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78 Cards in this Set

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  • Back
What are the most common viral URI etiologies?
• rhinovirus
• adenovirus
• influenza
• parainfluenza
What are ingredients in decongestants and what do they do?
• ingredients include pseudoephedrine (Sudafed) and phenylpropanolamine
• shrink the swollen nasal membrane & decrease mucus production
• most useful for nasal stuffiness
• have some stimulant properties (may increases heart rate & BP)
List some examples of antihistamines
• Benadryl
• Chlor-Trimeton
• Dimetane
List examples of cough suppressants?
• dextromethorphan (main OTC cough suppressant)
• Tessalon Perles (reduces cough reflex by anesthetizing stretch receptors)
• Narcotics (ex. Codeine)
Generally, what causes sinusitis in an immuno-competent host?
a bacterial infection that follows a viral URI
Explain how a viral cold can develop into sinusitis
• Viral colds do not cause symptoms of sinusitis, but inflame the sinuses »

• nose produces mucus and sends WBCs to the lining of the nose, causing swelling and congestion »

• swelling can affect mucous membrane of the sinuses, causing mucus to become trapped behind narrowed opening of sinus »

• trapped mucus allows bacteria to multiply »
What are precipitating factors of sinusitis?
• anatomical variations of drainage tracts
• barotrauma (from deep sea diving or airplane travel)
• ciliary syndromes (ex. cystic fibrosis)
• chronic granulomatous disease (ex. Wegener's granulomatosis, Sarcoidosis)
• chemical irritants
• excessive production of secretions
What is the most frequent nosocomial infection in ICUs?
sinusitis (secondary to nasal intubation > 48 hrs)
What are the most common bacterial causes of sinusitis?
• Streptococcus pneumonia & H. Flu (70% of cases)
• Streptococci
• Moraxella catarralis
• gram negative organisms (in ICU)
• Staphylococcus aureus (in sphenoid sinuses)
What is the most commonly affect sinus in patients with sinusitis?
• maxillary sinus
• can present with pain over malar area, upper jaw, teeth, and cheeks
What cases of sinusitis should be treated with antibiotics?
• purulent discharge
• have symptoms for > 1 week with being treated
• worsening of symptoms (fever, leukocytosis, tender sinuses) > 5-10 days
How long is the antibiotic treatment for sinusitis?
treatment is for 10-14 days (except for Zithromax)
What antibiotics can be used to treat sinusitis?
• Augmentin (amoxicillin + clavulanate) or amoxicillin
• Bactrim
• Cephalosporins
• Quinolones (not approved in children)
• Macrolides (ex. Zithromax for children or Clarithomycin)
What is the antibiotic treatment for sinusitis in ICU patients?
• removes tubes (NG tubes)
• give ofloxacillin OR
• vancomycin w/ 3rd generation cephalosporin OR
• unasyn (ampicillin + sulfabactum)
What is Pott's puffy tumor?
• a complication of sinusitis
• infection spreads to frontal bone causing breakthrough of cortical bone and formation of a periosteal abscess
What are symptoms of sinusitis?
• Anosmia
• Cough
• Fever
• Halatosis
• Headache
• Metallic taste
• Nasal congestion
• Pain during mastication
• Purulent nasal discharge
• Toothache
• Unilateral face pain
• Weakness
When is a CT scan the preferred imaging method for sinusitis?
• necessary incases of treatment failure or chronic disease
• to exclude alternate diagnosis (ex. tumors, abscess, etc.)
• can differentiate orbital cellulitis from periorbital cellulitis
What are common bacterial causes of chronic sinusitis?
anaerobic bacteria and S. aureus
What can untreated sinusitis lead to?
• brain abscess
• chronically infected sinuses
• orbital cellulitis
• osteomyelitis
• meningitis
Afrin is a nasal spray that causes vasoconstriction to reduce the swelling sinusitis. What can develop if Afrin is used for more than 3 days?
rhinitis medicamentosa
Patient, with a history of sinusitis, presents with local soft, doughy swelling suggestive of what?
• Osteomyelitis (most common cause S. aureus)
• CT or MRI eval needed
What are Charcot Leyden crystals?
• proteins that originate in the cytoplasm of eosinophils
• found in fungal sinusitis
What is phycomycosis?
• fungal invasion of the sinusitis
• characterized by rapid & wide debridement
• associated w/ bread molds in the US & infections in diabetics and immunosuppression
• TX: Amphotericin B
What is the definition of pharyngitis?
• irritation/inflammation of the pharynx
• usually includes tonsils
What are more serious conditions that need to be ruled out for patients with pharyngitis?
• epiglottitis
• peri-tonsilar abscess
• helps to diagnose group A beta-hemolytic streptococcus
What are etiologies for pharyngitis?
• Virus (most common cause: 40-60%)
• Bacteria (~5-40%)
• Allergies
• Trauma
• Toxins
• Neoplasia.
List causes of tonsilopharyngeal exudates
• Streptococcal infections
• Adenovirus
• Clamidyia pnuemoniae
• Diptheria
• Haemolyticus
• Herpes Virus
• Mononucleosis
• Mycoplasma pneumoniae
True/False: The presence of exudates alone can differentiate between viral and bacteria pharyngitis
• Exudates can be caused by either virus or bacteria
• The correct answer is: False
Which bacteria accounts for 5-38% of sore throats in adults who are cultured?
Streptococcus pyogenes
What is the Centor criteria?
• 4 criteria used in diagnosing pharyngitis:

