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Respiratory Physiology, Medicine and Critical Care > Upper Respiratory tract infection and disease > Flashcards

Upper Respiratory tract infection and disease Flashcards

1
Q

What is acute coryza?

A

The common cold - due to infection by a wide range of respiratory viruses, of which the rhinoviruses are the most common

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2
Q

What viruses can cause the common cold?

A
  • Rhinovirus - most common
  • Coronavirus
  • Adenovirus
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3
Q

What are the features of a common cold?

A
  • Tiredness
  • Slight pyrexia
  • Malaise
  • Sore nose and pharynx
  • Sneezing
  • Mild muscle ache
  • Profuse, watery nasal discharge, followed by thick mucopurulent secretions - may persist for up to a week
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4
Q

How would you treat a common cold?

A
  • Symptomatic relief with paracetamol
  • NO ANTIBIOTICS
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5
Q

What is sinnusitis?

A

An infection of the paranasal sinuses that either is bacterial (mainly Streptococcus pneumoniae and Haemophilus influenzae) or is occasionally fungal. It is most commonly associated with an upper respiratory tract infection and can occur with asthma.

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6
Q

What are the most common organsisms to cause sinnusitis?

A
  • S. pneumoniae
  • H. influenzae
  • Some fungi
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7
Q

What are the features of sinusitis?

A
  • Frontal headache
  • Purulent rhinorrhoea
  • Facial pain with tenderness
  • Fever
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8
Q

How would you treat sinnusitis?

A
  • Nasal decongestant - sudafed
  • Broad Spectrum antibiotics - co-amoxiclav
  • Anti-inflammatory nasal spray
  • Steam inhalations
  • ENT opinion if recurrent - CT Scan
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9
Q

What is the definition of acute sinnusitis?

A

1 week to 1 month

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10
Q

What is the definition of recurrent acute sinusitis?

A

>4 episodes sinusitis per year

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11
Q

What is the definition of subacute sinusitis?

A

1-3 months of symptoms

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12
Q

What is the definition of chronic sinusitis?

A

> 3 months of symptoms

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13
Q

What is rhinitis?

A

Irritation and inflammation of the mucous membrane inside the nose.

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14
Q

What is the clinical definition of rhinitis?

A

Sneezing attacks, nasal discharge or blockage occurring for more than an hour on most days:

  • For a limited period of the year
  • Throughout the whole year
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15
Q

What are the different types of rhinitis?

A
  • Seasonal rhinitis
  • Perenial Rhinitis
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16
Q

What is seasonal rhinitis?

A

This is the commonest allergic disorder. It is often called ‘hayfever’ but as this implies that only grass pollen is responsible, it is better described as seasonal (or intermittent) allergic rhinitis

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17
Q

What are the symptoms of seasonal rhinitis?

A
  • Nasal irritation
  • Sneezing
  • Watery rhinorrhoea
  • Itching of the eyes and soft palate + occasionally the ears
  • Wheezing
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18
Q

What are nasal polyps?

A

These are round, smooth, soft, semi-translucent, pale or yellow, glistening structures attached to the sinus mucosa by a relatively narrow stalk or pedicle, occurring in patients with allergic or vasomotor rhinitis.

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19
Q

How would you treat allergic rhinitis?

A
  • Oral H1 blocker, or
  • Intranasal H1 blocker, or
  • Leukotriene Receptor antagonist, or
  • Intranasal corticosteroids - if severe symptoms
  • Cromone
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20
Q

What is pharyngitis?

A

Inflammation of the pharynx

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21
Q

What is the definition of acute pharyngitis?

A

Characterised by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). Absence of cough, nasal congestion, and nasal discharge distinguishes bacterial from viral aetiologies.

22
Q

What are features of acute pharyngitis?

A
  • Tender anterior cervical lymph nodes
  • Sore Throat
  • Fever
  • Inflamed tonsils
  • Reddened oropharynx and soft palate
23
Q

What are the causes of pharyngitis?

A
  • Adenovirus is most common cause
  • Can be strep pneumoniae
24
Q

How would you manage pharyngitis?

A

Most are self limiting - symptomatic control

25
Q

How would you manage strep throat?

A
  • Oral penicillin for 10 days, or
  • If allergic to penicillin
    • Clindamycin/clarithromycin for 10 days
    • Azithromycin for 5 days
26
Q

What is laryngitis?

