Upper respiratory tract infection (RESP) Flashcards
What parts of the body does the upper respiratory tract consist of? (5)
- nose
- sinuses
- pharynx
- larynx
- trachea
What type of infection are URTIs generally? (2)
- mainly viral
- bacterial in some instances
List examples of URTIs. (8)
- rhinitis
- rhinosinusitis / sinusitis
- pharyngitis
- tonsillitis
- laryngitis
- epiglottitis
- otitis media
- common cold
What are some common pathogens causing different types of URTIs? (5)
- rhinitis (nose) - rhinovirus, influenza, parainfluenza, RSV, adenovirus
- rhinosinusitis (nose and sinuses) - Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, fungi, Aspergillus
- pharyngitis - EBV, Group A Strep.
- laryngitis (most common) - rhinovirus, adenovirus, influenza, Group A Strep, S. pneumoniae, H. influenzae
- epiglottitis (bacteria that cause laryngitis) - H. influenzae
What are the clinical features of URTIs? (9)
- cough
- sore throat
- runny nose & sneezing
- nasal congestion
- headache
- fever
- facial pressure
- fatigue
- loss of appetite
How might rhinitis present (URTIs)?
Runny/stuffy nose + sneezing
How might rhinosinusitis present (URTIs)?
- pain/pressure on face near affected sinus
- change in voice
How might pharyngitis present (URTIs)?
Sore throat
How might tonsillitis present (URTIs)?
Hard to swallow
How might laryngitis present (URTIs)?
Hoarse voice + dry cough
How might epiglottitis present (URTIs)?
Trouble breathing and tripoding = emergency
What are some risk factors for URTIs? (5)
- exposure to affected individuals
- young age
- winter season
- day care attendance
- exposure to cigarette smoke or other respiratory irritants
How are URTIs usually diagnosed?
Clinical diagnosis
What investigations could be done for URTIs? (3)
Usually not needed but:
- FBC - raised WCC, lymphocytosis
- throat swab - if McIsaac sore throat score 2/3
- sputum culture
What are some differential diagnoses for URTIs? (10)
- COVID-19
- Streptococcal tonsillopharyngitis
- acute sinusitis
- chronic sinusitis
- infectious mononucleosis - maculopapular rash, fatiguability, hepatosplenomegaly, EBV antibody titres
- influenza
- meningococcal disease - tachycardia, low BP, high fever
- Avian flu / swine flu / diphtheria
- pertussis
- allergic rhinitis
What does the general management of URTIs include? (3)
Symptomatic support:
- analgesia
- decongestants
- cough medicine
What is the management for viral infections (URTIs)?
- rest + fluids
- analgesia
- decongestant / antihistamine (ipratropium)
- honey
What is the management for suspected Group A Streptococcus infection (URTIs)?
Delayed phenoxymethylpenicillin
What is the management for infectious mononucleosis (URTIs)?
- hydration
- systemic corticosteroids
- IV Ig
What is the management for recurrent pharyngitis (URTIs)?
Tonsillectomy
What is the management for Candida infection (URTIs)?
Antifungal agents
What is the management for diphtheria (URTIs)?
Diphtheria antitoxin
What is the management for suspected bacterial infection (URTIs)?
Delayed targeted Abx
For URTIs, when do we consider an immediate Abx approach (vs delayed Abx)? (4)
- children <2y with bilateral acute otitis media
- children with otorrhoea who have acute otitis media
- high risk of developing complications:
- systemic illness
- pneumonia, mastoiditis, peritonsillar abscess, peritonsillar cellulitis, intraorbital/intracranial complications
- 65y or >80y with 2 or 1 (respectively) more of: hospitalisation in last year, diabetes, congestive HF, use of oral glucocorticoids
- patients with acute sore throat/pharyngitis/tonsillitis when 3+ McIsaac criteria are present
What do we do if we see unilateral polyps in URTIs?
Urgent referral to ENT - red flag symptom
What are some complications of URTIs? (5 + 4)
- otitis media
- acute sinusitis
- pneumonia
- bronchospasm
- Group A Streptococcus complications
- Scarlet fever - diffuse papular eruption that has a characteristic ‘sandpaper’ feel
- rheumatic fever - polyarthritis, carditis, subcutaneous nodules, erythema marginatum, chorea
- glomerulonephritis
- toxic shock syndrome
What are the features of otitis media (complication of URTIs)?
- otalgia, irritability, decreased hearing, anorexia, vomiting, fever
- bulging, opacified tympanic membrane with an attenuated light reflex (white/yellow/pink/red TM)
- pain control with analgesics and maybe delayed Abx
- complications include: otitis media with effusion, perforation of tympanic membrane and rarely, mastoiditis
