Term
Rhinovirus
Coronavirus
Respiratory Syncytial Virus
Parainfluenza Virus
Adenovirus
Enterovirus
CRAPE |
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Definition
| Etiology of the common cold |
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Term
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Definition
signs and symptoms: sore "scratchy" throat (resolves in 24-72 hours), nasal stuffiness and nasal obstruction, nasal discharge (slightly red pharnyx)
Duration: 2-14 days (common 7-10 days) |
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Term
analgesics (HA, malaise, myalgia, fever): aspirin and APAP suppress the development of antibodies and prolong the duration of viral shedding, ibuprofen and naproxen do not effect serum antibody response and viral shedding
antihistamines: no major effect on overall cold symptoms, may be effective in reducing sneezing and rhinorrhea
decongestants:
topical (oxymetazoline and xylometazoline) - rapidly effective in relieving nasal congestion and improving nasal airflow, indicated for short term use only
systemic (pseudoephedrine) - effective in relieving nasal congestion and improving nasal airflow
other options:
cromolyn sodium intranasal and inhalation: duration of cold significantly shortened and symptoms decreased in final 3 days
interferon nasal spray, zinc gluconate lozenges, high dose vitamin C, and investigational antiviral drugs have shown little or no benefit
echinacea for prevention or treatment of the common cold cannot be recommended at this time |
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Definition
| treatment options for the common cold |
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Term
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Definition
inflammation or infection of the mucosa of the nasal passages and at least one of the paranasal sinuses
common signs/symptoms: sinus tenderness, cough, sinus pressure, nasal obstruction, headache, postnasal drainage, discolored nasal discharge, sore throat
possible signs/symptoms: halitosis, malaise, fever/chills, maxillary toothache, periorbital swelling
predictability: purulent nasal discharge (discolored), pain on bending forward, maxillary toothache, symptoms of URI, nasal obstruction, pain with chewing |
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Term
viral
bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
EXAM QUESTION |
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Definition
| etiology of rhinosinusitis |
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Term
| allergies, GERD, structural abnormalities, immunodeficient |
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Definition
| risk factors of rhinosinusitis |
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Term
| usual dose (45 mg/kg/day divided in 2 doses) to high dose (90 mg/kg/day divided in 2 doses in children and 500-875 mg BID max 2-3 g/day in adults) amoxicillin |
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Definition
| treatment of a patient with rhinosinusitis not in day care, no recent antibiotics, and not allergic to penicillin |
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Term
usual dose = 45 mg/kg/day divided into 2 doses
high dose = 90 mg/kg/day divided into 2 doses |
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Definition
| usual and high dose of amoxicillin in children |
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Term
| 500-875 mg BID; max 2-3 g/day |
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Definition
| high dose of amoxicillin in adults |
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Term
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Definition
| high dose of amoxicillin/clavulanate in adults |
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Term
| 90 mg/kg/day amoxicillin; 6.4 mg/kg/day clavulanate in 2 divided doses |
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Definition
| high dose of amoxicillin/clavulanate in children |
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Term
cefuroxime
cefpodoxime
cefdinir
azithromycin
clarithromycin
adults also include: bactrim and macrolides |
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Definition
| treatment of a patient with rhinosinusitus that is not in day care, has not been on recent antibiotics, and is allergic to penicillin |
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Term
amox/clav high dose = 90 mg/kg/day amox and 6.4 mg/kg/day divided in 2 doses for children and 4g/250mg per day in adults
cefuroxime
cefpodxime
cefdinir
adults w/ recent antibiotic use: fluoroquinolones or HD augmentin |
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Definition
| treatment of rhinosinusitis in a patient who is not in day care that has been on recent antibiotics |
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Term
IV cefotaxime or ceftriaxone
or patient is referred for sinus imaging and sinus aspiration |
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Definition
| if patient fails oral therapy for rhinosinusitus, what is the next step? |
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Term
topical and systemic decongestants: relieves nasal congestion, may not promote sinus drainage
antihistamines: may be useful in patients with allergic rhinitis
intranasal corticosteroids: provide relief from symptoms (facial pain and tenderness, turbinate swelling) |
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Definition
| symptomatic treatment of rhinosinusitis |
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Term
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Definition
inflammation or infection of the oropharynx and/or nasopharynx; "sore throat"
duration: 2-7 days, sudden onset
signs and symptoms:
acute onset sore throat
fever
tonsilar exudate
swollen, tender anterior cervical lymph nodes
Grop A Strep: Erythematous throat with patches of purulent exudate (white to gray) on tonsils and posterior pharynx, erythema of the uvula and tongue, fever > 38 |
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Term
bacterial:
Streptococcus pyogenes (#1 cause)
group C and G Streptococci
Arcanobacterium hemolyticum
Mycoplasma pneumoniae
Chlyamydia pneumoniae
MAC
Viral:
Rhinovirus
coronavirus
adenovirus
parainfluenza virus
herpes simplex virus
influenza virus
