URI (quiz 1, exam 1) Flashcards
(105 cards)
1
Q
__ most common primary diagnosis in ambulatory visits in 2002
URI
A
3
2
Q
__ most common acute illness in US
URI
A
1
3
Q
URI
majority are __ in etiology
A
viral
4
Q
URI
difficult to differentiate between viral and bacterial illness due to __
A
overlap of signs and symptoms
5
Q
URI
leading diagnosis for prescribing __ on an outpatient basis despite mostlly viral in etiology (~__%); this has led to __
A
-antibiotics
~75%
-bacteria resistant to antibiotics
6
Q
URI
most URIs are self-__ and self-__
A
- diagnosed
- treated
7
Q
common cold: epidemiology
the common cold is the general term for an upper respiratory tract infection (URI) that has __
A
no prominent localizing features (when a specific localizing symptom is present, the diagnosis is made based on location: pharyngitis, sinusitis, bronchitis)
8
Q
common cold: epidemiology
in an average year, every person in the US has from __ URIs
A
2-4
9
Q
common cold: epidemiology
incidence peaks during the __ seasons, __ from person to person, and __ with age
A
- fall and winter
- varies considerably
- declines
10
Q
common cold: epidemiology
URI is a leading reason for __
A
consultation with health care providers and of missed work days (in 1998, 25 million individuals received care for URI and 20 million days were missed from work)
11
Q
common cold: epidemiology
DESPITE THE FACT TAHT URIs ARE NEARLY ALWAYS CAUSED BY __, APPROX. __% OF MEDICAL PROVIDER VISITS FOR URTIs RESULTS IN AN __ PRESCRIPTION
A
- viruses
- 30%
- antibiotic
12
Q
common cold: pathophysiology
URIs are nearly always caused by __ infection of the __
A
- viral
- anterior nasal mucosa
13
Q
common cold: pathophysiology
virus reaches nasal __ via __ with infectious secretions on the __
A
- epithelium
- aerosol spread or direct contact
- skin or other surfaces
14
Q
common cold: pathophysiology
viral replication within __ cells or __ mucosa
A
- epithelial
- oral, nasal, and upper respiratory
15
Q
common cold: pathophysiology
viral replication triggers __ mediated inflammatory reactions leading to __ symptoms
A
- cytokine
- typical cold symptoms
16
Q
common cold: pathophysiology
symptoms begin about __ days after viral __
A
- 2-8 days
- inoculation
17
Q
common cold: microbiology
__ infection is the main cause of URI and peaks in the __ when __% of URI may be caused by this virus
A
- rhinovirus
- autumn
- 80%
18
Q
common cold: microbiology
the majority of transmission of rhinoviruses occurs via __ and is transferred from __ via the __ to the __, from where the viruses then migrate to the __
A
- fomites
- fomites
- hand
- nose, eyes, or mouth
- nasopharynx
19
Q
common cold: microbiology
experimental infection has demonstrated that __% of individuals who are infected develop symptoms, some as early as __ hours after exposure
A
- 75%
- 10 hours
20
Q
common cold: microbiology
shedding of viral particles peaks __ days after infection, but may continue at low levels for __ weeks
A
- 2 days
- 1-3 weeks
21
Q
viruses ass. with common cold
rhinovirus (>100 serotypes): % of cases and seasonal peak
A
- 30-50%
- fall and spring
22
Q
viruses ass. with the common cold
coronavirus: % of cases and seasonal peaks
A
- 10-15%
- mid-winter
23
Q
viruses ass. with the common cold
influenza: % of cases and seasonal peak
A
- 5-7%
- winter
24
Q
viruses associated with the common cold
RSV: % of cases and seasonal peak
A
- 5%
- winter
25
**viruses ass. with the common cold**
parainfluenza virus: % of cases and seasonal peaks
- \<5%
- winter
26
**viruses ass. with the common cold**
adenovirus: % of cases and seasonal peak
- \<5%
- year round
27
**viruses ass. with the common cold**
metapneumovirus: % of cases and seasonal peak
- 5%
- late winter and early spring
28
**viruses ass. with the common cold**
\_\_ to virus are protective against them. But, rhinovirus has __ antigenically different types and adenovirus has \_\_. Therefore, large number of reinfections with them. Influenza has __ serotypes, so reinfection due to \_\_
- antibodies
- \>100
- 47
- 3
- rapid mutations on the surface of the virus
29
**viruses ass. with the common cold**
rhinovirus spread via \_\_
direct contact with infected respiratory secretions: hand-hand, hand-face
30
**viruses ass. with the common cold**
viruses that spread through droplets by air include __ (note overlaps)
- adenovirus
- RSV
- influenza
31
**viruses ass. with the common cold**
\_\_ affects kids; peaks __ after infection with \_\_
- HMPV
- 1-2 months
- RSV
32
**viruses ass. with the common cold**
viruses found mainly in children include __ and are both in the cateogry of __ viruses
- bocavirus
- HMPV
- emerging viruses (HMPV discovered in 2002, bocavirus in 2005)
33
**viruses ass. with the common cold**
can have reinfections with virus due to 3 things
