URTI ☺️

Question 1

Description

Answer 1

Illness caused by acute infection which involves

• nose (colds)
• sinuses (sinusitis)
• pharynx, larynx (pharyngitis, laryngitis)
• bronchi (bronchitis)

Not flu because that is more systemic

Question 2

Epidemiology

Answer 2

URTI is more common in children 0-4 than other age groups and declines with age
LRTIs are the highest at the extremes of age and are lowest in adolescence, adulthood but increase past 50

Common cold is the most common followed by sinusitis, bronchitis, otitis media

Question 3

Aetiology

Answer 3

MOST COMMON - VIRUSES

• rhino
• adeno
• coxsackie
• parainfluenza
• RSV

Bacterial
-GAS

Question 4

Symptoms

Answer 4

Runny, blocked nose
Sneezing
Productive cough (colour can indicate if it is viral or bacterial)
Aches, pains
Mild fever

Question 5

Pathophysiology

Answer 5

Inoculation occurs when hands come into contact with pathogens and they touch their nose/mouth/person directly inhales respiratory droplets from coughs or sneezes

Direct invasion of bacteria or viruses into mucosa lining upper airway and bypasses our normal defences

• nose hairs, cilia
• mucus
• change in angle between posterior nose and pharynx
• adenoids, tonsils

Question 6

Signs

Answer 6

May have a fever
Inflammed pharynx, if purulent more likely to be strep
Runny nose
No signs of shock

Resp exam
-clear lower chest to rule out LRTI

Positive Kernig sign and neck stiffness => meningitis, admit to A&E

Night sweats

Question 7

Differentials

Answer 7

Infective/inflammatory

• meningitis => neck stiffness, photophobia
• allergic rhinitis => atopy, chronic fluctauting course
• pharyngitis => pharyngeal exudate, cervical swelling, no runny nose
• sinusitis => reproducible pain on percussion of frontal, maxillary sinus (X pattern around nose)
• glandular fever => swollen cervical lymph nodes, maculopapular rash, heptosplenomegaly, feeling very unwell (4-6wks)
• flu => high fever, muscle aches, more systemic
• whooping cough => several weeks with increasing severity of cough, inspiratory stridor
• diphtheria => travel to Asia, Middle East, sore throat, mild fever, grey plaques on pharynx, tongue
• HIV seroconversion => similar to glandular fever, unprotected sex, IVDU
• otitis media => ear pain

Trauma
-foreign aspiration => sudden onset cough with no fever

Question 8

Investigations

Answer 8

Clinical diagnosis
May want to investigate if symptoms have persisted for longer than expected, atypical features present

Throat swab => rule out strep pharyngitis, identify causative bacterial organism
CXR => rule out pneumonia

HIV ELISA testing => rule out seroconversion

Question 9

Diagnostic criteria

Answer 9

Generally a diagnosis of clinical reasoning

Question 10

Management - bacterial

Answer 10

Want to identify causative organism, take a throat, nose swab if persistent
-give broad spec ABx

Question 11

Management - viral

Answer 11

MOST URTIs are viral
Reassurance that it is self limiting
-rest
-plenty of fluids
-dispose of used tissues, cover mouth when coughing/sneezing

Paracetamol for pain and fever

Question 12

Prognosis

Answer 12

Generally recover in around 2 weeks.