Influenza,brochiolitis,tonsilitis

Question 1

What are some complications of influenza?

Answer 1

• Otitis media, sinusitis and bronchitis
• Viral pneumonia
• Secondary bacteria pneumonia
• Worsening chronic health conditions, such as COPD and heart failure
• Febrile convulsions (young children)
• Encephalitis

Question 2

What are the most common types of influenza?

Answer 2

Type A and B

Question 3

Which groups of people are at higher risk of developing complications from influenza?

Answer 3

• Aged 65 and over
• Young children
• Pregnant women
• Chronic health conditions, such as asthma, COPD, heart failure and diabetes
• Healthcare workers and carers

Question 4

What are the clinical presentations of having influenza?

Answer 4

• Fever
• Lethargy and fatigue
• Anorexia (loss of appetite)
• Muscle and joint aches
• Headache
• Dry cough
• Sore throat
• Coryzal symptoms

Question 5

How can you differentiate between someone having a common cold or the flu?

Answer 5

Flu tends to have abrupt onset, whereas a common cold has a more gradual onset.People with the flu are also “wiped out” with muscle aches and lethargy whereas someone with a cold could continue with everyday activities

Question 6

How do you test for influenza?

Answer 6

Point of care tests (readily available and detect the viral antigens but do not show the subtype)
Viral nasal/throat swabs can be sent to virology lab for PCR testing to confirm diagnosis

Question 7

What are the 2 management plan options for somone who has influenza but is at risk of developing complications? State the route of the medication,how many times a day and for how many days?

Answer 7

• Oraloseltamivir(twice daily for 5 days)
• Inhaledzanamivir (twice daily for 5 days)

Question 8

When does the medication (to manage influenza) need to be given for it to be effective?

Answer 8

Treatment needs to be startedwithin 48 hoursof the onset of symptoms to be effective.

Question 9

Post-exposure prophylaxis can be given to patients who are at risk of getting influenza, but what criteria must they meet?

Answer 9

Post-exposure prophylaxis may be given where patients meet specific criteria:

• It isstarted within 48 hours of close contact with influenza
• Increased risk(e.g., chronic disease or immunosuppression)
• Not protectedby vaccination (e.g., it has beenless than 14 dayssince they were vaccinated)

Question 10

What are the options for post-exposure prophylaxis for influenza?

Answer 10

• OralOseltamivir75mg once daily for 10 days
• Inhaledzanamivir10mg once daily for 10 day

Question 11

What is bronchiolitis usually caused by?

Answer 11

Respiratory syncytial virus (RSV)
Other causes include:
-Mycoplasma
-Adenoviruses

Question 12

What are some of the clinical presentations of a child with bronchiolitis?

Answer 12

Coryzal symptoms (runny nouse,sneezing,mucus in throat and watery eyes)

Dyspnoea (heavy laboured breathing)

Tachypnoea

Poor feeding

Mild fever

Apnoeas (episodes when the child stops breathing)

Wheeze and crackles on auscultation

Question 13

What are the signs of respiratory distress? (MUST KNOW THESE FOR EXAMS)

Answer 13

• Raised respiratory rate
• Use ofaccessory muscles of breathing, such as thesternocleidomastoid, abdominal andintercostal muscles
• Intercostal andsubcostal recessions
• Nasal flaring
• Head bobbing
• Tracheal tugging
• Cyanosis(due to low oxygen saturation)
• Abnormal airway noises

Question 14

What abnormal ariway sounds may be heard when an infant has bronchiolitis?

Answer 14

May hear:
Wheezing (due to narrowed airway.It is a whistling sound and is continual.Is typically heard during expiration)

Crackles

Grunting

Question 15

Most infants are managed at home when they have bronchiolitis. But what criteria should be met if the infant/child was to be admitted into hospital? (Quite a few points)

Answer 15

-Aged under 3 months

-Have pre-existing condition like prematurity,Downs syndrome or cystic fibrosis

-Clinical dehydration

-50%-75% or less of their normal intake of milk

-Respiratory rate > 70

-Oxygen saturations < 92%

-Moderate to severe respiratory distress like deep recession or head bobbing

-Apnoeas

-Parents not confident to manage child at home

Question 16

What investigation can be done if someone has bronchiolitis?

Answer 16

Immunofluoresence of nasopharyngeal secretions may show RSV

Question 17

What is the management for bronchiolitis?