1. antigenic shift
2. incomplete induction of immunity
3. waning immunity
34
**common cold: clinical features**
mild, self-limited illness characterized by 1 or more of the following (7)
1. nasal congestion and discharge - clear to yellow-green
2. sneezing
3. coughing
4. hoarseness or sore throat
5. headache
6. sinus pressure
7. malaise
35
**common cold: clinical features**
these symptoms are usually not present (3)
1. myalgias
2. arthalgias
3. fever is uncommon in adults
36
**common cold: clinical course**
within __ days the sore throat usually __ and the rhinorrhea becomes more \_\_, appearing thick and yellow to green. This change in nasal discharge results from \_\_, and is a natural part of the progressino of a viral URI
- 2-3 days
- resolves
- purulent
- recruitment of leukocytes
37
**common cold: clinical course**
purulent sputum and phlegm are __ with bacterial infection/risk for bacterial infection
not associated
38
**common cold: clinical course**
other associated symptoms include __ (5)
1. headache
2. hoarse voice
3. malaise
4. laryngitis
5. lethargy
39
**common cold: clinical course**
symptoms usually peak withing __ days and resolve over __ days
- 2-3 days
- 5-10 days
40
**common cold: clinical course**
cough may persist for __ weeks after resolution of other symptoms. When this occurs it is usually referred to as __ or a chest cold
- several
- bronchitis
41
**common cold: clinical course**
included in the differential diagnosis of URI is influenza. However, with influenza \_\_(2) are more prominent, and the illness is usually more \_\_
- myalgias and fever
- severe
42
**common cold: risk factors**
T or F: cold exposure increases the risk of URI
False
43
**common cold: risk factors**
2 risk factors that increase the risk for the development of URI
1. psychological stress
2. poor hand hygeine (frequent hand washing decreases URI incidence, which makes sense, since fomites are a major source for transmission)
44
**common cold: risk factors**
smoking: risk for __ infections
LOWER respiratory infections
45
**common cold: risk factors**
T or F: smoking has demonstrated to increase the risk for URIs
False
46
**common cold: risk factors**
smoking increases the __ and __ of URI
- duration
- severity
47
**common cold: risk factors**
T or F: asthma and emphysema increase the risk for developming URIs
False
48
**common cold: risk factors**
URIs can lead to __ of both asthma and emphysema
exacerbations
49
**common cold: risk factors**
prevention is best achieved through \_\_
frequent hand washing (its spread via fomites)
50
**common cold: risk factors**
T or F: zinc, Echinecea, garlic, and vitamin C decrease the risk of developing URIs
False: no adequately blinded studies supports a prophylactic effect of popular supplements for the prevention of URIs
51
**common cold**
there are minimal findings of PE but they include \_\_
1. nasal congestion, secretions in nasal cavity
2. oral respiration
3. mild tonsillar and pharyngeal injeciton without exudate
52
**common cold**
\_\_ labs are done and treatment is \_\_
- no
- symptomatic
53
**common cold: complications**
the most common complication of URI is \_\_
exacerbation of underlying asthma or COPD
54
**common cold: complications**
very rarely (\_\_% of cases) do URIs progress to bacterial infection in adults (usually bacterial __ or \_\_)
- \<2%
- sinusitis
- otitis media
55
**common cold: complications**
development of __ are suggestive of bacterial sinusitis and otitis media
-fever and/or symptoms of otitis media or sinusitis after initital improvement (purulent nasal secretions alone do not suggest bacterial super infection)
56
**common cold: complications**
T or F: there is evidence to support use of antibiotics for URI to reduce duration, severity, or risk of complications
False (the most significant potential adverse outcome of having a URI is inappropriately receiving antibiotics)
57
**common cold: complications**
antibiotic prescribing does have 2 direct negative effects on pts
1. adverse drug effects
2. selection of resistant bacateria among an individual's colonizing flora, increasing the risk of a future infection with antibiotic resistant bacteria
58
**common cold: over-prescribing of antibiotics**
surveys of physicians evaluating clinical perceptions towards use of antibiotics for URI have identified the following as pt characteristics leading to prescribing antibiotics
1. current tobacco use
2. green or yellow nasal discharge or phlegm
3. tonsillar exudates
(none of these symptoms are specific to bacterial infection and all can occur with viral URI)
59
**common cold: over-prescribing of antibiotics**
pt __ also play an important role in clinical prescribing practices; in 1 survey, over \_\_% of adults surveyed believed that antibiotics were effective against viral infection
