Fever and Cough: URTI's

Question 1

Most frequently managed problems in NZ general practice

Answer 1

Hypertension- 6.0%
URTI- 5.5%
Acute bronchitis- 5.4%
Pre and post natal care- 5.2%
Otitis media- 4.9%
Asthma- 4.5%
Tonsilitis- 3.9%

Question 2

Causes of URTI

Answer 2

Bacteria: Strep pyogenes; strep pneumoniae (stand out for causing pneumonia, sinusitisor otitis media bacterially) ; haemophilus influenzae (2nd to strep pneumoniae); moraxella catarrhalis; bordetella pertussis

Viruses: Rhinoviruses; coronaviruses; resp syncytial virus; influenza. VIRALSO MUCH MORE COMMON

Question 3

Infection and localisation

Answer 3

Diffuse and multi-center: More often viral

Focal, one area- Typically bacterial

Question 4

Aetiology of pharyngitis

Answer 4

MOST COMMON is rhinovirus
Alarm bell for strep pyogenes, somewhat common about a third
Less common include EBV, influenza

Question 5

Strep pyogenes versus common virus

Answer 5

Strep: More severe, fever, pain, dysphagia adenopathy. A focal pharyngeal infection, may be swelling or exudate. Consider a higher temp, absence of cough, swollen cervical lymph nodes, tonsilar swelling w exudate, age

Common viruses: Less severe, more diffuse with rhinorrhea, hoarse voice, cough, conjunctival

Question 6

Blood haemolysis

Answer 6

Alpha: Partial haemolysis with green fragments seen. Includes strep pneumoniae

beta: GAS as well as B,C and G. Complete haemolysis

Gamma: No haemolysis, such as enterococcus faecalis

Question 7

If a sore throat and is a GAS, when do you prescribe antibiotics?

Answer 7

Younger
Maori/Pacific
Family history

Question 8

Rhinosinusitis presentation and aetiology

Answer 8

Purulent anterior and posterior discharge
Nasal congestion or obstruction
Facial congestion or fullness
Facial pain/pressure
fever
reduced/absent smell

Viral-90-98% of the time, rhinovirus, influenza
Bacterial 2-10%, strep pneumoniae, haemophilus influenzae

Question 9

Typical viral URTI course

Answer 9

fever lasts short time

Resp symptoms can last up to 2 weeks!