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Clinical Pathology > Upper respiratory tract infections > Flashcards

Upper respiratory tract infections Flashcards

1
Q

Give examples of the normal flora of upper respiratory tract (URT).

A

Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.

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2
Q

Give examples of respiratory pathogens that may be carried asymptomatically.

A

Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes.

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3
Q

What other pathogen may be carried asymptomatically?

A

Neisseria meningitidis

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4
Q

What kinds of pathogen can colonise the URT post-antibiotics?

A

Coliforms, Pseudomonas, Candida

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5
Q

What is the most common route of spread for respiratory disease?

A

Droplet - coughing/sneezing and contact with contaminated surfaces. Handwashing and decontamination very important.

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6
Q

Describe the epidemiology of URTI?

A
  • Most often v. young children/teenagers
  • Winter/viral. Bacterial and viral common in children.
  • (Also immunosuppressed - Very ill with seemingly less pathogenic viruses in adults e.g. RSV)
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7
Q

What are the possible causes of the common cold?

A
  • Viral esp. Rhinovirus. Also….
  • Coronoviruses
  • RSV,
  • Parainfluenza viruses
  • Enteroviruses
  • Adenovirus
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8
Q

What are the symptoms of the common cold?

A

Nasal discharge, sneezing and S/T

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9
Q

Should antibiotics be given for the common cold?

A

Fuck no!

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10
Q

What are the symptoms of rhino-sinusitis?

A

Facial pain, nasal blockage, reduction smell.

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11
Q

What is the possible aetiology of rhinosinusitis?

A
  • Post viral inflammation
  • Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus milleri group, anaerobes, fungal
  • Complications of chronic sinusitis
  • Osteomyelitis, meningitis, cerebral abscess
    (also allergic and non-infective)
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12
Q

What are the investigations that should be performed for rhinosinusitis?

A

Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.

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13
Q

What treatment can be given for rhinosinusitis?

A

Sinus washouts (diagnostic and therapeutic) after referral to ENT (not GPs)
Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway. Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
(beware undiagnosed dental infection)

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14
Q

What are the possible pathogens responsible for pharyngitis/tonsillitis?

A
  • Viral (RSV, Influenza, Adeno, EBV, HSV1)
  • Bacterial (Streptococcus pyogenes, Rarely - Neisseria gonorrhoeae, Corynebacterium diphtheriae)
  • (Mycoplasma pneumoniae and Chlamydophila pneumoniae)
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15
Q

What investigations should be done in pharyngitis/tonsillitis?

A

Throat swabs and proper history

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16
Q

What are the signs and symptoms of pharyngitis/tonsillitis?

A

S/T, dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy

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17
Q

What are the possible complications of a group A streptococcal pharyngitis/tonsillitis?

A

acute glomerulonephritis/ rheumatic fever/scarlet fever. Aim to prevent this rheumatic fever by giving penicillin and prevent suppurative complications too (e.g. otitis media and quinsy (peritonsillar abscess))

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18
Q

Which virus virus causes infectious mononucleosis (glandular fever)

A

Epstein-Barr virus

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19
Q

What are the symptoms and complications of infectious mononucleosis?

A
  • S/T, fever, cervical lymphadenopathy

- Complications e.g. splenic rupture

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20
Q

What antibiotic should be avoided in infectious mononucleosis?

A

Ampicillin (can cause mac-pap rash - not true allergy)

  • not that Abx should be given anyway coz it’s a bloody virus!!
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21
Q

What serology should be performed in suspected infectious mononucleosis?

A

IgM/IgG, Paul Bunnell Test/PCR

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22
Q

Why is epiglottitis a medical emergency?

A

Airway obstruction - cellulitis of epiglottis

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23
Q

What are the clinical features of epiglottitis?

A

Child (2-4 yrs), fever, irritable, difficulty speaking (“hot potato”) and swallowing. Leans forward, drools. Stridor, hoarse.

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24
Q

What investigations should be performed in suspected epiglottitis?

A
  • Lateral neck X-ray – enlarged epiglottis
  • Must send blood cultures. DO NOT swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).
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25
Q

What is the treatment for epiglottitis?

A

Maintain airway, cefotaxime

26
Q

What is the aetiology of epiglottitis?

A

Previously most commonly caused by H. influenzae type B prior to immunisation. Now rarer and variety causes – esp. resp. bacteria and S. aureus

27
Q

What are the signs/symptoms of acute laryngitis?

A

Hoarse/husky voice, globus pharyngeus (lump in throat), fever, myalgia, dysphagia

28
Q

What is the aetiology of laryngitis?

