Upper Respiratory tract infections

Question 1

Otitis media

Answer 1

precipitated viral infection 
source: adenoid 
streptococcus pneumoniae, H influenzae 
fever and earache 
irritability when lying down 
acute purulent otorrhoea 
bulging and redness 
consider watchful wait 72 hours < 6m not severely ill and able f/u 
high dose amoxycillin - S pneumoniae
augmentin - H influenzae

Question 2

Otitis media with effusion

Answer 2

chronically blocked nose/adenoids 
eardrums retracted negative pressure 
mild moderate hearing loss 
> 3months = grommets 
no pain, tenderness, purulent drainage, bacterial infection or systemic symptoms

Question 3

Chronic otitis media

Answer 3

purulent discharge from middle ear + perforation eardrum more than 2 weeks
TB and HIV considered

dry mopping/cleaning
augmentin oral and topical eardrops
fluoroquinolone if no response - pseudomonas
persistance TM perforation = tympanoplasty

complication: Mastoiditis –> intra-cranial infection –> IV Rocephine

Question 4

Acute bacterial Rhino sinusitis

Answer 4

viral rhinitis progresses to a bacterial rhino-sinusitis
uncommon < 5 years
characteristics
- deterioration of common cold after 7 days
- headache
- purulent nasal discharge
- pain and tenderness over one or more sinuses
- fever

URTI presenting with

• persistent illness
• worsening course
• severe onset

High dose Amoxicillin
topical nasal decongestant and steroid
recurrent - remove adenoids

Complications - pre-septal cellulitis or orbital cellulitis and intracranial complications - meningitis, IC abscess, CST

Question 5

Tonsillitis or Pharyngitis

Answer 5

mostly viruses
20% bacteria - group A beta-haemolytic streptococci - strep pyogenes
Rheumatic heart fever

phenoxymethylpenicillin
benzathine penicillin
amoxicillin

complications - peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess
augmenter IV and surgical drainage