• exudates
• lymphadenopathy
• fever > 101
• absence of cough
What are complications of pharyngitis?
• Peritonsilar cellulitis
• Peritonsillar abscess (PTA)
• Post-streptococcal glomerulonephritis
• Rheumatic fever (most important nonsuppurative complication)
• Scarlet fever (rare in adults)
• Toxic shock syndrome
Acute rheumatic fever most frequently appears in what age group?
5 - 15 y/o
What are the Major Jones Criteria?
• J - Joints (Polymigratory arthritis)
• Carditis
• N - Nodules (subcutaneous)
• E - Erythema marginatum
• S - Syndenhams chorea
What are the minor Jones criteria?
• Fever
• Arthralgia
• Previous rheumatic fever or rheumatic disease
• Acute Phase Reaction (elevated ESR or C-reactive protein & leukocytosis)
• Prolonged PR interval
How many Jones criteria are require for a diagnosis of rheumatic fever?
• 2 major Jones criteria OR
• 1 major + 2 minor criteria
What is Post-Streptococcal Glomerular Nephritis?
• a nonsuppurative complication of strep pharyngitis
• inflammation of small blood vessels (glomeruli) in the kidneys after streptococcal infection
What are signs & symptoms of post-streptococcal glomerular nephritis?
• Edema
• Gross Hematuria
• HTN
What lab tests can be done when evaluating for strep pharyngitis?
• Rapid Strep-antigen test (85-90% sensitivity; 98-99% specificity)
• Throat Cultre (if rapid strep is negative, but suspicion is high)
What is the treatment strategy of patients who meet 2 or more Centor criteria?
test patients who meet 2 or more Centor criteria and treat only positive results
What types of patients receive immediate treatment without testing for strep pharyngitis?
• history of rheumatic fever
• pt is symptomatic and a housefould member w/ documented group A beta-streptococcal infection
• those who meet 3-4 of the Centor criteria
What is the antibiotic treatment for strep pharyngitis?
• benzatine penicillin IM x 1
• penicillin V potassium (Pen VK) PO x 10 days
• Cefuroxime axetil
• Erythromycin (in PCN allergic pts)
• Azithromycin
What are causes of pharyngitis with a high fever?
• CMV
• coxsackie virus
• group A beta-hemolytic strep
• herpes simplex
• HIV
• infectious mononucleosis
What are prodromal symptoms of infectious mononucleosis?
• headache
• malaise
• fatigue followed by:
• cervical adenopathy
• sore throat (most common feature)
• fever

