Upper respiratory Tract Infections Flashcards
What are the three features of rhinitis?
1) nasal discharge
2) a blockage occurring for more than an hour on most days
3) sneezing attacks
What is acute coryza?
common cold
What is the most common infectious agent behind the common cold?
rhinovirus
Other than rhinovirus, name two viruses that commonly cause the common cold?
1) coronavirus
2) adenovirus
What is the mode of transmission of the common cold?
direct contact and droplet
Give 5 clinical presentations associated with upper respiratory tract infections:
1) tiredness
2) slight pyrexia
3) sore nose and pharynx
4) sneezing
5) profuse watery nasal discharge followed by thick mucopurulent secretions
What is seasonal rhinitis?
hay fever - allergic, intermittent rhinitis
Give 5 clinical presentations associated with seasonal rhinitis:
1) nasal irritation
2) watery rhinorrhoea
3) itching of the eyes
4) itching of the soft palate
5) wheeze
Give 3 common seasonal allergens that cause seasonal rhinitis:
1) tree pollen
2) grass pollen
3) mould spores
What is perennial rhinitis?
persistent rhinitis experienced throughout the year
How does perennial rhinitis present?
1) long term nasal blockage
OR
2) long term sneezing and watery rhinorrhoea
+ patients may lose their sense of smell and taste
What is the most common cause of perennial allergic rhinitis?
faecal particles of the dust mite
What is vasomotor rhinitis?
non-allergic/ non-infectious rhinitis without eosinophilia caused by cold air, smoke, perfume or newsprints
Describe the appearance of nasal polyps:
round, smooth, soft, semi-translucent, pale or yellow glistening structures attached to the sinus mucosa by a narrow stalk or pedicle
In which two types of rhinitis would you find nasal polyps?
1) allergic rhinitis
2) vasomotor rhinitis
What three cells make up nasal polyps?
1) mast cells
2) eosinophils
3) mononuclear cells
Give 3 clinical presentations associated with nasal polyps:
1) nasal obstruction
2) loss of smell and taste
3) mouth breathing
What two methods can be used to check for allergies associated with rhinitis?
1) skin prick testing
2) allergen-specific IgE antibody tests
Give 6 ways in which rhinitis can be managed:
1) allergen avoidance
2) H1 antihistamines
3) decongestants
4) anti-inflammatory drugs
5) corticosteroids
6) leukotriene antagonists
Name two sedative antihistamines which are no longer used in practice:
1) chlorphenamine
2) hydroxyzine
Name two non-sedative antihistamines:
1) loratadine
2) cetirizine
Name two alpha adrenergic decongestants:
1) xylometazoline
2) oxymetazoline
Name two anti-inflammatory drugs used to treat rhinitis:
1) sodium cromoglicate
2) nedocromil sodium
How do sodium cromoglicate and nedocromil sodium act as anti-inflammatory drugs for rhinitis?
they act by blocking intracellular Cl- channels influencing mast cell and eosinophil activation and nerve function
What is the most effective treatment for rhinitis?
topical corticosteroid sprays
Name 4 topical corticosteroid sprays used to treat rhinitis:
1) becolmetasone
2) fluticasone propionate
3) fluticasone furoate
4) mometasone furoate
Give an example of a leukotriene antagonist used to treat rhinitis:
montelukast
When would you consider prescribing a leukotriene antagonist for rhinitis?
when there is no response to antihistamines or topical steroids
Is sinusitis typically caused by viruses or bacteria?
viruses
What two bacteria are the leading causes of sinusitis?
1) Streptococcus pneumoniae
2) Haemophilus influenzae
Give 4 symptoms associated with sinusitis:
1) frontal headache
2) purulent rhinorrhoea
3) facial pain and tenderness
4) fever
Give 4 management techniques for bacterial sinusitis:
1) antibiotics (broad spectrum e.g. co-amoxiclav)
2) topical corticosteroid spray
3) steam inhalation
4) nasal decongestants
How should chronic (>3 month) sinusitis be managed?
referral to ENT for CT of the sinuses
What antibiotic is typically given for sinusitis?
Co-amoxiclav
What infectious agent is the most common cause of pharyngitis?
adenoviruses
Give three clinical presentations associated with pharyngitis:
1) sore throat
2) oropharynx and soft palate are reddened
3) inflamed and swollen tonsils
Give the Centor Score point system:
1) absent cough - 1 point
2) exudate on tonsils - 1 point
3) tender cervical lymph nodes - 1 point
4) temp >38 degrees C - 1 point
5) age 3-14 - 1 point
(4-5 points indicates Strep throat infection - prescribe antibiotics)
What antibiotic is typically prescribed for Strep throat/ bacterial pharyngitis?
phenoxymethylpenicillin
What is acute laryngotracheobronchitis?
infection and inflammation of the larynx which may include the trachea and bronchi
What two infectious agents typically cause acute laryngotracheobronchitis?
1) parainfluenza viruses
2) measles virus
Give 4 presentations associated with acute laryngotracheobronchitis?
1) hoarse voice
2) barking cough
3) audible stridor
4) progressive airway obstruction
Give 3 ways that acute laryngotracheobronchitis is managed?
1) nebulised adrenalin
2) oral or IM corticosteroids e.g. dexamethasone
3) oxygen and fluids
What bacteria causes acute epiglottitis?
Haemophilus influenzae type B (Hib)
In which patient demographic does acute epiglottitis occur?
children under 5 years of age (this is a life threatening emergency)
Give two presentations associated with acute epiglottitis?
1) high fever
2) severe air flow obstruction
Give the two step management technique for severe acute epiglottitis:
1) urgent endotracheal intubation
2) IV ceftazidime antibiotics
What vaccine is used to prevent acute epiglottitis?
Hib vaccine (given to infants)
What type of virus is influenza?
Orthomyxovirus
How long is the incubation period for influenza?
1-3 days
Give 6 presentations associated with influenza:
1) fever
2) shivering
3) generalised aching of the limbs
4) severe headache
5) soreness of throat
6) cough that can persists for several weeks
Why are antibiotics given to influenza patients with chronic bronchitis, cardiac or renal diseases?
to prevent secondary bacterial infection
What two bacteria are the most common causes of secondary infection post-influenza?
1) Streptococcus pneumoniae
2) Haemophilus influenza
Although lab testing is not required to diagnose influenza, what tests can be done for a definitive diagnosis? (2)
1) testing for a four fold increase in complement fixing antibody or haemagglutinin antibodies
OR
2) nasopharyngeal swabs
How is influenza managed?
bed rest and paracetamol
What antiviral drug may be given to influenza patients?
neuraminidase inhibitors such as oseltamivir (can help shorten the duration of symptoms in patients with influenza if given within 48 hours of the first symptom)
Who is the flu jab offered to?
1) 65+ year olds
2) those with chronic disease
3) healthcare workers
