URT infections Flashcards
What is Stridor?
High-pitched whistling sound during breathing
- predominantly inspiratory wheeze due to large airway obstructionn
Causes of stridor
(1) In children - most commonly infections (croup, epiglottitis), or a foreign body obstructing airway
(2) In adults - most commonly due to tumours
(3) Other causes include anaphylaxis and trauma
What investigation should you be careful with if you have/ suspect acute epiglottitis?
Laryngoscopy
Explain what is an emergency - cricothyroidotomy
Cricothyroidotomy involves puncturing the cricothyroid membrane to establish an airway
Explain what is an emergency - tracheostomy?
Tracheostomy involves creating an opening in the trachea to establish an airway (C6 level)
A 22-year-old female presents to the emergency department with severe neck trauma after getting hit with a hockey puck. An emergency tracheostomy is performed to bypass the damaged airway. Which of the following structures is most susceptible to damage during the procedure?
Left brachiphellic vein
What is croup mostly caused by and when would you mostly like to get it?
parainfluenza virus I, 2nd year of life
Explain what is croup
A viral URTI which causesnasopharyngeal inflammation that may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway at its narrowest portion
→ Movement of vocal cords is impaired leading to characteristic cough
Clinical presentaion of croup
-Normally starts with nonspecific symptoms of viral URTI →
= runny nose, sore throat, fever and cough
This progresses throughout a couple of days to include the characteristic
= barking cough, hoarseness and stridor; these symptoms tend to be worse at night
mild croup treatment
Managed at home
Moderate to severe croup treatment
Requires hospital management -
dexamethasone and supportive care e.g. O2
Most common cause of tonsillitis (viral + bacterial)
viral - EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus
bacterial- Strep. pyrogenes (Group A strep)
40% are what?
beta-lactamase-producing
What causes strep throat
inflamed tonsils and surrounding part of throat caused by Streptococcus
What’s the difference between viral and bacterial tonsillitis?
Viral tonsillitis:
Mild symptoms like sore throat, and low-grade fever, lasts 3-4 days.
Tolerable discomfort, able to do normal activities.
Bacterial tonsillitis:
Severe symptoms like high fever, and swollen and red tonsils, lasts about a week.
Painful swallowing, feeling very unwell, may need antibiotics.
Why are throat swabs not routinely done for tonsillitis in primary care?
Throat swabs are often unhelpful as they may not accurately reflect the bacteria causing the infection
What scoring systems are used to determine if antibiotics are needed for tonsillitis caused by Strep. pyogenes?
Centor criteria + FeverPAIN criteria
Explain centre criteria
Points given for tonsillar exudate, tender anterior cervical lymph nodes, history of fever, absence of cough.
Explain FeverPAIN criteria
Points given for purulence, attending rapidly (within 3 days), very inflamed tonsils, and absence of cough
When is tonsillectomy recommended?
for recurrent severe sore throat due to acute tonsillitis in adults
When should antibiotics be used for tonsillitis?
Prescribe antibiotics if the cause is bacterial, like Strep. pyogenes.
Use scoring systems to decide if antibiotics are necessary
How should severely unwell patients with tonsillitis be managed in secondary care?
Admit them to the hospital if they have trouble breathing, severe dehydration, or other serious symptoms.
Treat with IV fluids, antibiotics, and steroids
For children with mild sore throats whats the best course of action?
‘watchful waiting’
What is Lemierre syndrome?
rare complication of tonsillitis caused by Strep. pyogenes infection. It involves suppurative thrombophlebitis of the jugular vein
Ddefine rhinitis
refers to the inflammation of nasal tissues
Define Rhinorrhea
refers to a thin, mostly clear nasal discharge
Pathophysiology of Allergic rhinitis
- Inhalation of allergen increases specific IgE levels
- IgE binds to receptors on mast cells and basophils
- Re-exposure to an allergen causes degranulation of mast cells and basophils → release of inflammatory mediators e.g. histamine
- This causes acute rhinorrhoea, itching and sneezing
- Recruitment of lymphocytes and eosinophils causes the delayed response
Pathophysiology of non-allergic rhinitis
Any rhinitis that does not involve IgE e.g. viral infection or hormonal imbalance
Clinical presentation of rhinitis
- Rhinorrhoea (‘runny nose)
- Sneezing
- Itching
- Nasal congestion and obstruction
Management of allergic rhinitis
(1) Antihistamines (1st line)
- loratadine
(2) Glucocorticoids (several weeks)
(3) SAMA
- Ipratoprium
(4) LTRA
- Monteleukast
(5) Vasoconstrictors
- Oxymetazoline
What is Diphtheria?
- Life-threatening bacterial throat infection (toxins)
- Characteristic pseudo-membrane
- Not seen in the UK - vaccination
= plaque looking thing stuck at back of throat
Clinical presentation of sinuses
- Frontal headache
- Toothache
- Nasal discharge
Causes of Epiglottitis are what?
(1) Streptococcus spp. (most common),
(2) Staph. aureus and Pseudomonas spp
Investigations for Epiglottitis include what?
Laryngoscopy - gold standard
Lateral neck X-ray - may show the ‘thumbprint sign’
Management for Epiglottitis is what?
Phone on-call anaesthetist
Ceftriaxone (a type of cephalosporin)
FeverPAIN stands for what?
(FPAIN)
Fever (during previous 24hrs)
Pus (on tonsils)
Attended rapidly (within 3 days)
Inflamed tonsils (severely )
No cough or coryza
Incubation time for Rhinoviruses
1-5 days
Incubation time for Group A streptococci
1-5 days
Incubation time for Pertussis (whooping cough)
7-21 days
Incubation time for Diphtheria
1-10 days
Incubation time for EBV
4-6 weeks
A 6-month-old child is brought to A&E in December. Her mum says the
child has been suffering from a cold but now has a cough and is struggling
for breathe. On examination, there is an intercostal recession, an audible wheeze
and crackles on auscultation.
What is the MOST LIKELY diagnosis?
Bronchiolitis
A 69-year-old woman attends the respiratory clinic after a referral from
primary care. She has a six-month history of increasing breathlessness and a
non-productive cough with no weight loss or other systemic symptoms.
Upon examination, she has finger clubbing and fine inspiratory basal crackles
can be heard on auscultation. She is referred for a high-resolution CT scan
(HRCT).
What is the MOST LIKELY diagnosis?
Idiopathic pulmonary fibrosis
A 52-year-old schoolteacher presents with progressive shortness of breath
over the past year, chest pain, fatigue
and weight loss. Her spirometry results
provide evidence of restrictive lung
disease with impaired gas exchange.
The following is a chest CT taken from
the patient. What is the diagnosis?
Idiopathic pulmonary fibrosis
