Respiratory Tract Infections Lecture

Question 1

What are the normal flora found in the respiratory tract?

Answer 1

Staphylococcus
Streptococcus
Haemophilus
Anaerobes

Question 2

Patient presents with a background of asthma, nasal congestion, green nasal discharge and a headache that is frontal, constant and worse leaning forward. What is the likely diagnosis?

Answer 2

Rhinosinusitis

Question 3

Is rhinosinusitis more likely viral or bacterial cause?

Answer 3

Viral (98%)

Question 4

Which viruses can cause rhinosinusitis?

Answer 4

Rhinovirus
Influenza
Para-influenza

Question 5

How long does viral rhinosinusitis last?

Answer 5

Less than 10 days, usually self resolving

Question 6

How long does bacterial rhinosinusitis last?

Answer 6

More than 10 days, biphasic illness secondary to allergic/ viral rhinitis

Question 7

What bacteria cause bacterial rhinosinusitis?

Answer 7

Strep. Pneumoniae
Heamophilus Influenzae
Moraxella Catarrhalis

Question 8

What are the red flags to look for in rhinosinusitis?

Answer 8

Severe/ persistant headache
Periorbital oedema
Visual changes
Ophthalmoplegia (double vision as eye muscles effected)
Cranial nerve palsy
Altered mental state
Neck stiffness
Papapilloedema

Think of the signs/ symptoms that would suggest infection has travelled further into the head/ bone than just in the sinuses.

Question 9

What complications can be found with rhinosinusitis?

Answer 9

Pre orbital/ orbital cellulitis
Subperiosteal Abscess
Osteomyelitis of sinus
Meningitis
Intracranial Abscess
Septic Cavernous Sinus Thrombosis

Question 10

How is viral rhinosinusitis treated?

Answer 10

Will self resolve - treat with supportive therapy:
Analgesics (paracetamol/ibuprofen)
Intranasal steroids (>10 days)
Decongestants

Question 11

How is bacterial rhinosinusitis treated?

Answer 11

Will self resolve - treat with supportive therapy:
Can give ‘back up’ antibiotics to be taken if not resolving in 5-7 days, though evidenceis poor.
Follow up after 3-5 days if not improving

Question 12

Patient presents with a 5 day history of dry cough, sore throat, tiredness (malaise) and a runny nose (rhinorrhea). What is the likely diagnosis?

Answer 12

Common cold

Question 13

What is the common cold caused by?

Answer 13

50% rhinovirus
25% coronavirus
15% influenza
5% parainfluenza
5% Respiratory Syncytial Virus (RSV)

Question 14

How is the common cold treated?

Answer 14

Normally self limiting and uncomplicated.

Supportive treatment including nasal decongestants/ antihistamine combination and analgesics

Question 15

What are the potential complications of the common cold?

Answer 15

Acute Rhinosinusitis
Lower resp tract infection
Asthma exacerbation
Acute Otitis Media

Question 16

What are the potential causes of acute pharyngitis (tonsillitis)?

Answer 16

Adenovirus
Rhinovirus
Coronavirus
Streptococcus bacteria
Epstein-Barr virus

Question 17

How is viral tonsillitis treated?

Answer 17

Will resolve with supportive measures

Question 18

How is bacterial tonsillitis treated?

Answer 18

Penicillin antibiotics

Question 19

Are tonsillitis, common cold and rhinosinusitis upper or lower respiratory tract infections?

Answer 19

Upper RTI

Question 20

Young child presents with 2 day history of snuffly cold and runny nose with fever, cough, wheezing, increased resp rate and poor feeding. What is the likely diagnosis?

Answer 20

Bronchiolitis

Question 21

What is Bronchiolitis?

Answer 21

Viral infection of the small airways.

URTI prodrome followed by secondary inflammation of bronchi/ bronchioles.

Question 22

What is Bronchiolitis caused by?

Answer 22

Respiratory Syncytial Virus (RSV) - seasonal outbreaks in autumn and winter

Question 23

What is the clinical course of Bronchiolitis?

Answer 23

Day 0 - URTI symptoms
Day 2 - LRTI symptoms
Day 3-5 - Peak illness
Day 15 - Cough resolves

Question 24

What are the risk factors for severe disease when contracting Bronchiolitis?

Answer 24

Prematurity (<36wks)
Low birth weight
Age <12
Chronic lung disease
Anatomic defects
Congenital heart disease
Immunodeficiency
Neurological disease

Question 25

How is Bronchiolitis treated?

Answer 25

Will normally self resolve. Supportive treatment and non invasive ventilation (NIV).

Discharge when:
Clinically stable
Taking oral fluids
SpO2 sats >92%

Question 26

Patient presents with 4 day history of worsening cough with green sputum, lower right sided chest pain when breathing in (pleuritic chest pain), fatigue and confusion. What is the likely diagnosis?

Answer 26

Pneumonia

Question 27

What symptoms would you expect to find in a patient with pneumonia?

Answer 27

Systemic:
High fever
Chills

Central:
Headaches
Loss of appetite
Mood swings

Skin:
Clamminess
Blueness

Vascular:
Low BP

Lungs:
Cough with sputum or phlegm
SOB
Pleuritic chest pain
Hemoptysis

Heart:
High HR

Gastric:
Nausea
Vomiting

Muscular:
Fatigue
Aches

Joints:
Pain

Question 28

What features do the CURB65 score on?

Answer 28

Confusion
Urea >7.0mmol
Respiratory rate >30
BP <90 systolic or <60 diastolic
>65 years old

Question 29

What are the three groups of causes of community acquired pneumonia?

Answer 29

Typical - Sensitive to beta lactams (penicillin), visible on a gram stain

Atypical - Cannot be viewed on a gram stain, often require non beta lactams (doxycyclin or clarithormyin)

Other - ie vial, fungal, TB. Likely to cause 1/3 of CAP

Question 30

What is hospital acquired pneumonia?

Answer 30

Pneumonia that occurs >48hrs after admission to hospital. Risk increased by VAP.