Respiratory Infections

Question 1

Describe features of the common cold

Answer 1

Caused by coronavirus, rhinovirus, RSV
Normally presents with rhinorrhoea, sneezing, nasal obstruction and pharyngitis. Minimal fever/systemic symptoms
In children this can present with URTI, Croup, otitis media, pneumonia, diarrhoea and necrotising enterocolitis.
In the elderly it can present with a flue-like illness, pneumonia and IECOPD

Question 2

Describe features of pharyngitis

Answer 2

Causes: CMV, EBV, Group B strep (strep throat), M.pneumoniae, Chlamydophila pneumoniae.
Presentation - Sore throat, erythema and tonsillar enlargement.
Treatment - Supportive care. If strep infection then give phenoxymethylpenicillin. If M.pneumoniae/C.pneumoniae then give tetracycline or macrolides.

Question 3

Describe features of cytomegaloviruses

Answer 3

Normally causes a mild infection but can be reactivated when ever the is cell mediated immunity compromised.
Diagnosis: IgM in blood
Treatment - Antivirals ef, gancivlovir

Question 4

Describe features of Glandular fever

Answer 4

Features: Fever, headache, malaise, sore throat, anorexia, palatal petechiae, cervical lymphadenopathy, splenomegaly, mild hepatitis
Diagnosis: Detect herterophile antibodies for EBV (monospot test)
Complications: Burkitt lymphoma, nasopharyngeal carcinoma and guillian barre syndrome.

Question 5

What is acute sinusitis and its presentation

Answer 5

Infection of the sinuses. Can be caused by respiratory viruses or bacteria (H.influenzae, S.pneumonia)
Presentation - Facial pain, nasal obstruction, discharge, malaise and fever

Question 6

What is the treatment of acute sinusitis?

Answer 6

Watchful waiting for 10 days. If symptoms last <10 days then likely to be viral. If symptoms > 10 days then likely to be bacterial.
If symptoms > 10days or immunocompromised then give amoxicillin

Question 7

what is chronic sinusitis?

Answer 7

Inflammation of paranasal sinus for over 12 weeks.
Diagnosis made clinically but can do nasal endoscopy
Treatment: Nasal saline irrigation and topical intranasal steroids

Question 8

Describe features of tonsilitis

Answer 8

• Viral or bacterial. More likely to be bacterial in the absence of a cough and exudative tonsils.
• Presents with sore throat, headaches, fever, lymphadenopathy

Question 9

What is the CENTOR criteria?

Answer 9

Used to identify tonsilitis caused by Group A strep. Give Abx if patient has 3+ of following:
- History of fever,
- Presence of tonsillar exudate,
- Absence of cough,
- Tender anterior cervical lymphadenopathy

Question 10

What is the antibiotic of choice for tonsilitis and the complications of tonsilitis?

Answer 10

Abx- Phenoxymethylpenicillin
Complications - Scarlet fever, peritonsilar abscess, rheumatic heart disease, glomerulonephritis

Question 11

describe features of diphtheria

Answer 11

Corynebacterium diphtheriae
Presents with sore throat, fever, lymphadenopathy, formation of pseudomembrane and oedema of anterior cervical tissue.
Clinical diagnosis then treated with prompt antitoxins and concurrent antibiotcs

Question 12

Describe features of parotiditis

Answer 12

Presents with: Fever, malaise, headaches, anorexia, trismus, severe pain and swelling of parotid gland.
Caused by mumps virus, treated with supportive care.
Complications are CNS involvement and epididymo-orchitis

Question 13

Describe features, diagnosis and management of acute laryngitis

Answer 13

It is temporary hoarsness or loss of voice that occurs with pharyngitis due to oedema of vocal cords.
Diagnosis: Clinical but can do laryngoscopy. Nasal culture if you suspect diphtheria.
Treatment: Supportive care.

Question 14

What is chronic laryngitis?

Answer 14

When symptoms last for over 3 weeks. This requires more investigations as it can mimic laryngeal malignancy

Question 15

What are the symptoms of croup?

