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MBBS VI - SpC - Family Medicine > Acute Respiratory: URTI, Allergic rhinitis, Rhinosinusitis, Nasal obstruction > Flashcards

Acute Respiratory: URTI, Allergic rhinitis, Rhinosinusitis, Nasal obstruction Flashcards

1
Q

Spectrum of URTI

A
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2
Q

URTI

Microbiology

A
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3
Q

URTI

Transmission

A
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4
Q

URTI

Clinical presentation

A
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5
Q

Ddx cough and sputum

A
  • P: URTI
  • R: Pneumonia, TB, CA Lung, CHF
  • O: Allergic Rhinitis (PND), Asthma, COPD,
    Bronchiectasis, GERD, Drugs (ACEI)
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6
Q

Ddx rhinorrhea and nasal congestion

A
  • P: URTI (Common Cold)
  • R: NPC
  • O: Allergic Rhinitis, Polyps, Foreign body,
    Sinusitis
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7
Q

Ddx sore throat

A
  • P: URTI (Pharyngitis), Strep. Throat
  • R: Acute Epiglottitis (Drooling saliva)
  • O: Postnasal drip, Irritation, Foreign body,
    Infectious Mononucleosis
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8
Q

Ddx hoarseness of voice

A
  • P: URTI (Laryngitis), Vocal cord polyp/
    nodule
  • R: Acute Epiglottitis, CROUP, CA Larynx
  • O: Sputum, Laryngeal injury/ compression,
    Trauma from intubation
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9
Q

Natural course of simple viral URTI

A
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10
Q

Differentiate viral pharyngitis vs GAS pharyngitis

A
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11
Q

Diagnostic criteria for GAS pharyngitis

A
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12
Q

GAS pharyngitis

Diagnostic tests

A
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13
Q

GAS Pharyngitis

Complications

A
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14
Q

GAS pharyngitis

Antibiotics function
Options/ prescriptions

A
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15
Q

Acute rhinosinusitis

Spectrum of diseases
Symptoms

A
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16
Q

Acute rhinosinusitis

Diagnostic criteria

A
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17
Q

Influenza

Clinical features

A
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18
Q

Influenza complications

Management
Non-pharmacological advice
Prevention

A

Non-pharmacological advice (Murtagh)
- Rest and fluid
- Analgesics: ibuprofen or paracetamol
- Fresh lemon juice with honey/ Nip of whisky with fruit juice
- Monitor for symptoms

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19
Q

URTI

Management principles
Non-pharmacological advice

A

Non-pharmacological advice (Murtagh):
- Rest
- Fluid: 2L per day
- Analgesics: Paracetamol, ibuprofen and aspirin (avoid for under 16)
- Inhale steam +/- menthol or friar’s balsam. Inhale with towel over head, breathe through nose and exhale through mouth
- Gargle aspiring in water or lemon juice for sore throat
- Monitor for red flags: SOB, Ear pain, green purulent sputum, high fever refractory to paracetamol

20
Q

Sore throat treatment

A
21
Q

Cough symptomatic treatment

A
22
Q

Sputum treatment

A
23
Q

Treatment of Rhinorrhoea, Sneeze & Nasal Congestion

A
24
Q

Treatment of Coryza

A
25
Q

Combined preparation for URTI

Common combination prescription
Benefit and risks

A

Common prescriptions for URTI
- Paracetamol tablet 500mg PO q.i.d.
- Chlorpheniramine tablet 4mg (Piriton®) PO Q4-6h (max. 24mg/d)
- Loratadine tablet 10mg PO q.d.

26
Q

Prevention of URTI

A
27
Q

Allergic rhinitis

Clinical presentation

A
28
Q

Allergic rhinitis

Diagnosis

A
29
Q

Allergic rhinitis

General management

A
30
Q

Allergic rhinitis

Medication/ prescription
Prevention

A

Avoid allergens

Drug options:

  • Oral antihistamine
  • Intranasal steroid
  • Leukotriene receptor antagonists (especially in patients with asthma)
  • Saline douching (wash away allergen in mucus)
  • Refractory: short-term systemic steroid (S/E), decongestant
  • Immunotherapy

Surgery

31
Q

Chronic rhinosinusitis

Types
Clinical presentation

A
32
Q

Chronic rhinosinusitis

Associated diseases

A

Asthma

Allergic fungal sinusitis

Cystic fibrosis

Aspirin -induced (Samter’s triad)

33
Q

Chronic rhinosinusitis

Diagnostic criteria

A
34
Q

Chronic rhinosinusitis

Management

A
35
Q

Key question in history taking for nasal conditions

A

Nose:
* Congestion/ blockage/ obstruction
* Nasal discharge
* Sneezing, itchiness (allergy)
* Olfactory disturbances/ anosmia
* Epistaxis (anterior/ posterior)
* Snoring

Associated features:
* Facial pressure/ pain
* Eye itchiness, Visual disturbances
* Otalgia/ aural fullness (connected to nasopharynx via Eustachian tube)
* Dental pain
* Fever
* Atopy, asthma
* Smoking, drugs, social
* Family history of NPC, Allergies

36
Q

Outline exams for the nose

A

External nose:

  • Skin changes, wounds, scars
  • Frontal: Nasal bridge
  • Base: Rhinoplasty scar
  • Side: Nasal ridge, proportion

