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30 Cards in this Set
- Front
- Back
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59. Clinical features of Acute Bronchitis?
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a. Cough (w/ or w/o sputum) is the predominant symptom!!! It lasts 1-2 weeks.
i. In a significant number of pts, the cough may last for 1 month or longer. ii. Chest discomfort and SOB may be present. iii. Fever may or may not be present. |
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60. Tx of Acute bronchitis?
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a. Abx are usually NOT necessary- most cases are viral.
b. Cough suppressants (codeine-containing meds) are effective for symptomatic relief. c. Bronchodilators (albuterol) may relieve sx. |
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61. What does susceptibility to common cold depend on?
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a. Pre-existing antibody levels.
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62. Causes of common cold?
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a. Rhinovirus is most common (at least 50% of cases)- there are more than 100 antigenic serotypes, so reinfection w/another serotype can lead to symptoms (no cross-immunity among serotypes).
b. Other viruses include: coronovirus, parainfluenza virus (types A, B, and C), adenovirus, coxsackie, and RSV. |
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63. Most common route of transmission of cold!?!?!?!?!?!
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a. Hand-to-hand transmission.
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64. Progression of common cold?
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a. Most resolve w/I 1 week, but symptoms may last up to 10-14 days.
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65. Presentation of common cold?
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a. Rhinorrhea
b. Sore throat c. Malaise d. Nonproductive cough e. Nasal congestion. f. Fever is uncommon in adults (suggests a bacterial complication or influenza), but is not unusual in children. |
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66. Tx of cold?
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a. Symptomatic
b. Adequate hydration i. Loosens secretions and prevents airway obstruction ii. Can be achieved by increasing fluid intake and inhaling steam. c. Rest and analgesics (aspirin, acetaminophen, ibuprofen) – for relief of malaise, HA, fever, aches. d. Cough suppressant (dextromethorphan, codeine). e. Nasal decongestant spray (Neo-Synephrine) for less than 3 days. f. Oral first-gen antihistamines for rhinorrhea/sneezing. |
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67. What features occur in both bacterial sinusitis and viral rhinosinusitis?
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a. Sneezing/rhinorrhea
b. Nasal d/c (whether clear, purulent, or coloured) c. Nasal obstruction d. Facial pain/HA |
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68. Note: Many of the symptoms that occur w/the common cold are also seen in influenza but are more severe in the latter. Fever, HA, myalgias, and malaise are much more pronounced w/the flu.
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68. Note: Many of the symptoms that occur w/the common cold are also seen in influenza but are more severe in the latter. Fever, HA, myalgias, and malaise are much more pronounced w/the flu.
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69. Sinusitis?
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a. Inflammation of the lining of the paranasal sinuses, often due to infection.
b. Mucosa oedema obstructs the sinus openings (ostia), trapping sinus secretions. |
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70. Pathophys of acute sinusitis?
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a. Most cases occur are a complication of common cold or other URIs (However, fewer than 1% of URIs lead to acute sinusitis).
b. May also be caused by nasal obstruction due to polyps, deviated septum, or foreign body. |
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71. What is acute bacterial sinusitis most commonly due to?
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1. Strep pneumoniae
2. Haemophilus 3. Anaerobes b. Other types: viral, fungal, or allergic. |
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72. Most commonly involved sinuses w/acute sinusitis?!?
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a. Maxillary.
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73. Presentation of Acute sinusitis?
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a. Nasal stuffiness, purulent nasal discharge, cough.
b. Sinus pain or pressure (location depends on which sinus is involved)-pain worsens w/percussion or bending head down). |
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74. Maxillary sinusitis (most common) presentation?
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a. Pain over cheeks that may mimic pain of dental caries!!!
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75. Frontal sinusitis presentation?
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a. Pain over lower forehead.
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76. Ethmoid sinusitis presentation?
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a. Retro-orbital pain
b. Or c. Pain in upper lateral aspect of nose |
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77. Chronic sinusitis?
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a. Nasal congestion, postnasal d/c.
b. Pain and HA are usually mild or absent. c. Fever is uncommon. d. By definition: Symptoms should be present for at least 2-3 months. |
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78. Aetiologies of Chronic sinusitis?
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a. In addition to the organisms listed for acute sinusitis, pts w/a hx of multiple sinus infections (and courses of abx) are at risk for infection w/staph aureus and gram-negative rods.
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79. Diagnosis of sinusitis?
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a. Diagnosis is based on clinical findings. Consider acute bacterial sinusitis if a pt has a cold for more than 8-10 days or has prolonged nasal congestion.
b. PE: Look for purulent d/c draining from one of the turbinates. c. Perform transillumination of maxillary sinuses (note impaired light transmission)- the room must be completely dark w/a strong w/a strong light source. d. Palpate over the sinuses for tenderness (not a reliable finding). |
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80. Imaging studies for sinusitis?
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a. Usually not indicated in routine community-acquired infections.
b. A CT scan (coronal view) is superior to plain radiograph. c. It should be performed in complicated disease of if surgery is being planned. |
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81. Complications of sinusitis?
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a. Mucocele, polyps
b. Orbital cellulites-Usually originating from ethmoid sinusitis. c. Osteomyelitis of frontal bones or maxilla d. Cavernous sinus thrombosis (rare) e. Very rare: epidural abscess, subdural empyema, meningitis, and brain abscess-due to contiguous spread through bone or via venous channels. |
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82. From what type of sinusitis does Orbital cellulitis usually originate?
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a. ethmoid sinusitis.
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83. General measures/advice for pt w/acute purulent sinusitis?
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a. Saline Nasal spray aids drainage
b. Avoid smoke and other environmental pollutants |
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84. Tx of acute purulent sinusitis (4 things)?
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a. Decongestants
b. Abx c. Antihistamines d. Nasal steroids |
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85. 2 decongestants for acute purulent sinusitis and MOA?
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1. Pseudoephedrine
2. Oxymetazoline b. Facilitate Sinus drainage!!!! And relieve congestion c. Available in both topical and systemic preps. d. Give for no more than 3-5 days. |
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86. Abx for acute purulent sinusitis?
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a. Amoxicillin
b. Amoxicillin-clavulanate (Augmentin) c. TMP/SMX d. Levofloxacin e. Moxifloxacin f. Cefuroxime |
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87. Course of abx for acute purulent sinusitis?
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a. Tx for 1-2 weeks, depending on severity.
b. If there is no improvement after 2 weeks of therapy, then sinus films and a penicillinase-resistant abx are appropriate. c. Consider ENT consult. d. Bc of the anatomic difficulties of drainage, the course of acute sinusitis takes longer to resolve than other URIs. |
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88. Antihistamines for tx of acute purulent sinusitis?
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a. Reserve for pts w/allergies; use discriminately bc of “drying effect”
b. Loratadine, fexofenadine, chlorpheniramine (Chlortrimenton). |