Answer 17

Typically supportive management
Ensuring adequate intake (orally,via NG tube or IV fluids depending in severity)

Overfeeding can limit breathing

Saline nasal drops and nasal suctioning (to help clear nasal secretions)

Supplementary oxygen if the OS sats are BELOW 92%

Ventilatory support if required

Question 18

What ventilatory support options are there for a child who has bronchiolitis?

Answer 18

1.High-flow humidified oxygen via a tight nasal cannula

Is called AirVo/Optiflow

Helps prevent their airways from collapsing

It adds PEEP (positive end-expiratory pressure)

2.Continuous positive airway pressure (CPAP)

Involves using a sealed nasal cannula (performs similar way to AirVo/Optiflow but can deliver much HIGHER and more controlled pressures)

3.Intubation and ventilation

Involves inserting an endotracheal tube into the trachea to fully control ventilation

Question 19

How do you assess ventilation if a child has bronchiolitis?

Answer 19

Capillary blood gases (used in severe respiratory distress and in monitoring children who are having ventilatory support)

Question 20

What is palivizumab and what is it used for?

Answer 20

It is a monoclonal antibody taht targets RSV and is given to high-risk patients (like ex-premature or those with congenital heart disease) as monthly injections (as the levels in the body deplete over time)

Question 21

What is acute tonsilitis?

Answer 21

Inflammatory infection of the palatine tonsils

Question 22

Thetonsilsare collections of lymphatic tissue located within the pharynx. What is the ring arrangement that it forms and what are the different parts of it?

Answer 22

It forms the Waldeyer’s ring and consists of ;
pharyngeal tonsil (also known as the adenoid, only 1 of these)
Tubal tonsils (2 of these)
Palatine tonsils (2 of these)
Lingual tonsil (1 of these)

Question 23

What are the clinical presentations of someone who has tonsilitis?

Answer 23

Patients typically present with a combination of an acute onset of:
Sore throat (99%)
Fever >38ºC (82%)
Dysphagia (66%)
Nasal congestion, headache, earache, cough (47%)
These 4 symptoms may be present if viral aetiology.
If no cough is present, this is more likely a bacterial cause.

Question 24

If NO cough is present when a pt has tonsilitis, is it likely to be a bacterial or viral cause?

Answer 24

More likely to be a bacterial cause

Question 25

When you examine in the pharynx of a pt who has suspected tonsilitis, what findings would there be?

Answer 25

Severely inflamed tonsils (87%)
Painfully enlarged anterior cervical lymph nodes (49%)
Purulent tonsils (41%)

Pus on the tonsils is suggestive of bacterial cause.

Question 26

In what case do you NOT examine a pt who has tonsilitis?

Answer 26

If epiglottitis is suspected.
Additional features (on top of the findings in tonsilitis) suggestive of epiglottitis include:
A young child
A muffled voice
Excessive drooling and pooling of saliva.

Call for an anaesthetist and an ENT surgeon

Question 27

What is the centor criteria used for?

Answer 27

It is used to estimate the probability that tonsilitis is due to bacterial infection and will benefit from antibiotics

Question 28

What do you do if a patient with tonsilitis has a FeverPAIN score of 4 or 5 or a Centor criteria score of 3 or 4?

Answer 28

Consider an immediate antibiotics prescription or a backup antibiotics prescription

Question 29

What does the FeverPAIN score stand for?

Answer 29

Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza

Question 30

On the Centor criteria, a point is given to each of the following features to estimate the probability that the tonsilitis is due to a bacterial cause. What are the following features?

Answer 30

Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

Question 31

What are the investigations for tonsilitis?

Answer 31

It is usually CLINICAL DIAGNOSIS

but investigations are only used if there is confirmation of group A streptococcal (GAS) infection is required (like immunocompromised patients).

In these patients, perform a rapid antigen test for GAS.If the antigen tests is negative, a throat culture should be performed.

Question 32

How do you manage a patient that has acute tonsilitis?

Answer 32

If bacterial –> give penicillin V (phenoxymethylpenicillin) for 10 DAYS.
If they have a penicillin allergy, give clarithromycin

Question 33

When would you consider admitting a patient who has tonsilitis?

Answer 33

Consider admission if the pt is immunocompromised, systemically unwell, dehydrated, has stridor, respiratory distress or evidence of a peritonsillar abscess or cellulitis

Question 34

What are the complications of tonsilitis?

Answer 34

peritonsillar abscess (also known as quinsy)
otitis media (if spreads to inner ear)
scarlet fever
rheumatic fever
post-streptococcal glomerulonephritis
post-streptococcal reactive arthritis