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  • Rhinitis
  • Rhinosinusitis
  • Sinusitis
  • Nasopharyngitis
  • Pharyngitis
  • Epiglottitis
  • Laryngitis
  • Laryngotracheitis
  • Tracheitis

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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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  • J06.9 Acute upper respiratory infection, unspecified

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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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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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Laboratory Tests

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  • Viral culture
  • Nasopharyngeal swab for influenza

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Imaging

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

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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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  • Exercise limitation
  • Shortness of breath
  • Limited endurance capacity

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  • Increased fluid intake
  • Smoking cessation
  • Manual sinus drainage
  • Coughing techniques
  • Pulmonary rehabilitation (PR)
    • Enhances the patient’s sense of well-being
    • Improves exercise capacity
  • Inspiratory muscle training (IMT)

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  • Improve oxygenation
    • Achieved by
      • Reducing airway edema secondary to inflammation and bronchospasm
      • Facilitating elimination of bronchial secretions
      • Preventing/treating respiratory infection
      • Increase exercise tolerance
      • Avoid irritants/allergens
      • Relieve anxiety/treat depression
      • Improve muscle oxidative capacity
  • Patient will be able to
    • Ambulate more than 600 m in a 6-minute walk test
    • Score more than 80% of their predicted ...

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