Exam with Solved Solutions.
rhinitis - Answer common cold, generally NOT accompanied by fever, symptoms begin 2-3
days after infection, many symptoms due to immune response not the virus
rhinitis details - Answer CC: rhinovirus (ALSO 'mild' RSV/pertussis)
VF: penetrate mucus & atach to cells
- binds sialic acid residues + ICAM
-200+ serotypes, mutable
dx: appearance
treatment: aerosol droplet control:-), chicken soup and rest
enterovirus d68 - Answer -similar to common cold, but more severe URTInf
-'summer cold' or 'pre-flu'
SYMPTOMS: sneezing, scratchy throat, runny nose (rhinorrhea) generally low grade fever
----> peak infection @ late summer to sept/oct 'pre flu'
enterovirus d68 details - Answer cc: enterovirus strains (many)
VF: viral, over 100+ serotypes
dx: appearance
treatments: aerosol droplet control chicken soup n rest
-watch/educate about respiratory collapse, supportive care (ICU, airway, ventilation)
sinusitis - Answer nasal congestion, pressure above the nose or in forehead, feeling of
headache or toothache, facial swelling/tenderness is common
-often follows a bout with the common cold
-discharge appears opaque with a white, brown, green, or yellow color (bacterial inf) -> viral
infection has clear discharge
sinusitis details - Answer cc: bacterial, viral, and fungal agents
-typically caused by NF (recurrence)
VF: biofilms, persistence, mixed infections
Dx: appearance, occasional radiology
,treatments: broad spec, antibiotics
ear infection (acute otitis media) - Answer sensation of fullness or pain in the ear, loss of
hearing, pus/inflammatory fluid response in middle ear
-infections of URT continue to Eustachian tubes
-untreated or severe infections can lead to eardrum rupture or meningitis
ear infection details - Answer cc: streptococcus pneumoniae, h. flu
vf: capsule
dx: appearance, screaming child
treatment: NONE is preferred (watchful waiting 72 hours)
-> b lactams (increased resistance), vaccination (HiB, Pneumovax, Prevnar)
pharyngitis - Answer inflammation of the throat, pain and swelling, reddened mucosa,
swollen tonsils, bad breath, potential for white packets of inflammatory pus, may affect speech
and swallowing
-DOWNSTREAM CONSEQUENCES
pharyngitis details - Answer CC #1: usually viral (less severe, hoarseness common)
CC #2: streptococcus pyogenes
VF: tons (aerosol, toxins, invasive, superantigens)
VF: M Protein (1 3 5 6 12 18 19 24
CC #3: fusobacterium necrophorum: g- rare (adolescent/young adults), can lead to Lemierre's
syndrome (blood infection), *PEN but not z-paks*
DX: apperance, rapid strep testing
treatment: treat GAS with b lactams (augmentin)
strep complications - Answer -Scarlet Fever (erythrogenic toxin production, sandpaper like
rash and high fever, school age children most common
-Rheumatic Fever (x reaction between M protein and heart muscle, occurs 3 weeks after
pharyngitis subsides, damage to heart valves & circulatory system, arthritis)
-Glomerulonephritis (formation of antigen antibody complexes, characterized by nephritis and
kidney failure)
, -TSS and NF
diphtheria - Answer URT infection with sore throat, lack of appetite, low grade fever,
pseudomembrane forms on tonsils or pharynx, asphyxiation
-Systemic: toxin attacks CNS and cardiac tissue
-Extreme fatigue, dementia, and eventual death that looks much like an MI (dead cardiac tissue
diphtheria details - Answer CC: Corynebacterium diphtheriae (gram + rod)
VF: toxin (NO invasion) -- a/b toxin attacks protein synthesis
-ID: gram stain of Chinese character or XY pattern
ELEK Test, Tinsdale agar (black colonies)
DX: appearance, rapid strep testing
Treatment: anti toxin, PEN or ERY, DPT Vaccine
pertussis - Answer cold like symptoms progresses to paroxysmal stage
-severe and unctrollable coughing usually wiht a whoop sound, can result in burst blood vessels
in eyes, vomiting, and cracked ribs
Pertussis details - Answer cc: bordetella pertussis (gram - coccobacilli)
vf: toxins
Tracheal cytotoxin (CT): AB toxin, kills nasopharynx cells
Pertussis toxin (PT)
DX: sound and throat culture
treatment: Erythromycin, vaccine (DPT)
croup - Answer mimics common cold, but results in inflammation of URT voicebox and
windpipe, can spread to affect bronchi
-leads to barking cough or hoarseness
-may be worse at night
croup details - Answer CC: parainfluenza virus
VF: viral
DX: sound, CXR helpful - steeple sign (narrowing of trachea)
treatment: treat symptoms and monitor airflow/breathing, cool mist humidifiers and outdoors
RSV - Answer Fever lasting ~3 days, rhinitis, pharyngitis, and otitis