Pulm Lecture 19 - URIs

darodri6's version from 2016-09-22 23:38


ConditionPathophysiologyCommon SymtpomsTreatmentOther
Sinusitis-Obstruction of sinus drainage pathways that prevents normal drainage and causes hypoxia within sinus causes ciliary dysfunction and alterations in mucous production.

-Ciliary impairment which is unable to move waste and infectious bi-products out of sinuses.

-Mucous quantity/quality
FACIAL PAIN/PRESSURE, HYPOSMIA, NASAL OBSTRUCTION/BLOCKAGE, POSTNASAL DRIP, FEVER, Cough, Fatigue, Dental pain, Ear fullness/pressure, Halitosis, headaches

*Must present with 2 MAJOR or 1 MAJOR + 2 minor symptoms
Amoxicillin = first line

Alternatives = Bactrim (TMP/SMX)

if poor response or chronic = Amoxicillin + Clavulanate (Augmentin) OR 3rd gen Ceph or resp. Fluroquinolones
Rhinitis-Inflammation of the nasal mucosa. It is often just a presenting symptom of the common cold.
-Can be seen in a patient with what is commonly called seasonal allergies and it is called Allergic [x]. With allergic [x] the nasal mucosa is pale and boggy instead of red and swollen with an infection.

Also possible facial pressure or pain w/altered sense of smell and post nasal drainage.

Also possible sore throat, tearing and burning of eyes, malaise and cough.
Pharyngitis (viral)Causes include;
-Herpes Simplex (HSV)
-Low grade fever
-Erythema of the pharynx
-Occasional tonsillar enlargement
-Occasional cervical adenopathy but usually minimal
-Rarely Exudate (almost exclusively in Mono)
Pharyngitis (bacterial)Causes include;
-Group A Strep (Streptococcus pyogenes)
-Group C Strep
-Neisseria gonnorrhea
-Corynebacterium diphtheriae
-Mycoplasma pneumoniae
-Chlamydophila pneumoniae
-Archanobacterium haemolyticum
-Fusobacterium necrophorum
-Tonsillar edema and erythema
-Tonsillar exudates
-Anterior cervical lymphadenopathy
-Fever or history of fever
-Absence of cough
First line = Pen G + VK, or Amoxicillin

*For Penicillin allergies, use Clindamycin or Azithromycin (broad spectrum = last resort)
Complications of Group A Strep =
-Acute Rheumatic Fever
-Scarlet Fever
-Acute Glomerulonephritis
-Otitis Media
-Peritonsilar abscess
Acute Rheumatic Fever (ARF)-An autoimmune disease brought on by inappropriate treatment of Streptococcal A throat infection.

-It causes future heart disease in patients.
Mitral valve stenosis
Congestive heart failure
Atrial Fibrillation

-Fever, muscle aches, swollen joints are some of the symptoms. Jones Criteria is used to diagnose this condition.
To diagnose you need the required criteria below and one of two options:
-1 Required Criteria and 2 Major Criteria and 0 Minor Criteria
-1 Required Criteria and 1 Jones Criteria for diagnosis:
Major Criteria and 2 Minor Criteria

Required Criteria:
Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent SCARLET FEVER/ anti-deoxyribonuclease B / anti-hyaluronidase

Major Diagnostic Criteria:
Erythema marginatum
Subcutaneous Nodules

Minor Diagnostic Criteria:
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
EpiglottitisCauses in children = H. Influenza type B (most common) > H. influenza non-type B > Strep> Staph

Adults = HiB (most common

Immunocompromised = Pseudomonas aeruginosa (most common)
stridor, muffled/hoarse voice. tender anterior neck, cough, dysphagia, voice changes, drooling/inability to handle scretions, hypoxia w/tachycardia