URTI Flashcards
What is Sinusitis? (Acute rhinosinusitis)
Inflammation of the mucosal liningsof the nasal passage and paranasal sinuses
How does sinusitis present?
- Nasal congestion
- Nasal discharge
- Facial pain or headache
- Facial pressure
- Facial swelling over the affected areas
- Loss of smell
List 4 causes of sinusitis
- Infection esp following a viral URTI
- Allergies ie. hayfever (with allergic rhinitis)
- Obstruction of drainage ie. foreign body, trauma or polyps
- Smoking
Label each of the sinuses on the image below
(1) Frontal sinuses
(2) Ethmoid sinuses
(3) Sphenoid sinuses
(4) Maxillary sinuses
What differentiates acute vs chronic rhinosinusitis?
Symptoms >12 wks are chronic
How do we diagnose acute sinusitis
Presence of nasal blockage (obstruction/congestion) OR nasal discharge
WITH
facial pain/pressure (or headache) and/or reduction (or loss) in sense of smell
List 2 DDx for acute sinusitis
- Viral upper respiratory tract infection
- Allergic rhinitis
- Facial pain syndromes (e.g. migraines)
Investigations for Sinusitis
Typically made on clinical symptoms alone
Investigations may incl Nasal endoscopy or CT scan
Management of Sinusitis
(For symptoms ≤ and ≥ 10 days)
≤ 10 days: analgesia + nasal decongestants
≥ 10 days: nasal steroid spray for 14 days and Abx (phenoxymethylpenicillin)
List 4 red flag symptoms for acute sinusitis that require ENT refferal
- A severe systemic infection
- Intraorbital or periorbital complications
- Intracranial complications
- Reduced concious levels
What is Tonsillitis?
Inflammation of the palatine tonsils, most commonly due to infection
Is Tonsillitis most commonly bacterial or viral?
Viral (2/3)
Bacterial (1/3)
What is the most common cause of bacterial tonsillitis?
Group A streptococcus (Streptococcus pyogenes)
How does Tonsillitis present?
- Sore throat
- Fever (above 38°C)
- Pain on swallowing
Examination findings of acute tonsilits?
- Red, inflamed and enlarged tonsils
- +/- exudates (white patches)
- May be anterior cervical lymphadenopathy
What is the Centor Criteria?
Used to estimate the probability that tonsillitis is due to bacterial infection and will benefit from antibiotics
Explain the Centor criteria
≥ 3 means 40-60 % probability of bacterial tonsillitis → offer antibiotics. Following is worth 1 pt each
- Fever > 38ºC
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymphadenopathy
What can be used as an alternative to the Centor critera?
FeverPAIN score
- Fever during previous 24 hours
- Purulence
- Attended within 3 days of the onset of symptoms
- Inflamed tonsils
- No cough or coryza
What values of the FeverPAIN score indicate likelihood of bacterial tonsillitis
- 2-3 = 34 – 40% probability
- 4-5 = 62 – 65% probability
Management of tonsillitis that is likely viral?
Educate patients and give safety net advice
Advise simple analgesia with paracetamol and ibuprofen to control pain and fever
What specific safety net advise would you give for tonsillitis?
- Return if the pain has not settled after 3 days OR
- If fever rises > 38.3ºC
List 4 instances where we may consider prescribing antibiotics in tonsilitis?
- Centor score is ≥ 3,
- FeverPAIN score is ≥ 4
- Young infants
- Immunocompromised
- Significant co-morbidities
- History of rheumatic fever
What is a delayed prescription?
Involves educating patients or parents about the likely viral nature of the sore throat and providing a prescription to be collected only if the symptoms worsen or do not improve in the next 2 – 3 days
First line antibiotics for tonsilitis?
Alternative if allergic?
- Phenoxymethylpenicillin for a 10-day course
- Clarithromycin if penicillin allergy
List 4 complications of Tonsilitis
- Peritonsillar abscess (quinsy)
- Otitis media
- Scarlet fever
- Rheumatic fever
- Post-streptococcal glomerulonephritis
- Post-streptococcal reactive arthritis
What is Epiglottitis?
Inflammation and swelling of the epiglottis caused by infection
Life threatening emergency
Most common causative organism of Epiglottitis
Haemophilus influenza type B
In which specific patient group must we have the highest suspicion of Epiglottitis?
Unvaccinated children
Routine vaccination programs protect against haemophilus
Presenting features suggesting Epiglottitis?
- Sore throat and stridor
- Drooling
- Tripod position
- Fever
- Difficulty or painful swallowing
Child may have a muffled voice or be scared and quiet. Keep a look out for signs of sepsis
Characteristic X-ray sign in acute epiglottitis
Lateral xray of the neck shows “thumb sign” or “thumbprint sign”
Caused by the oedematous and swollen epiglottis
Management of acute Epiglottitis
- Do NOT distress the patient - can prompt closure of the airway
- Alert paediatrician and anaesthetist (incase tracheostomy required)
- Secure the airway
- IV antibiotics (e.g. ceftriaxone)
- Steroids (i.e. dexamethasone)
Common complication of Epiglottitis?
Epiglottic abscess
Also threatens the airway, treatment similar to epiglottitis
