Upper respiratory Tract Infections

Question 1

What are the three features of rhinitis?

Answer 1

1) nasal discharge
2) a blockage occurring for more than an hour on most days
3) sneezing attacks

Question 2

What is acute coryza?

Answer 2

common cold

Question 3

What is the most common infectious agent behind the common cold?

Answer 3

rhinovirus

Question 4

Other than rhinovirus, name two viruses that commonly cause the common cold?

Answer 4

1) coronavirus
2) adenovirus

Question 5

What is the mode of transmission of the common cold?

Answer 5

direct contact and droplet

Question 6

Give 5 clinical presentations associated with upper respiratory tract infections:

Answer 6

1) tiredness
2) slight pyrexia
3) sore nose and pharynx
4) sneezing
5) profuse watery nasal discharge followed by thick mucopurulent secretions

Question 7

What is seasonal rhinitis?

Answer 7

hay fever - allergic, intermittent rhinitis

Question 8

Give 5 clinical presentations associated with seasonal rhinitis:

Answer 8

1) nasal irritation
2) watery rhinorrhoea
3) itching of the eyes
4) itching of the soft palate
5) wheeze

Question 9

Give 3 common seasonal allergens that cause seasonal rhinitis:

Answer 9

1) tree pollen
2) grass pollen
3) mould spores

Question 10

What is perennial rhinitis?

Answer 10

persistent rhinitis experienced throughout the year

Question 11

How does perennial rhinitis present?

Answer 11

1) long term nasal blockage
OR
2) long term sneezing and watery rhinorrhoea
+ patients may lose their sense of smell and taste

Question 12

What is the most common cause of perennial allergic rhinitis?

Answer 12

faecal particles of the dust mite

Question 13

What is vasomotor rhinitis?

Answer 13

non-allergic/ non-infectious rhinitis without eosinophilia caused by cold air, smoke, perfume or newsprints

Question 14

Describe the appearance of nasal polyps:

Answer 14

round, smooth, soft, semi-translucent, pale or yellow glistening structures attached to the sinus mucosa by a narrow stalk or pedicle

Question 15

In which two types of rhinitis would you find nasal polyps?

Answer 15

1) allergic rhinitis
2) vasomotor rhinitis

Question 16

What three cells make up nasal polyps?

Answer 16

1) mast cells
2) eosinophils
3) mononuclear cells

Question 17

Give 3 clinical presentations associated with nasal polyps:

Answer 17

1) nasal obstruction
2) loss of smell and taste
3) mouth breathing

Question 18

What two methods can be used to check for allergies associated with rhinitis?

Answer 18

1) skin prick testing
2) allergen-specific IgE antibody tests

Question 19

Give 6 ways in which rhinitis can be managed:

Answer 19

1) allergen avoidance
2) H1 antihistamines
3) decongestants
4) anti-inflammatory drugs
5) corticosteroids
6) leukotriene antagonists

Question 20

Name two sedative antihistamines which are no longer used in practice:

Answer 20

1) chlorphenamine
2) hydroxyzine

Question 21

Name two non-sedative antihistamines:

Answer 21

1) loratadine
2) cetirizine

Question 22

Name two alpha adrenergic decongestants:

Answer 22

1) xylometazoline
2) oxymetazoline

Question 23

Name two anti-inflammatory drugs used to treat rhinitis:

Answer 23

1) sodium cromoglicate
2) nedocromil sodium

Question 24

How do sodium cromoglicate and nedocromil sodium act as anti-inflammatory drugs for rhinitis?

Answer 24

they act by blocking intracellular Cl- channels influencing mast cell and eosinophil activation and nerve function

Question 25

What is the most effective treatment for rhinitis?

Answer 25

topical corticosteroid sprays

Question 26

Name 4 topical corticosteroid sprays used to treat rhinitis:

Answer 26

1) becolmetasone 2) fluticasone propionate 3) fluticasone furoate 4) mometasone furoate

Question 27

Give an example of a leukotriene antagonist used to treat rhinitis:

Answer 27

montelukast

Question 28

When would you consider prescribing a leukotriene antagonist for rhinitis?

Answer 28

when there is no response to antihistamines or topical steroids

Question 29

Is sinusitis typically caused by viruses or bacteria?

