URT infections

Question 1

What is Stridor?

Answer 1

High-pitched whistling sound during breathing
- predominantly inspiratory wheeze due to large airway obstructionn

Question 2

Causes of stridor

Answer 2

(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

Question 3

What investigation should you be careful with if you have/ suspect acute epiglottitis?

Answer 3

Laryngoscopy

Question 4

Explain what is an emergency - cricothyroidotomy

Answer 4

Cricothyroidotomy involves puncturing the cricothyroid membrane to establish an airway

Question 5

Explain what is an emergency - tracheostomy?

Answer 5

Tracheostomy involves creating an opening in the trachea to establish an airway (C6 level)

Question 6

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?

Answer 6

Left brachiphellic vein

Question 7

What is croup mostly caused by and when would you mostly like to get it?

Answer 7

parainfluenza virus I, 2nd year of life

Question 8

Explain what is croup

Answer 8

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

Question 9

Clinical presentaion of croup

Answer 9

-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

Question 10

mild croup treatment

Answer 10

Managed at home

Question 11

Moderate to severe croup treatment

Answer 11

Requires hospital management -
dexamethasone and supportive care e.g. O2

Question 12

Most common cause of tonsillitis (viral + bacterial)

Answer 12

viral - EBV, rhinovirus, influenza, parainfluenza, enterovirus, adenovirus

bacterial- Strep. pyrogenes (Group A strep)

Question 13

40% are what?

Answer 13

beta-lactamase-producing

Question 14

What causes strep throat

Answer 14

inflamed tonsils and surrounding part of throat caused by Streptococcus

Question 15

What’s the difference between viral and bacterial tonsillitis?

Answer 15

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.

Question 16

Why are throat swabs not routinely done for tonsillitis in primary care?

Answer 16

Throat swabs are often unhelpful as they may not accurately reflect the bacteria causing the infection

Question 17

What scoring systems are used to determine if antibiotics are needed for tonsillitis caused by Strep. pyogenes?

Answer 17

Centor criteria + FeverPAIN criteria

Question 18

Explain centre criteria

Answer 18

Points given for tonsillar exudate, tender anterior cervical lymph nodes, history of fever, absence of cough.

Question 19

Explain FeverPAIN criteria

Answer 19

Points given for purulence, attending rapidly (within 3 days), very inflamed tonsils, and absence of cough

Question 20

When is tonsillectomy recommended?

Answer 20

for recurrent severe sore throat due to acute tonsillitis in adults

Question 21

When should antibiotics be used for tonsillitis?

Answer 21

Prescribe antibiotics if the cause is bacterial, like Strep. pyogenes.
Use scoring systems to decide if antibiotics are necessary

Question 22

How should severely unwell patients with tonsillitis be managed in secondary care?

Answer 22

Admit them to the hospital if they have trouble breathing, severe dehydration, or other serious symptoms.

Treat with IV fluids, antibiotics, and steroids

Question 23

For children with mild sore throats whats the best course of action?

Answer 23

‘watchful waiting’

Question 24

What is Lemierre syndrome?

Answer 24

rare complication of tonsillitis caused by Strep. pyogenes infection. It involves suppurative thrombophlebitis of the jugular vein

Question 25

Ddefine rhinitis

Answer 25

refers to the inflammation of nasal tissues

Question 26

Define Rhinorrhea

Answer 26

refers to a thin, mostly clear nasal discharge

Question 27

Pathophysiology of Allergic rhinitis

Answer 27

1. Inhalation of allergen increases specific IgE levels
2. IgE binds to receptors on mast cells and basophils
3. Re-exposure to an allergen causes degranulation of mast cells and basophils → release of inflammatory mediators e.g. histamine
4. This causes acute rhinorrhoea, itching and sneezing
5. Recruitment of lymphocytes and eosinophils causes the delayed response

Question 28

Pathophysiology of non-allergic rhinitis

Answer 28

Any rhinitis that does not involve IgE e.g. viral infection or hormonal imbalance

Question 29

Clinical presentation of rhinitis

Answer 29

• Rhinorrhoea (‘runny nose)
• Sneezing
• Itching
• Nasal congestion and obstruction

Question 30

Management of allergic rhinitis

Answer 30

(1) Antihistamines (1st line)
- loratadine
(2) Glucocorticoids (several weeks)
(3) SAMA
- Ipratoprium
(4) LTRA
- Monteleukast
(5) Vasoconstrictors
- Oxymetazoline

Question 31

What is Diphtheria?

Answer 31

• Life-threatening bacterial throat infection (toxins)
• Characteristic pseudo-membrane
• Not seen in the UK - vaccination

= plaque looking thing stuck at back of throat

Question 32

Clinical presentation of sinuses

Answer 32

• Frontal headache
• Toothache
• Nasal discharge

Question 33

Causes of Epiglottitis are what?

Answer 33

(1) Streptococcus spp. (most common),
(2) Staph. aureus and Pseudomonas spp

Question 34

Investigations for Epiglottitis include what?

Answer 34

Laryngoscopy - gold standard

Lateral neck X-ray - may show the ‘thumbprint sign’

Question 35

Management for Epiglottitis is what?

Answer 35

Phone on-call anaesthetist

Ceftriaxone (a type of cephalosporin)

Question 36

FeverPAIN stands for what?
(FPAIN)

Answer 36

Fever (during previous 24hrs)
Pus (on tonsils)
Attended rapidly (within 3 days)
Inflamed tonsils (severely )
No cough or coryza

Question 37

Incubation time for Rhinoviruses

Answer 37

1-5 days

Question 38

Incubation time for Group A streptococci

Answer 38

1-5 days

Question 39

Incubation time for Pertussis (whooping cough)

Answer 39

7-21 days

Question 40

Incubation time for Diphtheria

Answer 40

1-10 days

Question 41

Incubation time for EBV

Answer 41

4-6 weeks

Question 42

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?

Answer 42

Bronchiolitis

Question 43

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?

Answer 43

Idiopathic pulmonary fibrosis

Question 44

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?

Answer 44

Idiopathic pulmonary fibrosis