Upper Respiratory Tract Infections

Question 1

URTI are mainly caused by which organisms?

Answer 1

viral (but we say self-limiting)

Question 2

In short, what is the best way to treat URTIs?

3

Answer 2

1. clear fluids with sugar
2. paracetamol
3. time

Question 3

What are the main clinical dilemmas associated with URTIs?

How do you get around these issues?

Answer 3

1. viral or bacterial
2. fever present - do you treat with abx

Review patients id unsure - parents can do this!

Question 4

Is rhinitis viral or bacterial?

What are the common symptoms?

Answer 4

mainly viral, but could be bacterial

rhinorrhea (runny nose)
congested nose
headache
sneezing
sore throat

Question 5

How long does rhinorrhea last usually?

Answer 5

14 days

Question 6

Is otitis media viral or bacterial?

What are the common symptoms?

Answer 6

mainly viral, but abx could help

ear ache
fever
loss of appetite/thirst
purulent discharge
URTI symptoms
diarrhoea (in infants)

Question 7

When would you treat otitis media?

Answer 7

• children <24months with bilateral AOM

- severe unilateral

Question 8

What is the duration of ear ache?

Answer 8

3-7 days

Question 9

What antibiotics would be used to treat otitis media?

3

Answer 9

narrow spectrum (e.g. amoxicillin)
co-amoxiclav
azithromycin (less side effects)

Question 10

Is tonsillitis/pharyngitis viral or bacterial?

What are the common symptoms?

Answer 10

mainly viral, but can also be bacterial

sore throat
fever
difficulty swallowing
cough
swollen neck glands

Question 11

What can be used to determine whether the tonsillitis is viral or bacterial?

Answer 11

CENT score

Cough
Exudate
Nodes
Temperature

score of 3-4 = bacterial, treat with abx

Question 12

What is the likely causative agent of bacterial tonsillitis?

Answer 12

Group A streptococcus

Question 13

How would tonsillitis be managed?

Answer 13

• symptomatic relief (NSAIDs, paracetamol)
• abx (penicillin, not amoxicillin)

other abx (co-amoxiclav, clindamycin)
penicillin allergy - azithromycin/erythromycin

Question 14

How long does symptoms last for tonsillitis?

Answer 14

3-7 days

Question 15

Why do we not prescribe amoxicillin for tonsillitis?

Answer 15

If px has glandular fever, amoxicillin will develop a rash

Question 16

What are the symptoms of croup (laryngotracheobronchitis)?

What is the duration of croup?

Answer 16

"barking" cough
stridor
hoarseness in voice
fever
rhinorrhea 

3 days

Question 17

How is croup treated?

Answer 17

corticosteroids (dexamethosone)
epinephrine nebulised (if severe)
O2 therapy (if sats below 92%)

Question 18

If there was a secondary bacterial infection along with croup, which antibiotics would be used to treat this?

Answer 18

vancomycin

cefotaxime

Question 19

What are the symptoms and clinical signs of epiglottitis?

Answer 19

difficulty swallowing
drooling
fever
tachypnoea
changes to the voice
throat pain

signs = leaning forward, cyanosis, stridor

Question 20

How is epiglottitis managed?

Answer 20

airway management (ET intubation)
IV antibiotics (ceftriaxone, vancomycin, clindamycin)
corticosteroids 
nebulised epinephrine (possibly)