Respiratory Viruses: Flu, URTIs, TB

Question 1

Flu

• causative organism
• spread
• presentation
• management
• complications

Answer 1

Orthomyxovirus
A-pandemics, humans+animals
B-humans only, less severe
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

Question 2

Bronchiolitis

• causative organisms
• presentation

Answer 2

RSV - most common in U2

• flulike
• dry cough, SOB
• wheeze, fine inspiratory crackles

Clinical diagnosis
-immunofluorescence of nasopharyngeal secretions

Supportive management

Question 3

Croup

• causative organism
• diagnosis
• management

Answer 3

Parainfluenza - most common in U3

• stridor
• barking cough
• flulike

Clinical diagnosis

Medical - dexmeth

Question 4

Acute epiglottitis

• causative organism
• presentation
• management

Answer 4

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

Question 5

Acute tonsilitis

• causative organism
• presentation
• management
• COMPLICATIONS TO BE AWARE OF

Answer 5

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

Question 6

TB

• causative organism
• primary TB
• secondary TB
• risk factors

Answer 6

Mycobacterium tuberculosis
Primary - lung infection
-immunocompetent => heals by fibrosis
-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

Question 7

TB

• presentation and contagiousness
• diagnosis of active TB
• screening for latent TB

Answer 7

Only infectious if symptomatic
-weight loss, fever, night sweats, fatigue, anorexia

Diagnosis of active - sputum culture

• CXR - upper lobe cavitation, bilar hilar LN
• sputum smear - AFB test

Screening for latent - Mantoux/IGRA

Question 8

TB management

Answer 8

Pyrazinamide + Ethambutol - 2months
Isoniazid + Rifampicin - 6 months
-brain, pericardium involvement - also add CS