Upper RTI

Question 1

Acute Otitis Media

• who gets it
• risk factors

Answer 1

• common in infancy (6-18 mo). More boys than girls

- age, family Hx, day care, lack of breastfeeding, tobacco smoke/air pollution, pacifier use

Question 2

Acute Otitis media

-etiology

Answer 2

• 2/3 combined viral/bacterial
• Bacterial: S. pnuemoniae, H. influenzae, M. cattarhalis
• Viral: RSV, rhinovirus, picoronaviruses, coronaviruses, influenza virus, adenovirus, human metapneumovirus

Question 3

Acute otitis media

-pathophysiology

Answer 3

• antecedent viral URTI closes the eustachian tube with inflammation
• middle ear secretions build up
• bacteria gain access to middle ear and grow in secretions

Question 4

Acute otitis media

-S/S in infants and children

Answer 4

• Infants: nonspecific, maybe fever

- children: otalgia, bulging tympanic membrane, otorrhea

Question 5

Acute otitis media

-management

Answer 5

• many resolve spontaneously (organism-dependant)
• Usually watchful waiting
• Treat if <6 months, perforated ear drum, day care, previous Ab in last 3 months, unlikely to return
• Amoxicillin (want to cover S. pneumoniae)

Question 6

Acute otitis media

-how long do children have effusions

Answer 6

50% of children have them at 1 month (do not treat) only 10% have them at 3 months

Question 7

Acute sinusitis

• epidemiology
• Risk factors

Answer 7

• adults and children, but women more frequent than men

- dental infection, allergies, swimming, obstruction of nose

Question 8

Acute sinusitis

-etiology

Answer 8

• Viral 200x more common (rhinovirus, influenza virus, parainfluenza virus
• Bacterial: S. pneumoniae, H. influenzae, M. cattarhalis, anaerobes associated with dental disease

Question 9

Acute sinusitis

-pathophysiology

Answer 9

• common cold spreads to paranasal sinuses (systemic or direct)
• secondary spread of bacteria into nasal cavities

Question 10

Acute sinusitis

-S/S

Answer 10

• purulent rhinorhea
• nasal congestion
• Cannot differentiate viral vs. bacterial, but bacterial more likely if:

-URTI persist for >10 days, or worsen after 5-7 days AND (above symptoms +pain OR fever and pain)

Question 11

Acute sinusitis

-Management

Answer 11

• No Ab (even for bacterial sinusitis), no topical steroid
• Analgesics
• Saline irrigation
• Steam inhalation
• Decongestants

-If must use Ab, use Amoxil

Question 12

Croup

-epidemiology (demographics, season, time of day)

Answer 12

• 6-36 months, rare beyond 6 y.o
• more common in boys
• more common in the fall/winter
• more common in late evening/early morning

Question 13

Croup

-Etiology

Answer 13

• Parainfluenza virus type 1 (50%)
• RSV
• Adenovirus
• Coronavirus
• Influenza

Question 14

Croup

-Pathophysiology

Answer 14

• Virus invades respiratory epithelium
• Inflammation of trachea and larynx
• Narrowing trachea –> barking cough

Question 15

Croup

-S/S

Answer 15

-inspiratory stridor, barking cough, sudden onset and rapid progression

Question 16

Croup

-management

Answer 16

• no Ab
• systemic or nebulized steroids
• no sedation– have to be awake to breath

Question 17

Pertussis

-epidemiology (transmission, frequency of outbreaks)

Answer 17

• cyclic epidemics q2-5 yrs
• highly contagious
• respiratory droplet or direct contact
• adults are a reservoir for transmission

Question 18

Pertussis

-etiology

Answer 18

Bordetella pertussis

Question 19

Pertussis

-pathophysiology

Answer 19

-various toxins and interference of host-defence (e.g. lives in macrophages)

Question 20

Pertussis

• S/S
• typical course

Answer 20

-paroxysmal cough, inspiratpry whoop, post-tussive emesis

1) cattarhal phase (runny nose, fever) (1-2 wks, v. contagious)
2) paroxysmal phase (3-6 wks)
3) convalescent phase ( >6 wks)

Question 21

Pertussis

-diagnosis

Answer 21

• nasopharyngeal swab–> culture and PCR

- clinical signs

Question 22

Pertussis

-management

Answer 22

• macrolides or TMP-SMX

- give longer if infant, pregnant woman, health care worker, childcare worker

Question 23

Common cold

-epidemiology (who gets it, what season, transmission, infectivity)

Answer 23

• mostly children
• year round (mostly winter)
• hands +++, droplets +
• incubation: 24/72h
• Infectivity: peaks with symptoms, shedding continues ~3wks

Question 24

Common cold

-etiology

Answer 24

ALL VIRAL
rhinovirus
influenzavirus
adenovirus
enterovirus
coronavirus
RSV
Parainfluenza virus
human metapnuemovirus

Question 25

Common cold | -pathophysiology

Answer 25

virus attaches to conjunctival and nasal mucosa and replicates causing inflammation

Question 26

Common cold | -diagnosis

Answer 26

-rhinorhea, sneezing/congestion, low-grade fever, cough

Question 27

Common cold management

Answer 27

- HANDWASHING - Saline irrigation - Steam inhalation - Decongestants - No antibiotics

Question 28

Pharyngitis | -epidemiology (who gets it, when)

Answer 28

- school aged kids | - winter/spring

Question 29

Pharyngitis | -etiology

Answer 29

-80-90% viral ``` adenovirus RSV parainfluenzae virus rhinovirus influenza virus coxsackie virus echovirus HSV EBV ``` -10-20% virus ``` GAS, GCS, GGS N. gonorrhea C. diptheriae Fusobacterium necrophorium arcanobacterium hemolyticum ```

Question 30

Pharygitis | -pathophysiology

Answer 30

GAS resists phagocytosis

Question 31

Pharyngitis | -S/S of viral vs. bacterial

Answer 31

Viral: ``` Rhinorhea cough conjunctivitis rash diarrhea ``` Bacterial F: fever A: adenopathy C: absence of cough E: exudate on tonsils

Question 32

Pharyngitis | -Daignosis

Answer 32

- Only swab or do RADT on those that don't appear to be viral

Question 33

Pharyngitis | -Management

Answer 33

-Viral: analgesic, antipyretic. NO antispetic or antibiotic Bacterial: Penicillin (want to prevent rheumatic fever)

Question 34

Signs of infectious mononucleosis

Answer 34

Fever, LAD, pharyngitis

Question 35

Two most common causes of mono

Answer 35

CMV and EBV