Upper Respiratory Tract Infections

Question 1

What is the Centor criteria used to assess?

Answer 1

To assess the likelihood of bacterial tonsillitis in patients

Question 2

What is assessed in the Centor criteria?

Answer 2

Cervical lymphadenopathy
Exudate (tonsillar)
No cough
Temperature raised

Abx indicated if score 3 or more

Question 3

Abx are indicated for a Centor score of what?

Answer 3

3 or more

Question 4

What would you advise a px complaining of a sore throat with a Centor score of 2?

Answer 4

Likely to be viral

So recommend analgesics, antipyretic, hydration, salt water gargles

Question 5

What are red flags for a px with a headache?

Answer 5

Age >50/ <10
Early morning waking with pain
Associated with posture
Vomiting
Head trauma
Neurological changes
Visual changes

Question 6

How does giant cell arthritis present?

Answer 6

Usually in >50s
Headache (subacute)
Jaw claudication

Question 7

How does a cluster headache typically present?

Answer 7

Rapid onset severe pain around one eye
Associated with watery eye, bloodshot, lid swelling, facial flushing, rhinorrhea
Clusters last 4-12 weeks then pain free periods of month or even 1-2years before the next cluster

Question 8

Where are cluster headaches typically felt?

Answer 8

Unilaterally around one eye

Question 9

What can precipitate cluster headaches?

Answer 9

Alcohol
Usually experienced at night
Smoking
Usually males

Question 10

How would you manage an acute attack of a cluster headache?

Answer 10

SC sumatriptan injection (if not, then nasal spray)

O2 100% given via non rebreathe mask for 15 mins up to 5 x per day

Question 11

What can be used for prophylaxis of cluster headache?

Answer 11

Verapamil (ECG monitor at high dose for risk of AV block)
Course of prednisolone
Lithium

Question 12

How do tension type headache present?

Answer 12

Often chronic
Bilateral
Generalised
Pressure/ tightness round the head
Can have pain in neck too
No photophobia/ phonophobia

Question 13

How should tension type headaches be managed?

Answer 13

Exercise
Minimise stress
Avoid opioids due to risk of precipitating medication induced headache
Simple analgesics, ibuprofen 1st line (naproxen, aspirin, paracetamol)
Amitriptylline if recurrent

Question 14

How do migraines typically present?

Answer 14

May be associated with aura
Classically unilateral throbbing headache
Photophobia
Phonophobia
Allodynia
May have trigger factors

Question 15

How would you manage a px with migraines?

Answer 15

Avoid trigger factors

1. Simple analgesics e.g. ibuprofen
2. Triptans (5HT receptor agonists)
3. If weekly, consider prophylaxis e.g. beta blocker, amitriptylline