List I - Core Conditions

Question 1

What is the upper respiratory tract?

Answer 1

• Nose
• Nostrils
• Nasal cavity
• Mouth
• Throat (pharynx)
• Voice box (larynx

Question 2

What is the guidance regarding antibiotic prescribing for upper respiratory tract infections?

Answer 2

• No antibiotic prescribing is generally recommended for patients with acute otitis media, acute sore throat/acute pharyngitis/acute tonsillitis, common cold, acute rhinosinusitis or acute cough/acute bronchitis

Question 3

In which patients with upper respiratory tract infection may an immediate antibiotic prescribing approach be considered?

Answer 3

• Children younger than 2 years with bilateral acute otitis media
• Children with otorrhoea who have acute otitis media
• Patient with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

Question 4

What are the Centor criteria?

Answer 4

• Presence of tonsillar exudate
• Tender anterior cervical lymphadenopthy or lymphadenitis
• History of fever
• Absence of cough

If 3 or more of the criteria are present there is a 40-60% chance the sore throat is caused by Group A beta-haemolytic Streptococcus

Question 5

In which patients with upper respiratory tract infection is immediate antibiotic prescribing recommended?

Answer 5

• Systemically unwell
• Symptoms and signs suggestive of serious illness and/or complications (particularly pneumonia, mastoiditis, peritonsilar abscess, peritonsillar cellulitis, intraorbital or intracranial complications)
• High risk because of serious pre-existing disease - heart, lung, renal, liver or neuromuscular disease, immunosuppression, CF and young children born prematurely
• Age >65 years with acute cough and two or more of the following, or older than 80 years with acute cough and one or more of the following:
• Hospitalisation in the previous year
• Type 1 or 2 DBM
• History of CCF
• Current use of oral glucocorticoids

Question 6

How long do the common upper respiratory tract infections last?

Answer 6

• Acute otitis media = 4 days
• Acute sore throat/acute pharyngitis/acute tonsillitis = 1 week
• Common cold = 1 1/2 weeks
• Acute rhinosinusitis 2 1/2 weeks
• Acute cough/acute bronchitis 3 weeks

Question 7

What is acute epiglotittis?

Answer 7

• A life threatening condition caused by infection with Haemophilus influenzae B
• Now rare since HiB immunisation introduced

Question 8

How does acute epiglotittis present?

Answer 8

• Signs of toxicity
• Fever
• Drooling
• Inability to swallow
  (If this condition is suspected, examination of the mouth must not be attempted as it can lead to acute and total airway obstruction)

Question 9

What is the management of acute epiglotittis?

Answer 9

• Protect the airway
• Investigations can begin after intubation
• Blood cultures grow haemophilus influenzae - treatment with IV cefotaxime
• Tracheal tube can be removed after 24 hours and antibiotics given for 3-5 days - with appropriate treatment most children recover within 2-3 days
• Rifampicin offered to close household contacts

Question 10

What are the investigations for acute epiglottitis?

Answer 10

• Fibre optic laryngoscopy remains the gold standard for diagnosing epiglottitis as the epiglottis can be seen directly
• Lateral neck x-ray may be useful if laryngoscopy is not possible - soft tissue radiography of the neck may show the ‘thumbprint sign’
• Posterior angle view in croup will now show subglottic narrowing, commonly called the steeple sign