Upper Respiratory Tract Infections

Question 1

What is the upper respiratory tract?

Answer 1

Everything above the trachea e.g. the nose, paranasal sinuses, middle ear, nasopharynx, oropharynx, laryngopharynx, tonsils and adenoids

Question 2

Is the upper respiratory tract sterile?

Answer 2

No, it’s colonised by a variety of normal flora

Question 3

What causes the vast majority of upper respiratory tract infections?

Answer 3

Viral infections

Question 4

What causes a ‘cold’?

Answer 4

Caused by many strains of rhinovirus and sometimes coronaviruses

Question 5

What is the main virus implicated in causing a cold?

Answer 5

Rhinovirus

Question 6

What may follow as a result of a cold?

Answer 6

Transient opportunistic bacterial infection such as otitis media in children and sinusitis in adults

Question 7

How is a ‘sore throat’ referred to medically?

Answer 7

Pharyngitis

Question 8

What may cause a sore throat?

Answer 8

Pharyngitis may be caused by group A streptococci infection

Question 9

What are the four main viruses that are implicated in the cause of upper respiratory tract infection

Answer 9

Rhinovirus, respiratory syncytial virus, parainfluenza virus and adenovirus

Question 10

What are two important bacterial causes of upper respiratory tract infection?

Answer 10

Group A streptococci (pyogenes) infection and haemophilia influenza type B

Question 11

What is quinsy?

Answer 11

Peritonsillar abscess

Question 12

What types of antibiotic are given to fight group A streptococci infection?

Answer 12

Penicillin (all Streptococci are sensitive to this) or erythromycin

Question 13

What are the potential complications of untreated pharyngitis?

Answer 13

Rheumatic fever and/or glomerulonephritis

Question 14

What is otitis media?

Answer 14

A middle ear infection that most often effects children

Question 15

What is the cause of otitis media?

Answer 15

This commonly occurs due to viral infection causing dysfunction of the Eustachian tube which allows for opportunistic bacterial infection

Question 16

What is sinusitis?

Answer 16

Inflammation of the air sinuses in the head due to viral or bacterial infection due to the overgrowth of the normal sinus flora

Question 17

What may cause sinusitis?

Answer 17

Overgrowth of the normal sinus flora such as treptococcus pneumoniae, haemophilus influenza and moraxalla catarrhalis that leads to infection

Question 18

What is epiglottitis?

Answer 18

Inflammation of the epiglottis which has a role in closing off the trachea to allow swallowing of food

Question 19

What is the most common cause of epiglottis?

Answer 19

It is almost always caused by a bacterial infection

Question 20

Why is epiglottitis a medical emergency?

Answer 20

It can lead to asphyxiation if it becomes so inflamed that it prevents the opening to the trachea from being available

Question 21

How is epiglottitis treated?

Answer 21

Airway opening (either via intubation or tracheostomy), antibiotics (cefotaxime or ceftriaxone), prophylaxis for unimmunised household contacts and immunisation of index cases

Question 22

What is whooping cough?

Answer 22

A highly contagious bacterial disease that appears similarly to a cold

Question 23

What is the cause of whooping cough?

Answer 23

Bordatella pertussis bacterial infection

Question 24

What are the symptoms of whooping cough?

Answer 24

To begin there is just a cough, but after 2 weeks there will be severe coughing with a typical whoop on vigorous inspiration

Question 25

Describe the treatment of whooping cough

Answer 25

Erythromycin is given in the first week (catarrhal phase) to decrease transmission

Question 26

How can whooping cough be prevented?

Answer 26

Acellular vaccines – these contain an inactive form of the pertussis toxin alongside filaments of haemaglutinin, agglutinogens and an outer membrane protein

Question 27

What is diphtheria?

Answer 27

Diphtheria is a potentially fatal contagious bacterial infection that mainly affects the nose and throat, and sometimes the skin.

Question 28

What causes diphtheria?

Answer 28

Corynebacterium diphtheriae

Question 29

Outline the pathophysiology of diphtheria

Answer 29

Normally EF-Tu is a molecule that is required to transfer tRNA to the growing polypeptide in gene translation, diphtheria toxin binds to EF-Tu and inactivates it, inhibiting protein synthesis

Question 30

How is diphtheria treated?

Answer 30

Use of antitoxin

Question 31

What is glandular fever?

Answer 31

Infectious mononucleosis (mono) which is a viral infection that effects the upper respiratory tract

Question 32

What is the cause of glandular fever?

Answer 32

Epstein-Barr virus

Question 33

What are the symptoms of glandular fever?

Answer 33

Tonsilar exudates, gross pharyngeal swelling, hepatosplenomegaly

Question 34

How is adenovirus transmitted?

Answer 34

Via droplets, fomites and ingestion

Question 35

What is the action of adenovirus?

Answer 35

It effects he mucous membranes of the • eye, respiratory and GI tract and local lymph nodes become enlarged and tender

Question 36

What can adenovirus infection lead to?

Answer 36

o Epidemic kerato-conjunctivitis – a mild trauma to the eye may facilitate damage and lead to infection of the cornea e.g. if towels are shared o Pneumonia – adenovirus infection may follow measles and may cause a severe destructive pneumonia o Acute respiratory disease (ARD)

Question 37

What is main pathogen involved in respiratory infections in childhood?

Answer 37

Respiratory syncytial virus

Question 38

Describe the structure of paramyxoviruses

Answer 38

Apears similarly to influenza virus , it is roughly spherical with an inner helical nucleocapsid which contains protein and the envelope of the virus is covered with haemaglutinin and neuroaminidase

Question 39

How may infection with influenza virus be treated?

Answer 39

With neuraminidase inhibitors e.g. zanamavir or oseltamivir