URTI

Question 1

Main differences between common cold and influenza symptoms?

Answer 1

Common cold: gradual onset, sneezing, stuffy nose, sore throat, mild-moderate cough

Influenza: sudden onset, fever, aches, chills, cough, headache

Question 2

Which influenza strain can cause pandemics? What are the 2 proteins on its surface?

Answer 2

Influenza A
Hemagglutinin (H) & neuraminidase (N)

Question 3

Which is the mildest influenza?

Answer 3

Influenza C

Question 4

Can influenza B be split into different classifications?

Answer 4

Yes, B/Yamagata and B/Victoria

Question 5

What is the treatment for influenza, the time to initiate and dose?

Answer 5

Oseltamivir PO 75mg BD x 5 days
within 48h of symptom onset

Question 6

Does oseltamivir require renal impairment adjustment?

Answer 6

Yes, CrCl <60ml/min need to adjust

Question 7

What is the dose and duration of oseltamivir in children?

Answer 7

For ≥1 year old:
≤ 15kg: 30mg
>15-23kg: 45mg
>23-40kg: 60mg
>40kg: 75mg
BD, 5 days

Question 8

Side effects of oseltamivir?

Answer 8

N/V/D, HA, stomach upset (take after food)
Rare: hallucination, mood or behaviour change

Question 9

What kind of vaccine is the influenza vaccine? How is it administered? What is the minimum age?

Answer 9

Inactivated, IM, 6 months

Question 10

When are the Northern and Southern hemisphere seasons?

Answer 10

Northern: Nov to Feb
Southern: May to Jul

Question 11

Difference between viral and bacterial pharyngitis?

Answer 11

Bacterial has tonsillar exudates and hypertrophy while viral does not

Viral has other symptoms like cough, rhinorrhoea etc but bacterial only has fever, tonsillar exudates, cervical lymphadenopathy

Question 12

What is the bacteria that causes pharyngitis?

Answer 12

S. pyogenes (Strep Group A)

Question 13

What is the modified centor criteria for pharyngitis?

Answer 13

Fever >38: 1
Swollen, tender anterior cervical lymph nodes: 1
Tonsillar exudate: 1
Absence of cough: 1
Age
- 3-14 years: 1
- 15-44 years: 0
- ≥45 years: -1

Question 14

What do the different number of points for the modified centor criteria mean?

Answer 14

0-1: presumed viral, no antibiotics
2-3: test for S pyogenes pharyngitis, treat with abx if positive
4-5: treat with empiric abx

Question 15

Treatment for bacterial pharyngitis? including duration and alternatives

Answer 15

• PO penicillin 250mg QDS
• PO amoxicillin 500mg BD

Alternatives if penicillin allergy:
- if not allergic to amoxicillin: PO cephalexin 500mg BD
- PO azithromycin: 500mg OD (for 5 days)
- PO clarithromycin: 250mg BD
- PO clindamycin 300mg TDS

Duration: 10 days (except azithromycin)

Question 16

Red flags for rhinosinusitis?

Answer 16

Unilateral weakness, confusion, acute vision changes, limited ocular movements -> spread to orbits/CNS

Question 17

Common bacteria causing rhinosinusitis?

Answer 17

Strep pneumo, Haemophilus influenzae

Question 18

When to treat sinusitis with antibiotics?

Answer 18

• sx persist >10D without clinical improvement
• sx are severe (fever >39, purulent nasal discharge, facial pain >3 consecutive days)
• sx worsen (new onset fever, HA, increased nasal discharge) after an initial period of improvement for >3 days

Question 19

Treatment for sinusitis? and duration

Answer 19

• PO amoxicillin 500mg TDS
• PO augmentin 625mg TDS (target H influenza -> have beta lactamase)

Penicillin allergy:
- PO cefuroxime 500mg BD
- PO levofloxacin 500mg OD or moxifloxacin 400mg OD

Duration: 5-7 days