Medicine 1; Lecture 2 Uri

Front 1

Common cold:Causative agent(s)

Back 1

25-30% by rhinoviruses (early fall to mid/late spring); 10-15% coronaviruses (winter); influenza, parainfluenza, RSV, adenovirus; incubation 24-72h

Front 2

Common cold: Etiology/Pathophysiology/Sx

Back 2

Nasal d/c and obs, sneezing, sore throat, cough & hoarseness may follow in smokers; <10% w/ pharyngitis, sinusitis, otitis; max sx on 2nd-4thd. lasts 1-2 wks

Front 3

Common cold:Tx

Back 3

Tx sx only; acetaminophen to red fever, HA; NSAIDs; topical nasal decongestant x5d max; oral decong/antihx; heat/humidif air, inc fluid, rest

Front 4

Flu syndrome: Causative agent(s)

Back 4

85% influenza virus; parainfluenza, RSV, adenovirus

Front 5

Flu syndrome: Etiology/Pathophysiology/Sx

Back 5

Abrupt onset fever (up to 106), malaise, HA, myalgias, coryza, sore throat x3-14d – 1-4wks; non-prod cough, hoarseness; flushed face, hot skin, red, watery eyes, clear nasal d/c, cervical lymphadenopathy, mild neutropenia w/ lymphocytosis
incub x 18-72h; viral shedding x5-10d (highest=2d)

Front 6

Flu syndrome: Tx

Back 6

Amantadine (Symmetrel); rimantadine (Flumadine), oseltamivir (Tamiflu)

Front 7

Acute Epiglottitis:Causative agent(s)

Back 7

H. influenza type b (Hib) - decreased d/t vaccination

Front 8

Pharyngitis:
Etiology/Pathophysiology/Sx

Back 8

Inflamed/edematous epiglot - may block airway; pt presents w/ sudden onset sore throat, odynophag, muffled voice, drooling, dyspnea, stridor; “thumb sign” on soft tissue neck films

Front 9

Pharyngitis:Tx

Back 9

Indirect laryngoscopy to dx; admit to ER; abx for S. aureus, H flu, S. pneumo, S. pyo; incl oxacillin, nafcillin, cefazolin, clindamycin, and ceftriaxone x 10d

Front 10

Pharyngitis: Etiology/Pathophysiology/Sx

Back 10

-Corynebacterium haemolyticum exudative, scarlitinaform rash,fever, adenopathy
-Mononucleosis: sore throat, fever, lymphadenopathy, hepatosplenomegaly, maculopapular skin rash
-Adenovirus: associated with conjunctivitis and influenza-like symptoms
-Coxsackie A (presents w/ rash), herpes simplex (more painful): mucosal vesicles or ulcers

Front 11

Gonococcal Pharyngitis: Presentation

Back 11

-sore throat in association with urethritis or vaginitis

Front 12

Diphtheria: Etiology/Pathophysiology/Sx

Back 12

Incub 2-5d; pharyngitis, low fever, cerv adenop, exudates w/ gray, adherent membrane (may cause obs); pt appears toxic. May cause myocarditis, neuritis, nephritis

Front 13

Diphtheria: Tx

Back 13

Antitoxin; e-mycin/PCNx14d
Prevent with DPT vaccine

Front 14

Gonococcal Pharyngitis: Tx

Back 14

-Treatment: ceftriaxone 250mg IM; Co-treatment for presumed Chlamydia infection should be given
Doxycycline 100mg po BID x 7d

Front 15

Streptococcal Pharyngitis: Etiology/Pathophysiology/Sx

Back 15

Incub 2-5d;sudden onset sore throat, malaise, fever, HA, tonsillar exudate, Anterior cervical lymph, scarlitinaform rash, Diffuse red blushing on trunk, blanch w/ press. & desquamates X1week (10% pres.Sx). No cough, hoarseness,rhinorrhea

Front 16

Streptococcal Pharyngitis: When to tx?

Back 16

-Tonsillar exudate and lymphadenopathy, T>100°
43% positive cx
-Hx rheumatic fever

Front 17

Streptococcal Pharyngitis: Tx

Back 17

-Tx Sx
-Preferred tx: 1.2 million units benzathine PCN given IM; or Pen VK 500mg PO QID x 10 days

Front 18

Rheumatic: FeverEtiology/Pathophysiology/Sx

Back 18

-nonsuppurative inflammatory lesions of the heart, joints, and CNS following a group A strep pharyngeal infection
-MC 6-15YO
-Latent period between strep pharyngitis and Acute Rheumatic Fever is 2-4 weeks

Front 19

Rheumatic: Tx

Back 19

PCN x10days

Front 20

Jones Criteria: Etiology/Pathophysiology/Sx

Back 20

-Major criteria: carditis, polyarthritis, chorea, subcutaneous nodules (usually along tendons), erythema marginatum
-Minor criteria: fever, arthralgia (joint pain), previous rheumatic fever or rheumatic heart disease

Front 21

Jones Criteria: Criteria need to Dx?

