URT conditions and infections II

Question 1

Bacterial sinusitis definition

Answer 1

Bacterial infection of one or more paranasal sinuses that occurs most often after a
viral nasal infection or allergic rhinitis.

Question 2

Bacterial sinusitis characteristics (6)

Answer 2

» Deterioration of a common cold after 5–7 days.
» Headache.
» Purulent nasal discharge, especially if unilateral.
» Pain and tenderness over one or more sinuses.
» Nasal obstruction.
» Fever.

Question 3

At what age can a person have sinusitis?

Answer 3

Sinusitis is uncommon in children < 5 years of age, as sinuses are not fully
developed

Question 4

Drug Tx for acute bacterial sinusitis

Answer 4

Amoxicillin for 5 days (Pen allergy: azithromycin for 3 days)
AND
* Oxymetazoline nose drops (not more than 5 days!)
AND/OR
* Sodium chloride 0.5% nose drops
For pain and fever:
* Paracetamol

Question 5

Describe pharyngotonsilitis

Answer 5

A painful red throat and/or enlarged inflamed tonsils. White pus
exudates, either spots or patches, may be present. Tender anterior
cervical lymphadenopathy may be present.

Question 6

Causes of pharyngotonsilitis

Answer 6

Viruses cause the majority of cases. Group A beta haemolytic
streptococcus causes 20% of pharyngitis/tonsillitis and may result in
rheumatic fever (which can cause serious heart disease) as well as
local suppurative complications.

Question 7

Clinical features associated with streptococcal infection

Answer 7

palatal petechiae, inflamed tongue mucosal papillae
(strawberry tongue), a scarlitiniform (i.e.: rough, diffuse, fine papular)
rash

Question 8

Signs of bacterial pharyngotonsilitis

Answer 8

Red, swollen tonsils with white spots, red swollen uvula, red sore throat, gray furry tongue

Question 9

measures for acute pharyngotonsilitis

Answer 9

Homemade salt mouthwash, gargle for 1 minute twice daily:
* 2.5 mL (½ medicine measure) of table salt in 200 mL lukewarm water.
* Do not give to children unable to gargle.
* Advise adequate hydration.
* Avoid irritants e.g. vaporubs inserted into nostrils.

Question 10

measures for acute pharyngotonsilitis in children < 6yrs

Answer 10

Soothe the throat with breastmilk. If
not exclusively breastfed, give warm water or weak tea: add sugar or
honey and lemon if available.

Question 11

Which signs tell you to use antibiotics in pts with acute pharyngotonsilitis?

Answer 11

Acute onset
Fever 38 deg
anterior cervical lymphadenopathy
white patches or pus on tonsils
hx of rheumatic fever or rheumatic heart disease
PCT>0.25ng/ml

Question 12

Who should be given antibiotics for sore throat?

Answer 12

Antibiotics to eradicate streptococci must be given to patients
presenting with a sore throat who are at risk for rheumatic fever (3
21 years of age) if they have:
* Enlarged tonsils;
* PLUS at least one of the following criteria:
* Exudates on their tonsils
* No cough
* No runny nose

Question 13

Drug treatment for acute pharyngotonsilitis

Answer 13

Benzathine benzyl penicillin, IM, single dose
* OR
* Amoxicillin, PO, 1000mg 12 hourly for 10 days
* OR
* Phenoxymethylpenicillin, PO, 500mg 12 hourly for 10 days
* Severe penicillin allergy
* Macrolide: Azithromycin 500mg daily for 3 day

Question 14

What drug-virus interaction causes cause skin rash in children?

Answer 14

Interesting drug-disease interaction between amoxicillin and
ampicillin and Epstein-Bar virus: cause skin rash in children
It is thought to induce the reactivation of EBV, leading to a skin eruption

Question 15

When do you refer a pt with acute pharyngotonsilitis?

Answer 15

Any suppurative complications, e.g. retropharyngeal or peritonsillar
abscess.
* Tonsillitis accompanied by difficulty in opening the mouth (trismus).
* Recurrent tonsillitis (≥ 6 documented episodes/year) for possible
tonsillectomy.
* Suspected acute rheumatic fever.
* Suspected acute glomerulonephritis.
* Heart murmurs not previously diagnosed.

Question 16

Explain rheumatic fever

Answer 16

A condition in which the body develops antibodies against its own tissues,
following a streptococcal throat infection. Effective treatment of
streptococcal pharyngitis can markedly reduce the occurrence of this
disease

Question 17

Age at risk of rheumatic fever

Answer 17

Commonly occurs in children, 3–15 years of age.

Question 18

Signs and symptoms of rheumatic fever (7)

Answer 18

arthralgia or arthritis that may shift from one joint to another
* carditis including cardiac failure
* heart murmurs
* subcutaneous nodules
* erythema marginatum
* chorea (involuntary movements of limbs or face)
* other complaints indicating a systemic illness e.g. fever

Question 19

Medicine tx of rheumatic fever

Answer 19

Eradication of streptococci in throat:
* Phenoxymethylpenicillin / amoxicillin, po, for 10 days / benzathine benzylpenicillin, im, stat (severe pen allergy) azithromycin

Question 20

Prophylaxis for rheumatic fever

Answer 20

All patients with confirmed rheumatic fever and no persistent
rheumatic valvular disease
* Treat for 10 years or until the age of 21 years, whichever is longer.

Question 21

Define rheumatic heart disease

Answer 21

These are chronic sequelae of rheumatic fever consisting of valvular
damage, usually involving left heart valves, with progression and
complications.

Question 22

Mx of acute phase of rheumatic heart disease

Answer 22

bed rest and supportive care

Question 23

Drug tx of rheumatic heart disease

Answer 23

• All patients with confirmed rheumatic fever and persistent rheumatic
  valvular disease:
  Treat lifelong.
• Benzathine benzylpenicillin (depot formulation), IM, every 3–4 weeks
  (preferred treatment).
• OR
• Phenoxymethylpenicillin, oral, 12 hourly.
• Severe penicillin allergy: Macrolide, e.g.: Azithromycin, oral, daily