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Clinical Pathology - > CP17 - Upper Respiratory Tract Infections > Flashcards

CP17 - Upper Respiratory Tract Infections Flashcards

1
Q

what is the normal flora of the upper respiratory tract?

A

strep viridans
commensal neisseria species
diphtheroids
anaerobes

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2
Q

what are potential respiratory pathogens that may be carried asymptomatically? (bacteria)

A 
strep pneumoniae
moraxella catarrhalis
H. influenzae
strep pyogenes 
N. meningitidis (not a resp pathogen)
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3
Q

which pathogens colonise the URT post antibiotics?

A

coliforms
pseudomonas
candida

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4
Q

which bacteria causes whooping cough?

A

bordetella pertussis

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5
Q

which bacteria causes diphtheria?

A

corynebacterium diphtheriae

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6
Q

which bacteria causes flu?

A

H. influenzae

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7
Q

which virus causes cold sores

A

herpes simplex

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8
Q

which viruses cause cough and cold?

A

influenza and parainfluenza

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9
Q

which virus commonly affects children?

A

respiratory syncytial virus

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10
Q

which other viruses can harm the URT?

A 
adenovirus
epstein-barr virus 
enterovirus
coronavirus
human metapneumovirus
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11
Q

other pathogens of the URT

A

mycoplasma pneumoniae
chlamoydophila pneumoniae
candida

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12
Q

how are URT pathogens transmitted?

A

droplet spread - coughing and sneezing

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13
Q

when are URTIs most commonly seen?

A

children and teenagers, frequent during winter

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14
Q

what are the NICE guidelines for management of URTIs in children under 3?

A

no antibiotics
delay prescribing antibiotics
prescribe antibiotics if there is a risk of complications
depending on the case

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15
Q

which organisms cause the common cold?

A

rhinovirus corona virus, RSV, parainfluenza, enterovirus, adenovirus

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16
Q

what are the clinical features of a common cold?

A

nasal discharge
sneezing
sore throat

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17
Q

how is a common cold treated?

A

DO NOT PRESCRIBE ANTIBIOTICS

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18
Q

wha organisms cause rhino-sinusitis?

A 
strep pneumoniae
H. influenzae
strep millers
anaerobes
fungi
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19
Q

what are the clinical features of rhino sinusitis?

A

usually presents after a viral infection

complications - osteomyelitis, meningitis, cerebral abscess

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20
Q

what is osteomyelitis?

A

inflammation of the bone or bone marrow, usually due to infection

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21
Q

how is rhino-sinusitis diagnosed?

A

imaging for severe or suspected complications
see air fluid levels
sinus washouts allow samples to be taken

22
Q

how is rhino-sinusitis treated?

A

no antibiotics if cause is viral

if disease is severe, provide antibiotics to cover suspected or proven pathogens, eg. amoxicillin

23
Q

what are the pathogens causing laryngitis/tonsilitis?

A

viral - RSV, influenza, adenovirus, EBV, HSV1

bacterial - strep pyogenes

24
Q

what is the clinical presentation of laryngitis or tonsillitis?

A

sore throat, dysphagia, fever, headache, red tonsillar/uvular area, exudate may or may not be present
lymphadenopathy

25
Q

how is laryngitis to tonsillitis diagnosed?

A

history, throat swabs

26
Q

what are the complications of a group A strep infection?

A

acute glomerulonephritis, rheumatic fever, scarlet fever, otitis media and quinsy (peritonsillar abscess)

27
Q

how is a group A strep infection treated?

A

antibiotics, prevent other complications

28
Q

what is rheumatic fever?

A

non contagious acute fever marked by inflammation and pain in the joints. mainly affects young people and is caused by a strep infection

29
Q

what is scarlet fever?

A

infectious bacterial disease affecting especially children, causing fever and a scarlet rash. caused by streptococci

30
Q

what causes infectious mononucleosis/glandular fever/kissing disease?

A

EBV

31
Q

what is the clinical presentation of glandular fever?

A

often asymptomatic,
symptoms if any include - sore throat, fever, cervical lymphadenopathy

complications - spleen rupture

32
Q

how is glandular fever diagnosed?

A

serology - IgM, IgG levels

paul bunnell test or PCR

33
Q

what medication should be avoided in glandular fever?

A

ampicillin, since it reacts with EBV resulting in a mac pap rash, not a true allergy, only when the body is infected

34
Q

what is a mac pap rash?

A

maculopapular rash - one containing both macule and papule. macule is a flat discoloured area of the skin. papule is a small raised bump

35
Q

what is the clinical presentation of diphtheria ?

A

malaise, fatigue, fever, with or without a sore throat

36
Q

what questions are important to ask in a history when you suspect diphtheria?

A

immunisation status and travel history

37
Q

how is diphtheria treated?

A

erythromycin, penicillin, antitoxin

38
Q

what is diphtheria?

A

a contagious condition, causes inflammation of mucous membranes, forming a false membrane in the throat

39
Q

what pathogens cause epiglottitis?

A

respiratory bacteria and S. aureus.
H. influenzae type B if not vaccinated
it is a medical emergency!

40
Q

what is the clinical presentation of epigottitis?

A

cellulitis of the epiglottis - looks cherry red
airway obstruction
fever, irritable child, difficulty speaking and swallowing (like a hot potato in their mouth)
drooling, stridor, leans forward

41
Q

how is epiglottitis diagnosed?

A

lateral neck xray revealing enlarged epiglottis
blood cultures,
DO NOT swab/examine/stick anything down their throat or irritate it because this will close off their airway entirely

42
Q

how is epiglottitis managed?

A

cefotaxime, maintain airway patency

43
Q

what are the causes of acute laryngitis?

A

usually viral and self-limiting, especially in children
could be bacterial
non infective causes include voice abuse or a tumour

44
Q

what is the clinical presentation of acute laryngitis?

A

hoarse, husky voice, globus pharyngeus, (lump in the throat)

fever, myalgia, dysphagia

45
Q

how can acute laryngitis be managed?

A

no antibiotics unless severe disease
maintain airway patency if stridor present
symptomatic treatment only

46
Q

what is the clinical presentation of whooping cough?

A

initially - runny nose, fever, malaise like any other URTI
later - dry non productive cough, which becomes paroxysms (whooping) usually due to slight weaning of immunity from vaccinations
complications include otitis media, pneumonia, secondary infection, convulsions, subconjunctival haemorrhages

47
Q

how is whooping cough diagnosed?

A

perinasal swab and PCR

48
Q

how is whooping cough treated?

A

incubation period 1-3 weeks. Supportive treatment and erythromycin
immunisation important
erythromycin to people they may have been in contact with

49
Q

what is a convulsion?

A

a sudden, violent, irregular movement of the body caused by involuntary contraction of muscles

50
Q

some other URTIs to keep in mind

A 
vincent's angina
ludwig's angina
lemierre's syndrome
gingivitis
periodontal infection
51
Q

how are URTIs generally diagnosed?

A 
send swabs, blood cultures etc to the lab 
gram staining
culture
sensitivity testing for medication
reference lab work
serology and antibody detection
52
Q

how are URTIs generally treated?

A

penicillin and amoxicillin

erythromycin if penicillin allergic, or if they have whooping cough or diphtheria

Clinical Pathology - (15 decks)

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