Respiratory Infections - Flu, Cold, TB, URTI, Bronchitis, Sinusitis, Chronic Rhinosinusitis Flashcards
Flu
-causative organisms and types
-spread
-presentation, diagnosis
-management
-complications
Orthomyxovirus
A - pandemics (humans, animals)
B - less severe (humans)
C - mild
Resp spread
Fever, cough, sore throat
Cervical LN, muscle ache
Clinical diagnosis
Supportive - fluids, pracetamol/NSAIDs, rest
If high risk of complications => oseltamivir/zanamivir within 2 days of symptoms
Antivirals for at risk exposures
URTI => otitis media, sinusitis
LRTI => pneumonia
Bronchiolitis
- causative organisms
- presentation
RSV - most common in U2
- flulike
- dry cough, SOB
- wheeze, fine inspiratory crackles
Clinical diagnosis
-immunofluorescence of nasopharyngeal secretions
Supportive management
Croup
- causative organism
- diagnosis
- management
Parainfluenza - most common in U3
- stridor
- barking cough
- flulike
-increased work of breathing
Clinical diagnosis
CXR
PA - steeple sign
L - thumb sign
Medical - PO STAT dexmeth 0.15mg/kg regardless of severity
Emergency treatment
-high flow O2
-adrenaline nebs
Admit if
Moderate or severe
-audible stridor at rest
-frequent barking cough
-increased works of breathing
U3 months
Known upper airway abnormalities
Uncertainty about diagnosis
Acute epiglottitis
- causative organism
- presentation
- management
HiBs
- rapid onset, flulike
- stridor
- drooling of saliva
- tripod
Diagnosis made by direct visualisation
- Lateral Xray - thumb sign
- PA Xray - steeple sign
IMMEDIATE SENIOR INVOLVEMENT
- intubate if needed
- O2, IV ABx
Acute tonsilitis
- causative organism
- presentation
- management
- COMPLICATIONS TO BE AWARE OF
Strep pyogenes
- pharyngitis, fever, fatigue
- purulent tonsils
Penicilin
QUINSY - severe lateral throat pain, uvula deviation, trismus, decreased neck mobility
- ENT REFFERAL
- abscess drainage + IV ABx
- tonsillectomy to prevent recurrence if needed
Strep pyogenes can also lead to rheumatic heart disease
TB
- causative organism
- primary TB
- secondary TB
- risk factors
Mycobacterium tuberculosis
Primary - lung infection forming caseating granuloma
-immunocompetent => cleared completely or become latent
-IC => miliary disseminated TB
Secondary - reactivation in IC in lungs and elsewhere
- lymphadenopathy
- joint/spinal - back, joint pain
- GU/GI - abdo/pelvic pain, constipation, bowel obstruction
- CNS - meningitis, neuro signs
Risk factors
- low SES
- IC
- excess alcohol, IVDU, smokers
TB
- presentation and contagiousness
- diagnosis of active TB
- diagnosis of past infection/vaccination
- screening for latent TB
Only infectious if symptomatic
-weight loss, fever, night sweats, fatigue, anorexia
Diagnosis of active - sputum culture (GOLD)
- CXR - upper lobe cavitation, bilar hilar LN
- sputum smear - AFB test 3x
Past infection/BCG/latent - Mantoux
Cold vs flu
Both are viruses
Cold
-gradual onset
-nose and throat
-unwell but can carry on as normal
Flu
-acute onset within a few hours
-more than nose and throat
-too unwell to carry on as normal
Bronchitis
-presentation
-risk factors
-investigations
-management
Acute cough (may/may not be productive)
Sore throat
Runny nose
Wheeze
Normal chest exam, no systemic features
Clinical diagnosis
CRP - guides ABx use
Analgesia, fluids
ABx if
-systemically very unwell
-comorbidities
CRP 20-100 - delayed doxycycline
CRP 100+ - immediate doxycycline
Pregnant - amox
TB
-management
-complications
HIV test
Active
-1st 2months RIPE
-next 4months RI
Latent
-3months RIP - U35, hepatotoxicity is a concern
-6months IP - R interactions (HIV, transplant
Baseline U&E, LFT, vision test, FBC needed
Rifampacin
-liver enzyme inducer, hepatitis
-flulike
Isoniazid
-peripheral neuropathy (prevent with pyridoxine)
-liver enzyme inducer, hepatitis
-agranulocytosis
Pyrazinamide
-high urate => gout
-arthralgia, myalgia
-hepatitis
Ethambutol
-optic neuritis
Tonsilitis
-when to consider tonsilectomy
-complications
All 3 indications must be met
-sore throats are due to tonsilitis
-episodes of sore throats are disabling and prevent normal functioning
-has 7/year, 5/2years, 3/3years with no other explanation
Or
-recurrent febrile convulsions from tonsilitis
-OSA, stridor, dysphagia from enlarged tonsils
-quinsy unresponsive to standard treatment
HEMORRHAGE
Pain
Sinusitis
-what is it
-presetation
-risk factors
-causative agents
-management
Inflammation of nasal sinuses
-strep pneumoniae
-haem influenzae
-rhinoviruses
Facial pain, worse in bending forward
Nasal discharge - thick, purulent
Nasal obstruction
Nasal obstruction - septal deviation, polyps
Local infection - rhinitis, dental extraction
Swimming/diving
Smoking
Analgesia
IN CS - 10+ symptoms
IN decongestants - but evidence is limited
PO ABx - phenoxymethylpenicillin IF SYSTEMICALLY UNWELL, more serious illness, high risk of complications
Chronic rhinosinusitis
-how does this differ from acute sinusitis
-risk factors
-presentation
-management
-RED FLAGS
Inflammatory disorder of nasal sinuses - 12wks+
Atopy
Nasal obstruction - septal deviation, polyps
Recent local infection - rhinitis, dental extraction
Swimming, diving
Smoking
Sinusitis symptoms
-discharge may be clear if allergic or vasomotor
Post nasal drip => chronic cough
Avoid allergen
IN CS
Nasal irrigation with saline
Unilateral symptoms
Persisting after 3 months of treatment
Epistaxis