Internal nose:

  • Anterior rhinoscopy (speculums)
  • Nasoendoscopy (nasopharynx)
37
Q

Ddx Nasal obstruction in adults

A

Nasal deformities:

  • Crooked, deviated nose, saddle nose
  • Injuries: Septal haematoma, Fracture nasal bone, Fracture/ dislocation of the septum

Mucosal swelling:

  • URTI
  • Nasal vestibulitis
  • Acute/ Chronic bacterial rhinosinusitis
  • Allergic rhinitis
  • Non-allergic rhinitis
  • Mucoceles

Neoplasm:

  • Sinonasal tumors
  • NPC
38
Q

Acute bacterial rhinosinusitis

Causes

Causative pathogens

Risk factors

A

Causes:
 Upper respiratory tract infection
 Dental abscess, extraction (pre- molar/ molar teeth: infection spreads upward to maxillary sinus)
 Trauma

Organisms:
 Streptococcus pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis
 Anaerobic organisms (look for dental source)

Predisposing factors:
 Poor drainage, e.g. septal deviation, turbinate hypertrophy, nasal polyposis
 Poor immunity

39
Q

Acute bacterial rhinosinusitis

S/S

A

Symptoms:

  • Symptoms of viral URTI >10 days or worsening after 5-7 days (double sickening)
  • Nasal obstruction
  • Nasal discharge (anterior/ post- nasal drip)
  • Anosmia
  • Facial pain (collection of fluid distends sinus)
  • Fever

Signs:
 Facial tenderness
 Edema, mucopurulent discharge in middle meatus/ nasopharynx

40
Q

Acute bacterial rhinosinusitis

Complications

Treatment

A

Complications need urgent surgical intervention:
 Orbital cellulitis, abscess
 cavernous sinus thrombosis (Posteriorly along sinus drainage)
 Intracranial infection: meningitis, encephalitis, abscesses (Superiorly: ethmoid
and frontal sinus separated from brain by only thin bone)

Treatment:

 Analgesics
 Antibiotics (if bacterial)
 Intranasal steroid spray
 Short-term (<7 days) nasal decongestant, e.g. oxymetazoline, ephedrine
 Nasal douching (rinsing with saline)

41
Q

Nasal mucoceles

Histological structure and pathogenesis
Common site of occurence
Presentation
Treatment

A

epithelial-lined sac containing mucus:
Drainage of paranasal sinus is blocked&raquo_space; mucus collects inside mucocele which expands and erodes bone

Most common in the fronto-ethmoidal region

Symptoms: orbital displacement, proptosis, nasal obstruction

Treatment: Surgical marsupialization (open up blocked pathway for drainage to nose)

42
Q

Drug-induced rhinitis

Causative drugs
Treatment

A

Drugs:
 Anti-hypertensive (β blockers, calcium channel blockers)
 Sedatives
 Antidepressants
 Oral contraceptives

Prolonged use of topical sympathomimetic agents nasal decongestants*)&raquo_space;> rhinitis medicamentosa

Treatment:
 Prevention (do not use decongestants for extended period of time)
 Intranasal steroid
 Surgery, e.g. turbinate reduction/ turbinectomy

43
Q

Red flag signs of nasal neoplasm

A

Red flags:
 Unilateral obstruction
 Epistaxis
 Bleeding
 Cacosmia (sensation of bad smell)
 Proptosis, diplopia, epiphora (overflow of tear (obstruction of nasolacrimal duct))
 Neurological symptoms (tumor spreads superiorly to brain (frontal lobe))

44
Q

NPC

Prevalence in HK
Demographics
Risk factors

A

Prevalence in HK = 10th most common
Demographics = middle age, male predominant

Risk factors:
1) Epstein-Barr virus infection
2) Host genetics (family history)
3) Environmental factors:
 Preserved foods (nitrosamines; salted fish)
 Alcohol
 Poor oral hygiene
 Active and passive tobacco smoking

45
Q

NPC

Screening and investigations

A

Screening:
1) Anti-EBV IgA antibodies (out of favor):
 Early antigen (EA-IgA)
 Viral capsid antigen (VCA-IgA)
 Nuclear antigen 1 (EBNA1-IgA)
(Low sensitivity, low specificity for asymptomatic participants)

2) EBV DNA (expensive; higher sensitivity and specificity)

Investigations:
o Nasoendoscopy + biopsy
o Ultrasound neck +/- fine needle aspiration cytology (if enlarged LN)
o Magnetic resonance imaging with contrast (better for soft tissue)

46
Q

NPC

Histological subtypes

A

a) Non-keratinizing:
 Differentiated

 Undifferentiated (>95% cases in endemic area, EBV infection)

b) Keratinising squamous
c) Basaloid squamous

47
Q

NPC

Treatment options

A

o Early stage: intensity-modulated radiotherapy

o Late stage: radiotherapy + concurrent chemotherapy

o Residual disease/ recurrence:
Surgery, e.g.:
 Open maxillary swing
 Endoscopic/robotic nasopharyngectomy
If not fit for surgery:
 Chemotherapy, second-dose radiotherapy
 Immunotherapy

MBBS VI - SpC - Family Medicine (42 decks)

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