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66 Cards in this Set
- Front
- Back
What are some defense mechanisms of the URI?
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Cough, gag, sneeze reflexes
Viscous mucus secretions Ciliary action Abundant lymphoid tissue IgA in respiratory secretions Rich vasculature delivers leukocytes |
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What is an example of an afebrile URI?
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common cold
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What are 4 examples of febrile URI?
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influenza
adenoviruses parainfluenza pharyngitis |
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What are 2 illnesses that are characterized by a mild to moderate sore throat?
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-common cold
-diptheria |
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What are 2 illnesses that are characterized by sore throat as a "major complaint"?
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-influenza
-peritonsillar abscess |
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What is an example of an illness that is characterized by dysphagia?
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strep throat
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If a patient is complaining of multiple symptoms, what is the likely source of the illness?
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virus
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On PE, what are 3 things you may find on URI?
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tonsillar exudate
cervical nodes fever |
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What are 2 illnesses where tonsillar exudate would be absent?
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common cold and influenza
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What are 3 illnesses where tonsillar exudate would be present?
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strep, EB virus, adenovirus
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What is 1 illness where tonsillar exudate would present as a pseudomembrane?
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diptheria
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What are some associated findings with URI?
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cough (productive?)
rhinorrhea SOB diarrhea |
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For common cold, what are some pertinent findings from patient history?
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nasal congestion
nasal discharge mild sore throat ("scratchy") non-productive cough headache malaise |
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For common cold, what are some pertinent findings from physical exam?
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temperature below 101
coryza (red, edematous membrane; watery discharge) throat: normal to mild erythema rhonchi possible |
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How many subtypes of the common cold exist?
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200!!
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How many types of rhinoviruses exist?
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100 types (35%)
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What percentage of common cold is accounted for by the coronavirus?
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10%
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What are 6 subtypes of the common cold?
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-rhinovirus
-coronavirius -parainfluenza -influenza -adenovirus -respiratory syncytial virus |
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What is adenovirus characterized by?
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fever and pharyngitis
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How many colds do adults get a year?
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2-4 (most frequent acute illness!)
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When are the peak incidences of the rhino/corona/entero viruses?
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-rhino: early fall and late spring
-corona: winter -entero: summer |
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What are 3 ways in which the common cold transmitted?
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-respiratory route
-direct contact with secretions -fomites (any inanimate object or substance capable of carrying infectious) |
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What are 4 ways to treat/alleviate symptoms of the common cold?
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-fluid and saline gargles (1-2 tbsp salt and tall glass of warm water)
-decongestants (NOT antihistamine; pseudoephedrine tablets, phenylephrine nasal spray) -cough suppression (dextromethorphan, codeine) -expectorant (guaifenesin) |
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What are 4 things that would be in the DDX of a common cold?
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-complications
-strep infections -mono -allergy |
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What are some complications of the common cold?
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-conjunctivitis
-middle ear effusion/infection (50-80% adults Eustachian tube dysfunction) -sinusitis (0.5-2.5%) -exacerbation in asthmatics |
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What is the incubation time and duration time of influenza?
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incubation: 1-4 days
duration: 2-5 days |
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What are 2 facts re: the incidence of the flu?
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-influenza infects 5-20% of the US population annually
-up to 200,000 patients require hospitalization |
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Viral shedding (flu)
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1-2 days then decline
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What does the incidence of influenza peak?
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February
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What might you find in the history of a person w/ influenza?
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-nasal congestion/dischage
-sore throat w/o dysphagia -headache -non-productive cough becomes productive -fever -substernal pain/burning -myalgia/arthralgia -prostration -nausea w/ or w/o vomiting |
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Which of the history findings are most important when dx the flu?
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Fever
Substernal pain or burning Myalagia and/or athralgia Prostration Nausea with or without vomiting |
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What are some physical findings of someone w/ the flu?
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Clear nasal discharge (no congestion)
Mild pharyngeal injection (no exudate) Rhonchi Temperature 101oF or more (3 days) Face flushed Skin hot & moist |
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Which of the PE findings are most important when dx the flu?
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Temperature 101oF or more (3 days)
Face flushed Skin hot & moist |
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When is flu season?