Back 21

-Two major criteria or one major and two minor required for diagnosis

Front 22

Pharyngeal Abscess: Causative agent(s)

Back 22

(complication of URI)

Front 23

Pharyngeal Abscess: Etiology/Pathophysiology/Sx

Back 23

Odynophagia, unable to swallow secretions, muffled voice, trismus, systemic toxicity, swelling of sup ant tonsillar pillar; tonsil displaced medially

Front 24

Pharyngeal Abscess: Tx

Back 24

Needle aspiration; airway mgmt;Incision and drainage
; PCN/Clindamycin; tonsillect for repeat recurrences

Front 25

Acute Otitis Media: Causative agent(s)

Back 25

Most are viral – 30% of all cases are bacterial: 30-40% S. pneumo, 21% H flu, 12% M. cat, 6% S. aureus; also group A strep, p. aer, Myco pneumo

Front 26

Acute Otitis Media: Predisposing and recurrence factors

Back 26

day care attendance, parental smoking (kill cilia), bottle drinking while supine, male gender, anatomic defects

Front 27

Acute Otitis Media: Etiology/Pathophysiology/Sx

Back 27

Irritability, fever, earache, occasionally w/ d/c, vertigo; erythematous TM w/ dec mobility of TM on pneumatic otoscopy; bulging, retracted or perforated TM. Can - chronic OM, OE, mastoiditis, hearing loss

Front 28

Acute Otitis Media: Tx

Back 28

Amox or Augmentin, cefdinir, azythromycin; myringotomy, tympanostomy
->2YO = wait 72hrs

Front 29

Acute Otitis Media: Complications

Back 29

-Chronic otitis media
-Otitis externa – external ear infection
-Mastoiditis – infection is eroding it’s way out of middle ear into mastoid bone.
-Direct intracranial extension from recurring otitis media and persistent effusion
-Persistent hearing loss

Front 30

Acute Localized Otitis Externa: Causative agent(s)

Back 30

MC form Otitis Externa
Staph aureus (also P. aeruginosa)

Front 31

Acute Localized Otitis Externa:
Etiology/Pathophysiology/Sx

Back 31

-Intense pain and tenderness
-Canal has local erythema, heat, and tenderness over the tragus
-Associated periauricular adenopathy

Front 32

Diffuse Otitis Externa: Causative agent(s)

Back 32

“Swimmer’s ear”
-Most commonly due to P. aeruginosa
-Occurs in hot, humid climates
-May be associated with contaminated hot tubs

Front 33

Diffuse Otitis Externa: Etiology/Pathophysiology/Sx

Back 33

Canal is erythematous, edematous and in some cases hemorrhagic

Front 34

Chronic Otitis Externa: Causative agent/Sx

Back 34

-Leads to chronic irritation
-Complication of persistent otitis media with resultant drainage into the external auditory canal
-itching is the main symptom

Front 35

Malignant Otitis Externa:Causative agent(s)

Back 35

-Invasive otitis externa
-Severe necrotizing infection of the external auditory canal with invasion into the surrounding tissues including blood vessels, cartilage, and bone
-P. aeruginosa most frequently implicated organism
-Immunocompromised hosts: elderly, HIV, diabetic

Front 36

Malignant Otitis Externa: Tx

Back 36

-heat
-Topical antibiotic otic suspension: polymyxin, ofloxacin, cipro, gentamicin
-May be combined with steroids to decrease edema & itching
-Severe infections may require systemic antibiotics: Augmentin, dicloxacillin, fluoroquinolones

Front 37

Acute Sinusitis: Causative agent(s)

Back 37

60% d/t H flu, S. pneumo. Obs d/t viral URIs mostly; 10% d/t dental abscess; complication of noninfectious rhinosinusitis,foreign bodies, swimming/diving, anatomic nasal obstruction, nasogastric tube; less commonly caused by S. pyo, M. cat, Strep, Myco pneumo, S. aur

Front 38

Acute Sinusitis: Etiology/Pathophysiology/Sx

Back 38

Purulent infl behind obs ostium causes sinus pain - can be throbbing, severe; coughing/percussion exacerbate pain; Ddx incl dental abscess, cluster HA, trigeminal neuralgia, migraine; pt will have poor response to nas decong; opacification on SXR; MEDICAL EMERGENCY if tender periorbital swelling, proptosis, chemosis (=periorbital cellulites!)

Front 39

Acute Sinusitis: Tx

Back 39

Topical decongestants/steroids; oral abx (augment/amoxicillin, bactrim, macrolides); if toxic - hospitalization, IV abx,and drain

Front 40

Chronic Sinusitis: Causative agent(s)

Back 40

S. pneumo or H. flu

Front 41

Chronic Sinusitis: Etiology/Pathophysiology/Sx

Back 41

Facial pain, purulent nasal d/c >6wks-3mos; postnasal drip w/ cough, minimal facial pain and tenderness; definitive CT scan

Front 42

Chronic Sinusitis: Tx

Back 42

-ENT referral; tx as acute sinusitis; topical corticosteroids
-antihx-decongestants not recommended

Front 43

Lower Respiratory Infections: S/Sx, Causative agents

Back 43

-cough, rhonchi, rales, wheezes, or consolidation
-Bronchitis and pneumonia are the major infectious syndromes

Front 44

Differential of Cough: Acute <2 weeks

Back 44

Acute pulmonary edema
Acute bronchitis – URI
Pneumonia

Front 45

Differential of Cough: Persistent (> 2 weeks)

Back 45

-Repeated aspiration (w/ ETOH & bed bound)
-Tuberculosis
-Fungal pneumonias
-Postinfectious brochospasm – irritation in bronchial tree which goes away on its own – will last ~2-6 weeks

Front 46

Acute Bronchitis: Causative agent(s)

Back 46

Adenovirus, rhinovirus, parainfluenza, influenza A/B, RSV
Uncommonly – M pneumo, chlam pneumo, B pertussis

Front 47

Acute Bronchitis: Etiology/Pathophysiology/Sx

Back 47

Cough w or w/o sputum, usu 1-2wks after onset of URI, low grade fever, rhonchi and /or wheezes – particularly on expiration
CXR not useful

Front 48

Acute Bronchitis: Tx

Back 48

-symptomatic tx with cough suppressants, adequate hydration, antipyretics, inhaled bronchodilators (steroid and β-adrenergic) for bronchospasm
-Smoking cessation
-No Abx unless immune compromised; macrolides (Zpak, clarithro), fluroq, tetracyclines (doxy) x10d