Microbiology Exam 2 Uri

Front 1

What are some defense mechanisms of the URI?

Back 1

Cough, gag, sneeze reflexes
Viscous mucus secretions
Ciliary action
Abundant lymphoid tissue
IgA in respiratory secretions
Rich vasculature delivers leukocytes

Front 2

What is an example of an afebrile URI?

Back 2

common cold

Front 3

What are 4 examples of febrile URI?

Back 3

influenza
adenoviruses
parainfluenza
pharyngitis

Front 4

What are 2 illnesses that are characterized by a mild to moderate sore throat?

Back 4

-common cold
-diptheria

Front 5

What are 2 illnesses that are characterized by sore throat as a "major complaint"?

Back 5

-influenza
-peritonsillar abscess

Front 6

What is an example of an illness that is characterized by dysphagia?

Back 6

strep throat

Front 7

If a patient is complaining of multiple symptoms, what is the likely source of the illness?

Back 7

virus

Front 8

On PE, what are 3 things you may find on URI?

Back 8

tonsillar exudate
cervical nodes
fever

Front 9

What are 2 illnesses where tonsillar exudate would be absent?

Back 9

common cold and influenza

Front 10

What are 3 illnesses where tonsillar exudate would be present?

Back 10

strep, EB virus, adenovirus

Front 11

What is 1 illness where tonsillar exudate would present as a pseudomembrane?

Back 11

diptheria

Front 12

What are some associated findings with URI?

Back 12

cough (productive?)
rhinorrhea
SOB
diarrhea

Front 13

For common cold, what are some pertinent findings from patient history?

Back 13

nasal congestion
nasal discharge
mild sore throat ("scratchy")
non-productive cough
headache
malaise

Front 14

For common cold, what are some pertinent findings from physical exam?

Back 14

temperature below 101
coryza (red, edematous membrane; watery discharge)
throat: normal to mild erythema
rhonchi possible

Front 15

How many subtypes of the common cold exist?

Back 15

200!!

Front 16

How many types of rhinoviruses exist?

Back 16

100 types (35%)

Front 17

What percentage of common cold is accounted for by the coronavirus?

Back 17

10%

Front 18

What are 6 subtypes of the common cold?

Back 18

-rhinovirus
-coronavirius
-parainfluenza
-influenza
-adenovirus
-respiratory syncytial virus

Front 19

What is adenovirus characterized by?

Back 19

fever and pharyngitis

Front 20

How many colds do adults get a year?

Back 20

2-4 (most frequent acute illness!)

Front 21

When are the peak incidences of the rhino/corona/entero viruses?

Back 21

-rhino: early fall and late spring
-corona: winter
-entero: summer

Front 22

What are 3 ways in which the common cold transmitted?

Back 22

-respiratory route
-direct contact with secretions
-fomites (any inanimate object or substance capable of carrying infectious)

Front 23

What are 4 ways to treat/alleviate symptoms of the common cold?

Back 23

-fluid and saline gargles (1-2 tbsp salt and tall glass of warm water)
-decongestants (NOT antihistamine; pseudoephedrine tablets, phenylephrine nasal spray)
-cough suppression (dextromethorphan, codeine)
-expectorant (guaifenesin)

Front 24

What are 4 things that would be in the DDX of a common cold?

Back 24

-complications
-strep infections
-mono
-allergy

Front 25

What are some complications of the common cold?

Back 25

-conjunctivitis
-middle ear effusion/infection (50-80% adults Eustachian tube dysfunction)
-sinusitis (0.5-2.5%)
-exacerbation in asthmatics

Front 26

What is the incubation time and duration time of influenza?

Back 26

incubation: 1-4 days
duration: 2-5 days

Front 27

What are 2 facts re: the incidence of the flu?

Back 27

-influenza infects 5-20% of the US population annually
-up to 200,000 patients require hospitalization

Front 28

Viral shedding (flu)

Back 28

1-2 days then decline

Front 29

What does the incidence of influenza peak?

Back 29

February

Front 30

What might you find in the history of a person w/ influenza?

Back 30

-nasal congestion/dischage
-sore throat w/o dysphagia
-headache
-non-productive cough becomes productive
-fever
-substernal pain/burning
-myalgia/arthralgia
-prostration
-nausea w/ or w/o vomiting

Front 31

Which of the history findings are most important when dx the flu?

Back 31

Fever
Substernal pain or burning
Myalagia and/or athralgia
Prostration
Nausea with or without vomiting

Front 32

What are some physical findings of someone w/ the flu?

Back 32

Clear nasal discharge (no congestion)
Mild pharyngeal injection (no exudate)
Rhonchi
Temperature 101oF or more (3 days)
Face flushed
Skin hot & moist

Front 33

Which of the PE findings are most important when dx the flu?

Back 33

Temperature 101oF or more (3 days)
Face flushed
Skin hot & moist

Front 34

When is flu season?

