30. Upper RTIs

Question 1

What are the risk factors for URTIs?

Answer 1

Age
Gender
Seasonal
Travel
Sick contacts
Smoking
Underlying conditions

Question 2

What age is the peak for pharyngitis?

Answer 2

4-7

Question 3

What age is peak for epiglottitis?

Answer 3

3

Question 4

What age is peak for laryngitis and laryngotrachulobronchitis?

Answer 4

2

Question 5

How are URTIs spread?

Answer 5

Droplet
Fomites
Aspiration
Direct (ventilator)

Question 6

What pathogens are responsible for the common cold?

Answer 6

Rhinovirus
Coronaviruses
RSV

Question 7

How long does the common cold last?

Answer 7

3-14 days

Question 8

What is sinusitis?

Answer 8

Inflammation of paranasal sinuses

Question 9

What are the most common causes of sinusitis?

Answer 9

Rhinovirus

Influenza

Question 10

What are the bacterial causes of sinusitis?

Answer 10

Strep pneumoniae

Haemophilus influenzae

Question 11

When should a sinusitis be suspected of being bacterial?

Answer 11

High fever
Facial pain
Lasts longer than 10 days
Maxillary toothache
Cacosmia (bad smell)

Question 12

What investigations should be done into suspected sinusitis?

Answer 12

X-ray
CT
Aspirate fluid for culture

Question 13

What can be seen on x-ray in sinusitis?

Answer 13

Fluid level and thickening of soft tissue

Question 14

What is the treatment for sinusitis?

Answer 14

Viral will resolve spontaneously
Bacterial: amoxicillin or clarithromycin
Decongestants and analgesia
Surgical debridement if fungal

Question 15

What are the complications of sinusitis?

Answer 15

Meningitis
Brain abscess
Orbital cellulitis
Bronchitis

Question 16

What is otitis media?

Answer 16

Fluid in the middle ear with signs of acute illness

Usually a complication of viral URTI due to congestion of the eustachian tube or bacterial from sinusitis

Question 17

What are the symptoms of otitis media?

Answer 17

Fever
Ear pain
Discharge
Red tympanic membrane

Question 18

What investigations should be done into suspected otitis media?

Answer 18

Otoscopy

Tympanocentesis

Question 19

What treatment should be given for otitis media?

Answer 19

5 days of antibiotics if severe

Analgesia

Question 20

What are the complications of otitis media?

Answer 20

Chronic otitis media
Mastoiditis
Attic infection

Question 21

What are the most common causes of a sore throat?

Answer 21

Adenovirus

EBV

Question 22

What are the bacterial causes of a sore throat?

Answer 22

Strep pyogenes

C. diphtheria

Question 23

What symptoms are specific to diphtheria?

Answer 23

Bull neck

Pseudomembrane

Question 24

What micro investigations can be done for a sore throat?

Answer 24

Throat swab
Serology in EBV
Blood cultures in epiglottitis

Question 25

What conditions should antibiotics be given for a sore throat?

Answer 25

``` 3 of: -fever -purulent tonsilitis -otitis media -no cough -cervical adenopathy or a positive culture ```

Question 26

What is the treatment of group A strep?

Answer 26

10 days of penicillin | Given to prevent sequelae rather than treat

Question 27

What is the treatment of diphtheria?

Answer 27

Diphtheria antitoxin Benzylpenicillin and erythromycin Airway management, ECG, cardiac enzymes and neuro

Question 28

What precautions should be taken if the patient has diphtheria?

Answer 28

Droplet precautions | Notify lab and public health

Question 29

What are the symptoms of laryngitis?

Answer 29

Hoarseness | Hyperaemic vocal cords

Question 30

What is epiglottitis?

Answer 30

Cellulitis of epiglottis with potential for airway obstruction

Question 31

What are the common pathogens in epiglottitis?

Answer 31

H. influenzae Group A strep Strep pneumoniae

Question 32

What are the symptoms of epiglottitis?

Answer 32

Drooling Dysphagia Stridor Dyspnoea

Question 33

What is the correct management of epiglottitis?

Answer 33

Urgent hospital admission to secure airway Blood cultures Epiglottic swab only if airway secure IV cefuroxamine

Question 34

What are the common pathogens in croup?

Answer 34

Parainfluenza Influenza RSV

Question 35

What are the symptoms of croup?

Answer 35

Seal-like cough Inspiratory stridor Breathlessness

Question 36

What is the treatment of croup?

Answer 36

Corticosteroids | Humidified oxygen

Question 37

What is acute bronchitis?

Answer 37

Inflammation of the trachea and bronchi

Question 38

What are the common pathogens that cause acute bronchitis?

Answer 38

Rhinovirus Coronavirus Influenza

Question 39

What are the bacterial causes of acute bronchitis?

Answer 39

Bordetella Chlamydia Mycoplasma

Question 40

What are the symptoms of acute bronchitis?

Answer 40

Non productive cough Substernal pain Fever

Question 41

What pathogens cause acute COPD exacerbation?

Answer 41

Influenza, parainfluenza, rhinovirus | Haemophilus influenzae, strep pneumoniae

Question 42

When should antibiotics be given in an acute COPD exacerbation?

Answer 42

If ventilation is required | Increase in sputum purulence and volume or increased dyspnoea

Question 43

What antibiotics are given in COPD exacerbations?

Answer 43

Amoxicillin Clarithromycin Doxycycline