25

Sx: severe sore through drooling, trismus. fever, neck swelling, ipsilateral ear pain, fatigue, anxiety, irritability Signs: swelling with push tonisl with deviation of oppositice side. Fullnes of posterior of solft palate, cervical LAD, hot potato muffled voice

Question 26

PTA dx

Answer 26

Labs: CBC, electroytes, throat culture, culture/gram stain of the abscess of fluid Imaging - CT with IV contrast- if unable to diagnose clinically > r/o spread of infection to parapharyngeal space * will disstinguidhe cellulitis from abscess - US helpful an d good for needle guidance during aspiration

Question 27

PTA managment Drainage

Answer 27

``` - needle aspiration ED/OR Antimicrobial therapy adults -Ampicillin 3gm q6hrs -clindamycin 600mg q8hrs -vancomycin if ^ mRSA Oral: Augmentin 875mg q 12hrs clindamycin 300 mg q6hrs + supportive care and fluids ```

Question 28

Epiglottitis

Answer 28

h. influenzae - consider unvaccinated children or older aldult Sx: drooling, stridor (resp distress- squeeking sounds ), severe sore throat, toxi appearance - danger of airway obstruction, rapid course - if suspect do not exam oropharynx if patient is in resp distress Imaging: X ray ( lateral neck x-ray) , thumb sign CT/MRI Managment: hospitalizaions, intubation, antibiotics

Question 29

Laryngitis etilogy

Answer 29

Virus is the MOST common Bacterial- step, moraxella catarrhalis, influenza Non infect: vocal abuse, intubation, toxi exposure, GERD, vocal cord coduels or laryngeal polyps, cancer, neuo disfucntion

Question 30

Laryngitis Presentation

Answer 30

Hoarsness- key*** dysphnia URI sx:rhinorrhea, nasal congestion, cough, sore throat Signs: if URI related: nasal edema, congestion, benign post parync Direct laryngoscopy: erythema, edema, vascular engorgment of voca cords, nodes or ulcerations

Question 31

ARS sx

Answer 31

- purulent nasal drainage and nasal obstruction and or facial pain with pressure or fullness Sx: fever, congestion, cough, maxillary tooth discomfort, ear pressure, HA Digns - purulent drainage in nose or post pharynx, nasal mucosal edema, tenderness to percussion of upper teeth, sinus tendernessto palpation

Question 32

Acute viral RHinosinisitis (ARVC) Dx;

Answer 32

often rhinovirus, influenza, parainfluenza clinically < 10 days od sx with sx of ARS that are not worsening - radiography is not indicated limited use of plaing sinus fims cultures not indicated

Question 33

ARVC managment

Answer 33

supportive care 98% | - analgesics, salin irrigation, mucolytics, intranasal decongestants , intranasal glucocorticoids

Question 34

Acute Bacterial Rhinosisnusitis (ABRS) Dx

Answer 34

strep, h ful, moraxella catarrhalis persisitant sx >10days with no improvement or onset with severe sx >102 purulent nasal discharge facial pain, lasting 3-4 consecutive days or viral URI for 5-6 dyas that was initally imprving followed by severe Sx " double worsening"

Question 35

Pt considered at high risk for abx resistance

Answer 35

> 65, severe infection temp >102 | recent hospitalization, immunocomp, comorbidities, recent antimicrobial use

Question 36

ABRS tx 1st line

Answer 36

``` First: Amoxicillin-clavulanate 875/125mg BID doxycyline 100mg BID levofloxacin 500mg qd moxifloxacin 400mg qd 5-7 days ```

Question 37

ABRS 2nd line

Answer 37

``` if no repsonse or worsening of sx Amox-clav0 2000mg/125mg bid Levofloxacin 500mg qd Moxifloxacin 400mg qd Doxycycline 100mg bid 7-10 days ```

Question 38

Complications of ABRS

Answer 38

extension of infection - osteomyelitis, menegitis, brain or epidual abscess, presptal or orbital cellulitis - Use CT or MRI is suspected complicated ABRS * * Sinus aspirate culture is gold standard**

Question 39

Chronic RHinosinisitis risks

Answer 39

``` a;;ergic rhinitis hx chronic exp to envior irritants defects in muco clearance presence of mmuno def anatomocal ab latrogenic ( sinus surgeries ) ```

Question 40

CRS presentation

Answer 40

``` Adults - mucopurulent nasal discharge - nasal obstruction and congestion - facial pain, pressure, fullness - reduction or loss of smell Children may also have a cough not a disturbance sense of smell ```

Question 41

CRS Dx

Answer 41

2-4 cardincal sx and infection lasting > 12wks Recurrent RS - non contrast CT and ENT referall Tx: nasal saline lavage, intranasal corticosteroids, oral corticosteroids, antihistamines, topical antifungals

Question 42

Laryngitis Dx/TX

Answer 42

Based on Hx and PE hoarsnss > 2wks in absence of URI sx Tx: Treat undlerlying cause / managment of systemic disease -coice rest/humidifyers