Back 34

december-april (85% correlation)

Front 35

Of those w/ fever and acute respiratory symptoms, who should be tested?

Back 35

-most appropriate for hospitalized patients (and immuno-compromised)
-oupatient healthy: adults w/ in 5 days of illness onset; children: anytime during course of illness
-epidemiologic link to outbreak

Front 36

When would you want to test for the flu?

Back 36

When you are suspicious/worried about a patient, or when you think there might be an outbreak in the community, also healthcare workers

Front 37

If you test within 5 days of onset, what is more likely?

Back 37

positive RIDT results more likely (if you test after 5 days, you might have false positives)

Front 38

What is the sensitivity of the RIDT test?

Back 38

50-70% sensitivity

Front 39

What are some treatments for the flu?

Back 39

Bedrest
Fluids
Vaporizer
Aspirin for adults
Nasal spray
Cough suppressants

Front 40

What should you worry about when giving aspirin to a child?

Back 40

Reye's syndrome

Front 41

When is prevention of the flu optimal?

Back 41

oct-nov

Front 42

What are 2 ways to prevent the flu?

Back 42

-trivalent inactivated vaccine (TIV)
-live attenuated vaccine

Front 43

2 types of TIV

Back 43

high dose TIV, intradermal TIV

Front 44

Live attenuated vaccine

Back 44

-intranasal vaccine (flumist)
-not below age 2 or above age 50
-not with asthmatics
-not with pregnant women

Front 45

TIV

Back 45

-vax al pts age greater than or equal to 6 months
-usually one intramuscular dose (0.5 ml)
-????? finish this card!!!

Front 46

Can the person eat lightly cooked egg (i.e. scrambled eggs) w/o reaction?

Back 46

administer TIV per usual protocol

Front 47

After eating eggs or egg-containing foods, does the person ONLY have hives?

Back 47

administer TIV and observe for reaction after 30 minutes

Front 48

Does the person have cardio/respiratory/GI reaction to eggs, reaction requiring epi or reaction requiring medical attention?

Back 48

Refer to physician w/ expertise in management of allergic reactions for further evaluation

Front 49

Preference for elderly woman to prevent her from getting the flu?

Back 49

immunoprophylaxis

Front 50

Chemoprophylaxis of flu (anti-viral therapy)

Back 50

-prevention for high risk, unvaccinated in outbreak (continue 10 days)
-given in conjunction w/ vax (immunity about 2 weeks after vaccination)

Front 51

Treatment for confirmed or highly suspected (anti-viral therapy)

Back 51

-hospitalized for influenza
-outpatients at high risk for complications (if infection suspected or confirmed (within 2 days); more than 2 days but not improving and positive flu test)
-outpatients wanting shorter duration and less complicated risk

Front 52

Recommended regimens for the flu

Back 52

-tamiflu (oseltamivir for Type A&B)
-relenza (zanamivir for Type A&B)

Front 53

What are other regimens for the flu that are available but not recommended?a

Back 53

-amantadine or ramantadine (Type A)

Front 54

?? slide 28

Back 54

??

Front 55

What would you find in the history of patient w/ strep pharyngitis?

Back 55

Marked pharyngeal pain
Dysphagia

Front 56

What would you find in the PE of patient w/ strep pharyngitis?

Back 56

Fiery red pharynx
Tonsillar exudate
Tender cervical nodes
Fever (103oF)

Front 57

Diagnosis of strep pharyngitis

Back 57

High level of clinical suspicion
Rapid antigen detection tests
Throat culture
CBC and/or Monospot

Front 58

Suppurative complications of strep pharyngitis

Back 58

Sinusitis
Otitis media
Mastoiditis
Peritonsillar abscess

Front 59

Non-suppurative complications of strep pharyngitis

Back 59

Rheumatic fever
Glomerulonephritis

Front 60

For whom is RADT (rapid antigen detection test) NOT recommended?

Back 60

-children or adults w/ likely viral etiology (cough, rhinorrhea, hoarseness, oral ulcers)
-children under age 3 (acute rheumatic fever is rare)

Front 61

If there is a negative RADT...

Back 61

-In children & adolescents, needs back-up throat culture
-In adults, not needed (due to low incidence of GAS pharyngitis & low risk acute rheumatic fever)
-see slide 33

Front 62

People with group A beta hemolytic strep...

Back 62

will get better w/o abs

Front 63

What is the purpose of treating strep pharyngitis?

Back 63

-prevention of rheumatic fever
-prevention of suppurative complications

Front 64

What is the standard tx for strep pharyngitis?

Back 64

-penicillin VK 500mg qid for 10 days
-erythromycin 500 mg qid for 10 days

Front 65

When will patients feel improvement in symptoms from strep pharyngitis?

Back 65

-2-4 days (w/ or w/o meds!)

Front 66

What can patients use as an analgesic for strep pharyngitis?

Back 66

acetaminophen