Common Cold

Question 1

Hi Dr which age group typically gets acute otitis media

Answer 1

Children age 10 and under

Question 2

Hi Dr is the middle ear infection only caused by bacteria

Answer 2

Now it can also be caused by viruses

Question 3

Hi Dr if I was in examining a child what signs would indicate a middle ear infection

Answer 3

Fever and poor feeding

Question 4

Hi Dr I’ve just examined a child with a middle ear infection and I’m trying to describe my findings with the correct medical terminology

Answer 4

Middle ear infection you typically see a red bulging eardrum

Question 5

Hi Dr I have just finished examining child with the middle ear infection do I need to give them an antibiotic

Answer 5

Not generally it is enough to give paracetamol and ibuprofen in an alternating regimen

Question 6

Hi Dr I have just finished examining a 1 month old child who has a middle ear infection can I give her antibiotics

Answer 6

Yes because she is under 3 months

Question 7

Hi Dr I’ve just finished examining a one year old child who has an ear infection in both ears can I give him antibiotics

Answer 7

Yes as bilateral symptoms is an indication to give antibiotics

Question 8

Hi Dr what is the worst complication a child with an ear infection may go on to have

Answer 8

Meningitis

Question 9

Hi Dr which medications do we generally give to children under 5 who are suffering with the temperature

Answer 9

Paracetamol and ibuprofen on an alternating basis are generally enough

Question 10

Hi Dr I have just finished examining a 3 week old child I just wanted to check was I correct in taking the temperature from the ear

Answer 10

No in a child under 4 weeks you should use an electric thermometer under the armpit

Question 11

Hi Dr I have just finished examining a 1 month old child and the respiratory rate was 50 is this normal

Answer 11

Yes children under 2 months old have a maximum normal respiratory rate of 60 beats per minute

Question 12

Hi Dr I have just finished examining an 11 month old child with a respiratory rate of 45 is this normal

Answer 12

Yep children between 2 months and 12 months should have a respiratory rate less than 50

Question 13

Hi Dr I have just finished the examining a 6 month old child his heart rate is 150 isn’t this too high

Answer 13

Notes for children under 1 year old there heart rate is expected to be around this range

Question 14

Hi Dr at what age would you expect a child to have a respiratory rate closer to an adult

Answer 14

From age 9 onwards

Question 15

Hi Dr I have just finished examining a 18 year old girl who regularly swings and has been complaining of earache is this more likely to be an external ear problem or a middle ear problems

Answer 15

Swimmers are generally more prone to external ear problems specifically otitis externa

Question 16

Hi Dr I’m treating in 18 year old girl for otitis externa and I can’t remember which preparation I need to give her can you tell me

Answer 16

Give an aminoglycoside antibiotic and corticosteroid for one week

Question 17

Hi Dr I have just seen a 8 year old boy I believe has tonsillitis his mum has asked me how long I expect it to last for I can’t remember can you tell me

Answer 17

One week

Question 18

Hi Dr I have just finished an examination of a 13 year old boy who I believe has the common cold I checked his temperature took his pulse and did an ENT examination do I need to do a lymph node examination

Answer 18

Yes

Question 19

Hi Dr I read that typically you wouldn’t give antibiotics for a sore throat unless it was a specific type of infection can you tell me which infection

Answer 19

If the patient meets 3 of 4 Centor criteria for a group a beta hemolytic strep infection then you can give antibiotics

Question 20

Hi Dr I’m trying to remember all of the Centor criteria for group a beta haemolytic strep infection

I remember that tonsillar exudate, no cough and a history of fever were three of the four can you tell me what the last one was

Answer 20

Tender anterior cervical lymph nodes

Question 21

Hi Dr I remember that there was a better criteria list then centor can you tell me what it was called

Answer 21

Feverpain criteria

Question 22

Hi Dr I remember that one of the Centor criteria was the same as the feverpain criteria but I can’t remember which one can you tell me

Answer 22

No cough

Question 23

Ok doctor so from what I understand the senthil criteria has four points where has the feverpain criteria has five points are any of these points similar

