Upper respiratory tract infections

Question 1

What is included in the upper respiratory tract

Answer 1

Nose, paranasal sinuses, middle ear, oropharynx, nasopharynx, laryngopharynx, tonsils and adenoids

Question 2

Are majority of upper respiratory tract infections viral or bacterial

Answer 2

Viral

Question 3

4 most common viruses causing upper resp. infections

Answer 3

Adenovirus
Parainfluenza virus
Respiratory syncytial virus
Rhinovirus

Question 4

Usual onset of upper resp tract infections

Answer 4

1-3 days

Question 5

How long do upper resp tract infections usually last

Answer 5

7-10 days

Question 6

What usually causes acute pharyngitis

Answer 6

Group A strep

Question 7

Symptoms of strep throat

Answer 7

Sore throat

May not have runny nose/ cough/ sneezing

Question 8

Main features of colds

Answer 8

Watery to mucoid, sometimes purulent nasal discharge called coryza

Question 9

What family is responsible for about 50% of common colds

Answer 9

Picrona virus family (rhinoviruses)

Question 10

Incubation period for rhinoviruses colds

Answer 10

1-3 days

Question 11

What follows incubation period of rhinoviruses

Answer 11

Headache, sore throat, fullness of nose

Profuse watery discharge from nose which gradually thickness

Question 12

What type of immunity follows rhinovirus cold

Answer 12

Short period of immunity to all colds

Prolonged immunity to specific serotype causing recent infection

Question 13

What is the proper name for croup

Answer 13

Acute laryngo-tracheo-bronchitis

Question 14

What causes croup

Answer 14

Viruses (RSV, parainfluenza 1-3)

Question 15

Signs and symptoms of croup

Answer 15

Hoarseness, seals bark cough, stridor

Question 16

Treatment of croup

Answer 16

Monitor for obstruction
Inspire humidified air
Consider ribavirin

Question 17

What is the single main pathogen in resp infections of childhood

Answer 17

Respiratory syncytial virus (RSV)

Question 18

Describe morphology of paramyxoviruses

Answer 18

• Similar to influenza
• Roughly spherical
• Inner helical nucleocapsid
• Envelop studded with spikes of haemagglutinin and neuraminidase

Question 19

Proper name for ear infection

Answer 19

Otitis media

Question 20

What can group A strep infection lead to

Answer 20

• Severe sore throat
• Peritonsilar abscess
• Rheumatic fever

Question 21

What causes epiglottisis

Answer 21

Haemophilus influenzae type B

Question 22

Clinical features of group A strep

Answer 22

• Sore throat, fever
• Tender cervical nodes
• May lead to quinsy
• Occasionally leads to scarlet fever
• Incubation period 2-3 days

Question 23

Lab diagnosis of strep A?

Answer 23

Bacterial culture- beta- haemolytic colonies on agar, gram positive cocci in chains, and lancefield group A (cell wall antigen)

Question 24

How to treat strep A

Answer 24

Antibiotics

Question 25

What causes glandular fever/ infectious mononucleosis

Answer 25

Epstein Barr virus

Question 26

How is Epstein Barr virus diagnosed

Answer 26

- Peripheral white cell count - Monospot test - Detection of IgM antibodies against EBV

Question 27

Management of Epstein Barr virus

Answer 27

Rest and analgaesia | Occasionally causes obstruction- hospital and steroids

Question 28

What antibiotics should be avoided in treated secondary bacterial infection bollowing Epstein Barr?

Answer 28

Ampicillin (causes a rash)

Question 29

What causes sinusitis

Answer 29

Bacterial overgrowth of normal flora

Question 30

Clinical features of epiglottis

Answer 30

- Rapid onset of severe, sore throat, dysphagia - May lead to resp obstruction - Bacteria

Question 31

What would CT scan of person with epiglottis show

Answer 31

Swelling of soft tissues in neck

Question 32

Management of epiglottitis

Answer 32

Medical emergency: - Airway (intubation/ tracheostomy) - Antibiotics - Prophylaxis for unimmunised household contacts

Question 33

What microorganism causes whooping cough

Answer 33

Bordetella pertussis

Question 34

What happens in week 1 of whooping cough

Answer 34

Catarrhal phase: cough increases

Question 35

What happens in week 3-4 of whooping cough

Answer 35

Paroxysmal stage Severe spells of cough Whoop is created by vigorous inspiration through glottitis May turn blue or vommit

Question 36

Treatment of whooping cough

Answer 36

Erythromycin

Question 37

How is whooping cough diagnosed

Answer 37

Pernasal swab Grab negative rod Slow growing- 5 days Direct immunofluorescence

Question 38

Define acellular vaccine

Answer 38

Contains inactive forms of pertussis toxin, filamentous haemagglutinin, agglutinogens, outer membrane protein

Question 39

What toxin causes diphtheria

Answer 39

Corynebacterium diphtheriae

Question 40

What does the diphtheria toxin do

Answer 40

Binds to EF-Tu to form inactive diphthamide EF-Tu and stop protein synthesis

Question 41

What childhood vaccination prevent diphtheria

Answer 41

DTP

Question 42

Management of diphtheria

Answer 42

``` Isolate Anti-toxin Penicillin Monitor for obstruction Contact trace ```

Question 43

How are adenovirus spread

Answer 43

Droplet, formites and ingestion

Question 44

What do adenoviruses infect

Answer 44

Mucous membrane of eye resp and gastro intestinal tract, occasionally urinary tract

Question 45

Describe process of viral infection

Answer 45

Virus binds to cell surface Viral genome released into cell for replication Viral proteins produced allowing assembly of progeny virus particles to be formed and released

Question 46

Where does influenza act on the body

Answer 46

Infects upper airways but may go down and cause pneumonia and bronchiolitis

Question 47

What do we know about pandemic waves

Answer 47

More than one way likely Waves last 6-8 days Gaps may be weeks or months Subsequent wave may be worst

Question 48

How to prevent spread of influenza

Answer 48

Staff in hospitals should be vaccinated

Question 49

How can influenza be treated pharmacologically

Answer 49

Zanamavir/ oseltamavir