IC15 URTI

Question 1

Types of Influenza virus

Which Influenza virus can cause seasonal epidemics?

Answer 1

Influenza A, B, C

Influenza A and B cause seasonal epidemics

Question 2

Which influenza virus can cause pandemics

Answer 2

Influenza A

Question 3

When should antivirals be used in Influenza? (3 points)

Answer 3

1) Hospitalised
2) High risk for infections eg. immunocompromised, respiratory conditions, anatomical anomalies
3) Have severe or complicated illness

Question 4

What is the antiviral for Influenza and the MOA?

Answer 4

Oseltamivir
Neuraminidase inhibitor, inhibit release of new virus

Question 5

Oseltamivir dose

When need to have dose adjustment?

Answer 5

75mg BD for 5 days
Need dose adjustment for renal impairment < 60ml/min

Question 6

What is the concept of the Influenza vaccine?

Answer 6

Prepared from prevailing strains of Influenza A and B and predicting strain for the season

Question 7

Criteria for Bacterial pharyngitis (5 points)

Answer 7

Fever >38

Swollen lymph nodes

Tonsillar exudate

Absence of cough

Age
3 - 14 (+1)
15 - 44 (0)
45 years or older (-1)

0-1: presumed viral
2-3: Treat S.pyogenes if (+)
4-5: Start empiric

Question 8

How to test for S.pyogenes pharyngitis

Answer 8

Throat culture (gold standard)

Question 9

What are 2 acute complications that can arise from S.pyogenes infection?

Which can be prevented by antibiotics?

Answer 9

Acute rheumatic fever
Acute glomerulonephritis

Fever can be prevented

Question 10

What is the bacteria causing pharyngitis?

Answer 10

Grp A beta hemolytic strep: Strep Pyogenes

Question 11

First line treatment for S.pyogenes pharyngitis?

Answer 11

Penicillin V 250mg Q6
Amoxicillin 500mg Q12

Question 12

Treatment for S.pyogenes with Penicillin allergy

Answer 12

(only for Penicillin V allergy) Cephalexin 500mg Q12
(For Amoxicillin allergy) Cefuroxime 250mg Q12

Clindamycin 300mg Q8

Question 13

Second line for S.pyogenes

Why is this second line?

Answer 13

Azithromycin 500mg OD
Clarithromycin 250mg Q12

Macrolides are 2nd line due to increasing resistance

Question 14

Symptoms of acute rhinosinusitis (4 points)

Answer 14

Purulent nasal discharge
Facial pain
Fever
Nasal congestion, obstruction

Question 15

When should acute rhinosinusitis cases be referred to ED?

Answer 15

When there is evidence that infection has spread to orbits or CNS

Limited ocular movements
Acute vision changes
Confusion
Unilateral weakness

Question 16

Most common pathogens for Acute Rhinosinusitis

Answer 16

Strep Pneumo
Haem Influenzae

Question 17

First line for Acute Rhinosinusitis (2 points, both are penicillins)

Answer 17

Higher dose than Pharyngitis

Amoxicillin 500mg Q8
Amoxicillin Clav 625mg Q8

Question 18

Treatment for Acute Rhinosinusitis with non-severe / severe penicillin allergy

Answer 18

Non severe
Cefuroxime 500mg Q12

Severe
Levofloxacin 500mg OD
Moxifloxacin 400mg OD

Question 19

When should antibiotics be given for acute rhinosinusitis? (3 points)

Answer 19

Symptoms persist for more than 10 days without improvement

Symptoms are severe and last more than 3 days (Fever > 39, Purulent nasal discharge, facial pain)

Symptoms worsen after initial improvement (eg. new onset fever, headache, nasal discharge)

Question 20

Common cold VS Influenza

Answer 20

Common cold
No high fever (>38), low grade fever
gradual symptom onset

Influenza
High fever, chills , headache
sudden symptom onset
can cause secondary bacterial infection (worsening symptoms)