- expectations
- 50%
60
**URI: management**
current therapy of URI is based on \_\_
symptomatic management
61
**URI: managment**
recommendation made to a pt should focus of the major symptoms, which include:
1. nasal congestion and sinus pressure/pain
2. cough
3. sore throat
62
**URI: nasal congestion and sinus pressure/pain managment**
oral decongestants: purpose, duration of benefits, examples
- relieves rhinorrhea and nasal congestion
- hours
1. phenylephrine (*Neo-Synephrine* and other brand names)
2. pseudoephedrine (*Sudafed)*
63
**URI: nasal congestion and sinus pressure/pain management**
topical nasal decongestants: purpose, duration of benefit, comments, examples
- relieves rhinorrhea and nasal congestion
- hours
- benefit varies by pt
1. ipratropium nasal spray (*Atrovent* Nasal)
2. oxymetazoline nasal spray (*Afrin)*: use for as little as 3 days may lead to rebound nasal congestion (*rhinitis medicamentosa)*, so it should be recommended with caution
64
**URI: nasal congestion and sinus pressure/pain management**
first generation histamines: purpose, duratin of benefits, comments, examples
- reduces mucus produciton, rhinorrhea, and sneezing
- hours
- 1st generation antihistamines are more effective in reducing rhinorrhea and sneezing than 2nd generation antihistamines, due to their greater anticholinergic properties (but they make you more drowsy and than 2nd generation antihistamines)
1. diphenhydramine
65
**URI: nasal congestion and sinus pressure/pain managment**
Second-generation antihistamines: purpose, duration of benefits, comments, examples
- reduce mucus production, rhinorrhea, and sneezing
- hours
- are less effective in reducing sneezing and rhinorrhea, but also causes less drowsiness, when compared to 1st generation antihistamines (2nd generation has lesser anticholinergic properties)
1. loratadine
2. fexofenadine
66
**URI: treatment**
acetaminophen: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits
- oral analgesic
- relieves pain
- rhinosinusitis
- hours
67
**URI: treatment**
ibuprofen: type of drug, purpose, symptomatic treatment for what symptom, duration of benefit
- oral analgesic
- relieves pain
- rhinosinusitis
- hours
68
**URI: treatment**
diphenhydramine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefit, comments
- 1st generation antihistamine
- reduces mucous production, sneezing, and rhinorrhea
- rhinosinusitis
- hours
- works better than 2nd generation due to ther greater anticholinergic properties
69
**URI: treatment**
loratadine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments
- 2nd generation antihistamine
- reduces mucous production, sneezing, and rhinorrhea
- rhinosinusitis
- hours
- works worse than 1st generation due to there lesser anticholinergic properties
70
**URI: treatment**
fexofenadine: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments
- 2nd generation antihistamine
- reduces mucous production, sneezing, and rhinorrhea
- rhinosinusitis
- hours
- works worse than 1st generation due to there lesser anticholinergic properties
71
**URI: treatment**
phenylephrine (*Neo-Synephrine*): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits
- oral decongestant
- relieve rhinorrhea and nasal congestion
- rhinosinusitis
- hours
72
**URI: treatment**
pseudoephedrine *(Sudafed)*: type of drug, purpose, symptomatic treatment for what symptom, duration of benefits
- oral decongestant
- relieve rhinorrhea and nasal congestion
- rhinosinusitis
- hours
73
**URI: treatment**
ipratropium nasal spray *(Atrovent* Nasal): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments
- topical nasal decongestant
- relieves rhinorrhea and nasal congestion
- rhinosinusitis
- hours
- benefit varies by pt
74
**URI: treatment**
oxymetazoline nasal spray (*Afrin*): type of drug, purpose, symptomatic treatment for what symptom, duration of benefits, comments
- topical nasal decongestant
- relieves rhinorrhea and nasal congestion
- rhinosinusitis
- hours
- benefit varies by pt; use for as little as 3 days may lead to rebound nasal congestion (*rhinitis medicamentosa)*, so it should be recommended with caution
75
**URI: treatment**
nasal saline lavage/irrigation (Neti pot, etc.): purpose, symptomatic treatment for what symptom, duration of benefits, comments
- nasal passage irrigation
- rhinosinusitis
- none
- no evidence of reduced duration or symptoms;may provide symptom relief for some; cleaning pot and boiling water important to avoid introducing bacterial infection
76
**URI: treatment**
nasal steroid spray: symptomatic treatment for what symptom, duration of benefits, comments
- rhinosinusitis
- temporary
- conflicting evidence of benefit
77
**URI: treatment**
saline spray: symptomatic treatment for what symptom, duration of benefits, comments
