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Question 1

What are the common viral causes of URTI?

Answer 1

Rhinoviruses

Coronaviruses

Influenza viruses

Respiratory syncytial virus (RSV)

Adenoviruses

Question 2

What are some risk factors for developing viral URTI?

Answer 2

Age - young or elderly

Immunocompromised

Chronic diseases

Lifestyle factors - smoking, excess alcohol, poor nutrition, lack of physical activity

Crowded environment

Question 3

What are the main symptoms and signs or viral URTI?

Answer 3

Symptoms:
-nasal discharge
-nasal obstruction
-sore throat
-headache
-cough
-tiredness
-general malaise

-facial pain
-earache
-hoarseness
-nausea

Signs:
-erythema of back of throat
-nasal discharge
-tender cervical lymphadenopathy
-mild fever

Question 4

What should be used to assess likelihood of streptococcal infection in adult with sore throat?

Answer 4

FeverPAIN score

Fever
Purulence
Attend rapidly (3 or less days)
Severely (I)nflamed tonsils
No cough or coryza

Score 2-3, prescribe delayed Abx
Score >=4, immediate Abx

Question 5

What are some complications of viral URTI?

Answer 5

Sinusitis

Otitis media

Secondary bacterial infection e.g. pneumonia

Exacerbations of pre-existing respiratory conditions such as asthma, or COPD

Viral wheeze, bronchiolitis and croup in infants and young children

Question 6

What is acute epiglottitis?

Answer 6

also known as supraglottitis, is a life-threatening medical emergency characterized by inflammation of the epiglottis and surrounding supraglottic structures

rapid airway obstruction

Question 7

What are some common causative organisms of acute epiglottitis?

Answer 7

Streptococcus pneumoniae, group A streptococci, and Staphylococcus aureus

Question 8

What’s the clinical presentation of acute epiglottitis?

Answer 8

Severe sore throat and odynophagia: Painful swallowing often accompanied by drooling due to difficulty handling secretions.

Muffled voice or ‘hot potato’ voice: A characteristic change in voice quality due to the swollen epiglottis.

Stridor: A high-pitched, inspiratory noise indicative of airway obstruction.

Respiratory distress: Including tachypnea and the use of accessory muscles.

Fever: High-grade fever is often present in cases of bacterial infection.

Tripod or sniffing position: Patients may lean forward with their hands on their knees, chin thrust forward, and mouth open in an effort to maintain airway patency

Question 9

What is first line treatment for bacterial tonsillitis?

Answer 9

Penicillin V (phenoxymethylpenicillin) for a 10-day course

Clarithromycin is the usual first-line choice in true penicillin allergy

Question 10

What are some complications of tonsillitis?

Answer 10

Peritonsillar abscess, also known as quinsy

Otitis media, if the infection spreads to the inner ear

Scarlet fever

Rheumatic fever

Post-streptococcal glomerulonephritis

Post-streptococcal reactive arthritis

Question 11

What Abx are recommended if otitis media is severe?

Answer 11

Amoxicillin for 5-7 days first-line
Clarithromycin (if penicillin allergic)
Erythromycin (in pregnant women allergic to penicillin)

Co-amoxiclav is a second-line option if the infection is not responding to amoxicillin.