Answer 15

• Stridor (caused by laryngeal oedema and -secretions)
• Barking cough
• Fever
• Coryzal symptoms
• Mild
• Moderate: Audible stridor at rest. Suprasternal and sternal wall retraction at rest but little to no distress
• Severe: Prominent stridor, marked sternal wall retractions, significant distress, tachycardia and hypoxic.

Question 16

What are the investigations for croup?

Answer 16

Clinical diagnosis but can do a chest x ray which can show Steeple sign (subglotic narrowing) and thumb sign in lateral view (swelling of epiglottis)

Question 17

What is the treatment for croup?

Answer 17

• Admit any patient with moderate to severe croup. Also admit if baby is under 6 months old, known upper airway abnormalities or uncertain about diagnosis.
• Give all children a single dose of Dexamethasone
• Emergency: High flow oxygen and nebulised adrenaline

Question 18

Describe features of Pertussis?

Answer 18

• Caused by Bordetella Pertussis.
• Catarrhal phase: Nasal discharge, pharyngitis and conjunctivitis.
• Paroxysmal phase: Severe cough with spasms of coughing that end in deep inspiration (whoop) followed by vomiting
• Convalescent phase: Cough subsides over weeks to months

Question 19

What is the diagnostic criteria for Pertussis (whooping cough)

Answer 19

Coough lasting for mor than 14 days and one of the following:
- Paroxysmal cough(violent coughing spells),
- Inspiratory whoop,
- Post-tussive vomiting,
- Undiagnosed apnoeic attacks

Question 20

What is the diagnosis and management of pertussis (whooping cough)

Answer 20

Diagnosis: Nasal swab culture for bordetella pertussis (this may take weeks to come back). More frequently used is PCR and serology
Management:
If under 6m then admit
Notifiable disease
Oral macrolide if in cattarhal stage with household contacts being offered prophylactic antibiotics

Question 21

What are the complications of Pertussis (whooping cough)

Answer 21

Subconjunctival hemorrhage
Pneumonia
Bronchiectasis
Seizures

Question 22

Describe features of acute epiglottitis?

Answer 22

Caused by virulent strains of GroupA strep H.influenzae.
Presentation: Fever, stridor, drooling, tripod position (easier to breath if leaning forward and extending their neck). Can lead to respiratory distress.

Question 23

What is the diagnosis and management of acute epiglottis?

Answer 23

Diagnosis - Direct visualization by senior only. Neck X-ray.
Management:
- Immediate senior involvement and anaesthetist as intubation may be needed.
- DO NOT EXAMINE THROAT as it may cause airway obstruction
- Oxygen
- IV antibiotics

Question 24

Describe features of tracheitis?

Answer 24

Caused by S.aureus
Signs and symptoms: Fever, stridor, barking cough, tachypneoa, dyspnoea, cyanosis

Question 25

What are the investigations and management of tacheitis?

Answer 25

Investigations: Bloods, throat swabs, CXR and in severe cases CT scan
Management: IV antibiotics and in severe cases may need intubation

Question 26

Describe features of acute and chronic bronchitis?

Answer 26

Acute - Inflammation of tracheobronchial tree due to viral infections.
Chronic - Cough and excessive mucus production caused by anatomical disturbances to resp system form things like smoking or CF

Question 27

What is bronchiolitis?

Answer 27

Respiratory infection caused by RSV. Occurs in children under two.

Question 28

What are the different serotypes of influenza?

Answer 28

Influenza A - Can cause pandemics
Influenza B - Epidemics only. Animal reservoir
Influenza C - Sporadic infections

Question 29

What are the clinical features of influenza?

Answer 29

• Fever,
• Nonproductive cough,
• Myalgia,
• Headaches,
• Malaise,
• Sore throat,
• Rhinitis

Question 30

Explain the diagnosis and treatment of influenza?

Answer 30

Diagnosis - Rapid PCR testing
Management: Supportive care or neuraminidase inhibitors eg, olsetamivir if within 48h of symptom onset and patient is at risk of complications

Question 31

What are the complications of influenza virus?

Answer 31

Pulmonary - Viral pneumonia or secondary bacterial pneumonia,
Cardiovascular - myocarditis or heart failure,
Neurological - Encephalopathy
GI - Anorexia and vomiting