- rhinosinusitis
- none
- no clinical evidence of benefit
78
**URI: cough management**
symptomatic relif by
keeping the throat moist (by drinking wamr liquids and sucking on cough drops)
79
**URI: cough management**
nocturnal cough, when occuring in association with a URI, may be the result of
post-nasal drip
80
**URI: cough managment**
reducing mucus drainage through the use of __ and \_\_
- antihistamines
- nasal decongestants (such as phenylephrine and pseuoephedrine)
81
**URI: cough management**
over-the-counter cough syrups containing __ may also provide relief, including supressing __ cough
- dextromethorphan
- nocturnal
82
**URI: treatment**
stop smoking/avoid second-hand smoke: symptomatic treatment for what symptom, duration of benefits
- cough
- long-term benefits
83
**URI: treatment**
oral fluids: symptomatic treatment for what symptom, comments
- cough
- may reduce thraot irritation and cough
84
**URI: treatment**
dextromethorpan: type of drug, duration of benefits, comments
- cough suppressant
- hours
- may help with symptoms in some pts
85
**URI: treatment**
carbetapentane: type of drug, duration of benefits, comments
- cough suppressant
- hours
- may help with symptoms in some pts
86
**URI: treatment**
benzonatate: type of drug, duration of benefits, comments
- cough suppressant
- hours
- may help with symptoms in some pts
87
**URI: treatment**
phenylephrine: type of drug, duration of benefits, comments
- oral decongestant (symptomatic treatment for cough)
- hours
- may reduce post-nasal drip associated cough
88
**URI: treatment**
pseudoephedrine: type of drug, duration of benefits, comments
- oral decongestant (symptomatic treatment for cough)
- hours
- may reduce post-nasal drip associated cough
89
**URI: treatment**
cough drops: symptomatic treatment for what symptom, duration of benefit
- cough
- brief relief
90
**URI: treatment**
guaifenesin: type of drug, comments
- mucolytics (for treatment of cough)
- may improve expectoration of mucous build-up (little clincial data of benefit)
91
**URI: treatment**
air humidifier: symptomatic treatment for what symptom, comments
- cough
- may help to maintain upper airway moisture and reduce throat irritation
92
**URI: treatment**
beta-agonist MDI (albuterol): routes, symptomatic treatment for what symptom
- oral, inhalational, IV
- cough
93
**URI: management**
non-steroidal anti-inflammatory drugs (NSAIDs) may help with these 3 symptoms
1. sore throat
2. headache
3. fever
94
**URI: sore throat management**
a varieity of supplements and naturopathic prodcuts have been promoted for treatment of URI, includine __ (3), none of which have consistently demonstrated efficacy in blinded studies
1. vitamin C
2. zinc
3. *Echinacea*
95
**URI: treatment**
acetaminophen/ibuprofen: type of drug, duration of benefits, comments
- oral analgesics (for fever, sore throat)
- 6 hours
- Ibuprofen superior in some studies
96
**URI: treatment**
Demulcents (soothing topical preparations/lozenges usually with menthol, e.g. Cepacol): symptomatic treatment for what symptom, duration of benefits
- sore throat
- 30 minutes
97
**URI: treatment**
demulcents with lidocaine/benzocaine: symptomatic treatment of what symtom, duration of beneefits
- sore throat
- 1+ hours
98
**URI: treatment**
dexamethasone: dose, symptomatic treatment for what symptom, comments
- 10 mg po qd for 1-3 days
- sore throat
- reduces symptom duration in multiple randomized clinical trials; however, potential adverse effects of steroids limit this treatment
99
**URI: treatment**
zinc lozenges: how long taken, symptomatic treatment for what symptom, comments
- every 2 hours while awake
- sore throat
- data suggesting possible benefit with use of zinc lozenges soon after symptom onset; in a recent meta-analysis, 2 of 6 studies included reduction in symptom duration and severity
100
**URI: treatment**
these 4 treatments show brief duration of benefits when treating sore throat
1. salt water gargle
2. gargle of cayenne, black pepper, (long list of herbal remedies): no evidence of lasting benefit
3. drinking wam liquids
4. tea with honey or whisky: untested (some suggestion that honey may reduce cough)
101
**URI: treatment**
these 2 treatments for sore throat who no duration/evidence of benefit
1. Echinacea
2. vitamin C
102
**URI: prevention**
T or F: vitamin C and Echinacea reduce the risk of infection with a symptomatic URI
False
103
**URI: prevention**
\_\_ is the highly efficacious method of reducing URI related illness
fastidious hand hygeine
104
**URI: prevention**
washing hands and keeping them away from eyse and mouth reduces frequency of URI by approx. \_\_%
20%
105
**URI: American College of Physicians position statement**
\_\_ should not be used to treat nonspecific URIs in previously healthy adults
antibiotics