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december-april (85% correlation)
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Of those w/ fever and acute respiratory symptoms, who should be tested?
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-most appropriate for hospitalized patients (and immuno-compromised)
-oupatient healthy: adults w/ in 5 days of illness onset; children: anytime during course of illness -epidemiologic link to outbreak |
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When would you want to test for the flu?
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When you are suspicious/worried about a patient, or when you think there might be an outbreak in the community, also healthcare workers
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If you test within 5 days of onset, what is more likely?
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positive RIDT results more likely (if you test after 5 days, you might have false positives)
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What is the sensitivity of the RIDT test?
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50-70% sensitivity
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What are some treatments for the flu?
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Bedrest
Fluids Vaporizer Aspirin for adults Nasal spray Cough suppressants |
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What should you worry about when giving aspirin to a child?
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Reye's syndrome
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When is prevention of the flu optimal?
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oct-nov
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What are 2 ways to prevent the flu?
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-trivalent inactivated vaccine (TIV)
-live attenuated vaccine |
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2 types of TIV
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high dose TIV, intradermal TIV
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Live attenuated vaccine
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-intranasal vaccine (flumist)
-not below age 2 or above age 50 -not with asthmatics -not with pregnant women |
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TIV
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-vax al pts age greater than or equal to 6 months
-usually one intramuscular dose (0.5 ml) -????? finish this card!!! |
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Can the person eat lightly cooked egg (i.e. scrambled eggs) w/o reaction?
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administer TIV per usual protocol
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After eating eggs or egg-containing foods, does the person ONLY have hives?
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administer TIV and observe for reaction after 30 minutes
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Does the person have cardio/respiratory/GI reaction to eggs, reaction requiring epi or reaction requiring medical attention?
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Refer to physician w/ expertise in management of allergic reactions for further evaluation
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Preference for elderly woman to prevent her from getting the flu?
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immunoprophylaxis
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Chemoprophylaxis of flu (anti-viral therapy)
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-prevention for high risk, unvaccinated in outbreak (continue 10 days)
-given in conjunction w/ vax (immunity about 2 weeks after vaccination) |
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Treatment for confirmed or highly suspected (anti-viral therapy)
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-hospitalized for influenza
-outpatients at high risk for complications (if infection suspected or confirmed (within 2 days); more than 2 days but not improving and positive flu test) -outpatients wanting shorter duration and less complicated risk |
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Recommended regimens for the flu
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-tamiflu (oseltamivir for Type A&B)
-relenza (zanamivir for Type A&B) |
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What are other regimens for the flu that are available but not recommended?a
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-amantadine or ramantadine (Type A)
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?? slide 28
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??
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What would you find in the history of patient w/ strep pharyngitis?
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Marked pharyngeal pain
Dysphagia |
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What would you find in the PE of patient w/ strep pharyngitis?
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Fiery red pharynx
Tonsillar exudate Tender cervical nodes Fever (103oF) |
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Diagnosis of strep pharyngitis
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High level of clinical suspicion
Rapid antigen detection tests Throat culture CBC and/or Monospot |
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Suppurative complications of strep pharyngitis
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Sinusitis
Otitis media Mastoiditis Peritonsillar abscess |
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Non-suppurative complications of strep pharyngitis
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Rheumatic fever
Glomerulonephritis |
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For whom is RADT (rapid antigen detection test) NOT recommended?
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-children or adults w/ likely viral etiology (cough, rhinorrhea, hoarseness, oral ulcers)
-children under age 3 (acute rheumatic fever is rare) |
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If there is a negative RADT...
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-In children & adolescents, needs back-up throat culture
-In adults, not needed (due to low incidence of GAS pharyngitis & low risk acute rheumatic fever) -see slide 33 |
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People with group A beta hemolytic strep...
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will get better w/o abs
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What is the purpose of treating strep pharyngitis?
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-prevention of rheumatic fever
-prevention of suppurative complications |
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What is the standard tx for strep pharyngitis?
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-penicillin VK 500mg qid for 10 days
-erythromycin 500 mg qid for 10 days |
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When will patients feel improvement in symptoms from strep pharyngitis?
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-2-4 days (w/ or w/o meds!)
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What can patients use as an analgesic for strep pharyngitis?
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acetaminophen
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