Upper Respiratory Tract Infection

Front 1

At what day during the normal common cold do sneezing, rhinitis, and nasal congestion predominate?

Back 1

Day 2-3

Front 2

At what day during the normal common cold does cough typically enter the picture?

Back 2

Day 4-5

Front 3

What is the duration of the common cold?

Back 3

The majority last 5-7 days but some may last as long as two weeks.

Front 4

What two key features can help to differentiate flu from common cold?

Back 4

High fevers and myalgias

Front 5

What virus is the most common cause of cold?

Back 5

Rhinovirus

Front 6

What are three viruses that can cause the common cold?

Back 6

Rhinovirus, Coronavirus, RSV

Front 7

What population can have dire consequences from pneumonia?

Back 7

Elderly

Front 8

Describe the transmission for the common cold.

Back 8

 Direct contact, with hand-to-hand being most important
 Virus can remain viable on hands and surfaces for hours
 Direct aerosol spread occurs - spread through airplane not a huge risk
 Saliva not a risk

Front 9

What is the mechanism of action of ipatropium bromide nasal spray?

Back 9

Ipatropium bromide is an anticholinergic that binds to muscarinic ACh receptors.

Two sprays 3-4 times daily
Decreases volume of nasal discharge by 26% and reduces sneezing.

Front 10

What is the mechanism of action cromolyn sodium?

Back 10

Leukotriene receptor antagonist.

One spray/nostril tid-qid
Recent studies show symptoms resolve faster if treatment started within 24
hours of onset.

Front 11

Discuss use of antihistamines, decongestants, and mucolytics and compare them to placebo.

Back 11

 Antihistamines
Studies mixed whether helps reduce nasal symptoms
Use limited by sedation
 Decongestants
Pseudoephedrine shown to decrease symptoms in the first few days of cold
by 13% compared to placebo in meta-analysis
 Anti-tussives/Mucolytics
Studies show variable efficacy when compared to placebo

Front 12

Is sinusitis typically viral or bacterial in origin?

Back 12

Viral

Front 13

What percent of viral sinusitis is complicated by bacterial infection?

Back 13

2%, CT sinus scan is not helpful in acute diagnosis.

Front 14

What are signs and symptoms of secondary bacterial sinusitis?

Back 14

Maxillary pain or tenderness in teeth and face and persistent nasal discharge
without improvement for 7-14 days.

Front 15

How do you treat bacterial sinusitis in an adult?

Back 15

Adults: Amoxicillin 1.5-3.0gm/day or doxycycline 100mg BID or
trimethaprim/sulfamethoxasole 1 DS tablet BID

Front 16

How do you treat sinusitis in children?

Back 16

Children:

1. Amoxicillin 45-90 mg/day divided BID or cefdinir 14mg/kg/day in one to
two doses

2. Defpodoxime10mg/kg/day BID

3. clarithromycin 15mg/kg/day BID

4. azithromycin 10mg/kg/day times one then 5mg/kg/day for four days.

Front 17

How do you treat sinusitis in children who do not improve with initial therapy?

Back 17

Children who do not improve, who have been in daycare recently or have recently
received antibiotics, use amoxicillin/clavulanate 80-90mg/kg/day of amoxicillin
component and 6.4 mg/kg/day of clavulanate BID

Front 18

List four abnormal vital signs that may indicate an underlying pneumonia.

Back 18

• Heart rate >100
• Resp. rate >24 breaths/min
• Oral temperature >38
• Abnormal chest findings (rales, fremitus, egophony)

Front 19

What percent of a acute bronchitis is viral? What is the recommended treatment?

Back 19

90% of acute bronchitis is non-bacterial and treatment is not recommended regardless of the duration of the cough.

Front 20

If an acute bronchitis absolutely must be treated, what are medications that can be considered?

Back 20

• Acute or early coughs due to viral URIs do not appear to respond to dextromethorphan or codeine

• Chronic cough (2-3 weeks) may respond to above agents

Front 21

What are primary distinguishing features between the common cold and influenza?

Back 21

 Very acute onset
 High fever (38-40oC, severe myalgias, headache, sore throat, non-productive
cough, rhinitis, substernal soreness, nausea common
 Cough can persist for two weeks or more
 Malaise may persist for weeks
 Mortality related to influenza as high as 36,000 per year in the USA

Front 22

How does strep throat caused by Group A strep present?

Back 22

Presence of fever, anterior cervical adenopathy ,abdominal pain, erythematous pharynx and absence of other URI symptoms increase the likelihood that Strep is the cause.

Front 23

If the following symptoms are not present: cough, rhinorrhea, minimal or no cervical adenopathy, no fever, lack of
tonsillar exudates, hoarseness what is the likelihood that you are dealing with a strep pharyngitis?

Back 23

20% likelihood

Bonus fact: most likely seen between age 5-15

Front 24

How do you treat group A strep pharyngitis?

Back 24

 Treatment of illness aimed at preventing rheumatic fever and other suppurative
complications
o Peritonsilar abscess
o Retropharyngeal abscess
o Otitis media
 Decrease the duration of illness by 1-2 days
o Strep is a self-limited disease
 Decrease contagion

Front 25

What are the best antibiotics for treating group A strep?

Back 25

 Penicillin still drug of choice due to cost, narrow bacterial spectrum and lack of
resistance
 Erythromycin can be used for penicillin allergy
 Amoxicillin as effective as penicillin, and may be used in children because of higher
acceptance rate (due to taste)
 Although other macrolides and cephalosporins are effective, their routine use has
been discouraged because of fear of creating antibiotic resistance

Front 26

What is the gold standard for diagnosing strep infection?

Back 26

Strep culture is gold standard

Front 27

What is the specificity of rapid antibody testing?

Back 27

 RAT has specificity of >95%
o If test is positive treatment should be started
o Useful in making a diagnosis quickly

Front 28

What is the sensitivity of rapid antibody testing?

Back 28

 RAT sensitivity 60-80%
o If RAT is negative and pre-test index of suspicion is high based on clinical signs and symptoms, do Strep culture to confirm in children.
o No need to confirm negative RAT in adults because incidence of Strep is
markedly less in this population and the pneumatic complications are extremely rare

Front 29

What are important features of a diagnostic test?

Back 29

Sensitivity and specificity

Front 30

What does PICO stand for?

Back 30

A treatment question should be phrased in the form of a PICO (population, intervention, comparison, and outcome).