T6 - L3 Clinical respiratory infections

Question 1

what makes up the upper respiratory tract?

Answer 1

• mouth
• sinuses
• nose
• pharynx
• larynx

Question 2

what makes up the lower respiratory tract?

Answer 2

• trachea
• bronchi
• bronchioles
• lungs

Question 3

what is Pharyngitis?

Answer 3

nflammation of the back of the throat (pharynx), resulting sore throat & fever

Question 4

what is Acute tonsillar pharyngitis?

Answer 4

symmetrically inflamed tonsils and pharynx (+/- fever +/-
headache)

(Severe infection: patient has marked systemic symptoms of infection and/or
unable to swallow).

Question 5

what is the Centor criteria?

Answer 5

a set of criteria which may be used to identify the likelihood of a bacterial infection

criteria are:
• Tonsillar exudate 
• Tender anterior cervical lymphadenopathy 
• Fever over 38°C 
• Absence of cough

If 3 or 4 of Centor criteria are met, the positive predictive value is 40% to 60%. The absence
of 3 or 4 of the Centor criteria has a fairly high negative predictive value of 80%.

Question 6

how is the Fever PAIN Criteria scored?

Answer 6

Score 0-1 - no antibiotic

Score 2-3 - 3 days delayed antibiotic

Score 4-5 - Immediate antibiotic only if severe; otherwise 48 hours delayed antibiotic.

Question 7

what is the Fever PAIN Criteria?

Answer 7

• Fever in the last 24 hours 
• Purulence 
• Attend rapidly under 3 days 
• Inflamed tonsils • No cough or coryza 
• Plus additional parameters to help prescribers determine the severity of the sore
throat.

Question 8

what infections would you do for an acute sore throat?

Answer 8

No routine investigations,

unless infectious mononucleosis is suspected

Question 9

what is Infectious mononucleosis?

Answer 9

• glandular fever

- Epstein-Barr virus (EBV)

Question 10

what is Infectious mononucleosis also known as?

Answer 10

glandular fever

• Epstein-Barr virus (EBV)

Question 11

Infectious mononucleosis often presents with a triad of what 3 symptoms?

Answer 11

• fever
• tonsillar pharyngitis
• cervical lymphadenopathy

Question 12

what is Epiglottitis?

Answer 12

inflammation of structures above the glottis.

• Almost always caused by bacterial infection.
• most commonly Haemophilus influenzae type b

Question 13

what investigations would you do if you suspected Epiglottitis?

Answer 13

• blood cultures

- epiglottic swabs

Question 14

how do you manage Epiglottitis?

Answer 14

• IV antibiotics (usually 3rd generation cephalosporin)

* Analgesia

Question 15

what is Otitis externa (OE)?

Answer 15

inflammation of the external ear canal presenting with a

combination of: otalgia, pruritus and non mucoid ear discharge.

Question 16

what is otalgia?

Answer 16

ear pain

Question 17

what is pruritus?

Answer 17

severe itichng

Question 18

what are risk factors for Otitis externa (OE)?

Answer 18

• Swimming (or other water exposure)
• Trauma (e.g. ear scratching, cotton swabs)
• Occlusive ear devices (e.g. hearing aids, ear phones)
• Allergic contact dermatitis (e.g. due to shampoos, cosmetics)
• Dermatologic conditions (e.g. psoriasis).

Question 19

what is the most common cause for Acute Otitis externa (OE)?

Answer 19

Pseudomonas aeruginosa

&

Staphylococcus aureus

Question 20

what investigations would you do for Acute Otitis externa (OE)?

Answer 20

• ear swab
• pus sample (culture)
• blood culture is systemically unwell

Question 21

what is the non-antimicrobial management for Acute Otitis externa (OE)?

Answer 21

• Remove pus and debris from ear canal

* Analgesia

Question 22

what is the antimicrobial management for Acute Otitis externa (OE)?

Answer 22

• Topical agents for mild-moderate

* Topical plus systemic antibiotic such as flucloxacillin for severe AOE

Question 23

what is Malignant (necrotising) external otitis?

Answer 23

external otitis occurs when external otitis spreads to the skull base
(soft tissue, cartilage, and bone of the temporal region and skull).

• commonly diabetic or immunocompromised patients

Question 24

what is otorrhoea?

Answer 24

discharge of abnormal material through ear canal

Question 25

what is the treatment of Malignant (necrotising) external otitis?

Answer 25

Treat for a minimum of 6 weeks e.g. with iv ceftazidime then po ciprofloxacin

Question 26

what is a common cause of Chronic OE?

Answer 26

allergic contact dermatitis

Question 27

what is Otitis media (OM)?

Answer 27

Middle ear inflammation.

Fluid present in middle ear.

V. common in children

Question 28

what is uncomplicated Otitis media (OM)?

Answer 28

mild pain <72hours duration and an absence of

severe systemic symptoms, with a temperature of less than 39°C and no ear discharge.

Question 29

what is complicated Otitis media (OM)?

Answer 29

severe pain, perforated eardrum

and/or purulent discharge, bilateral infection, mastoiditis.

Question 30

what is Mastoiditis?

Answer 30

• complication of OM
• infection of mastoid bone and air cells
• CT always required

Question 31

what is the most common complication of Otitis media (OM)?

Answer 31

Mastoiditis

Question 32

what is the treatment for Mastoiditis?

Answer 32

Analgesia, IV antibiotics +/- mastoidectomy

Question 33

what condition may arise as a complication of a high ear piercing?

Answer 33

Perichondritis

Question 34

what is pneumonia?

Answer 34

Infection affecting the most distal airways and alveoli

• forming inflammatory exudate

Question 35

what is Bronchopneumonia?

Answer 35

Characteristic patchy distribution centred on inflamed bronchioles &
bronchi then subsequent spread to surrounding alveoli

Question 36

what is lobar pneumonia?

Answer 36

o Affects a large part, or the entirety of a lobe

o 90% due to S.pneumoniae