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41 Cards in this Set
- Front
- Back
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Acute bronchitis
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Acute cough illness
Acute inflammatory condition of the tracheobronchial tree that does not involve parenchyma Almost always viral <3 weeks No other significant symptoms |
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Acute bronchitis treatment
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Beta agonist, education
Maybe antitussives Do not treat with antibiotics - many randomized trials have shown no benefit |
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How to rule out pneumonia in case of bronchitis?
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CXR - gold standard
Normal vitals and no localizing lung signs Sputum is not predicitve |
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Acute bronchitis pathogens
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>90% viral
Rhinovirus Coronovirus, adenovirus, RSV, parainfluenza, <10% bacterial Mycoplasma pneumoniae, chlamydia pneumonia, bordetella pertussis |
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When to treat acute bronchitis with antibiotics?
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If it goes on for >2 weeks
Know exposure to a pathogen Bordetella pertussis specific diagnosis w/ nasopharygneal specimen M. pneumoniae IgM Chlamydia - no specific test Use macrolide (azithro, clarithro, etc) |
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Pharyngitis
symptoms |
Slow onset
Mild nasal discharge Scratchy throat - slighty erythematous Dry cough Glassy nasal mucosa No fever |
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Pharyngitis causes
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human rhinovirus>other respiratory viruses>>bacteria
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What causes the symptoms in viral pharyngitis?
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Immune response
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Transmission of pharyngitis
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Hand to hand or fomites for HRV and coronavirus
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Group A strep pharyngitis
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Exudates on an erythematous pharynx
Enlarged and tender anterior cervical LNs Abrupt onset severe pharyngitis Fever Transmitted by saliva or nasal discharge |
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Diagnosing strep pharyngitis
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Clinical and microbiologic
Clinical - 20% of kids carry this Tonsillar adenopathy, anterior cervical LNs, fever Microbiologic - need to not miss this Rapid enzyme immunoassay 80-90% sens, 95% spec Culture 90-95% sense |
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Why treat strep pharyngitis?
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To prevent rheumatic fever
Glomerulonephritis, etc |
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Mononucleosis pharyngtitis
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Mostly EBV (CMV, toxo, primary HIV)
Abrupt onset severe systemic symptoms (fever, malaise, fatigue) and headache Also have sore throat Generalized adenopathy, enlarged spleen |
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Mononucleosis transmisison
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Usually not from known cases
20% of adults are shedding EBV at any time Direct person-person -- never cultured from fomites |
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Complications of mononucleosis
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Airway obstruction
Severe thrombocytopenia Hemolytic anemia Give steroids for these |
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Diagnosing mononucleosis
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Do it to avoid further diagnostic workup
Atypical lymphcytosis (peaks in week 2) Plts <140 in 50% of cases Monospot tests for heterophile antibody (+ in EBV) --90% sens in adults, reduced in kids Test for anti-EBV antibodies |
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Pharyngitis work up
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If common cold presentation -- supportive care and RTC
Abrupt onset and systemic > pharygnitis -- flu in flu season, EBV otherwise -- supportive Abrupt onset and pharyngitis > systemic -- group A strep workup |
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Sinusitis
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Infection of one or more of the paranasal sinuses
Viral Bacterial Fungal -- most in immunocompromised |
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Viral rhinosinusitis
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viral sinusitis as part of the spectrum of the common cold
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Acute community acquired bacterial sinusitis
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Bacterial sinusitis with symptoms for less than a few weeks
Bacteria introduced by sneezing, coughing, nose blowing Usually from URI |
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Chronic sinusitis
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Bacterial or fungal sinusitis lasting more than a few weeks
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Acute community acquired bacterial sinusitis pathogens
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S. pneumoniae
H. flu M. catarrhalis - peds |
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Clinical presentation of acute community acquired bacterial sinusitis
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Rhinorrhea, nasal obstruction, facial pressure, headache, cough
Purulent drainage from middle meatus Pain will palpation Reduced transillumination |
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Complications of bacterial sinusitis
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Subdural empyema
Brain abscess Pott's puffy tumor Orbital cellulitis Cavernous sinus thrombosis Meningitis |
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Treating bacterial sinusitis
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ABx for 10 days
Amoxicillin-clavulanate, cefuroxime, cefpodoxime, moxifloxicin Antihistamines, nsaid No role for decongestants, steroids |
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Diagnosing bacterial sinusitis
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Difficult
Bacterial vs allergic -- sneezing, itchy eyes, previous history Bacterial vs viral -- high fever, unilateral pain, facial tenderness, redness, swelling or does not get better in expected time CT to support |
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CT finding in bacterial sinusitis
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Air fluid line with flat meniscus
--shows presence of thin fluid Not just mucosal thickening (could also be viral) |
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What increases pen resistant pneumocci carriage in kids?
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More antibiotic use
Personally and in community |
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Causes of common cold
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Rhinovirus
Coronovirus Adenovirus Parainfluenza virus Influenza A and B |
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Causes of pharyngitis
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Rhinovirus
Adenovirus Parainfluenza virus Influenza A and B Coxsackievirus A EBV CMV HIV RSV Groups A, B, G strep N. gonnorhea Mycoplasma pneumonia Chlamydia pneumonia H. flu Strep pneumoniaa Moraxella catarrhalis |
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Causes of acute bronchitis
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Rhinovirus
Adenovrius Influenza A and B RSV M. pneumoniae Chlamydia pneumonia H. influenzae Strep pneumo Moraxella catarrhalis |
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Most common cause of the common cold?
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Human rhinovirus
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How are cold viruses transmitted?
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Rhinovirus - mostly hands, can live on fomites for a bit
Flu/paraflu/coxsackie -- aerosols Not saliva |
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Treating the common cold
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Nasal: ipatropium bromide, cromolyn sdoium decrease discharge and rhinorrhea
Sore throat- ibuprofen, warm saline gargles Cough: antitussives Systemic: ibuprofen, rest Not: Abx, VitC, echinacea, antitussives, expectorants, glucocorticoids, zine |
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Complications of the common cold
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Sinusitis, mostly viral
Otitis media, mostly in kids Lower respiratory tract infection |
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Group A strep pharyngitis epi
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5-15% of adult pharyngitis
20-30% kids |
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Treating group A strep pharyngitis
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10 fold reduction in acute rheumatic fever if Abx started w/in 9 days and continued for 10 days
Use penicillin (erythro in allergic) |
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Pathogenesis of sinusitis
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Blocking of ostia
In chronic they remain blocked |
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Pathogens in chronic sinusitis
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Strep pneumo
H. flu Staph aur Anaerobic gram + Gram neg rods |
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Gold standard for diagnosing bacterial sinusitis?
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Aspiration and culture
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Acute bacterial sinusitis natural history and complications
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Spontaneous resolution in 40-50%
Maxillary/frontal - subdural empyema, pott's puffy tumor, meningitis Ethmoid - orbital abscess, cellulitis Sphenoid - cavernous sinus thrombis, meningitis |