Answer 29

viruses

Question 30

What two bacteria are the leading causes of sinusitis?

Answer 30

1) Streptococcus pneumoniae 2) Haemophilus influenzae

Question 31

Give 4 symptoms associated with sinusitis:

Answer 31

1) frontal headache 2) purulent rhinorrhoea 3) facial pain and tenderness 4) fever

Question 32

Give 4 management techniques for bacterial sinusitis:

Answer 32

1) antibiotics (broad spectrum e.g. co-amoxiclav) 2) topical corticosteroid spray 3) steam inhalation 4) nasal decongestants

Question 33

How should chronic (>3 month) sinusitis be managed?

Answer 33

referral to ENT for CT of the sinuses

Question 34

What antibiotic is typically given for sinusitis?

Answer 34

Co-amoxiclav

Question 35

What infectious agent is the most common cause of pharyngitis?

Answer 35

adenoviruses

Question 36

Give three clinical presentations associated with pharyngitis:

Answer 36

1) sore throat 2) oropharynx and soft palate are reddened 3) inflamed and swollen tonsils

Question 37

Give the Centor Score point system:

Answer 37

1) absent cough - 1 point 2) exudate on tonsils - 1 point 3) tender cervical lymph nodes - 1 point 4) temp >38 degrees C - 1 point 5) age 3-14 - 1 point (4-5 points indicates Strep throat infection - prescribe antibiotics)

Question 38

What antibiotic is typically prescribed for Strep throat/ bacterial pharyngitis?

Answer 38

phenoxymethylpenicillin

Question 39

What is acute laryngotracheobronchitis?

Answer 39

infection and inflammation of the larynx which may include the trachea and bronchi

Question 40

What two infectious agents typically cause acute laryngotracheobronchitis?

Answer 40

1) parainfluenza viruses 2) measles virus

Question 41

Give 4 presentations associated with acute laryngotracheobronchitis?

Answer 41

1) hoarse voice 2) barking cough 3) audible stridor 4) progressive airway obstruction

Question 42

Give 3 ways that acute laryngotracheobronchitis is managed?

Answer 42

1) nebulised adrenalin 2) oral or IM corticosteroids e.g. dexamethasone 3) oxygen and fluids

Question 43

What bacteria causes acute epiglottitis?

Answer 43

Haemophilus influenzae type B (Hib)

Question 44

In which patient demographic does acute epiglottitis occur?

Answer 44

children under 5 years of age (this is a life threatening emergency)

Question 45

Give two presentations associated with acute epiglottitis?

Answer 45

1) high fever 2) severe air flow obstruction

Question 47

Give the two step management technique for severe acute epiglottitis:

Answer 47

1) urgent endotracheal intubation 2) IV ceftazidime antibiotics

Question 48

What vaccine is used to prevent acute epiglottitis?

Answer 48

Hib vaccine (given to infants)

Question 49

What type of virus is influenza?

Answer 49

Orthomyxovirus

Question 50

How long is the incubation period for influenza?

Answer 50

1-3 days

Question 51

Give 6 presentations associated with influenza:

Answer 51

1) fever 2) shivering 3) generalised aching of the limbs 4) severe headache 5) soreness of throat 6) cough that can persists for several weeks

Question 52

Why are antibiotics given to influenza patients with chronic bronchitis, cardiac or renal diseases?

Answer 52

to prevent secondary bacterial infection

Question 53

What two bacteria are the most common causes of secondary infection post-influenza?

Answer 53

1) Streptococcus pneumoniae 2) Haemophilus influenza

Question 54

Although lab testing is not required to diagnose influenza, what tests can be done for a definitive diagnosis? (2)

Answer 54

1) testing for a four fold increase in complement fixing antibody or haemagglutinin antibodies OR 2) nasopharyngeal swabs

Question 55

How is influenza managed?

Answer 55

bed rest and paracetamol

Question 56

What antiviral drug may be given to influenza patients?

Answer 56

neuraminidase inhibitors such as oseltamivir (can help shorten the duration of symptoms in patients with influenza if given within 48 hours of the first symptom)

Question 57

Who is the flu jab offered to?

Answer 57

1) 65+ year olds 2) those with chronic disease 3) healthcare workers