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78 Cards in this Set
- Front
- Back
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What are the most common viral URI etiologies?
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• rhinovirus
• adenovirus • influenza • parainfluenza |
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What are ingredients in decongestants and what do they do?
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• 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) |
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List some examples of antihistamines
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• Benadryl
• Chlor-Trimeton • Dimetane |
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List examples of cough suppressants?
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• dextromethorphan (main OTC cough suppressant)
• Tessalon Perles (reduces cough reflex by anesthetizing stretch receptors) • Narcotics (ex. Codeine) |
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Generally, what causes sinusitis in an immuno-competent host?
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a bacterial infection that follows a viral URI
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Explain how a viral cold can develop into sinusitis
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• 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 » |
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What are precipitating factors of sinusitis?
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• 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 |
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What is the most frequent nosocomial infection in ICUs?
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sinusitis (secondary to nasal intubation > 48 hrs)
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What are the most common bacterial causes of sinusitis?
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• Streptococcus pneumonia & H. Flu (70% of cases)
• Streptococci • Moraxella catarralis • gram negative organisms (in ICU) • Staphylococcus aureus (in sphenoid sinuses) |
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What is the most commonly affect sinus in patients with sinusitis?
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• maxillary sinus
• can present with pain over malar area, upper jaw, teeth, and cheeks |
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What cases of sinusitis should be treated with antibiotics?
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• purulent discharge
• have symptoms for > 1 week with being treated • worsening of symptoms (fever, leukocytosis, tender sinuses) > 5-10 days |
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How long is the antibiotic treatment for sinusitis?
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treatment is for 10-14 days (except for Zithromax)
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What antibiotics can be used to treat sinusitis?
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• Augmentin (amoxicillin + clavulanate) or amoxicillin
• Bactrim • Cephalosporins • Quinolones (not approved in children) • Macrolides (ex. Zithromax for children or Clarithomycin) |
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What is the antibiotic treatment for sinusitis in ICU patients?
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• removes tubes (NG tubes)
• give ofloxacillin OR • vancomycin w/ 3rd generation cephalosporin OR • unasyn (ampicillin + sulfabactum) |
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What is Pott's puffy tumor?
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• a complication of sinusitis
• infection spreads to frontal bone causing breakthrough of cortical bone and formation of a periosteal abscess |
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What are symptoms of sinusitis?
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• Anosmia
• Cough • Fever • Halatosis • Headache • Metallic taste • Nasal congestion • Pain during mastication • Purulent nasal discharge • Toothache • Unilateral face pain • Weakness |
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When is a CT scan the preferred imaging method for sinusitis?
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• necessary incases of treatment failure or chronic disease
• to exclude alternate diagnosis (ex. tumors, abscess, etc.) • can differentiate orbital cellulitis from periorbital cellulitis |
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What are common bacterial causes of chronic sinusitis?
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anaerobic bacteria and S. aureus
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What can untreated sinusitis lead to?
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• brain abscess
• chronically infected sinuses • orbital cellulitis • osteomyelitis • meningitis |
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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?
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rhinitis medicamentosa
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Patient, with a history of sinusitis, presents with local soft, doughy swelling suggestive of what?
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• Osteomyelitis (most common cause S. aureus)
• CT or MRI eval needed |
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What are Charcot Leyden crystals?
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• proteins that originate in the cytoplasm of eosinophils
• found in fungal sinusitis |
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What is phycomycosis?
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• 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 |
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What is the definition of pharyngitis?
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• irritation/inflammation of the pharynx
• usually includes tonsils |
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What are more serious conditions that need to be ruled out for patients with pharyngitis?
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• epiglottitis
• peri-tonsilar abscess • helps to diagnose group A beta-hemolytic streptococcus |
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What are etiologies for pharyngitis?
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• Virus (most common cause: 40-60%)
• Bacteria (~5-40%) • Allergies • Trauma • Toxins • Neoplasia. |
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List causes of tonsilopharyngeal exudates
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• Streptococcal infections
• Adenovirus • Clamidyia pnuemoniae • Diptheria • Haemolyticus • Herpes Virus • Mononucleosis • Mycoplasma pneumoniae |
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True/False: The presence of exudates alone can differentiate between viral and bacteria pharyngitis
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• Exudates can be caused by either virus or bacteria
• The correct answer is: False |
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Which bacteria accounts for 5-38% of sore throats in adults who are cultured?
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Streptococcus pyogenes
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What is the Centor criteria?
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• 4 criteria used in diagnosing pharyngitis:
• exudates • lymphadenopathy • fever > 101 • absence of cough |
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What are complications of pharyngitis?
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• Peritonsilar cellulitis
• Peritonsillar abscess (PTA) • Post-streptococcal glomerulonephritis • Rheumatic fever (most important nonsuppurative complication) • Scarlet fever (rare in adults) • Toxic shock syndrome |
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Acute rheumatic fever most frequently appears in what age group?
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5 - 15 y/o
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What are the Major Jones Criteria?
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• J - Joints (Polymigratory arthritis)
• Carditis • N - Nodules (subcutaneous) • E - Erythema marginatum • S - Syndenhams chorea |
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What are the minor Jones criteria?
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• Fever
• Arthralgia • Previous rheumatic fever or rheumatic disease • Acute Phase Reaction (elevated ESR or C-reactive protein & leukocytosis) • Prolonged PR interval |
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How many Jones criteria are require for a diagnosis of rheumatic fever?
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• 2 major Jones criteria OR
• 1 major + 2 minor criteria |
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What is Post-Streptococcal Glomerular Nephritis?
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• a nonsuppurative complication of strep pharyngitis
• inflammation of small blood vessels (glomeruli) in the kidneys after streptococcal infection |
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What are signs & symptoms of post-streptococcal glomerular nephritis?
