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Upper Respiratory Tract Infections
Downstate > MS2 Respiratory Block > URI Lecture 8
49
Medical
Graduate
01/30/2011

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Term
rhinitis: primary mode of transmission
Definition
fomites
Term
when do PMNs infiltrate in rhinitis?
Definition
day 2
Term
rhinitis symptoms lasting >10d indicates...
Definition
complications or allergic rhinitis
Term
wheezing in rhinitis indicates...
Definition
underlying asthma or COPD
Term
differential diagnosis for rhinitis (5)
Definition
allergy, vasomotor, flu, sinusitis, pertussis
Term
AE: Zicam lozenge
Definition
anosmia
Term
why is aspirin contraindicated in children?
Definition
Reye's syndrome
Term
pertussis toxin
Definition
AB exotoxin; catalyzes the ADP-ribosylation of a G protein, increasing intracellular cAMP
Term
stages of pertussis
Definition
1. catarrhal: 1-2 wks of rhinorrhea, cough, conjunctivitis 2. paroxysmal: wheezing >2wks, chronic cough, lymphocytosis 3. convalescent: slow resolution
Term
apnea spells in infant; dx?
Definition
pertussis
Term
complications of whooping cough
Definition
vomiting, syncope, hypoxemia, atelectasis, low FiO2, death (age<2mo)
Term
what is used to diagnose pertussis?
Definition
direct fluorescence antigen testing
Term
tx for pertussis?
Definition
erythromycin for pt and for pt's contacts
Term
fever, facial pain and pressure, purulent nasal and postnasal discharge, maxillary tooth pain, unilateral headache, persistent cough, bad breath; dx?
Definition
sinusitis
Term
causes of sinusitis (4)?
Definition
H. influenza, Strep pneumo, M. catarrhalis, viruses
Term
complications of sinusitis
Definition
Pott's tumor, intracranial abscesses
Term
tx for sinusitis
Definition
amoxicillin +/- clavulanate or 2nd/3rd gen cephalosporin
Term
how long does sinusitis last? when do symptoms worsen?
Definition
lasts 2wks; symptoms worsen around 5-7d
Term
most common causes of tonsillopharyngitis
Definition
GAS; adenovirus most common cause of exudative pharyngitis
Term
tonsillitis is most common in ___yo and rare in ___yo
Definition
most common in 6-12yo; rare in <3yo
Term
what streptococcal protein is responsible for virulence in pharyngitis?
Definition
M protein
Term
fever, dysphagia, otalgia; swollen, hyperemic tonsils, swollen lymph nodes, petechiae on palate; no vesicles, no ulcers, no rhinorrhea; dx?
Definition
streptococcal pharyngitis
Term
what bugs must be ruled out when diagnosing strep throat?
Definition
EBV (Monospot), N. gonorrhea (child abuse!)
Term
differential diagnosis for pharyngitis (6)
Definition
EBV, HIV, epiglottitis (Hib), croup, diptheria, hand-foot-mouth disease (coxsackievirus A)
Term
fever, pharyngitis, cervical lymphadenopathy, splenomegaly, hepatitis; dx?
Definition
mono
Term
pharyngitis + gray exudates that bleed when removed; dx?
Definition
diphtheria
Term
pharyngitis + subglottic mucosal swelling, no drooling; dx?
Definition
croup
Term
tx for croup
Definition
humidified air, steroids, inhaled epinephrine
Term
pharyngitis + sandpaper rash; dx? bug?
Definition
Scarlet fever, GAS
Term
Scarlet fever toxin
Definition
erythrogenic exotoxin
Term
complications of GAS tonsillopharyngitis (4)
Definition
scarlet fever, peritonsillar and parapharyngeal abscesses, rheumatic fever, glomerulonephritis
Term
tx for scarlet fever
Definition
penicillin
Term
when are scarlet fever pts noncontagious?
Definition
on day 2 of therapy
Term
what percentage of AOM is caused by bacteria? by virus?
Definition
70%-bacteria; 30%-virus
Term
most common cause of bacterial AOM
Definition
Strep pneumoniae
Term
bacterial causes of AOM (3) and their targeted populations
Definition
Strep pneumo: most common; H. influenza: older children, adults; GBS: neonates, infants
Term
viral causes of AOM
Definition
RSV, adenovirus, rhinovirus
Term
__% of infants have at least 1 episode of AOM by 1y; __% by 3yo
Definition
50% by 1yo; 70% by 3yo
Term
risk factors for bacterial AOM (3)
Definition
smoking, viral URI, day care
Term
pathophysiology of AOM
Definition
infection of middle ear by obstruction of Eustachian tube or reflux of nasopharyngeal secretions
Term
otoscopic findings in AOM
Definition
erythema, bulging and immobile tympanic membrane, air fluid level, decreased light reflex
Term
differential diagnosis for ear pain (3)
Definition
myringitis, otitis externa, cholesteatoma
Term
complications of AOM (3)
Definition
hearing loss, mastoiditis, brain abscesses
Term
tx for AOM
Definition
amoxicillin
Term
what % of AOM resolves spontaneously?
Definition
70-90% resolve without antibiotic tx
Term
cause of epiglottitis
Definition
H. influenza, (S. aureus, S. pneumoniae)
Term
drooling, inspiratory stridor, muffled voice; dx?
Definition
epiglottitis
Term
management and tx for epiglottitis
Definition
intubation to avoid airway obstruction, ampicillin+sulbactam
Term
viral causes of pharyngitis
Definition
CRRIPE: coronavirus, RSV, rhinovirus, influenza, parainfluenza, EBV (same viruses for rhinitis too, except for EBV)
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