M11.1 Acute URTI

Question 1

what are 3 objectives in clinical approach to URTI

Answer 1

differentiate upper and lower tract infection
identify infective foci
decided if antibiotics needed

Question 2

how to tell between URTI and LRTI

Answer 2

LRTI will usually have signs of respiratory distress e.g. tachypnea, retractions, accessory muscles,

signs and symptoms e.g. crepitations, ronchi, wheezing, sob, chest pain

URTI: localizing symptoms to larynx and proximal areas

Question 3

list 3 viral exanthems

Answer 3

measles, rubella, roseola

Question 4

list 3 viral enanthems

Answer 4

HFMD, herpangina, acute ulcerative gingivo stomatitis

Question 5

3 viral urti syndromes with face and limb manifestations

Answer 5

erythema infectiosum (slapped cheek)
papular acro dermatitis (gianotti crosti)
STAR syndrome

Question 6

characteristics of common cold

Answer 6

minimal consitutional symptoms
low grade fever if have (38 and below)
1-2w of illness
lack of facial pain (if have consider sinusitis)

Question 7

when to consider secondary bacterial infection in influenza

Answer 7

fever >72h with WBC >10

Question 8

what viruses cause infectious mononucleosis

Answer 8

HHV 4 (EBV), HHV5, CMV

Question 9

if caused by CMV instead of the other 2, what sign is missing

Answer 9

no sore throat

Question 10

what are complications that can arise in IMS

Answer 10

splenic rupture, thrombocytopaenia, AIHA, myocarditis, glomerular nephritis, arthritis, meningitis, encephalitis, paresis, polyradiculitis

Question 11

describe the clinical course and s/s of IMS

Answer 11

incubation of 1-7w with malaise
mild fever in children, high fever in adults
exudative tonsils. enlarged and and post LN
enlarged spleen/liver
periorbital edema
fleeting morbilliform eruption

Question 12

how to diagnose IMS vs strep throat

Answer 12

strep throat: fever comes AFTER sore throat a/w tender anterior cervical LN and no associated cough
FBC: >10% atypical mononuclear cells (IMS), in strep throat will see more polymorphs
thrombocytopaenia and granulocytopaenia are more present in severe IMS
monospot test

Question 13

differentiate between measles, rubella, roseola in terms of

virus causing it
s/s associated with and time frame
characteristic of rash and duration
complications and management

Answer 13

measles: measles virus, severe prodrome a/w URTI and conjunctivitis, koplik spots BEFORE rash, then diffuse confluent rash starting from face > arms > chest>back>thigh>leg + fever at same time. rash last for 7 days

rubella (rubella virus): mild illness, suboccipital and postauricular LN BEFORE rash. rash is transient 48h from face>trunk>extremities. can develop STAR, avoid pregnant women

roseola: HHV6. 3 days of mild fever with few URTI symptoms, pink MP rash for 24h AFTER fever ends

Question 14

differentiate HFMD/herpangina vs AHGS

Answer 14

acute herpetic gingivo stomatitis has erosions and ulcers on the gums a/w fever, ST and irritability. needs to be treated with oral acyclovir

Question 15

drug dose and regime for AHGS in children

Answer 15

oral acyclovir if within 96h onset, 15mg/kg (max 200mg/dose) 5x/day for 5-7 days

Question 16

describe erythema infectiosum

Answer 16

aka slapped cheek disease
intense confluent redness of both cheeks with edema
can spread to arms>legs>chest>abdo over 3-5 days
lacy morbilliform rash at extremities

Question 17

describe gianotti crosti syndrome

Answer 17

AKA papular acro dermatitis

mild URTI and fever BEFORE rash
rash: distinct eruptions of grouped papules on cheeks, hands, elbows and knees

mostly (85%) in under 3 years old
rash can persist 2-8 weeks

Question 18

viruses that can cause STAR syndrome

Answer 18

sore throat, arthritis, rash

rubella, parvovirus B19, EBV, CMV, coxsackie, Hep B

Question 19

what is a chronic complication that can be seen in chikugunya

Answer 19

chronic polyarthalgia that can last months to years

Question 20

in dengue, which days of illness is most critical and why

Answer 20

day 4-5, platelets fall and haematocrit rise the most and can cause shock and bleeding

Question 21

what hx might point towatds chikugunya

Answer 21

predominant boe, joint pain with rash and hx of mosquito bites

Question 22

when is it important to consider Zika?

Answer 22

mild rash, joint pain, conjunctivitis, myalgia, abdo pain, diarrhea, headache in pregnant women

Question 22

what is the centor criteria and mcisaac scoring

Answer 22

T>38, exudative/swollen tonsils, no cough, tender anterior cervical LN, age 3-14 | minus 1 if >44yo
<2 points = not bacterial
2-3 points = do rapid test
4 and more points = bacterial

Question 23

what abx to give in strep throat

Answer 23

ideally pen V 50mg BD or TDS for 10 days, if not amox 50mg/Kg OD or 25mg/kg BD (max 1000mg/day)

Question 24

alternative abx for strep throat if pen allergy

Answer 24

clindamycin 7mg/kg/dose TDS (max 300mg/dose)
azithro 12mg/kg OD (max 500mg) for 5 days
clarithro 7.5mg/kg/dose BD (max 500mg/day)

Question 25

when to consider epiglottitis

Answer 25

drooling, tripod position, severe illness

Question 26

what xray sign can point towards epiglottitis

Answer 26

lateral XR show thumb sign

Question 27

what are 5 signs of acute bacterial sinusitis and how to interpret score

Answer 27

maximillary toothache
purulent secretion
poor response to decongestants
abnormal transillumination
history of coloured discharge

<2 = unlikely bacterial
2-3 signs = xray to confirm
4 or more = quite likely

Question 28

what XR signs to look for to indicate bacterial sinusitis

Answer 28

air fluid level in sinus
complete opacification of sinus
mucosal thickening

Question 29

antibiotics to give for acute sinusitis

Answer 29

5-7 days of amox 500mg TDS or 875 BD or augmentin 500/125 TDS or 875/125 BD

second line: doxy 100mg BD or 200mg OD, levoflox 500-750mg OD, moxiflox 400mg OD

Question 30

complications that can arise from acute sinusitis

Answer 30

osteomyelitis, brain abscess, orbital cellulitis, menignitis, cavernous sinus thrombophlebitis

Question 31

differentiate between AOM vs OME

Answer 31

AOM has acute signs of infection e.g. otalgia, fever, otorrhea, bulging yellow or red TM
OME: fluid in middle ear in abscence of s/s acute infection

Question 32

when to give antibiotics in OME

Answer 32

if new signs of acute disease, or bilateral effusion with hearing loss for more than 3 months

Question 33

what abx for children in AOM

Answer 33

amox 90mg/kg/d for 10 days or augmentin 90/6.4 per kg/day in 2 doses

Question 34

what abx for adult with AOM

Answer 34

augmentin 875/125 BD for 5-10 days
pen allergy: doxy 100mg BD, levoflox 500-750mg OD, moxiflox 400mg OD

Question 35

what condition classically shows exudative tonsils with tender enlarged LN in posterior neck and inguinal area

Answer 35

IMS