Viral respiratory infection

Question 1

Uncomplicated influenza

• popultion
• virus

Answer 1

• in general population -> usually self-limiting

(usually n one week)

• caused by type A or B influenza virus

Question 2

Management of uncomplicated influenza

Answer 2

Treatment: supportive care

• antipyretics
• analgesics
• increased fluid intake

Pregnant women presenting with

uncomplicated influenza, with no evidence of

systemic disease -> Zanamivir or oseltamivir

offered (these are antivirus, neuraminidase

inhibitors)

Question 3

Complicated influenza

• virus causing it
• complications

Answer 3

• More severe symptoms occur -> mostly associated with influenza A
• Complications: otitis media, bacterial sinusitis, primary viral pneumonia, secondary bacterial pneumonia

Question 4

General Rx modes in complicated influenza

Answer 4

Treatment of complications:

• aggressive supportive care
• hospitalisation
• antibiotics
• antivirals

Question 5

What drug (classes) are used to manage complicated influenza?

Answer 5

• Antivirals -> effective against influenza A and B: neuraminidase inhibitors
• M2 inhibitors -> only against influenza A -> not used as 1st line

Question 6

Examples of anti-viral drugs used in Mx of complicated influenza

Answer 6

zanamivir, oseltamivir, peramivir

Question 7

Example of M2 drugs used in Mx of complicated influenza

Answer 7

amantadine and rimantadine

Question 8

SEs (2) of oseltamivir

Answer 8

Oseltamivir - for complicated influenza

• oseltamivir - well tolerated in adults but

vomting in children

• Potential to influence behaviour - higher risk

to self - injury/harm in children taking

oseltamivir

Question 9

Another name of Croup

Answer 9

Laryngo-tracheo-bronchitis

Question 10

Age group mostly affected by Croup

Answer 10

• usually in 6 months - 5 years old
• coccus mostly in autumn

Question 11

Symptoms of Croup

Answer 11

• ‘barking’ cough, stridor and a hoarse voice
• increased work for breathing and noisy airflow (stridor)
• Other symptoms: fever, runny nose

*often start or worse at night

Question 12

Croup causative organisms

Answer 12

Parainfluenza and influenza

Question 13

Investigations in Croup

Answer 13

• usually on basis of signs and symptoms
• after more severe causes e.g. epiglottitis or airway foreign bodies have been ruled out
• Further investigations (blood tests, X rays and cultures) usually not needed

Question 14

(2) serious differential diagnosis in Croup

Answer 14

• epiglottitis
• foreign body

Question 15

What’s that?

Answer 15

In Croup

• Although rarely performed, characteristic sign -> Steeple sign on X ray due to narrowing of the trachea

(Steeple sign is suggestive of diagnosis but not present in 50% of patients)

Question 16

Prevention of Croup (2)

Answer 16

Many causes of croup are prevented with vaccinations -> influenza and diphtheria

Question 17

Treatment of Croup

Answer 17

• single dose of oral steroid (dexamethasone, budesonide)
• in severe cases: inhaled epinephrine
• if O2 sats under 92% -> oxygen treatment given (‘blow-by’ administration, holding oxygen source near to child’s face is recommended over mask - as causes less agitation, and agitation may increase RR -> more work for breathing)

Question 18

prognosis of croup

Answer 18

Prognosis: self-limiting disease, half of cases resolving in a day, 80% will resolve in two

days time

Question 19

What anatomical structures are affected in bronchopneumonia?

Answer 19

alveoli and bronchi

Question 20

Causes of bronchopneumonia

Answer 20

as in pneumonia:

• Streptococcus Pneumonia
• Haemophilus Influenzae (type B)
• viral and fungal lung infection

Question 21

Complications of bronchopneumonia

Answer 21

• sepsis
• pleuritis
• empyema
• lung abscess
• respiratory failure

Question 22

Typical X-ray findings of bronchopneumonia

Answer 22