ID- respiratory infections

Question 1

Describe the presentation of tonsillitis/pharyngitis

Answer 1

Sore throat, difficulty swallowing
+/- lymphadenopathy, viral symptoms (cough, coryza)
+/- fever, dehydration, systemically unwell

Question 2

Describe how to differentiate between bacterial and viral tonsillitis

Answer 2

Centor criteria or Fever PAIN score
Centor:
-Exudates 
-Fever >38
-No cough
-Lymphadenopathy

FeverPAIN:

• Fever, no cough, short history (<3 days)
• Tonsillar exudates + inflammation

Question 3

Describe the investigations for tonsillitis/pharyngitis

Answer 3

Not routinely done.
Consider swabs for viral PCR/MC&S
Further tests if severely unwell

Question 4

Describe the management of tonsillitis/pharyngitis

Answer 4

Supportive Mx: fluids, paracetamol, gargle, etc

• No ABx if mild: Centor 0-2/ Fever PAIN 0-1.
• Backup/delayed ABx if mod: Fever PAIN 2-3
• ABx if likely bacterial: Centor 3-4/ Fever Pain 4-5

Antibiotics:

• 1st line 5 days phenoxymethylpenicillin 500mg QDS
• Alternative: clari/erythro

Question 5

Describe the common pathogens causing tonsillitis/pharyngitis

Answer 5

Viral: most common. Rhinovirus, coronavirus, RSV, influenza etc. Also EBV (glandular fever)
Bacterial: Strep pyogenes (Grp A beta-haemolytic), gonorrhoea rarely

Question 6

Describe the presentation of rhinosinusitis

Answer 6

-Runny nose, congestion
-Headache/facial pain
-Itchy, watery eyes
+/- fever

Question 7

Describe the investigations of rhinosinusitis

Answer 7

Not routinely done. Can swab

Question 8

Describe the management of rhinosinusitis

Answer 8

Supportive Mx: fluids, paracetamol, nasal decongestants (spray, breathing steam, etc)
Advise resolves in 2-3 weeks spontaneously
Antibiotics:
-Usually don’t prescribe.
-Consider if 10 days and no improvement
1st line phenoxymethylpen 5 days 500mg QDS
-Alternatively clari/erythro or co-amox in v unwell kids

Question 9

Describe the common pathogens in rhinosinusitis

Answer 9

Almost always viral: rhinovirus, coronavirus, adenovirus

2% bacterial eg. Grp A Strep

Question 10

Describe the presentation of otitis media and otitis externa

Answer 10

Otitis media: ear pain, coryza/cough/sore throat, fever. If perf -> purulent discharge w no pain. O/E- bulging, red TM with no cone of light
Otitis externa: usually just ear pain, itching. Normal TM with redness/crusting of external meatus

Question 11

Describe the common pathogens in otitis media and externa

Answer 11

Otitis media: resp viruses mostly. Some bacteria: Strep pneumo, HiB etc
Otitis externa: bacterial. Pseudomonas or S aureus

Question 12

Describe the management of otitis media and externa

Answer 12

Otitis media: supportive. Fluids, paracetamol.

• Advise that usually resolves in 3 days-1 week
• Consider antibiotics if perf/young child with bilateral
• ABx: amox TDS for 5-7 days or clari

Otitis externa:

• Conservative: avoid swimming, keep ears dry
• Consider topical ABx drops +/- steroid

Question 13

Describe the presentation of acute bronchitis

Answer 13

Cough- acute onset, worse at night + exercise. May last for several weeks/>1 month (postbronchitis syndrome)
+ sputum production, wheeze, chest pain/tightness, fever
***Key differentiation with asthma is presence of other viral symptoms eg. coryza, sore throat

Question 14

Describe the investigations for acute bronchitis

Answer 14

Usually not needed. Spirometry can show obstruction + may be confused with asthma
CXR may be used if suspecting pneumonia

Question 15

Describe the management of acute bronchitis

Answer 15

Supportive: fluids, paracetamol
-Advise usually viral. Cough may last for significant time
-Bronchodilator if wheezing
-Antibiotics only if systemically unwell or at high risk of complications eg. immunosuppressed, elderly
1st line doxy. Alternatively amox/clari

Question 16

Describe the presentation of glandular fever

Answer 16

Typically symptomatic in teenagers. Children are subclinical, most adults have been infected already
-Fever
-Sore throat
-Lymphadenopathy
-Fatigue. May last for months
+/- enlarged spleen, palatal petechiae, rash, hepatitis

Question 17

Describe the investigations for glandular fever

Answer 17

• Swab: viral PCR
• Bloods (in 2nd week of illness): atypical lymphocytosis (FBC + film), agglutination test eg. Monospot test/Paul-Bunnell (tests for heterophile antibodies), serology

Question 18

Describe the course of TB infection

Answer 18

Infection -> primary TB (symptoms) or becomes latent

Can re-activate to active TB or stay latent as granuloma

Question 19

Describe the presentation of TB

Answer 19

Latent TB: granulomas found incidentally
Pulmonary TB: most common. Cough, fever, haemoptysis, chest pain, night sweats, weight loss, fatigue, clubbing, erythema nodosum

Extra-pulmonary TB: can affect anywhere eg. GIT, urinary tract, adrenals, bone etc

Question 20

Describe the investigations for TB. What is the gold standard?

Answer 20

Active TB:

• Sputum sample x3: culture (Lowenstein-Jensen medium), Ziehl-Nielson AFB stain, auramine stain, NAAT etc
• Bloods: FBC, CRP, U+Es, LFTs
• CXR

Latent TB:

• TST
• IGRA (better if BCG vaxed)

Question 21

Describe the management for TB

Answer 21

Conservative: stop smoking, nutrition
Medical: anti-TB drugs
-Rifampicin, Isoniazid + pyridoxine, Pyrazinamide, Ethambutol
-6 months: 2 mos x 4 -> 4 mos x 2
+/- longer if risk factors eg HIV, DM, smoking

Question 22

Describe the common side effects/complications of anti-TB drugs

Answer 22

Rifampicin: turns secretions orange. Hepatotoxic*
Isoniazid: causes peripheral neuropathy (give with pyridoxine). Hepatotoxic*
Pyrazinamide: hepatotoxic*. Gout
Ethambutol: causes visual loss, colour blindness.

*Some rise in ALT is normal. Allow up to 5x ULN + continue to monitor