Respiratory Tract Infections

Question 1

COMMON COLD:
What’s it also known as?

What is it caused by?

What are the symptoms?
→ How does it differ in Smokers?

How is it managed? Can it be treated?

Answer 1

• Acute Viral Nasopharyngitis and Acute Coryza
• Rhinovirus and Coronavirus
• Sore throat, Runny nose, Nasal congestion, Cough, Sneezing, Headache, Fever
  → Lasts longer with more complications
• No treatment, Only symptomatic relief - Analgesics, Nasal decongestants, Throat lozenges

Question 2

INFLUENZA (FLU):
What are the symptoms?
→ What are the complications?

How is diagnosed?

How is treated?

How is it prevented each year?

What are the 3 types of it? Which is the most common and serious?
→ What is the structure of it?
→ What do point mutations in its genome lead to?
→ What does a genetic reassortment lead to?

Answer 2

• Sudden onset Fever, Myalgia, Headache
  → Viral/Bacterial Pneumonia
• Clinically or with PCR test
• Symptomatically or with Oseltamivir (Tamiflu)
• Vaccines (LAIV)
• Type A, B, C - Type A is the most common and serious
  → RNA, Surface glycoproteins (H & N subtypes)
  → Antigenic DRIFT (leads to Epidemics)
  → New strain = Antigenic SHIFT (leads to Pandemics)

Question 3

PHARYNGITIS (SORE THROAT):
What are the causes of it?

What is used to diagnose it?

What’s it treated with?

Answer 3

• Viruses, Epstein-Barr, S. pyogenes (Group A Strep), Other bacteria
• Throat culture, Monospot and EBV serology, ASOT (for Group A Strep)
• Penicillin, Clarithromycin

Question 4

ACUTE EPIGLOTTITIS:
What is it caused by?

Why shouldn’t it be physically examined?

How is it managed and treated?

What is seen on an X-ray?

Answer 4

• Haemophilus Influenzae type b (Hib)
• Can cause spasm, leading to breathing cessation
• Immediate Intubation, Bloods tests, Cultures, and Antibiotics (Ceftriaxone)
• Thumbprint sign

Question 5

CROUP:
What’s it also known as?

What is it caused by?

What sign is seen?

How is it managed and treated?

Answer 5

• Acute Viral Laryngo-Tracheobronchitis
• Parainfluenza virus
• Severe barking cough with inspiratory Stridor
• Normally gets better after 1-2 days, and can be managed with Steam and Steroids

Question 6

COMMUNITY ACQUIRED PNEUMONIA (CAP):
What is it caused by?
→ What is it called if it’s caused by anything else?

What is it investigated and diagnosed with?
→ When should the Sputum cultures be taken?

What are the symptoms?

What are the signs seen on examination?

What is it treated with?

Answer 6

• S. pneumonia - severe CAP is caused by Legionella and S. aureus
  → Atypical Pneumonia
• Sputum and Blood cultures, Serum and Urine antigen testing, Throat swab
  → Before antibiotics are given
• Pain on inspiration, Productive cough, Fever, Tachycardia, Tachypnoea
• Dull percussion over affected lung, Bronchial breathing and crepitations
• Oxygen, Fluids, Ibuprofen (NSAID) for pleuritic pain, Antibiotics (Clarithromycin)

Question 7

Acute Exacerbation of COPD:
What can it be caused by?

What do COPD patients have?

What are the signs and symptoms of an exacerbation?

What is it treated with?

What shouldn’t be given? Why?

Answer 7

• Virus infection, Cold, Allergens
• Chronic sputum production and colonisation with bacteria
• Worsening cough, SOB, Fever, Tachycardia, Productive cough, Poor air entry, Bilateral expiratory wheeze, Widespread coarse crepitations
• Oxygen, Antibiotics, Bronchodilators/Corticosteroids, Hydration
• 100% oxygen as this can lead to severe Acidosis