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Year 2 Clinical Pathology > Upper Respiratory Tract infection > Flashcards

Upper Respiratory Tract infection Flashcards

1
Q

Give 4 organism of the normal URT flora?

A

1) Streptococcus Viridans
2) Commensal Neisseria spp
3) Diphtheroids
4) Anaerobes

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2
Q

Give 5 respiratory pathogens that may be carried asymptomatically?

A

1) Streptococcus pneumonia
2) Moraxella catarrhalis
3) Haemophilus influenza
4) Streptococcus pyogenes

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3
Q

What is the mode of transmission of most respiratory pathogens?

A

Droplet spread

Hand washing and decontamination very important

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4
Q

Which 3 groups of people most commonly suffer from URTIs?

A

1) Very young children
2) Teenagers
3) Immunosuppressed

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5
Q

What are the NICE guidelines for prescribing of Abx for RTI in patients over 3 years?

A

1 of 3 strategies

1) No prescribing
2) Delayed prescribing
3) Prescribe if risk of complications

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6
Q

What is the medical term for the common cold?

A

Coryza

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7
Q

What is the most common pathogen to cause coryza?

A

Rhinovirus

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8
Q

Other than rhinovirus which 5 other viruses commonly cause coryza?

A

1) Coronoviruses
2) RSV
3) Parainfluenza virus
4) Enteroviruses
5) Adenovirus

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9
Q

What are the 3 main symptoms of rhino-sinusitis?

A

1) Facial pain
2) Nasal blockage
3) Reduction in smell

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10
Q

What is the basic aetiology of rhino-sinusitis?

A

Post-viral inflammation

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11
Q

What are the 4 possible complications of rhino-sinusitis?

A

1) Chronic sinusitis
2) Osteomyelitis
3) Meningitis
4) Cerebral abscess

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12
Q

What 6 pathogens can cause rhino-sinusitis?

A

1) Streptococcus pneumonia
2) Haemophilus influenza
3) Streptococcus milleri group
4) Anaerobes
5) Fungi

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13
Q

What are the 3 possible investigations/treatment procedures for rhino-sinusitis?

A

1) Imaging for severe or suspected complications
2) Sinus washouts - ENT (relieves symptoms and enables sample for microbiology to be collected)
3) No Abx if viral otherwise cover suspected/proven pathogens eg. amoxicillin for severe disease

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14
Q

What are the 5 possible viral causes of pharyngitis/tonsillitis?

A

1) RSV
2) Influenza
3) Adenovirus
4) EBV
5) HSV1

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15
Q

What is the most common bacterial cause of pharyngitis/tonsilitis?

A

Streptococcus pyogenes

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16
Q

What are the 4 rarer bacterial causes of pharyngitis/tonsillitis?

A

1) Neisseria gonorrhoeae
2) Corynebacterium
Don’t forget STDs
3) Mycoplasma pneumonia
4) Chlamydophilia pneumoniae

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17
Q

What 2 investigations should be carried out in pharyngitis/tonsillitis?

A

1) Proper history

2) Throat swabs

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18
Q

What are the 6 signs/symptoms of pharyngitis/tonsillitis?

A

1) Sore throat
2) Dysphagia
3) Headache
4) Red tonsillar/uvular area +/- exudate
5) Fever
6) Lymphadenopathy

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19
Q

Pharyngitis/Tonsilitis in children can be caused by what pathogen which leads to what serious complications? 3

A 
Group A streptococcal infection
Complications:
1) Acute glomerulonephritis
2) Rheumatic fever
3) Scarlet fever
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20
Q

How is rheumatic fever prevented in children with a group A streptococcal infection causing pharyngitis/tonsillitis?

A

Give penicillin

Prevent suppurative complications (otitis media and quinsy (peritonsillar abscess))

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21
Q

What virus can cause pharyngitis/tonsillitis commonly in teenagers? What are the 3 signs of this?

A

EBV

1) Sore throat
2) Cervical lymphadenopathy
3) Fever

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22
Q

In people with pharyngitis/tonsillitis caused by EBV what drug should be avoided and what investigations should be carried out?

A 
Avoid ampicillin (mac-pap rash, not a true allergy)
Serology - IgM/IgG, Paul Bunnell test/ PCR
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23
Q

Diphtheria can cause pharyngitis/tonsillitis what is the treatment for this and what part of the history is important in identifying this?

A

1) Erythromycin/Penicillin/Antitoxin if toxins have been shown in microbiology lab
Immunisation/travel history important

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24
Q

What are the 4 main symptoms of diphtheria?

A

1) Malaise
2) Fatigue
3) Fever
4) Sore throat

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25
Q

What fungal infection can cause pharyngitis/tonsillitis, when is this likely to occur?

A

Candia, usually after Abx or steroids

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26
Q

Why should epiglottitis be identified as early as possible?

A

Its a medical emergency as can cause complete occlusion of airways

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27
Q

What is epiglottitis?

A

Cellulitis of epiglottis - airway obstruction

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28
Q

Epiglottitis commonly occurs in which group of people?

A

Child aged 2-4 years

29
Q

What are the 8 common signs/symptoms seen in a child with epiglottitis?

A

1) Fever
2) Irritable
3) Difficulty speaking (sounds like hot potato in mouth)
4) Difficulty swallowing
5) Leans forwards
6) Drools
7) Stridor
8) Horse

30
Q

What 2 investigations would be carried out in suspected epiglottitis?

