Upper respiratory tract infection (RESP)

Question 1

What parts of the body does the upper respiratory tract consist of? (5)

Answer 1

• nose
• sinuses
• pharynx
• larynx
• trachea

Question 2

What type of infection are URTIs generally? (2)

Answer 2

• mainly viral
• bacterial in some instances

Question 3

List examples of URTIs. (8)

Answer 3

• rhinitis
• rhinosinusitis / sinusitis
• pharyngitis
• tonsillitis
• laryngitis
• epiglottitis
• otitis media
• common cold

Question 4

What are some common pathogens causing different types of URTIs? (5)

Answer 4

• 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

Question 5

What are the clinical features of URTIs? (9)

Answer 5

• cough
• sore throat
• runny nose & sneezing
• nasal congestion
• headache
• fever
• facial pressure
• fatigue
• loss of appetite

Question 6

How might rhinitis present (URTIs)?

Answer 6

Runny/stuffy nose + sneezing

Question 7

How might rhinosinusitis present (URTIs)?

Answer 7

• pain/pressure on face near affected sinus
• change in voice

Question 8

How might pharyngitis present (URTIs)?

Answer 8

Sore throat

Question 9

How might tonsillitis present (URTIs)?

Answer 9

Hard to swallow

Question 10

How might laryngitis present (URTIs)?

Answer 10

Hoarse voice + dry cough

Question 11

How might epiglottitis present (URTIs)?

Answer 11

Trouble breathing and tripoding = emergency

Question 12

What are some risk factors for URTIs? (5)

Answer 12

• exposure to affected individuals
• young age
• winter season
• day care attendance
• exposure to cigarette smoke or other respiratory irritants

Question 13

How are URTIs usually diagnosed?

Answer 13

Clinical diagnosis

Question 14

What investigations could be done for URTIs? (3)

Answer 14

Usually not needed but:

• FBC - raised WCC, lymphocytosis
• throat swab - if McIsaac sore throat score 2/3
• sputum culture

Question 15

What are some differential diagnoses for URTIs? (10)

Answer 15

• 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

Question 16

What does the general management of URTIs include? (3)

Answer 16

Symptomatic support:

• analgesia
• decongestants
• cough medicine

Question 17

What is the management for viral infections (URTIs)?

Answer 17

• rest + fluids
• analgesia
• decongestant / antihistamine (ipratropium)
• honey

Question 18

What is the management for suspected Group A Streptococcus infection (URTIs)?

Answer 18

Delayed phenoxymethylpenicillin

Question 19

What is the management for infectious mononucleosis (URTIs)?

Answer 19

• hydration
• systemic corticosteroids
• IV Ig

Question 20

What is the management for recurrent pharyngitis (URTIs)?

Answer 20

Tonsillectomy

Question 21

What is the management for Candida infection (URTIs)?

Answer 21

Antifungal agents

Question 22

What is the management for diphtheria (URTIs)?

Answer 22

Diphtheria antitoxin

Question 23

What is the management for suspected bacterial infection (URTIs)?

Answer 23

Delayed targeted Abx

Question 24

For URTIs, when do we consider an immediate Abx approach (vs delayed Abx)? (4)

Answer 24

• 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

Question 25

What do we do if we see unilateral polyps in URTIs?

Answer 25

Urgent referral to ENT - red flag symptom

Question 26

What are some complications of URTIs? (5 + 4)

Answer 26

• 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

Question 27

What are the features of otitis media (complication of URTIs)?

Answer 27

• 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