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Finals - CardioResp > URTI > Flashcards

URTI Flashcards

1
Q

What is Sinusitis? (Acute rhinosinusitis)

A

Inflammation of the mucosal liningsof the nasal passage and paranasal sinuses

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2
Q

How does sinusitis present?

A
  1. Nasal congestion
  2. Nasal discharge
  3. Facial pain or headache
  4. Facial pressure
  5. Facial swelling over the affected areas
  6. Loss of smell
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3
Q

List 4 causes of sinusitis

A
  1. Infection esp following a viral URTI
  2. Allergies ie. hayfever (with allergic rhinitis)
  3. Obstruction of drainage ie. foreign body, trauma or polyps
  4. Smoking
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4
Q

Label each of the sinuses on the image below

A

(1) Frontal sinuses
(2) Ethmoid sinuses
(3) Sphenoid sinuses
(4) Maxillary sinuses

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5
Q

What differentiates acute vs chronic rhinosinusitis?

A

Symptoms >12 wks are chronic

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6
Q

List 2 DDx for acute sinusitis

A
  1. Viral upper respiratory tract infection
  2. Allergic rhinitis
  3. Facial pain syndromes (e.g. migraines)
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7
Q

Investigations for Sinusitis

A

Typically made on clinical symptoms alone but may incl

  • Nasal endoscopy
  • CT scan
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8
Q

Management of Sinusitis

(For symptoms ≤ and ≥ 10 days)

A

≤ 10 days: analgesia + nasal decongestants

≥ 10 days: nasal steroid spray for 14 days and delayed Ab prescription (phenoxymethylpenicillin)

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9
Q

List 4 red flag symptoms for acute sinusitis that require ENT refferal

A
  1. A severe systemic infection
  2. Intraorbital or periorbital complications
  3. Intracranial complications
  4. Reduced concious levels
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10
Q

What is Tonsillitis?

A

Inflammation of the palatine tonsils, most commonly due to infection

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11
Q

Is Tonsillitis most commonly bacterial or viral?

A

Viral (2/3)

Bacterial (1/3)

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12
Q

What is the most common cause of bacterial tonsillitis?

A

Group A streptococcus (Streptococcus pyogenes)

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13
Q

How does Tonsillitis present?

A
  1. Sore throat
  2. Fever (above 38°C)
  3. Pain on swallowing
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14
Q

Examination findings of acute tonsilits?

A
  1. Red, inflamed and enlarged tonsils
  2. +/- exudates (white patches)
  3. May be anterior cervical lymphadenopathy
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15
Q

What is the Centor Criteria?

A

Used to estimate the probability that tonsillitis is due to bacterial infection and will benefit from antibiotics

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16
Q

Explain the Centor criteria

A

≥ 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
17
Q

What can be used as an alternative to the Centor critera?

A

FeverPAIN score

  • Fever during previous 24 hours
  • Purulence
  • Attended within 3 days of the onset of symptoms
  • Inflamed tonsils
  • No cough or coryza
18
Q

What values of the FeverPAIN score indicate likelihood of bacterial tonsillitis

A
  • 2-3 = 34 – 40% probability
  • 4-5 = 62 – 65% probability
19
Q

Management of tonsillitis that is likely viral?

A

Educate patients and give safety net advice

Advise simple analgesia with paracetamol and ibuprofen to control pain and fever

20
Q

What specific safety net advise would you give for tonsillitis?

A
  1. Return if the pain has not settled after 3 days OR
  2. If fever rises > 38.3ºC
21
Q

List 4 instances where we may consider prescribing antibiotics in tonsilitis?

A
  1. Centor score is ≥ 3,
  2. FeverPAIN score is ≥ 4
  3. Young infants
  4. Immunocompromised
  5. Significant co-morbidities
  6. History of rheumatic fever
22
Q

What is a delayed prescription?

A

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

23
Q

First line antibiotics for tonsilitis?

Alternative if allergic?

A
  1. Phenoxymethylpenicillin for a 10-day course
  2. Clarithromycin if penicillin allergy
24
Q

List 4 complications of Tonsilitis

A
  1. Peritonsillar abscess (quinsy)
  2. Otitis media
  3. Scarlet fever
  4. Rheumatic fever
  5. Post-streptococcal glomerulonephritis
  6. Post-streptococcal reactive arthritis
25
Q

What is Epiglottitis?

A

Inflammation and swelling of the epiglottis caused by infection

Life threatening emergency

26
Q

Most common causative organism of Epiglottitis

A

Haemophilus influenza type B

27
Q

In which specific patient group must we have the highest suspicion of Epiglottitis?

A

Unvaccinated children

Routine vaccination programs protect against haemophilus

28
Q

Presenting features suggesting Epiglottitis?

A
  1. Sore throat and stridor
  2. Drooling
  3. Tripod position
  4. Fever
  5. Difficulty or painful swallowing

Child may have a muffled voice or be scared and quiet. Keep a look out for signs of sepsis

29
Q

Characteristic X-ray sign in acute epiglottitis

A

Lateral xray of the neck shows “thumb sign” or “thumbprint sign”

Caused by the oedematous and swollen epiglottis

30
Q

Management of acute Epiglottitis

A
  1. Do NOT distress the patient - can prompt closure of the airway
  2. Alert paediatrician and anaesthetist (incase tracheostomy required)
  3. Secure the airway
  4. IV antibiotics (e.g. ceftriaxone)
  5. Steroids (i.e. dexamethasone)
31
Q

Common complication of Epiglottitis?

A

Epiglottic abscess

Also threatens the airway, treatment similar to epiglottitis

Finals - CardioResp (18 decks)

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