URI: upper respiratory infection caused either by bacteria or a virus, leading to congestion, sneezing, rhinorrhea, discharge, malaise. if bacterial in origin, a URI might be more likely to present with fever / chills and yellow/green mucopurulent discharge. if viral in origin a URI might present with clear rhinorrhea. diagnosis is by the jones criteria, rapid strep test, and microscopic smear of exudates.
asthma: can be extrinsic (allergic, to molds, pollens, etc), or intrinsic (infectious, emotional, etc.). usually results in coughing (worse at night), wheezing, dyspnea, sputum production. PE findings might include tachypnea, tachycardia, accessory muscle use, and if severe, pulsus paradoxus and muscle wasting. lung auscultation will reveal prolonged expiratory phase with expiratory wheezing, diminished breath sounds. a skin exam might also be performed to confirm signs of atopy (eczema, dermatitis).
sinusitis is an inflammation of the sinuses due to infection or allergies. it can result in a painful pressure in the sinus area from the swelling of the mucous membranes if associated with a URI. typical signs and symptoms might include swelling / tenderness over the affected sinus, malaise, toothache, severe frontal headache, swollen eyelids. on PE, one might find erythematous nasal mucosa and sinuses that do not transilluminate. labs might be useful to rule out periapical abscess (using xray) or to confirm chronic sinusitis (using CT scan).
bronchitis is an inflammation of the bronchial tree, either secondary to an infection, asthma, irritant, or primary/chronic. if infectious in origin, bronchitis is likely due to a bacterial URI, while common irritants might be organic solvents, ammonia, dust, chlorine. symptoms are similar to an infectious URI: coryza, malaise, f/c, myalgia, etc. the cough often progresses from a dry, non-productive, to a sputum producing cough. on a respiratory exam, one might hear scattered rhonchi, crackling/wheezing, moist rales.
pneumonia is an acute infection of the lung, and can be from a variety of different sources- bacterial, viral, or mycoplasmal. adults are more likely to get bacterial pneumonia, while young adults and children are more likely to get mycoplasmal or viral. risk factors include cigarette smoke, young/old age, immunocompromised, recurrent URI's, physical debilitation. patients might present with fever / chills, nausea / vomiting, pleurisy / dyspnea, productive cough with rusty colored sputum and an increased pulse and respiratory rate. a lung exam might reveal signs of lung consolidation: dullness to percussion, increased tactile fremitus, whispered pectriloquy, and bronchial breath sounds / crackles. ddx's might include bronchitis, goodpasture's, asthma, cystic fibrosis.
some notes on the different types of headaches. doing a good history is vital to determining the cause of the headache, as well as determining the location and radiation patterns. tension headaches are more likely to be described as a band-like pain around the occiput, whereas migraines are more frontal. pain around or in the eyes might be due to a cluster headache, and pain in the face is likely from trigeminal neuralgia. unilateral head pain on the side of the head could be from temporal arteritis. papilledema or A/V nicking on a fundoscopic can indicate serious conditions such as intracranial hemorrhage or malignant hypertension, respectively.
hay fever aka allergic rhinitis is inflammation of the mucosa of the eyes and nasal passageways, leading to rhinorrhea, itchy / burning eyes and nasal congestion. it is often due to seasonal allergens such as pollen and will present bilaterally. a skin test might be useful to check for signs of atopy in the form of dermatitis, etc. differentials might include sinusitis, acute rhinitis, vasomotor rhinitis, and cocaine use.
conjunctivitis is an inflammation of the conjunctiva of the eyes and can be bacterial, viral (pink eye), or allergic / irritant in nature. signs include conjunctival injection (superficial dilated vessels away from the iris), pruritis, discharge, hyperemic and swollen lids. if symptoms are bilateral, the origin is more likely to be infectious or allergic while unilateral symptoms suggest toxic/chemical/mechanical causes. a culture of secretions can be useful in differentiating the cause of conjunctivitis: bacterial related secretions would contain PMN's, viral would contain leukocytes, and allergic would contain eosinophils.
