Upper Airway Infections

Question 1

Common upper respiratory infections

Answer 1

1. Common cold (viral rhinitis)
2. Rhinosinitis and complications
3. Otitis media, mastoiditis
4. Tonsillitis and complications

Question 2

Common cold

Answer 2

Mostly rhinovirus but also others
Affects children 4-8 years
Begins to clear 3 days
Nasal stuffing, discharge, throat irritation (ever in children common)

No antibiotics just educate parents may give paracetamol and saline drops

Question 3

Sinus development

Answer 3

• Maxillary and ethmoid present at birth

* sphenoid and frontal from 4 years to 6

Question 4

Acute bacterial rhino-sinusitis (abr)

Answer 4

> 10;days to < 3months

Chronic is more than 3 months

Question 5

ABR

Answer 5

• Persistent illness (nasal discharge or daytime cough or both, lasting longer than (10 days without improvement)
• worsening course (worsening or new onset of nasal discharge, with day time cough or fever after initial improvement)
• sever onset (concurrent fever 39°C and purulent nasal discharge for at least 3 consecutive days)

Question 6

Bacterial rhinosinusitis complications

Answer 6

1. Orbital complications = pre-septal versus post septal, peri orbital cellulitis
2. Intracranial complications - meningitis’s intracranial abscess, cavernous sinus thrombosis CT scan and possible LP indicated.
   * all cases: urged surgical advice cent j ophthalmology, neurosurgery
   Admission for iv rocephin ceftriaxcone(50-80mg/kg daily)

Question 7

Rhine sinusitis complications

Answer 7

Pre septal cellulitis: peri orbital swelling only eye exam normal
Post septal cellulitis: abnormal eye exam cerythrema, chemosis, proptosis, vision loss and opthalmoplegia

Question 8

Acute otitis media

Answer 8

• viral infection
• bacterial: streptococcus pneumonia and homophiles influenza
• fever and eye ache (irritability when lying down, pulling of the ear
• sometimes with acute purylent otorrhoea
• must be confirmed by otoscopy

Question 9

Acute otitis media treatment

Answer 9

A/B * high dose amoxycilline (45mg/kg 12 hourly) to overcome intermediate resistant S. Pneumonia 5days
Augmentin if recent courser of a/b to overcome beta-lacta made producing resistant h. Influenza

Question 10

Otitis media with effusion

Answer 10

• Irritation of the middle ear mucosa-over production of mucous-obstruction of auditory taber - air absorbed from middle ear - eardrum retracted * water absorbed from mucus: glue ear
• mild tor moderate hearing loss - interference with speech and intellectual development, if persistent (more than 3 months -ent referral for grommets)