URTI

Question 1

innate immunity against URTI

Answer 1

1) nostril hair lining traps organism
2) mucous trap organism
3) angle between pharynx & nose -> prevent particles from falling into airways
4) mucocilliary system in lower airways transport pathogen back to pharynx
5) adenoids & tonsils contain immunological cells that attack pathogens

Question 2

management of URTI

Answer 2

1) symptomatic
2) Abx
3) prevent recurrence by managing/reducing risk factors

Question 3

initiation of treatment for influenza

Answer 3

• initiate antiviral ASAP from symptoms onset if pt have any of

1) hospitalised
2) high risk for complications
3) severe, complicated, progressive illness

Question 4

types of antivirals for influenza

Answer 4

PO oseltamivir

• active against influenza A & B
• MOA: neuraminidase inhibitor, interfere w protein cleavage -> X release of new virus
• dose adjust if renal impair
• generally well tolerated

Question 5

what type of vaccination is used for influenza

Answer 5

• inactivated trivalent/quadrivalent vaccine
• updated every year based on predicted predominant strain for season
• northern hemisphere seasons: Nov-Feb
• southern hemisphere season: May-Jul

Question 6

clinical presentation of pharyngitis

Answer 6

1) sore throat (worse w swallowing)
2) fever
3) erythema & inflammation of pharynx & tonsils w/wo patchy exudates
4) tender & swollen lymph nodes

Question 7

difference between viral & bacterial pharyngitis

Answer 7

viral: low grade fever, malaise, rhinorrhoea, cough, hoarseness, oropharyngeal lesions, conjunct

bacterial: sore throat w tonsillar exudates, fever, cervical lymphadenopathy wo typical viral symptoms

Question 8

bacterial pharyngitis complications

Answer 8

• appear 2-3 wks later
• acute rheumatic fever
  ** prevented w early initiation of Abx
  ** arthritis, endocarditis, subcutaneous nodules, damage to heart valves
• acute glomerulonephritis
  ** X preventable w early initiation of Abx

Question 9

likely pathogen for bacterial pharyngitis

Answer 9

• group A beta haemolytic streptococcus (pyogene)

Question 10

modified centor criteria copmonents (pharyngitis)

Answer 10

(1 point each)

1) fever > 38
2) swollen, tender anterior cervical lymph nodes
3) tonsillar exudate
4) absence of cough
5) 3-14 yo (15-44 yo 0 points, > 45 yo -1 point)

Question 11

scoring for modified centor criteria (pharyngitis)

Answer 11

1) 0/1

• X additional testing
• presume viral
• X Abx

2) 2/3

• test for S. pyogenes -> treat w Abx if +ve

3) 4/5

• high risk for S. pyogenes
• initiate empiric Abx

Question 12

choice of therapy for pharyngitis

Answer 12

1st line

• PO penicillin or PO amoxicillin

penicillin allergy

• non severe: PO cephalexin
• PO clindamycin

duration of treatment 10 days

Question 13

pathogenesis of acute rhinosinusitis

Answer 13

• direct contact w droplets of infected saliva/nasal secretion
• Viral URTI -> bacterial sinusitis
  ** inflammation -> sinus obstruction -> nasal mucosal secretions trapped -> medium of bacterial trapping & multiplication

Question 14

S&S of acute rhinosinusitis

Answer 14

purulent nasal discharge, facial pain/pressure, fever, nasal congestion/obstruction, reduced sense of taste/smell, headache, cough, ear fulness/pressure, bad breath, dental pain

Question 15

when to refer to emergency for acute rhinosinusitis

Answer 15

1) limited ocular movement
2) acute vision changes
3) confusion
4) unilateral weakness

Question 16

likely pathogen for acute rhinosinusitis

Answer 16

• viral > common than bacteria
• bacteria
  ** most common: strep pneumoniae, haemophilus influenzae

Question 17

when is Abx indicated for acute rhinosinusitis

Answer 17

1/> of:

1) symptoms persist > 10 days wo clinical improvement
2) symptoms severe > 3 consecutive days

• fever > 39, purulent nasal discharge, facial pain

3) symptoms worsen after initial period of improvement for 3 days

• new onset fever, headache, increased nasal discharge

Question 18

choice of therapy for acute rhinosinusitis

Answer 18

1st line

• PO augmentin

pen allergy

• non severe: PO cefuroxime
• severe: PO levofloxacin

duration 5-7days
X tetracycline, trimethoprim, sulfamethoxazole, macrolides cuz resistance