coxsackievirus
Epstein Barr virus
Cytomegalovirus
PRICE CHAC |
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Definition
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Term
throat culture: swab posterior pharynx, plate specimen on sheep blood agar, incubate at least 18-24 hours, > 90% sensitive and highly specific
rapid antigen test: throat swab test requiring 5 minutes, 60-90% sensitive and very specific
should culture patients with a negative rapid test |
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Definition
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Term
reduce duration of symptoms, limit spread, prevent rheumatic fever
DOC = penicillin
PCN allergy (type 1): erythromycin
PCN allergy (non type 1): 1st generation cephalosporins
alternatives: ampicillin, amoxicillin, 1st generation cephalosporins, macrolides |
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Definition
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Term
suppurative: peritonsillar abscess, retropharyngeal abscess, cervical lymphandenitis, otitis media, sinusitis, mastoiditis
toxin mediated: scarlet fever or streptococcal toxic shock like syndrome
non suppurative: rheumatic fever, acute glomerulonephritis |
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Definition
| complications from pharyngitis |
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Term
| acute laryngotracheobronchitis (viral croup) |
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Definition
viral illness that causes inflammation and edema of the tracheal wall, narrowing of the lumen, and restriction of airflow
signs and symptoms: rhinorrhea, mild pharyngitis, cough, low grade fever, inspiratory stridor, hoarseness
duration: improvement after 1-2 days, resolution by 3-7 days |
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Term
Parainfluenza virus
adenovirus
influenza A virus
Respiratory syncytial virus
PAIR |
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Definition
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Term
symptomatic:
analgesics (APAP or IBU)
adequate hydration
cool mist therapy (decreased viscosity of mucous secretions and soothe inflamed mucosa)
severe airway narrowing (decreased oxygen saturation and labored breathing):
nebulized epinephrine
CORTICOSTEROIDS: DEXAMETHASONE PO/IM or nebulized budesonide
KNOW THAT DEXAMETHASONE IS THE STEROID USED FOR CROUP |
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Definition
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Term
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Definition
inflammatory process of epiglottis and adjacent structures that can lead to life threatening acute respiratory obstruction
signs and symptoms: fever, irritability, sore throat, rapidly progressive stridor with respiratory distress |
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Term
H. influenzae
beta hemolytic strep
S. pneumoniae
S. aureus
aerobic gram - bacteria |
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Definition
| etiology of acute epiglottitis |
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Term
endotracheal intubation/emergency tracheostomy
ONLY IV ANTIBIOTICS: cefotaxime, ceftriaxone, or ampicillin/sulbactam
postexposure prophylaxis - rifampin for household use if: child < 4 yo, child < 12 mo and has not received Hib vaccine series, or immunosuppressed child |
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Definition
| treatment of acute epiglottitis |
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Term
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Definition
acute viral infection of lower respiratory tract that produces inflammatory obstruction of the bronchioles
signs/symptoms:
irritability/restlessness
mild fever
cough
rhinitis
vomiting/diarrhea
ABNORMAL BREATHING: inspiratory crackles, labored with retractions, tachypnea, nasal flaring, grunting
duration: depends on underlying disorders, in normal/healthy child symptoms improve in 3-4 days, but airways may remain sensitive for weeks |
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Term
respiratory syncytial virus
metapneumovirus
parainfluenza virus
secondary bacteria infection
RMP |
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Definition
| etiology of bronchiolitis |
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Term
season
age (premature infant)
underlying lung disease
congenital heart disease
immunocompromised
tobacco smoke exposure |
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Definition
| risk factors for bronchiolitis |
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Term
outpatient:
nasal saline with bulb suctioning
antipyretics
rehydration if needed
infection control
avoid tobacco smoke exposure
education of disease progression
inpatient:
standard measures: supplemental oxygen, nasal saline with deep suctioning, antipyretics, rehydration, infection control
questionable measures:
bronchodilators - only effective if patient has asthma component
corticosteroids - no proven efficacy
ribavirin - for respiratory syncytial virus |
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Definition
| management of bronchiolitis |
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Term
NOT ROUTINELY RECOMMENDED
MOA (?): decrease in neutralizing antibody responses to RSV, reduce viral shedding in RSV infected patients
issues/concerns: conflicting results of efficacy trials, aerosol route of administration, potential toxic effects for exposed health care professionals, availability of product, expensive
black box warning: sudden deterioration of respiratory function has been associated with initiation of aerosolized ribavirin use in infants, teratogenic |
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Definition
| MOA and ADRs of ribavirin |
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Term
Palivizumab: humanized mouse monoclonal antibody, exhibits neutralizing and fusion inhibitory activity against RSV
Dose: 15 mg/kg IM monthly during RSV season (Nov-April)
only recommended for select infants
duration depends on risk factors |
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Definition
| drug for bronchiolitis prevention |
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Term
patients < 2yo with: chronic lung disease requiring medical therapy within 6 months of RSV season, or hemodynamically significant congenital heart disease