strep throat is the result of infection via type A beta-hemolytic strep. it manifests as swollen, sore throat with fever and L/A. the jones criteria, used to diagnose strep, requires at least 2 of the following: fever above 100.4F po, no cough, pseudomembrane, tonsillar exudate. strep can also be diagnosed via a rapid strep test or throat culture. ddx's might include pharyngitis, mono, peritonsilar abscess, and diptheria.
vertigo is more of a symptom and can be due to several different causes, including benign paroxysmal positional vertigo, meniere's vestibular neuronitis, and other CNS disorders. episodic vertigo is more likely to be BPPV, while vertigo that lasts for hours / days is more likely to be meniere's or vestibular neuronitis. vertigo can also be associated with symptoms such as nausea / vomiting, tinnitus, and nystagmus-- which if unilateral and horizontal indicates benign causes and if variable indicates CNS disorders.
questions
URI...
1. what is the etiology of a URI?
2. what are some typical signs / symptoms of a URI?
3. what are some features that might distinguish a URI of bacterial vs. viral origin?
4. what labs should be performed for the diagnosis of a URI?
asthma...
5. what are three major features of asthma?
6. what is the difference between intrinsic and extrinsic asthma?
7. what are the major signs and symptoms of asthma?
8. what are some typical PE findings for asthma?
9. what signs might indicate a severe case of asthma?
10. what are the common findings for a lung exam on a patient with asthma?
11. why might a skin exam be performed on a patient suspected of having asthma?
sinusitis...
12. what is sinusitis?
13. what are the typical signs and symptoms of sinusitis?
14. what are some typical PE findings for sinusitis?
15. which labs might be performed to aid in a diagnosis of sinusitis?
bronchitis...
16. what is bronchitis?
17. what are the most common etiological agents for bronchitis?
18. the symptoms of infectious bronchitis are similar to...
19. describe the progression of the cough in infectious bronchitis.
20. severe cases of bronchitis might also present with...
21. what might be heard on a respiratory exam for bronchitis?
22. where in the lung might these sounds be heard?
pneumonia...
23. what is pneumonia?
24. what are three different types of pneumonia?
25. which type is most common in adults? young adults / children?
26. what are some risk factors for pneumonia?
27. what are the signs and symptoms for pneumonia?
28. what are the signs one would expect to find on a lung exam of a pneumonia patient?
29. what are some ddx's for pneumonia?
headaches...
30. what are some causes of head pain?
31. where do tension headaches usually present? how is the sensation described?
32. a frontal headache is more likely what type of headache?
33. a periorbital or deep orbital pain is most likely due to what type of headache?
34. pain in the face is likely due to...
35. unilateral head pain on the side of the head is likely due to...
36. patients with temporal arteritis might also present with what concomitant symptom?
37. what are some physical exams that one should perform on a patient that presents with head pain?
hay fever...
38. what is hay fever?
39. what are two useful questions to ask a patient suspected of hay fever?
40. what are the signs and symptoms of hay fever?
41. why might a skin test be performed in patients suspected of hay fever?
42. what are the differentials for hay fever?
conjunctivitis...
43. "pink eye" is...
44. what are the signs and symptoms of conjunctivitis?
45. what do bilateral vs. unilateral symptoms suggest about the origins of conjunctivitis?
46. what PE exams would be useful in diagnosing conjunctivitis?
47. what labs would you order with a patient suspected of conjunctivitis?
strep throat...
48. what is the etiology of strep throat?
49. what are the signs/symptoms of strep throat?
50. what are the jones criteria for diagnosing strep throat?
51. what are the lab tests used to diagnose strep throat?
52. what are the ddx's for strep throat?
vertigo...
53. episodic vertigo is more likely to be...
54. vertigo that lasts hours or days is more likely to be...
55. vertigo that is sudden onset and lasts for minutes is more likely to be...
56. what are the signs and symptoms associated with vertigo?
57. how can the type of nystagmus differentiate between potential causes of vertigo?
answers
1. viruses or bacteria invading upper respiratory tract, causing inflammation of the mucosa.
2. congestion, sneezing, rhinorrhea, post-nasal drainage, malaise.
