IC15 URTI

Question 1

What are the risk factors to developing URTI? (8)

Answer 1

1. Close contact with kids
2. Lack of personal or hand hygiene
3. Immunocompromised patients (CF, HIV, corticosteroids, splenectomy, transplant)
4. Smoking
5. Facial dysmorphia

Question 2

What are some of the options for symptomatic relief for URTIs? (5)

Answer 2

paracetamol/NSAIDs
nasal decongestants
normal saline nasal irrigation
cough suppressants/expectorants
warm water, tea honey

Question 3

What signs and symptoms does the common cold present with?

Answer 3

Low grade fever, rhinorrhea, nasal blockage, sneezing, productive cough, body aches

Question 4

What are the two key features of common cold presentation?

Answer 4

Lack of high fever
Clear bilateral lungs on auscultation

Question 5

Are diagnostics required for the common cold?

Answer 5

No

Question 6

Should antibiotics be used for the common cold?

Answer 6

No

Question 7

How should you counsel patients with the common cold?

Answer 7

Abx will make no difference or worsen symptoms, initiating will take 1-2 weeks. Best to go for symptomatic relief

Question 8

Should a patient presenting with greenish-yellow sputum in common cold be started on antibiotics?

Answer 8

Nasal discharge changing colour is normal and NOT an indication of bacterial infection, so no.

Question 9

What s/sx does influenza present with?

Answer 9

Fever, chills, headache, malaise, myalgia, dry cough, confusion in elderly

Question 10

How should diagnosis be made in influenza? (2)

Answer 10

Nasopharyngeal swab or aspiration

Question 11

How can nasopharyngeal swabs or aspiration samples be tested for in influenza? (2) (hint: think CEH)

Answer 11

EIA or PCR

Question 12

Who are the high risk groups that for influenza? (5)

Answer 12

1. Kids below 5 years old
2. Pregnant women or within 2 weeks postpartum
3. Patients in nursing homes or LT-care facilities
4. Obese BMI >=40
5. Patients with chronic medical conditions (eg. COPD, HF, CKD, DM, immunocompromised)

Question 13

What are the types and subtypes of influenza?

Answer 13

Influenza A - H1N1 and H3N2 (haemagglutinin and neuraminidase)

Influenza B - B/Victoria and B/Yamagata

Question 14

Within when should oseltamivir be started in high risk patients?

Answer 14

Best within 48h, if not within 5 days maximum

Question 15

How does oseltamivir work

Answer 15

Neuraminidase inhibitor, interferes with protein cleavage

Question 16

Who are high risk patients in which oseltamivir be started? (3)

Answer 16

1. hospitalised
2. high complication risk
3. severe or complicated illness

Question 17

What is the dosing for antiviral therapy in influenza?

Answer 17

PO Oseltamivir 75mg BD x 5 days
(requires adjustment in renal impairment CrCl < 60ml/min)

Question 18

What are the s/sx for bacterial pharyngitis?

Answer 18

Sore throat with tonsillar exudates, fever and cervical lymphadenopathy

Question 19

What bacteria causes pharyngitis?

Answer 19

Strep. pyogenes (same as SSTI)

Question 20

What are the components of the modified centor criteria?

Answer 20

1. Fever > 38ºC
2. Tonsillar exudate
3. Absence of cough
4. Swollen and tender lymph nodes
5. Age (plus 1pt for 3-14, minus 1pt for above 45yo)

Question 21

What is the centor criteria used for?

Answer 21

In pharyngitis, to tell us when to test and treat

Question 22

Explain what the different points mean in the centor criteria

Answer 22

0-1 points: do not test or treat

2-3 points: test for S. pyogenes and treat if positive

4-5 points: highly likely, start empiric treatment

Question 23

What is the first-line treatment for pharyngitis?

Answer 23

PO Penicillin V 250mg QDS x 10 days
PO Amoxicillin 500mg BD x 10 days

Question 24

What are treatment options for pharyngitis in a patient with penicillin allergy? (hint: PM)

Answer 24

PO Cephalexin 500mg BD x 10 days
PO Clindamycin 300mg TDS x 10 days
PO Azithromycin 500mg OD x 5 days
PO Clarithromycin 250mg BD x 5 days

Question 25

What is the duration of treatment for pharyngitis?

Answer 25

10 days
5 days for macrolides as they concentrate well in the tonsils

Question 26

What are the s/sx that sinusitis present with? (hint: i alw get this)

Answer 26

Purulent nasal discharge, facial pain, fever, nasal congestion and obstruction, reduced taste/smell, headache, ear fullness or pressure

Question 27

What red flag symptoms can sinusitis present with?

Answer 27

Limited ocular movement, acute vision changes, unilateral weakness

Refer to ED, may have spread to orbits or CNS

Question 28

What are the 2 most common pathogens (and others) that sinusitis presents with?

Answer 28

Common: Strep pneumo, H. influenzae
Others: Strep pyogenes, Moraxella catarrhalis, GP anaerobes

Question 29

When to treat sinusitis? (3)

(hint: treat if any ONE of the following)
(hint: this was during one of the CT cases)

Answer 29

1. symptoms persisting for more than 10 days without clinical improvement
2. severe sx (fever > 39ºC, purulent nasal discharge, facial pain for > 3 days)
3. worsening sx (new onset fever, headache, increased discharge) after initial improvement for > 3 days

Question 30

What is the first-line treatment for sinusitis?

Answer 30

PO Amoxicillin 500mg TDS x 5-7 days
PO Amoxicillin-clavulanate 625mg TDS x 5-7 days

Question 31

What treatment options are there for sinusitis in penicillin allergy?
(hint: SF)

Answer 31

PO Cefuroxime 500mg BD
PO Levofloxacin 500mg OD
PO Moxifloxacin 400mg OD

Question 32

How long should sinusitis be treated for?
(hint: sinusitis is a shorter word than pharyngitis)

Answer 32

5-7 days