premature infants: < 1yo born at < 28 weeks gestation, < 6mo born at < 29-32 weeks gestation, consider if < 6mo born at 32-35 weeks gestation with risk factors |
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Definition
| recommendations on use of Palivizumab |
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Term
allergy or URI causes congestion and swelling of nasal mucosa, nasopharynx, and eustachian tube
obstruction of eustachian tube isthmus results in accumulation of middle ear secretions
secondary bacterial or viral infection of effusion causes suppuration and features of acute otitis media |
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Definition
| pathophysiology of otitis media |
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Term
age
daycare attendance
environmental factors
more than 1 sibling living at home
pacifier use
previous antibiotic use
previous otitis media
season (fall and winter)
gender (male > female)
ethnicity
underlying pathology |
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Definition
| risk factors of otitis media |
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Term
otalgia - denoted by pulling of the ear
irritability
fever
otorrhea
hearing loss
URI present
symptoms of URI
nonspecific symptoms |
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Definition
| clinical presentation of otitis media |
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Term
history of acute onset of signs and symptoms
presence of middle ear effusion
signs and symptoms of middle ear inflammation |
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Definition
| what 3 criteria must be met for the diagnosis of acute otitis media? |
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Term
bacterial:
S. pneumoniae
H. influenzae
M. catarrhalis
S. pyogenes
S. aureus
anaerobic organisms
gram negative enteric bacilli
viral:
parainfluenza virus
adenovirus
influenza virus
respiratory syncytial virus
enterovirus
rhinovirus
PAIRER |
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Definition
| etiology of acute otitis media |
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Term
< 6mo
6-24mo with certain diagnosis
severe infection, sepsis, or immunocompromised |
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Definition
| what patient populations should be treated with antibiotics for otitis media? |
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Term
amoxicillin (90mg/kg/day x10d)
macrolide for children with type 1 penicillin allergy
cephalosporin for children with non type 1 penicillin allergy
consider ceftriaxone or amox/clav for children with severe otitis media or fever > 102.2 (39)
if symptoms persist: amox/clav, cefuroxime, or ceftriaxone
if symptoms still persist: clindamycin, tympanocentesis (culture), change antibiotics, imaging, tympanostomy |
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Definition
| what is the treatment for otitis media for patients < 6mo, 6-24mo with certain diagnosis, or immunocompromised patients? |
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Term
AMOXICILLIN
traditional treatment dose = 45 mg/kg/day
high treatment dose = 90 mg/kg/day
IF amoxicillin fails...treatment failure...consider culture or drainage or tympanocentesis
IF NO culture then cover beta lactamase producing organsisms |
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Definition
| DOC for acute otitis media |
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Term
mastoiditis
perforation of tympanic membrane
hearing problems
language and cognitive problems
meningitis |
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Definition
| complications of otitis media |
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Term
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Definition
inflammation of the skin lining the external ear canal leading to the ear drum
initial: pruritis, pain, erythema
progressive: edema, otorrhea, conductive hearing loss
chronic: pruritus, mild discomfort, erythematous external canal |
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Term
Pseudomonas aeruginosa
Staphylococcus aureus
various aerobic and anaerobic bacteria
fungal |
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Definition
| etiology of otitis externa |
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Term
prophylaxis: 2% acetic acid +/- diluted in half by 90-95% alcohol
mild OM treatment: 2% acetic acid +/- diluted in half by 90-95% alcohol +/- topical steroid
advanced disease treatment: ototopical antimicrobial agent
penetration to epithelium is mandatory
warming ototopical to body temperature helps decrease dizziness
improve migration of ototopical to medial canal: instruct patient to lie on side with affected ear up for a few minutes after administration, pumping the tragus, placement of wick for canal narrowed by > 50% by edema
duration: 5-10 days (depending on severity) OR 3 days after last symptoms
if the patient's tympanic membrane is not intact, they are excluded from using aminoglycosides, neomycin, polymyxin B, and hydrocotisone
consider oral antibiotics: moderate acute OE in older patients, immunocompromised patients, patients with DM, coexisting otitis media, malignant external otitis |
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Definition
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Term
psoriasis and atopic dermatitis respond when therapy for underlying disease is initiated (systemic or topical steroid)
acne and seborrhea managed with medicated creams and shampoos
contact allergies respond to removal of offending agent |
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Definition
| noninfectious otitis externa treatment |
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Term
common precipitants: moisture, trauma
daily prophylaxis during at risk period: acidifying or alcohol drops, use of hair dryer on lowest setting +/- head tilt,avoidance of cotton swabs
especially important in the following: immunocompromised, systemic dermatologic condition, contact sensitivities to ototopicals, excessive perspiration, water sports |
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Definition
| prevention of otitis externa |
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