IC15 URTI Flashcards
What are the risk factors to developing URTI? (8)
- Close contact with kids
- Lack of personal or hand hygiene
- Immunocompromised patients (CF, HIV, corticosteroids, splenectomy, transplant)
- Smoking
- Facial dysmorphia
What are some of the options for symptomatic relief for URTIs? (5)
paracetamol/NSAIDs
nasal decongestants
normal saline nasal irrigation
cough suppressants/expectorants
warm water, tea honey
What signs and symptoms does the common cold present with?
Low grade fever, rhinorrhea, nasal blockage, sneezing, productive cough, body aches
What are the two key features of common cold presentation?
Lack of high fever
Clear bilateral lungs on auscultation
Are diagnostics required for the common cold?
No
Should antibiotics be used for the common cold?
No
How should you counsel patients with the common cold?
Abx will make no difference or worsen symptoms, initiating will take 1-2 weeks. Best to go for symptomatic relief
Should a patient presenting with greenish-yellow sputum in common cold be started on antibiotics?
Nasal discharge changing colour is normal and NOT an indication of bacterial infection, so no.
What s/sx does influenza present with?
Fever, chills, headache, malaise, myalgia, dry cough, confusion in elderly
How should diagnosis be made in influenza? (2)
Nasopharyngeal swab or aspiration
How can nasopharyngeal swabs or aspiration samples be tested for in influenza? (2) (hint: think CEH)
EIA or PCR
Who are the high risk groups that for influenza? (5)
- Kids below 5 years old
- Pregnant women or within 2 weeks postpartum
- Patients in nursing homes or LT-care facilities
- Obese BMI >=40
- Patients with chronic medical conditions (eg. COPD, HF, CKD, DM, immunocompromised)
What are the types and subtypes of influenza?
Influenza A - H1N1 and H3N2 (haemagglutinin and neuraminidase)
Influenza B - B/Victoria and B/Yamagata
Within when should oseltamivir be started in high risk patients?
Best within 48h, if not within 5 days maximum
How does oseltamivir work
Neuraminidase inhibitor, interferes with protein cleavage
Who are high risk patients in which oseltamivir be started? (3)
- hospitalised
- high complication risk
- severe or complicated illness
What is the dosing for antiviral therapy in influenza?
PO Oseltamivir 75mg BD x 5 days
(requires adjustment in renal impairment CrCl < 60ml/min)
What are the s/sx for bacterial pharyngitis?
Sore throat with tonsillar exudates, fever and cervical lymphadenopathy
What bacteria causes pharyngitis?
Strep. pyogenes (same as SSTI)
What are the components of the modified centor criteria?
- Fever > 38ºC
- Tonsillar exudate
- Absence of cough
- Swollen and tender lymph nodes
- Age (plus 1pt for 3-14, minus 1pt for above 45yo)
What is the centor criteria used for?
In pharyngitis, to tell us when to test and treat
Explain what the different points mean in the centor criteria
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
What is the first-line treatment for pharyngitis?
PO Penicillin V 250mg QDS x 10 days
PO Amoxicillin 500mg BD x 10 days
What are treatment options for pharyngitis in a patient with penicillin allergy? (hint: PM)
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
