CP17 - Upper Respiratory Tract Infections

Question 1

what is the normal flora of the upper respiratory tract?

Answer 1

strep viridans
commensal neisseria species
diphtheroids
anaerobes

Question 2

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

Answer 2

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

Question 3

which pathogens colonise the URT post antibiotics?

Answer 3

coliforms
pseudomonas
candida

Question 4

which bacteria causes whooping cough?

Answer 4

bordetella pertussis

Question 5

which bacteria causes diphtheria?

Answer 5

corynebacterium diphtheriae

Question 6

which bacteria causes flu?

Answer 6

H. influenzae

Question 7

which virus causes cold sores

Answer 7

herpes simplex

Question 8

which viruses cause cough and cold?

Answer 8

influenza and parainfluenza

Question 9

which virus commonly affects children?

Answer 9

respiratory syncytial virus

Question 10

which other viruses can harm the URT?

Answer 10

adenovirus
epstein-barr virus 
enterovirus
coronavirus
human metapneumovirus

Question 11

other pathogens of the URT

Answer 11

mycoplasma pneumoniae
chlamoydophila pneumoniae
candida

Question 12

how are URT pathogens transmitted?

Answer 12

droplet spread - coughing and sneezing

Question 13

when are URTIs most commonly seen?

Answer 13

children and teenagers, frequent during winter

Question 14

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

Answer 14

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

Question 15

which organisms cause the common cold?

Answer 15

rhinovirus corona virus, RSV, parainfluenza, enterovirus, adenovirus

Question 16

what are the clinical features of a common cold?

Answer 16

nasal discharge
sneezing
sore throat

Question 17

how is a common cold treated?

Answer 17

DO NOT PRESCRIBE ANTIBIOTICS

Question 18

wha organisms cause rhino-sinusitis?

Answer 18

strep pneumoniae
H. influenzae
strep millers
anaerobes
fungi

Question 19

what are the clinical features of rhino sinusitis?

Answer 19

usually presents after a viral infection

complications - osteomyelitis, meningitis, cerebral abscess

Question 20

what is osteomyelitis?

Answer 20

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

Question 21

how is rhino-sinusitis diagnosed?

Answer 21

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

Question 22

how is rhino-sinusitis treated?

Answer 22

no antibiotics if cause is viral

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

Question 23

what are the pathogens causing laryngitis/tonsilitis?

Answer 23

viral - RSV, influenza, adenovirus, EBV, HSV1

bacterial - strep pyogenes

Question 24

what is the clinical presentation of laryngitis or tonsillitis?

Answer 24

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

Question 25

how is laryngitis to tonsillitis diagnosed?

Answer 25

history, throat swabs

Question 26

what are the complications of a group A strep infection?

Answer 26

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

Question 27

how is a group A strep infection treated?

Answer 27

antibiotics, prevent other complications

Question 28

what is rheumatic fever?

Answer 28

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

Question 29

what is scarlet fever?

Answer 29

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

Question 30

what causes infectious mononucleosis/glandular fever/kissing disease?

Answer 30

EBV

Question 31

what is the clinical presentation of glandular fever?

Answer 31

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

Question 32

how is glandular fever diagnosed?

Answer 32

serology - IgM, IgG levels | paul bunnell test or PCR

Question 33

what medication should be avoided in glandular fever?

Answer 33

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

Question 34

what is a mac pap rash?

Answer 34

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

Question 35

what is the clinical presentation of diphtheria ?

Answer 35

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

Question 36

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

Answer 36

immunisation status and travel history

Question 37

how is diphtheria treated?

Answer 37

erythromycin, penicillin, antitoxin

Question 38

what is diphtheria?

Answer 38

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

Question 39

what pathogens cause epiglottitis?

Answer 39

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

Question 40

what is the clinical presentation of epigottitis?

Answer 40

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

Question 41

how is epiglottitis diagnosed?

Answer 41

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

Question 42

how is epiglottitis managed?

Answer 42

cefotaxime, maintain airway patency

Question 43

what are the causes of acute laryngitis?

Answer 43

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

Question 44

what is the clinical presentation of acute laryngitis?

Answer 44

hoarse, husky voice, globus pharyngeus, (lump in the throat) | fever, myalgia, dysphagia

Question 45

how can acute laryngitis be managed?

Answer 45

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

Question 46

what is the clinical presentation of whooping cough?

Answer 46

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

Question 47

how is whooping cough diagnosed?

Answer 47

perinasal swab and PCR

Question 48

how is whooping cough treated?

Answer 48

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

Question 49

what is a convulsion?

Answer 49

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

Question 50

some other URTIs to keep in mind

Answer 50

``` vincent's angina ludwig's angina lemierre's syndrome gingivitis periodontal infection ```

Question 51

how are URTIs generally diagnosed?

Answer 51

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

Question 52

how are URTIs generally treated?

Answer 52

penicillin and amoxicillin | erythromycin if penicillin allergic, or if they have whooping cough or diphtheria