• tonsillar exudates (in 50% of patients)
• petechia in junction of soft & hard palate (in 33% of patients)
What presentation could a patient with pharyngitis cause by HSV have?
• stomatitis involving tongue & buccal mucosa and pharynx
• small ulcers and vesicles may develop
What presentation could a patient with pharyngitis caused by Coxsackie A virus?
oropharyngeal vesicular lession with concomitant vesicles on the hands and feet (hand-foot-and-mouth disease)
A patient with pharyngitis and a history of recent orogenital contact suggest the possibility of type of pharyngitis?
gonococcal pharyngitis
A patients presents with headache, pharyngitis, and lower respiratory symptoms. What is a likely etiology?
Mycoplasma pneumonia
A patient present with a foul smelling whitish-blue-gray pharyngeal exudate that bleeds when removed. What is the most likely etiology?
Corynebacterium deptheriae (Diptheria)
A patient present with a cheesy, white creamy exudate with an erythematous base on the tongue. What is the most likely etiology?
Candida albicans - "Oral Candidiasis" - "Thrush"
Oral Candidiasis is most commonly found in what patients?
• infants or immunosuppressed
• may be first symptom of HIV
What would a gram stain or KOH mount show on a patient with oral candidiasis?
shows typical yeasts and pseudohyphae
How can you distinguish between thrush and leukoplakia?
thrush can be scraped off, where as leukoplakia cannot
What is the treatment of oral candidiasis?
• Ketoconazole
• Clotrimazole troches
• Nystatin vaginal troches or mouth rinse

• AIDS patients require continuous prophylaxis with PO fluconazole or itraconazole
What is trench mouth and what organisms can cause it?
• aka Vincent's angina
• an acute necrotizing ulcerative gingivitis caused by Fusobacteria and spirochetes
What is the preferred method for diagnosing group A beta-hemolytic strep in the ED?
GABHS rapid antigen detection test
What is the criterion standard test for diagnosing GABHS infection?
throat culture (90-99% sensitive)
What would a peripheral smear show in a patient with infectious mononucleosis?
atypical lymphocytes
What lab test can be performed to test for C. Pneumoniae?
fluorescent monoclonal antibody test
What is the goal of antibiotic therapy in pharyngitis?
• decrease the duration of the illness and infective period

• provide symptomatic relief

• decrease the incidence of relapses and complications (ex. rheumatic fever, glomerulonephritis)
Why can steriods be used in the treatment of phatyngitis?
used for airway compromise, anti-inflammatory properties, and provide symptomatic relief
What is a symptom of laryngitis?
hoarseness (dysphonia)
What are etiologies for acute laryngitis?
• infection (usually viral URI)
• enviornmental insults (pollution)
• GERD
• Use of asthma inhalers
• Vocal trauma
What is the most common cause of vocal cord paralysis?
viral neuritis
When is a laryngoscopy indicated in a patient complaining of hoarseness?
if the hoarseness lasts longer than 2-3 weeks
What is the DOC for bacterial laryngitis?
Augmentin
What is the treatment of persistent vocal cord paralysis?
teflon paste injection
What is epiglottitis?
• an acute inflammation in the supraglottic region of the oropharynx
• inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds
What are some signs and symptoms of epiglottitis?
• drooling
• muffled voice
• odynophagia/dysphagia
• sore throat
• stridor
• tripod position
What is the preferred method of diagnosis of epiglottitis?
• nasopharyngoscopy (direct visualization of the epiglottis)

* nasopharyngoscopy is replacing X-ray eval as preferred method of diagnosis
What is the normal thickness of the epiglottis?
3-5 mm
Epiglottis thickness of ___ provides high sensitivity and specificity for epiglottitis.
7 mm
What is the treatment for epiglottitis?
• Cephalosporins (Rocephin, Ceftizoxime, Cefuroxime)
• Ampicillin
• Cloramphenicol
How do you differentiate epiglottitis from croup?
• croup occurs in younger children and has a viral prodrome
• croup has a barking cough and raely appears toxic
Name and describe the 3 types of apnea
• obstructive (most common): caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep

• central: the airway is not blocker but the brain fails to signal the muscles to breathe

• mixed: a combination of the two
What is the clinical definition of apnea?
• in adults, a cessation of breath that last at least 10 sec.

• in children, a cessation of breath that last the equivalent of 2½ missed breaths
What are risk factors for sleep apnea?
• abnormalities in upper airway structure
• age
• alcohol use
• excess weight
• family history of sleep apnea
• large neck w/ a recessed chin
• male sex
• smoking
What are presenting symptoms of a patient w/ sleep apnea?
• excessive daytime sleepiness
• feelings of depression
• HTN & other cardiovascular complications
• impotence
• loud snoring
• memory problems
• morning headaches
• nocturia
• reflux
What is the most common treament for pediatric patients with sleep apnea?
tonsillectomy and adenoidectomy