RTIs (upper + lower)

Question 1

How does sinusitis present?

Answer 1

• Dull, constant ache over frontal maxillary sinuses
• Post-nasal drip
• Coryza
• Tenderness
• Pain worse on bending over and lasts 1-2 weeks

Question 2

How is sinusitis managed?

Answer 2

• < 10 days - No antibiotics. Supportive measures
• >10 days
  
  • 1st: High dose corticosteroid nasal drops for 14 days.
  • No abx prescription or back up Abx prescription
    
    • Antibiotics: phenoxymethylpenicillin 500mg x 4 day for 5 days
    • 2nd: clarithromycin
    • If sx worsening or systemic unwell: co-amoxiclav 500mg TD 5 days

Question 3

What are the complications of sinusitis?

Answer 3

• Intra / peri orbital complications
• Peri orbital oedema or cellultis
• Double vision or opthalmoplegia
• Reduced visual acuity

Question 4

What is tonsillitis? How does it present

Answer 4

• Acute infection of the parenchyme of the palatine tonsils.
• Presents: odonyphagia, dysphagia, fever, tonsillar exudate, sore throat, headache

Question 5

What scoring scales are used to determine the cause and management of tonsillitis?

Answer 5

• Fever Pain Score
• Centor score

Question 6

How is tonsillitis managed?

Answer 6

• Viral: no antibiotics, rest, fluid, analgesia
• Bacterial:
  
  • Fever pain 0-1: No abx, come back if the symptoms worsen or no improvement after 1 week
  • Fever pain 2-3: Delayed abx prescription. If sx worsen or persist after 2-3 days return or start prescription
  • Fever pain 4-5: Immediate abx prescription + advice + self care OR delayed abx prescription with advice
    
    • Antibiotics: phenoxymethylpenicillin 500mg BD 14 days
    • 2nd: Erythromycin 500mg BD 14 days

Question 7

What are the complications of tonsillitis?

Answer 7

• Peri tonsillar abscess (or neck abscess)
• Acute sinusitis
• Acute otitis media
• Acute rheumatic fever

Question 8

What is laryngitis and how does it present?

Answer 8

• Acute inflammation of the larynx -> can lead to oedema of the true vocal chords
• Presents: odonyphagia, hoarseness of voice, dysphagia, fever, fatigue, malaise, cough

Question 9

How is laryngitis managed?

Answer 9

• Viral: supportive measures, fluids, analgesics
• Bacterial
  
  • 1st: Phenoxymethylpenicillin: 500 mg orally BD daily for 14 days
  • 2nd: erythromycin (same dose as above)

Question 10

What is the Fever Pain Score?

What do the scores mean?

Answer 10

• F - Fever
• P - Purulent Tonsils
• A - Attend Rapidly within 3 days of sx onset
• I - Inflamed tonsils
• N - No cough
• Each has a score of 1 so max 5
  
  • >4 - Give penicillin abx prescription
  • 2-3 - Delayed prescription
  • 1 - No abx

Question 11

What is the CENTOR score and what do the scores mean?

Answer 11

• C - Cough absent
• E - Exudate on tonsils (swollen)
• N - Lymph node swelling
• T - Temperature >38
• OR - Age:
  
  • Age >45 -1
  • Age 3-14 +1

Scores

• 3-4 - Give penicillin
• 1-2 - No abx