URTI

Question 1

What are the causes of tonsillitis?

Answer 1

Viral – adenovirus, rhinovirus, influenza, RSV

Bacterial – strep pyogenes (group A)

Question 2

Outline the pathophysiology of tonsillitis

Answer 2

Inflammatory infection of the tonsils caused by invasion of the mucous membrane by microorganisms.

Subtype of pharyngitis

Question 3

What are the signs and symptoms of tonsillitis?

Answer 3

Red, swollen tonsils

White or yellow coating or patches on the tonsils

Sore throat

Difficult or painful swallowing

Fever

Lymphadenopathy

A scratchy, muffled or throaty voice

Bad breath

Stomach-ache, particularly in younger children

Stiff neck

Headache

Question 4

How should tonsillitis be investigated?

Answer 4

Centor criteria: (3/4 40-60% GABHS)

• Absence of cough
• Tonsillar exudates (ooze)
• High fever
• Tender anterior cervical LN

Throat exam

Throat swab (if bacterial suspected)

Fever/pain score

Question 5

How is tonsillitis best managed?

Answer 5

Rest, hydration, saltwater gargle, lozenges, avoid irritants, ibuprofen/paracetamol

Abx – amoxicillin (1/3 bacterial)

Surgery – tonsillectomy

Pustular = penicillin V for 10d, paracetamol, difflam spray

Question 6

Outline the possible complications of tonsillitis

Answer 6

Difficulty breathing

Obstructive sleep apnoea

Tonsillar cellulitis

Peritonsillar abscess

Question 7

Outline the details of a common cold

Answer 7

Aetiology = viral – rhinovirus

Pathophysiology = viral infection of the URT, transmitted via airborne droplets.

S+S = cough, runny nose, sneezing, nasal congestion, sore throat, muscle ache, fatigue, headache, loss of appetite

Investigations = clinical diagnosis, Fever/pain score

Management = ibuprofen, rest, hydration, salt-water gargle

Complications = otitis media, sinusitis

Question 8

Outline the aetiology and pathophysiology of otitis media

Answer 8

Acute middle ear infection. More common in infants, children than in adults (eustachian tube shorter and more horizontal = easier passage for infection from nasopharynx, can block easily, increased risk of infection)

Bacterial = H. influenzae S. pneumoniae, S. pyogenes (All common upper resp track MO)

Viral = Respiratory Syncitial Virus, Rhinovirus

Question 9

What are the signs and symptoms of acute otitis media?

Answer 9

Otalgia (infants pull/tug at the ear)

Fever

Red +/- bulging TM and loss of normal landmarks

Malaise

Erythematous TM

TM perforation with discharge

Conductive hearing loss

Cervical lymphadenopathy

Question 10

How should acute otitis media be investigated?

Answer 10

Function of facial nerve

LN exam

Throat and oral cavity examination

FBC, CRP

Discharge = C+S

Question 11

What is the best management for acute otitis media?

Answer 11

Majority resolve within 1-3 days - watch and wait

Oral fluids, analgesia

Oral Abx (commonly amoxicillin) = Systemically unwell children, congenital heart disease, immunosuppression, >4 days, discharge

Question 12

What are the possible complications of acute otitis media?

Answer 12

TM perforation

Facial N involvement

Mastoiditis

Intracranial complications

Meningitis

Sigmoid sinus thrombosis

Brain abscess

Question 13

What is croup?

Answer 13

Layngotracheobronchitis

Tetrad of Sx = barking cough, hoarse voice, stridor, fever

Usually viral - parainfluenza, RSV, influenza virus

6m-6y (peak 2y)

S+S = fever, hoarse-voice, seal-like barking cough, stridor, sternal/ICS recession at rest

Ix = steeple sign on x-ray, wesley croup score

Tx = largely self-limiting, single dose oral dexamethasone, budesonide, neb adrenaline

DDx = epiglottitis, airway foreign body

Question 14

Outline acute epiglottitis

Answer 14

2-7y

Ae = H.influenza (vac decreased incidence)

S+S = febrile, tripod position, drooling, stridor

Mx = secure airway in theatre
- IV access, swabs, ceftriaxone, steroids