URTI, LRTI, Urinary, Eye Infections

Question 1

What are symptoms of Upper Respiratory Tract Infections?

Answer 1

• Cough
• Sneezing
• Stuffy or Runny nose
• Sore throat
• Headaches
• Muscle Aches
• High Temperature
• Breathlessness/Tight Chest/Wheezing
• Feeling generally unwell

Question 2

What are types of Upper Respiratory Tract Infections?

Answer 2

• Common Cold
• Sinusitis
• Tonsilitis
• Laryngitis

Question 3

What microbes cause Upper Respiratory Tract Infections?

Answer 3

• Rhinovirus
• Coronavirus
• Influenza
• Parainfluenza
• Respiratory syncytial virus (RSV)

Question 4

How can Sinusitis progress?

Answer 4

• Bacterial super-infection common with sinusitis and otitis media which can lead to mastoiditis, meningitis, brain abscess

Question 5

How can you treat bacterial upper respiratory tract infections?

Answer 5

• 500 mg amoxicillin x 3 daily for 5 days
• In penicillin allergy: Doxycycline 200mg on the 1st day then 100mg once daily for a total of 5 days
• Clarithromycin 500mg twice daily for 5 days

Question 6

What are general treatment for URTI?

Answer 6

• Stop smoking
• Antivirals/Antibiotics (can adopt a delayed strategy)
• Decongestants
• Nasal Sprays
• Paracetamol/Ibuprofen
• Cough Medicines, Throat Lozenges
• Prevention: Hygiene, Flu Vaccination, Pneumococcal Vaccine, Stop Smoking,

Question 7

What are symptoms of Lower Respiratory Tract infections?

Answer 7

• Chesty cough
• Wheezing and shortness of breath
• Chest pain or Discomfort
• High temperature
• Headache
• Aching muscles
• Tiredness

Question 8

What are types of LRTI?

Answer 8

• Pneumonia
• Bronchitis

Question 9

What are the usual causative organisms in LRTI?

Answer 9

• H.inluenzae
• S.pneumoniae
• S.aureus
  
  • See GP if coughing blood, cough for more than 3 weeks, pregnancy, over 65, weak immune system, LTC

Question 10

How is a LRTI managed?

Answer 10

• Analgesics
• Preventing dehydration
• Cough medicines
• Smoking cessation
• Chest X-ray. Bacterial such as pneumonia requires antibiotics (pneumonia requires radiological evidence)
• Self care such as air humdierfier, raising head when sleeping, drink water to make it easier to cough

Question 11

What is the treatment for LRTI?

Answer 11

• CURB-65 = 0
  
  • ​500 mg amoxicillin x 3 daily for 5 days
  • In penicillin allergy: Doxycycline 200mg on the 1st day then 100mg once daily for a total of 5 days
  • Clarithromycin 500mg twice daily for 5 days
• CURB-65 = 1/2
  
  • Dual therapy of 500 mg amoxicillin x 3 daily for 7-10 days and Clarithromycin 500mg twice daily for 7-10 days
  • In penicillin allergy: Doxycycline 200mg on the 1st day then 100mg once daily for a total of 5 days

Question 12

How are LRTI infections prevented?

Answer 12

• Cover mouth when coughing or sneezing
• Wash your hands regularly
• Throw away tissues immediately
• Annual flu vaccination, pneumococcal vaccine
• Stop smoking
• Alcohol reduction

Question 13

What are the types of Urinary Tract infections?

Answer 13

• Upper UTI
• Lower UTI
  
  • Complicated UTI
  • Uncomplicated UTI

Question 14

What is an uncomplicated UTI?

Answer 14

Defined as infection by a usual organism in a patient with a normal urinary tract and normal urinary function. May occur in males or females of any age

Question 15

What is a complicated UTI?

Answer 15

• UTI when one or more factors are present that predispose the person to persistent infect, recurrent infection or treatment failure.
  
  • Most cases in children, men and pregnant women are investigated as complicated.
    
    • Abnormal urinary tract
    • Virulent organism
    • Impaired host defences
    • Impaired renal function

Question 16

What are symptoms of Lower UTI and Upper UTI?

Answer 16

• Lower UTI
  
  • Frequency and Urgency
  • Pain or burning sensation when peeing
  • Smelly.
  • Grittiness
  • Low grade fever
• Upper UTI
  
  • Fever
  • Loin Pain
  • Dysuria and Frequency

Question 17

What are investigations for UTI?

Answer 17

• Turbidity
• Dipstick testing (Leucocyte esterase (+), Nitrites (+ for e. coli), Haematuria (+), Proteinuria (+)
• Imaging: Septic Patient, Males with posterior urethral valves, females with vesico-ureteric reflux

Question 18

What is the management of an Uncomplicated UTI and simple cystitis treated?

Answer 18

• Increase fluid intake, address underlying disorders
• Prescription of antibiotics can be made on symptoms alone
  
  • Nitrofurantoin 50mg four times daily orally or 100 mg twice daily (MR) or Trimethoprim 200 mg twice daily)
  • Analgesia 10 day course if impaired renal function, abnormal urinary tract
• Seek help if you develop fever, loin pain check with cultures post treatment in children and pregnant women.

Question 19

How is complicated lower UTI treated?

Answer 19

Prescribe a 7-day course of:

• 200mg of Trimethoprim twice daily (give folate as well 5mg for pregnancy women)
• 50 mg of Nitrofurantoin 4 times daily or 100 mg twice daily
• 500 mg Cephalexin twice daily or 250mg 6 hourly

Question 20

How is Pyelonephritis treated?

Answer 20

• Co-amoxiclav
• Ciprofloxacin
• Gentamicin IV

Question 21

How UTI prophylaxis administered?

Answer 21

Trimethoprim or Nitrofurantoin on a single nightly dose

Question 22

What are symptoms of conjunctivitis?

Answer 22

Inflammation of the conjunctiva which is a layer of tissue surrounding the eye

• Blood shot eyes
• Burn or feel gritty
• Produce pus that sticks to lashes
• Itch
• Water

Question 23

How is conjunctivitis managed?

Answer 23

• Easing of symptoms
• Using cotton wool to clean eyelash of crust

Question 24

What are symptoms of Uveitis?

Answer 24

• Inflammation of the choroid layer of the eye
• Red eye
• Sensitivity to light
• Blurry vision
• Headache

Question 25

What is the management of Uveitis?

Answer 25

Managed by ophthalmologist.

• Primary care to monitor use of DMARDs and steroids
  
  • Immunosuppressive drugs and cycloplegic-myadriatic drug
• Steroid medication to reduce inflammation
• Infectious uveitis is treated with antimicrobial drugs