A
  • Usually viral and self-limiting, occas. bacterial (the usual suspects) therefore no need therefore for antibiotics. If severe disease consider antibiotics
  • Non infective causes (voice abuse, malignancy etc.)
29
Q

When would you need to maintain airway patency in acute laryngitis?

A

If stridor is present

30
Q

What is Croup?

A

Acute laryngotracheobronchitis - inflammation of larynx and trachea following infection. Stridulous voice.

31
Q

What is the aetiology of Croup?

A

Viral esp. parainfluenza type 2 therefore NO antibiotics (also RSV)

32
Q

What is the treatment for Croup?

A

Symptomatic Rx only.

33
Q

What is the aetiology of whooping cough?

A

Bordetella pertussis - GN coccobacillus

Incubation period = 1-3 weeks

34
Q

What are the appropriate diagnostic tests for whooping cough?

A

Perinasal swab and PCR

35
Q

What are the initial symptoms of whooping cough?

A

Catarrhal phase - runny nose, malaise, fever

36
Q

What are the later symptoms of whooping cough?

A

Dry non productive cough. This becomes whooping/paroxysms. (short bursts on exhalation, then inspiratory gasp which is the whoop.

37
Q

What is the treatment for whooping cough?

A

Supportive and erythromycin

38
Q

What are the potential complications of whooping cough?

A

Otitis media, pneumonia Often secondary infection or aspiration). Convulsions. Subconjunctival haemorrhages etc.

39
Q

What is otitis externa?

A
  • Infection of the external auditory canal (EAC)
  • Pain, itch, swelling and erythema, otorrhoea
  • Main types - acute OE, chronic OE and malignant OE.
40
Q

What are the main organisms responsible for otitis externa?

A

S. aureus (likely if pustular) and Pseudomonas spp.(esp. after swimming)

41
Q

What is the treatment for otitis externa?

A

Toilet with saline and/or alcohol and acetic acid. Wick insertion. Topical drops (these may contain antibiotics, antifungals and steroids)

42
Q

What is the aetiology of chronic otitis externa?

A

Irritation from drainage from perforated tympanic membrane.

43
Q

What should you treat in chronic otitis externa?

A

The underlying cause

44
Q

What should you avoid in chronic otitis externa?

A

Aminoglycosides (gentamicin etc.) if perforation. Resistance may form and sensitisation occurs with prolonged courses

45
Q

What is malignant otitis externa?

A

Severe, necrotizing. Spreads from local area more deeply. May invade bone, cartilage and blood vessels. Life threatening – spread to temporal bone, base of skull, meninges and brain. Often Pseudomonas aeruginosa

46
Q

What are they symptoms of malignant OE?

A

+++++ pain and pus draining from the canal

47
Q

What is the treatment for malignant OE?

A

Treat 4-6 weeks altogether e.g. with iv ceftazidime then ciprofloxacin po

48
Q

What are the risk factors for malignant OE?

A

Elderly, immunocompromised

49
Q

What is otitis media?

A

Middle ear inflammation. Fluid present in the middle ear.

50
Q

What is the aetiology of otitis media?

A

VIRAL. H influenzae, S. pneumoniae, M. catarrhalis

51
Q

What are the signs and symptoms of otitis media?

A

Fever, pain, impaired hearing. Red bulging tympanic membrane

52
Q

What is the treatment for otitis media?

A
  • Swab any pus discharging

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

53
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.

54
Q

What are the signs/symptoms of mastoiditis?

A

Signs as AOM, but pain/swelling over mastoid too.

55
Q

What investigations should be performed in mastoiditis?

A
  • Need bacteriology samples

- Imaging – CT helps to assess extent

56
Q

What is the treatment for mastoiditis?

A
  • Similar Rx to acute OM unless Gram negatives are suspected and then need broader spectrum cover as per organism isolated
  • LTHT 1st line treatment is co-amoxiclav (amoxicillin-clavulanate)
57
Q

What is Vincent’s angina?

A

Acute necrotizing infection of the pharynx caused by a combination of fusiform bacilli (Fusiformis fusiformis - a Gram -ve bacillus) and spirochetes (Borrelia vincentii ). These are the same organisms that cause a gingivostomatitis known as trench mouth.

58
Q

What is Ludwig’s angina?

A

Cellulitis of the floor of the mouth, usually occurring in adults with concomitant dental infections

59
Q

What is Lemierre’s Syndrome?

A

Thrombophlebitis of the internal jugular vein.

aka postanginal shock, human necrobacillocis

60
Q

What antibiotic is commonly given in URTIs to people allergic to penicillin?

A

Erythromycin

Clinical Pathology (65 decks)

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