3. bacterial more likely to have fever / chills and yellow green mucopurulent discharge. viral more likely to have clear rhinorrhea.
4. rapid strep test if jones criteria met, microscopic smear of exudates.
5. airway obstruction
inflammation
irritability / hypersensitivity
6. extrinsic is to allergy to external factors such as mold, pollen, etc. intrinsic is non allergic- from infections or emotional or other internal causes.
7. coughing, especially at night
wheezing, shortness of breath, DOE
sputum production
8. tachypnea, tachycardia, diaphoresis, wheezing, accessory muscle use.
9. weight loss, wasting, pulsus paradoxus.
10. prolonged expiratory phase, expiratory wheezing and diminished breath sounds.
11. to look for signs of atopy: dermatitis, eczema, other allergic skin conditions.
12. inflammation of the paranasal sinuses due to infection or allergy.
13. swelling / tenderness
malaise
toothache
frontal headache
swollen eyelids
14. erythematous nasal mucosa, sinuses do not transilluminate.
15. CT scan for chronic sinusitis
xray of teeth apices to rule out periapical abscess
CBC
16. an infection of the bronchial tree, either secondary to an infection, asthma, irritant, or primary / chronic.
17. infectious: bacterial URI
irritant: organic solvents, ammonia, dusts, chlorine
18. infectious URI symptoms: coryza, malaise, fever/chills, myalgia, etc
19. begins as dry and non productive, then develops into a productive cough.
20. 101-102 degree fevers.
21. scattered rhonchi, crackling/wheezing, moist rales.
22. at the base for crackling / rales.
23. infection of the lung.
24. bacterial, viral, mycoplasma.
25. bacterial most common in adults, mycoplasma in young adults and children.
26. immunocompromised
young or old age
recurrent URI's
cigarette smoke
physical debilitation
27. fever / chills
pleurisy / dyspnea
productive cough with rusty sputum
tachycardia, tachypnea
N/V
malaise / myalgia
28. increased tactile fremitus
dullness to percussion
bronchial breath sounds
whispered pectriloquy
crackles
[touch dull bronchial whisper crackle]
[fremitus dullness whisper bronchial crackles] [touch the dull whisker to hear the bronchial crackles]
29. bronchitis
asthma
cystic fibrosis
goodpasture's
30. vasomotor instability
muscle tension
hypoglycemia
infection
trauma
mass lesion
cerebral hemorrhage
31. occiput, band-like.
32. migraine
33. cluster
34. trigeminal neuralgia.
35. temporal arteritis.
36. polymyalgia rheumatica.
37. vitals, M/S, eye exam, sinsuses, neurological exam.
38. also known as allergic rhinitis; an inflammatory process involving the nasal and throat mucosa, as well as the conjunctiva in response to various allergens.
39. do your symptoms appear seasonally? are they bilateral?
40. rhinorrhea
burning, itchy, watery eyes
nasal / sinus congestion
41. to check for signs of atopy: dermatitis, eczema.
42. sinusitis, acute rhinitis, vasomotor rhinitis, cocaine use.
43. viral conjunctivitis.
44. superficial dilated vessels in conjunctiva
pruritis
discharge
hyperemia, swelling of lids
45. bilateral more likely allergic / infectious. unilateral more likely toxic/chemical/mechanical.
46. vitals, lymph nodes, EENT, (heart, lungs)
47. culture of secretion: bacterial would contain PMN's, viral would contain lymphocytes, allergic would contain eosinophils.
48. pharyngitis caused by group A beta-hemolytic streptococcus.
49. sore throat
fever
no cough
cervical L/A
injected / erythematous mucous membranes
exudate / pseudomembrane
50. fever over 100.4 po, no cough, tonsilar exudate, pseudomembrane.
51. rapid strep test and throat culture.
52. viral / bacterial pharyngitis
infectious mononucleosis
diptheria
peritonsilar abscess
53. BPPV
54. meniere's, vestibular neuronitis
55. brain or vascular disease.
56. spinning sensation/disequilibirum
nystagmus
N/V
tinnitus
57. unilateral horizontal nystagmus is more likely benign, variable nystagmus likely due to a CNS disorder.
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