Upper Respiratory Tract Infections

Question 1

Epiglottis bacterial or viral?

Answer 1

Bacterial

Question 2

Common cold, laryngitis, bronchioles is and croup?

Answer 2

Viral

Question 3

Suppurative

Answer 3

Involves pus. Bacterial. E.g. Empyema, lung abscess, pneumonia, chronic bronchitis, sinusitis, otitis media.

Question 4

Pharyngitis causes, viral vs bacterial, complications, treatment.

Answer 4

Mainly caused by virus.
Bacterial causes: streptococcus pyroxenes type A
Bacterial vs viral: skin rash and cough if viral and also associated conjunctivitis via adenovirus. Bacterial signs and symptoms: tonsil at exudate, tender cervical lymphadenopathy, fever >38 degrees Celsius, no cough, oedema, erythema.
Sean of exudate and culture.
Penicillin for treatment.
Complications non-suppurative: rheumatic fever and glomerulonephritis. Suppurative: acute sinusitis, acute OM, peritonsillar abscess.

Question 5

Otitis media causes, diagnosis, treatment, complications.

Answer 5

Streptococcus pneumonia, moraxella cattharlis, haemophilus influenzae (non- type able).
Signs/ symptoms: ear pain, ear discharge, lethargy, fever, hearing loss.
Diagnosis: perforation, air-fluid line, bulging tympanic membrane, immobile on pneumatic otoscope.
Aspiration and sampling if: critically ill/still unwell, immunosupressed, no response to therapy in 48-72 hours.
Treatment: pain relief (analgesics). Give antibiotics if <6months old or systemically ill (vomiting/fever) or if immunosupressed. Antibiotic: amoxil, also beta lacy amaze inhibitor.
Complications: temporary hearing loss (can impact speech, language development). Maistoiditis (rare) which can then cause cavernous sinus thrombosis and cerebral abscess.

Question 6

Sinusitis causes, symptoms and signs, diagnosis, treatment and complications.

Answer 6

Causes: viral and steptococcus pneumonia, haemophilus influenzae and staphylococcus aureus.
Signs and symptoms: fever >38, facial pain, tenderness, erythema, swelling, duration >7 days.
Diagnosis: sinus cavity culture (puncture and aspiration), CT/MRI (in severe).
Exclude foreign body, cystic fibrosis, immunodeficiency.
Treatment: pain relief (analgesics), Nadal saline spray, nasal decongestants, nasal corticosteroids. Antibiotics if high fever, unilateral maxillary sinus tenderness, severe headache, worsening after initial improvement.
Complications: orbital cellulitis, orbital abscess, period real abscess of frontal bone, meningitis, cavernous sinus thrombosis, cerebral abscess, subdural empyema.

Question 7

Epiglottitis

Causes, signs and symptoms, diagnosis, treatment, complications.

Answer 7

Causes: haemophilus influenza type B 100% in children, 25% in adults.
Signs/symptoms: fever, dysphagia, dysphonia, drooling.
Diagnosis: blood culture, raised WCC.
Treatment: effective conjugate vaccine (prevention), immediate intubation, IV 3rd generation cephalosporin.
Complications: abrupt airway obstruction and death- medical emergency.

Question 8

Pneumonia Community aquired

Answer 8

Streptococcus pneumonia.
Fever, fatigue, chills, tachycardia, SOB, tachypnoea.
Complications: pleural effusion, empyema.

Question 9

Pneumonia hospital acquired/minor cause of community acquired.

Answer 9

Staphylococcus aureus.
Severe cough, pleuritic chest pain, SOB, haemoptysis, high fever, hypotension.
Complications: multiple lung abscesses
Empyema

Question 10

Pneumonia hospitalised/debilitated patients.

Answer 10

Cause: Klebsiella pneumonia
Signs/symptoms: extremely severe
Red currant jelly sputum 
Upper love involvement
Complications: lung abscesses

Question 11

Mixed (anaerobic/aerobic) pneumonia.

Answer 11

Depressed consciousness and aspiration.
Signs/symptoms: loss of appetite, low grade fever, foul-smelling sputum, cough, lethargy, gram stain numerous organisms but no culture growth.
Complications: abscesses, tissue necrosis.

Question 12

Why is it necessary to distinguish between viral and bacterial pharyngitis?

Answer 12

To treat it correctly. Also viral is not as dangerous as bacterial because bacterial pharyngitis can cause rheumatic fever and glomerulonephritis.

Question 13

Why don’t we use antibiotics in otitis media?

Answer 13

Provides modest benefit in reducing symptoms. Resistance. Best use in children <6months or systemically I’ll (fever, vomiting) or immunocompromised patients.

Question 14

Why are viral infections important in sinusitis?

Answer 14

• viruses cause increased mucus production and swelling/obstruction of infundibula (passageway) that allow bacteria to colonise static fluid.
• nose blowing (not sneezing or coughing) increases intranasal pressure that propels bacteria into sterile sinuses.

Question 15

Why is acute epiglottis rare?

Answer 15

Hib (haemophilus influenzae type B) conjugate vaccine is very effective.

Question 16

What are the risk factors for pneumonia?

Answer 16

Smoking, old age, diabetes, splenectomy, chronic illness.

Question 17

What are 3 ways microbes gain entry to the LFT?

Answer 17

• Aspiration of resident flora in altered consciousness
• spread through blood
• inhalation of infectious aerosols