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• Edema
• Gross Hematuria • HTN |
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What lab tests can be done when evaluating for strep pharyngitis?
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• Rapid Strep-antigen test (85-90% sensitivity; 98-99% specificity)
• Throat Cultre (if rapid strep is negative, but suspicion is high) |
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What is the treatment strategy of patients who meet 2 or more Centor criteria?
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test patients who meet 2 or more Centor criteria and treat only positive results
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What types of patients receive immediate treatment without testing for strep pharyngitis?
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• 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 |
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What is the antibiotic treatment for strep pharyngitis?
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• benzatine penicillin IM x 1
• penicillin V potassium (Pen VK) PO x 10 days • Cefuroxime axetil • Erythromycin (in PCN allergic pts) • Azithromycin |
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What are causes of pharyngitis with a high fever?
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• CMV
• coxsackie virus • group A beta-hemolytic strep • herpes simplex • HIV • infectious mononucleosis |
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What are prodromal symptoms of infectious mononucleosis?
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• 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) |
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What presentation could a patient with pharyngitis cause by HSV have?
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• stomatitis involving tongue & buccal mucosa and pharynx
• small ulcers and vesicles may develop |
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What presentation could a patient with pharyngitis caused by Coxsackie A virus?
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oropharyngeal vesicular lession with concomitant vesicles on the hands and feet (hand-foot-and-mouth disease)
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A patient with pharyngitis and a history of recent orogenital contact suggest the possibility of type of pharyngitis?
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gonococcal pharyngitis
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A patients presents with headache, pharyngitis, and lower respiratory symptoms. What is a likely etiology?
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Mycoplasma pneumonia
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A patient present with a foul smelling whitish-blue-gray pharyngeal exudate that bleeds when removed. What is the most likely etiology?
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Corynebacterium deptheriae (Diptheria)
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A patient present with a cheesy, white creamy exudate with an erythematous base on the tongue. What is the most likely etiology?
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Candida albicans - "Oral Candidiasis" - "Thrush"
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Oral Candidiasis is most commonly found in what patients?
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• infants or immunosuppressed
• may be first symptom of HIV |
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What would a gram stain or KOH mount show on a patient with oral candidiasis?
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shows typical yeasts and pseudohyphae
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How can you distinguish between thrush and leukoplakia?
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thrush can be scraped off, where as leukoplakia cannot
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What is the treatment of oral candidiasis?
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• Ketoconazole
• Clotrimazole troches • Nystatin vaginal troches or mouth rinse • AIDS patients require continuous prophylaxis with PO fluconazole or itraconazole |
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What is trench mouth and what organisms can cause it?
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• aka Vincent's angina
• an acute necrotizing ulcerative gingivitis caused by Fusobacteria and spirochetes |
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What is the preferred method for diagnosing group A beta-hemolytic strep in the ED?
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GABHS rapid antigen detection test
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What is the criterion standard test for diagnosing GABHS infection?
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throat culture (90-99% sensitive)
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What would a peripheral smear show in a patient with infectious mononucleosis?
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atypical lymphocytes
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What lab test can be performed to test for C. Pneumoniae?
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fluorescent monoclonal antibody test
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What is the goal of antibiotic therapy in pharyngitis?
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• decrease the duration of the illness and infective period
• provide symptomatic relief • decrease the incidence of relapses and complications (ex. rheumatic fever, glomerulonephritis) |
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Why can steriods be used in the treatment of phatyngitis?
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used for airway compromise, anti-inflammatory properties, and provide symptomatic relief
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What is a symptom of laryngitis?
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hoarseness (dysphonia)
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What are etiologies for acute laryngitis?
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• infection (usually viral URI)
• enviornmental insults (pollution) • GERD • Use of asthma inhalers • Vocal trauma |
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What is the most common cause of vocal cord paralysis?
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viral neuritis
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When is a laryngoscopy indicated in a patient complaining of hoarseness?
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if the hoarseness lasts longer than 2-3 weeks
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What is the DOC for bacterial laryngitis?
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Augmentin
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What is the treatment of persistent vocal cord paralysis?
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teflon paste injection
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What is epiglottitis?
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• an acute inflammation in the supraglottic region of the oropharynx
• inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds |
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What are some signs and symptoms of epiglottitis?
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• drooling
• muffled voice • odynophagia/dysphagia • sore throat • stridor • tripod position |
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What is the preferred method of diagnosis of epiglottitis?
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• nasopharyngoscopy (direct visualization of the epiglottis)
* nasopharyngoscopy is replacing X-ray eval as preferred method of diagnosis |
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What is the normal thickness of the epiglottis?
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3-5 mm
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Epiglottis thickness of ___ provides high sensitivity and specificity for epiglottitis.
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7 mm
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What is the treatment for epiglottitis?
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• Cephalosporins (Rocephin, Ceftizoxime, Cefuroxime)
• Ampicillin • Cloramphenicol |
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How do you differentiate epiglottitis from croup?
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• croup occurs in younger children and has a viral prodrome
• croup has a barking cough and raely appears toxic |
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Name and describe the 3 types of apnea
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• 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 |
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What is the clinical definition of apnea?
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• 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 |
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What are risk factors for sleep apnea?
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• abnormalities in upper airway structure
• age • alcohol use • excess weight • family history of sleep apnea • large neck w/ a recessed chin • male sex • smoking |
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What are presenting symptoms of a patient w/ sleep apnea?
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• excessive daytime sleepiness
• feelings of depression • HTN & other cardiovascular complications • impotence • loud snoring • memory problems • morning headaches • nocturia • reflux |
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What is the most common treament for pediatric patients with sleep apnea?
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tonsillectomy and adenoidectomy
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