A

1) Lateral neck x-ray - shows enlarged epiglottis
2) Must send blood cultures
NB. Do not swab epiglottis unless already intubated or can intubate immediately as airway may collapse

31
Q

What pathogen commonly caused epiglottitis prior to immunisations and which 2 types of pathogen are now more common causes?

A

Prior to immunisation - H. influenza type B

Now respiratory bacteria and staph aureus

32
Q

What are the 5 symptoms of acute laryngitis?

A

1) Hoarse/husky voice
2) Globus pharyngeus (lump in throat)
3) Fever
4) Myalgia
5) Dysphagia

33
Q

What is the medical name for croup?

A

Acute laryngotracheobronchitis

34
Q

What is Acute laryngotracheobronchitis?

A

Inflammation of larynx and trachea after infection of upper airways

35
Q

What is the most common cause of Acute laryngotracheobronchitis?

A

Viral - parainfluenza type 2

THUS NO ABX

36
Q

Which group is Acute laryngotracheobronchitis common in?

A

Children

37
Q

What is the therapy for Acute laryngotracheobronchitis?

A

Non Abx as viral cause

Symptomatic Rx only

38
Q

What pathogen commonly causes whooping cough?

A

Bordetella pertussis (Gram negative coccobacillus)

39
Q

What investigations are carried out for suspected whooping cough?

A

Pernasal swab and PCR

40
Q

What is the symptomatic course of whooping cough?

A

1) Initially catarrhal phase - runny nose, fever and malaise (like any other URTI)
2) Later (up to a week) - dry non productive cough which becomes whooping/paroxysms (short bursts on exhalation, then inspiratory gasps which is the whoop)

41
Q

What is the treatment for whooping cough?

A

Supportive and erythromycin

Immunisation is very important - erythromycin to household contacts

42
Q

What are the 4 possible complications of whooping cough?

A

1) Otitis media
2) Pneumonia (often secondary infection or aspiration)
3) Convulsions
4) Subconjunctival haemorrhages

43
Q

What is otitis externa?

A

Infection of the external auditory canal - like any other soft tissue infection in a way but as its a narrow canal can become easily blocked causing pain

44
Q

What are the 5 main symptoms of otitis externa?

A

1) Pain
2) Itch
3) Swelling
4) Erythema
5) Otorrhoea (ear drainage)

45
Q

What are the 3 main types of otitis externa?

A

1) Acute OE
2) Chronic OE
3) Malignant OE

46
Q

Which 2 organisms are the most likely causes of acute otitis externa?

A

1) S. aureus

2) Pseudomonas spp (esp. after swimming)

47
Q

What are the 3 possible treatments for otitis externa?

A

1) Toilet with saline and/or alcohol and acetic acid
2) Wick insertion
3) Topical drops (these may contain Abx, antifungals and steroids)

48
Q

What is chronic otitis externa?

A

Irritation from drainage from perforated tympanic membrane - itchy

49
Q

What is the treatment for chronic otitis externa?

A

Treat the underlying cause - nb. avoid aminoglycosides (gentamicin) if perforation as can lead to deafness

50
Q

What is malignant otitis externa?

A

Severe, necrotizing, spreads from local area more deeply. May invade bone, cartilage and blood vessels.

51
Q

What is the possible life threatening complication of malignant otitis externa?

A

Spread to temporal bone - base of skull, meninges and brain

52
Q

What pathogen commonly causes malignant otitis externa?

A

Pseudomonas aeruginosa

53
Q

What are the 2 main symptoms of malignant otitis externa?

A

Extreme pain

Drainage of pus from canal

54
Q

Which 3 kinds of patients is malignant otitis externa common in?

A

1) Elderly
2) Diabetics
3) Immunosuppressed

55
Q

What is the treatment for malignant otitis externa?

A

Treat 4-6 weeks altogether eg. with IV ceftazidime then ciproflaxin PO

56
Q

What is otitis media?

A

Middle ear inflammation - fluid present in the middle ear

57
Q

Which group is otitis media most common in?

A

V common in children

58
Q

What are the 4 signs/symptoms of otitis media?

A

1) Fever
2) Pain
3) Impaired hearing
4) Red bulging tympanic membrane

59
Q

What are the 3 common viral causes of otitis media?

A

1) H influenza
2) S. pneumonia
3) M. catarrhalis

60
Q

What possible investigations can be carried out in otitis media?

A

Swab any discharging pus

61
Q

What is the treatment for otitis externa?

A

If not unwell watch and treat symptomatically (decongestant etc.) and review early. If unwell give amoxicillin

62
Q

What is mastoiditis?

A

Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone

63
Q

What are the clinical signs of mastoiditis? 2

A

Signs same as acute otitis media

But pain/swelling over mastoid too

64
Q

What change to healthcare has much reduced the incidence of mastoiditis?

A

Introduction of Abx

65
Q

What 2 investigations would you carry out in suspected mastoiditis?

A

Bacteriology samples

Imaging - CT helps to assess extent

66
Q

What is the therapy for mastoiditis?

A

Similar therapy to acute otitis media unless gram negatives are suspected and then need broader spectrum cover as per organism isolated
LTHT 1st line treatment if co-amoxiclav (amoxicillin-clavulanate)

67
Q

What are Ludwig’s angina and lemierre’s syndrome?

A

Deep fascial space infections of head and neck

68
Q

What 6 investigations aid diagnosis of URTIs?

A

1) Send pus/throat swab/blood cultures
2) Gram stain
3) Culture
4) Sensitivity testing
5) Reference lab work (typing, toxin detection)
6) Serology and Ab testing

Year 2 Clinical Pathology (64 decks)

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