Answer 23

Yes both criteria include no cough and exudate

Question 24

Hi Dr is there a way that I can more easily remember the feverpain criteria

Answer 24

But letters in pain give the criteria

For example a stands for attend rapidly

Question 25

Hi Dr what does the I in the feverpain criteria stand for

Answer 25

Inflamed tonsils

Question 26

Hi Dr what does a patient need to score on the feverpain criteria in order to get delayed antibiotics

Answer 26

Two out of three

Question 27

Hi Dr what does a patient need to score on the feverpain criteria in order to get immediate to antibiotics

Answer 27

Four out of five

Question 28

Hi Dr I have just seen a 10 year old child is number parts that she has had 6 previous episodes of tonsillitis this year do I need to refer urgently for a tonsillectomy

Answer 28

No you can consider referral but it wouldn't be urgent

Question 29

Hi Dr I have just seen a patient who has been complaining of a temperature fatigue and headache when I did an examination of the lymph nodes I noticed there was some lymphadenopathy ENT examination showed some redness towards the back of the throat I feel confident that this is a case of glandular fever but I can't remember if I need to prescribe any medication

Answer 29

No it is a self limiting illness analgesia and fluids are adequate management

Question 30

Hi Dr I have just seen a 70 year old woman who is complaining of a really bad cough her past medical history she has type 2 diabetes and the history of congestive heart failure can I give her antibiotics immediately

Answer 30

Yes as she has met the criteria in terms of her past medical history and her age

Question 31

Hi Dr how long would you normally expect a case of bronchitis to last for

Answer 31

3 weeks

Question 32

Hi Dr it has come round to that time of year again when I'm seeing lots of patients complaining of fever headache aching limbs and general tiredness how many people need to have flu before it is considered an epidemic

Answer 32

1 in 500

Question 33

Hi Dr I was sitting in with the GP for a patient who presented with fever headache aching limbs and general tiredness the GP also asked if the patient has recently travelled anywhere why is this a relevant question to ask

Answer 33

To help exclude a diagnosis of malaria

Question 34

Hi Dr what type of virus is the influenza virus

Answer 34

Orthomyxovirus

Question 35

Hi Dr how many types of influenza virus can infect humans

Answer 35

Three types H1N1 H2N2 H3N2

Question 36

Hi Dr how many segments of RNA does the influenza orthomyxovirus contain

Answer 36

8 sections of RNA

Question 37

Hi Dr instead of paracetamol why don't we just give all the patients who get flu oseltamivir (tamiflu) or zanamivir (relenza)

Answer 37

You should only give these medications during an epidemic or a pandemic

Question 38

Hi Dr how do oseltamivir and zanamivir work

Answer 38

They are neuraminidase inhibitors

Question 39

Hi Dr what is the catch to using oseltamivir and zanamivir in the case of influenza

Answer 39

You have to give it within the first day of illness

Question 40

Hi Dr which age group is the flu vaccine typically offered to

Answer 40

Everyone over age 65 and pregnant women

Question 41

Hi Dr I have just seen a patient who I was about to give a flu vaccine jab to but then he's told me that he has an egg allergy is this going to be a problem

Answer 41

The flu vaccine is contraindicated in patients with an egg allergy

Question 42

Hi Dr I was doing some bedtime reading and discovered a neurological condition which means that these patients are contraindicated to getting a flu vaccine jab I can't remember what the condition is called can you tell me

Answer 42

Guillain barre

Question 43

Hi Dr I have just seen a 3 year old girl whose mum says that she has had this ear infection for a week now and it doesn't seem to be improving can I move on to give antibiotics

Answer 43

Yes as it has been longer than 4 days and the symptoms and improving

Question 44

Hi Dr if I do need to give a dose of tamiflu what does do I need to give

Answer 44

75 mg twice daily tablets

Question 45

Hi Dr if I do need to give a dose of Zanamivir what would it be

Answer 45

5mg twice daily inhaled

Question 46

Hi Dr a patient asked me if the influenza vaccine was a live vaccine what should I tell him

Answer 46

No it's not