M11.1 Acute URTI Flashcards
what are 3 objectives in clinical approach to URTI
differentiate upper and lower tract infection
identify infective foci
decided if antibiotics needed
how to tell between URTI and LRTI
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
list 3 viral exanthems
measles, rubella, roseola
list 3 viral enanthems
HFMD, herpangina, acute ulcerative gingivo stomatitis
3 viral urti syndromes with face and limb manifestations
erythema infectiosum (slapped cheek)
papular acro dermatitis (gianotti crosti)
STAR syndrome
characteristics of common cold
minimal consitutional symptoms
low grade fever if have (38 and below)
1-2w of illness
lack of facial pain (if have consider sinusitis)
when to consider secondary bacterial infection in influenza
fever >72h with WBC >10
what viruses cause infectious mononucleosis
HHV 4 (EBV), HHV5, CMV
if caused by CMV instead of the other 2, what sign is missing
no sore throat
what are complications that can arise in IMS
splenic rupture, thrombocytopaenia, AIHA, myocarditis, glomerular nephritis, arthritis, meningitis, encephalitis, paresis, polyradiculitis
describe the clinical course and s/s of IMS
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
how to diagnose IMS vs strep throat
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
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
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
differentiate HFMD/herpangina vs AHGS
acute herpetic gingivo stomatitis has erosions and ulcers on the gums a/w fever, ST and irritability. needs to be treated with oral acyclovir
drug dose and regime for AHGS in children
oral acyclovir if within 96h onset, 15mg/kg (max 200mg/dose) 5x/day for 5-7 days
describe erythema infectiosum
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
describe gianotti crosti syndrome
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
viruses that can cause STAR syndrome
sore throat, arthritis, rash
rubella, parvovirus B19, EBV, CMV, coxsackie, Hep B
what is a chronic complication that can be seen in chikugunya
chronic polyarthalgia that can last months to years
in dengue, which days of illness is most critical and why
day 4-5, platelets fall and haematocrit rise the most and can cause shock and bleeding
what hx might point towatds chikugunya
predominant boe, joint pain with rash and hx of mosquito bites
when is it important to consider Zika?
mild rash, joint pain, conjunctivitis, myalgia, abdo pain, diarrhea, headache in pregnant women
what is the centor criteria and mcisaac scoring
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
what abx to give in strep throat
ideally pen V 50mg BD or TDS for 10 days, if not amox 50mg/Kg OD or 25mg/kg BD (max 1000mg/day)
