17 - URTI

Question 1

Normal flora of URT

Answer 1

Strep. viridans
Neisseria spp
Diptheroids
Anaerobes

Question 2

Resp. pathogens carried asymptomatically

Answer 2

Strep. pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
Strep. pyogenes
Neisseria miningitidis

Question 3

Transient colonisation post antibiotics for URT

Answer 3

coliforms, pseudomonas, candida

Question 4

Rhino-sinusitis - causative agents

Answer 4

Strep. pneumoniae
Haemophilus influenzae
Strep. milleri
Anaerobes
Fungal

Question 5

Complications of chronic sinusitis

Answer 5

Osteomyelitis
Meningitis
Cerebral abscess

Question 6

Viral causes of pharyngitis/tonsilitis

Answer 6

RSV, influenza, adeno, EBV, HSV1

Question 7

Bacterial causes of pharyngitis/tonsillitis

Answer 7

Strep. pyogenes

Rarely - neisseria gonorrhoeaem, corynebacterium diphtheriae

Mycoplasma pneumoniae and chlamydophilia pneumoniae

Question 8

Complications of group A strep pharyngitis/tonsillitis

Answer 8

Acute glomerulonephritis, rheumatic fever / scarlet fever.

Question 9

Epiglottitis - what is it?

Answer 9

Medical emergency

Cellulitis of epiglottis causing airway obstruction

Question 10

Epiglottitis - who?

Answer 10

child (2-4yrs)

Question 11

Epiglottitis - clinical presentation

Answer 11

fever
irritable
difficulty speaking and swallowing
leans forward
drools
stridor
hoarse

Question 12

Epiglottitis - investigations

Answer 12

must send blood cultures - DO NOT SWAB unless intubated

Question 13

Epiglottitis - treatment

Answer 13

maintain airway & cefotaxime

Question 14

Acute laryngitis - clinical presentation

Answer 14

hoarse/husky voice
globus pharyngeus
fever
myalgia
dysphagia

Question 15

Whooping cough - causative agent

Answer 15

Bordella pertussis

Question 16

Whooping cough - clinical presentation

Answer 16

1-3wks incubation

runny nose, fever, malaise but up to week later: dry non-productive cough which becomes whooping / paroxysms

Question 17

Whooping cough - treatment

Answer 17

supportive and erythromycin

Question 18

Whooping cough - complications

Answer 18

otitis media, pneumonia
convulsions
subconjunctival haemorrhages

immunisation very important

tell CCDC

Question 19

Otitis externa -

Answer 19

infection of external auditory canal

Question 20

Otitis externa - clinical presentation

Answer 20

skin/soft tissue infection

pain, itch, swelling and erythema, otorrhoea

Question 21

Otitis externa - types

Answer 21

acute
chronic
malignant

Question 22

Otitis externa - acute - causative organisms

Answer 22

S.aureus (is pustular)

Pseudomonas spp. (swimming)

Question 23

Otitis externa - treatment

Answer 23

saline and/or -OH and acetic acid

Wick insertion
Topical drops (w/ antibiotics/fungals/steroids

Question 24

Otitis externa - chronic - what is it

Answer 24

irritation from drainage from perforated tympanic membrane

Question 25

Otitis externa - chronic - clinical presentation and treatment

Answer 25

itchy | avoid aminoglycosides if perforated as resistance may form

Question 26

Otitis externa - malignant

Answer 26

Severe, necrotising Spreads locally -> deeply May invade bone, cartilage and blood vessels

Question 27

Otitis externa - complications

Answer 27

spread to temporal bone, base of skull, meninges and brain

Question 28

Otitis externa - clinical presentation

Answer 28

Pain, drainage of pus from canal

Question 29

Otitis externa - who?

Answer 29

Elderly, diabetics, immunosuppressed

Question 30

Otitis externa - treatment

Answer 30

4-6 weeks altogether e.g. IV ceftazidime then ciprofloxacin po

Question 31

Otitis media - who?

Answer 31

children

Question 32

Otitis media - clinical presentation

Answer 32

fever, pain, impaired hearing red bulging tympanic membrane

Question 33

Otitis media - causative agents

Answer 33

viral - H.influenzae S. pneumoniae M. catarrhalis

Question 34

Otitis media - treatment

Answer 34

watch and treat symptomatically amoxicillin if unwell

Question 35

Mastoiditis - what is it

Answer 35

inflammation of the mastoid air cells after middle ear infection pus collects in cells and may proceed to necrosis of bone

Question 36

Mastoiditis - clinical presentation

Answer 36

same as acute otitis media | Pain, swelling over mastoid

Question 37

Mastoiditis - investigations

Answer 37

bacteriology | imaging - CT

Question 38

Mastoiditis - treatment

Answer 38

treat like acute otitis media unless gram -ve suspected then use broader spectrum co-amoxiclav is 1st line treatment (amoxicillin-clavulanate)

Question 39

Other infections of URT

Answer 39

Vincent's angina | Deep fascial space infections