URTI Flashcards
Symptoms and signs of acute otitis media
Bulging tympanic membrane / otorrhoea
How to diagnose acute otitis media
examination
otoscopy- red, yellow, or cloudy tympanic membrane.
Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks and an air-fluid level behind the tympanic membrane (indicates a middle ear effusion).
Perforation of the tympanic membrane and/or discharge in the external auditory canal.
Management of otitis media including the antibiotics used
Usually leave to clear itself.
If not better after 3 days: rescribe a 5–7 day course of amoxicillin.
For people who are allergic to, or intolerant of, penicillin, prescribe a 5–7 day course of clarithromycin or erythromycin (erythromycin is preferred in pregnant women).
Symptoms and signs of chronic otitis media
Patients will present with a chronically discharging ear (for >6 weeks), in the absence of fever or otalgia
tympanic membrane will be perforated
How to diagnose chronic otitis media
If the person’s signs and symptoms suggest a serious complication, arrange urgent admission or assessment by an ear, nose, and throat (ENT) specialist using clinical judgement.
For all other people with suspected chronic suppurative otitis media (CSOM):
Do not swab the ear or initiate treatment.
Refer for ENT assessment.
Explain that secondary care treatment is likely to involve antibiotics and steroids (usually topical), and intensive cleaning of the affected ear.
Management of chronic otitis media including antibiotics used
The mainstay of treatment is aural toileting and topical antibiotic/steroid treatments until symptoms reduce or resolve.
Symptoms and signs of rhinitis
Stuffy nose. Runny nose. Sneezing. Mucus (phlegm) in the throat (postnasal drip) Cough.
Describe the pathogenesis and causative organisms of pharyngitis
Viruses as for rhinosinusitis but also EBV, CMV (mononucleosis / glandular fever)
Adenovirus: pharyngoconjunctival fever
Enteroviruses: herpangina- v sore throat and ulceration around posterior aspect of throat
β-haemolytic streptococci (esp. Group A)
Anaerobes (fusobacteria sp.)
Group A strep can be associated with rheumatic fever and glomerulonephritis
Signs and symptoms of acute sinusitis
pain, swelling and tenderness around your cheeks, eyes or forehead. a blocked nose. a reduced sense of smell. green or yellow mucus from your nose. a sinus headache. a high temperature. toothache. bad breath.
Diagnosis of acute sinusitis
In adults, it is diagnosed by the presence of nasal blockage or nasal discharge with facial pain/pressure (or headache) and/or reduction of the sense of smell.
Management of acute sinusitis including antibiotics given
For symptoms >10d with no improvement: Consider prescribing a high-dose nasal corticosteroid for 14 days for adults and children aged 12 years and over (for example, mometasone 200 micrograms twice a day [off-label use]), being aware that nasal corticosteroids
phenoxymethylpenicillin 500 mg four times a day for 5 days.
If systemically unwell- co-amox
Management of chronic sinusitis including antibiotics used
Avoiding triggers
Nasal irrigation
intranasal corticosteroids
refer to ENT
Diagnosis of pharyngitis
rapid antigen test for group A Streptococcus (GAS)
culture of throat swab for group A Streptococcus (GAS)
culture of throat swab for gonococcus or chlamydia
serum monospot for Epstein-Barr virus infection
polymerase chain reaction for group A Streptococcus (GAS)
Signs and symptoms of tonsilitis
a sore throat. difficulty swallowing. hoarse or no voice. a high temperature of 38C or above. coughing. a headache. feeling sick. earache. swollen, painful glands in your neck (feels like a lump on the side of your neck) white pus-filled spots on your tonsils at the back of your throat bad breath
Management of tonsilitis including antibiotics used
Analgesia
clarithromycin and erythromycin
phenoxymethylpenicillin