A

Inflammation of the larynx

27
Q

What is the most common cause of laryngitis?

A

Bacterial

28
Q

What are the features of acute laryngitis?

A
  • Hoarseness
  • Sore throat
  • Fever
  • Cough
  • Rhinitis
  • Odynophagia/dysphagia
29
Q

How would you treat laryngitis?

A

Symptomatic management

30
Q

What is tonsilitis?

A

Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as “acute sore throat”

31
Q

What bacteria are implicated in acute tonsilitis?

A
  • Group A beta haemolytic strep - S. Pyogenes
  • H. Influenzae
  • T. Pallidum
  • N. Gonnorhoea
32
Q

What viruses can cause acute tonsillitis?

A
  • Rhinovirus
  • Coronavirus
  • Adenovirus
33
Q

What are symptoms of tonsillitis?

A
  • Dysphagia
  • Painful Cervical lymphadenopathy
  • Fever
  • Rhinorrhoea
  • Headache
  • Abdominal pain
34
Q

What are signs of tonsillitis?

A
  • Inflamed fauces/pharynx upon examination
  • Enlarged tonsils
  • Tonsillar exudates
  • Palatal Petechia
  • Enlarged cervical lymph nodes
35
Q

How might you investigate someone with tonsillitis?

A
  • Swabs - Throat, Nasal
  • Blood/Serology
  • Blood film
36
Q

How would you treat tonsillitis?

A
  • Symptomatic therapy - paracetamol etc
  • If persistent - penicillin V
37
Q

What are CENTOR Criteria?

A

Criteria which give an indication of the likelihood of a sore throat being due to bacterial infection

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever (over 38°C)
  • Absence of cough

A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.

38
Q

What is infectious mononucleosis?

A

Glandular fever - a clinical syndrome in a patient with primary Epstein Barr virus (EBV) infection; other causes of mononucleosis syndrome are much less common. The diagnosis ‘infectious mononucleosis’ is primarily used when the syndrome is caused by EBV; ‘mononucleosis syndrome’ should be used when the syndrome is caused by a non-EBV aetiology

39
Q

What is the cause of infectious mononucleosis?

A

EBV

40
Q

What are symptoms of infectious mononucleosis?

A
  • Cervical or generalised lymphadenopathy
  • Pharyngitis
  • Malaise
  • Fever
  • Myalgia
  • Fatigue
41
Q

What are signs of infectious mononucleosis?

A
  • Splenomegaly
  • Hepatomegaly
  • Rash
  • Jaundice
  • Palatal Petechiae
  • Cervical lymphadenopathy - posterior esp.
  • Anaemia
42
Q

What is the mode of spread of EBV?

A

Saliva/droplet

43
Q

What is the incubation period for EBV?

A

4-5 weeks

44
Q

What are complications of EBV?

A
  • Meningoencephalitis
  • Cerebellitis
  • Guillain-Barre Syndrome
  • Myeloradiculitis
  • Cranial nerve lesion (esp VII)
  • Hepatitis
  • RDS
  • AKI
  • Myocarditis
45
Q

How would you investigate someone with suspected EBV?

A
  • Blood Film
  • IM test/monospot
  • Look for Epstein Barr Virus itself
    • IgM raised in acute infection
    • IgG raised in past infection
46
Q

What might you see on blood film in someone with EBV?

A

Atypical mononuclear cells

47
Q

What quick test can be done to check for EBV?

A

Monospot

48
Q

What can give false positive monospot tests?

A
  • Hepatitis
  • Rubella
  • Parvovirus
  • Lymphoma
  • Leukaemia
  • Malaria
  • Pancreatic cancer
  • SLE
49
Q

How would you manage someone with EBV?

A
  • Supportive
  • Aspirin gargles
  • Rest
  • Steroids if pharyngeal oedema severe
  • Watch for splenomegaly (rupture!)
50
Q

What should you NEVER give in as part of management of EBV?

A

Ampicillin/amoxicillin - Severe rash

51
Q

What is the feverPain score for tonsillitis?

A
  • Fever (during previous 24 hours)
  • Purulence (pus on tonsils)
  • Attend rapidly (within 3 days after onset of symptoms)
  • Inflamed tonsils
  • No cough or coryza (inflammation of mucus membranes in the nose)

A score of 4 or 5 is thought to be associated with a 62 to 65% likelihood of isolating streptococcus.

Respiratory Physiology, Medicine and Critical Care (42 decks)

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