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Condition/Disorder Synonyms

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  • Rhinitis

  • Rhinosinusitis

  • Sinusitis

  • Nasopharyngitis

  • Pharyngitis

  • Epiglottitis

  • Laryngitis

  • Laryngotracheitis

  • Tracheitis

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ICD-9-CM Codes

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  • 465.9 Acute upper respiratory infections of unspecified site

  • PT diagnoses/treatment diagnoses that may be associated with respiratory disorders

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM Code

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  • J06.9 Acute upper respiratory infection, unspecified

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Preferred Practice Patterns1

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Key Features

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Description

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  • Non-specific term for acute infections in the nose, paranasal, sinuses, pharynx, larynx, trachea, and bronchi

  • Viruses are the main cause

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Essentials of Diagnosis

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  • Diagnosis is based upon clinical manifestation2

  • Sinusitis and acute bronchitis usually occur after a common cold

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General Considerations

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  • Influenza is a systemic illness involving the respiratory tract that is separate from URI

  • Spread by aerosol, droplet, hand-to-hand contact

  • Antibiotics have no to limited role in the treatment of the common cold or URI2

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Demographics

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  • Across the lifespan

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Clinical Findings

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Signs and Symptoms1

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  • Edema

  • Nasal congestion

  • Sneezing

  • Headache

  • Local swelling

  • Fever

  • Sore throat

  • Chest tightness

  • Wheezing

  • Cough

  • Shoulder raised to allow increased lung air flow

  • Shortness of breath

  • Tensed muscles from dyspnea

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Functional Implications

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  • Disabling dyspnea when performing simple tasks such as

    • Arm elevation to reach into cabinet

    • Decreased exercise tolerance

  • Patients with mononucleosis should avoid contact sports for 6 weeks as fear of splenic rupture

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Possible Contributing Causes

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  • Smoking

  • Cocaine use

  • Air pollution

  • Long-term exposure to lung irritants

  • Environmental irritants

  • Periodontal disease

  • Deviated septum

  • Immunodeficiency disorders

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Differential Diagnosis

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  • Influenza

  • Measles

  • Asthma

  • Chickenpox

  • Gastroesophageal reflux disease

  • Ludwig's angina

  • Bronchiectasis

  • Adult cystic fibrosis

  • Kawasaki disease

  • Pneumonia

  • Goiter

  • Bronchitis

  • Asthma (reversible)

  • Central airway obstruction

  • Lung tumor

  • Tuberculosis

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Viral culture

  • Nasopharyngeal swab for influenza

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Imaging

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  • Chest radiograph

  • CT for sinuses

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Findings and Interpretation

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  • Acute sinusitis on CT will show complete opacification and air-fluid level1

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Referrals/Admittance

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  • For imaging, x-ray

  • Medication: anti-inflammatory agents, bronchodilators, expectorants, antihistamines, or vaccines

  • Surgical consult, deviated septum

  • Ear, nose, and throat (ENT) physician

  • Pulmonologist

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Impairments

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  • Exercise limitation

  • Shortness of breath

  • Limited endurance capacity

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Intervention

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  • Increased fluid intake

  • Smoking cessation

  • Manual sinus drainage

  • Coughing techniques

  • Pulmonary rehabilitation (PR) ...

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