URTI

Question 1

What is Sinusitis? (Acute rhinosinusitis)

Answer 1

Inflammation of the mucosal liningsof the nasal passage and paranasal sinuses

Question 2

How does sinusitis present?

Answer 2

1. Nasal congestion
2. Nasal discharge
3. Facial pain or headache
4. Facial pressure
5. Facial swelling over the affected areas
6. Loss of smell

Question 3

List 4 causes of sinusitis

Answer 3

1. Infection esp following a viral URTI
2. Allergies ie. hayfever (with allergic rhinitis)
3. Obstruction of drainage ie. foreign body, trauma or polyps
4. Smoking

Question 4

Label each of the sinuses on the image below

Answer 4

(1) Frontal sinuses
(2) Ethmoid sinuses
(3) Sphenoid sinuses
(4) Maxillary sinuses

Question 5

What differentiates acute vs chronic rhinosinusitis?

Answer 5

Symptoms >12 wks are chronic

Question 6

How do we diagnose acute sinusitis

Answer 6

Presence of nasal blockage (obstruction/congestion) OR nasal discharge

WITH

facial pain/pressure (or headache) and/or reduction (or loss) in sense of smell

Question 7

List 2 DDx for acute sinusitis

Answer 7

1. Viral upper respiratory tract infection
2. Allergic rhinitis
3. Facial pain syndromes (e.g. migraines)

Question 8

Investigations for Sinusitis

Answer 8

Typically made on clinical symptoms alone

Investigations may incl Nasal endoscopy or CT scan

Question 9

Management of Sinusitis

(For symptoms ≤ and ≥ 10 days)

Answer 9

≤ 10 days: analgesia + nasal decongestants

≥ 10 days: nasal steroid spray for 14 days and Abx (phenoxymethylpenicillin)

Question 10

List 4 red flag symptoms for acute sinusitis that require ENT refferal

Answer 10

1. A severe systemic infection
2. Intraorbital or periorbital complications
3. Intracranial complications
4. Reduced concious levels

Question 11

What is Tonsillitis?

Answer 11

Inflammation of the palatine tonsils, most commonly due to infection

Question 12

Is Tonsillitis most commonly bacterial or viral?

Answer 12

Viral (2/3)

Bacterial (1/3)

Question 13

What is the most common cause of bacterial tonsillitis?

Answer 13

Group A streptococcus (Streptococcus pyogenes)

Question 14

How does Tonsillitis present?

Answer 14

1. Sore throat
2. Fever (above 38°C)
3. Pain on swallowing

Question 15

Examination findings of acute tonsilits?

Answer 15

1. Red, inflamed and enlarged tonsils
2. +/- exudates (white patches)
3. May be anterior cervical lymphadenopathy

Question 16

What is the Centor Criteria?

Answer 16

Used to estimate the probability that tonsillitis is due to bacterial infection and will benefit from antibiotics

Question 17

Explain the Centor criteria

Answer 17

≥ 3 means 40-60 % probability of bacterial tonsillitis → offer antibiotics. Following is worth 1 pt each

• Fever > 38ºC
• Tonsillar exudates
• Absence of cough
• Tender anterior cervical lymphadenopathy

Question 18

What can be used as an alternative to the Centor critera?

Answer 18

FeverPAIN score

• Fever during previous 24 hours
• Purulence
• Attended within 3 days of the onset of symptoms
• Inflamed tonsils
• No cough or coryza

Question 19

What values of the FeverPAIN score indicate likelihood of bacterial tonsillitis

Answer 19

• 2-3 = 34 – 40% probability
• 4-5 = 62 – 65% probability

Question 20

Management of tonsillitis that is likely viral?

Answer 20

Educate patients and give safety net advice

Advise simple analgesia with paracetamol and ibuprofen to control pain and fever

Question 21

What specific safety net advise would you give for tonsillitis?

Answer 21

1. Return if the pain has not settled after 3 days OR
2. If fever rises > 38.3ºC

Question 22

List 4 instances where we may consider prescribing antibiotics in tonsilitis?

Answer 22

1. Centor score is ≥ 3,
2. FeverPAIN score is ≥ 4
3. Young infants
4. Immunocompromised
5. Significant co-morbidities
6. History of rheumatic fever

Question 23

What is a delayed prescription?

Answer 23

Involves educating patients or parents about the likely viral nature of the sore throat and providing a prescription to be collected only if the symptoms worsen or do not improve in the next 2 – 3 days

Question 24

First line antibiotics for tonsilitis?

Alternative if allergic?

Answer 24

1. Phenoxymethylpenicillin for a 10-day course
2. Clarithromycin if penicillin allergy

Question 25

List 4 complications of Tonsilitis

Answer 25

1. Peritonsillar abscess (quinsy) 2. Otitis media 3. Scarlet fever 4. Rheumatic fever 5. Post-streptococcal glomerulonephritis 6. Post-streptococcal reactive arthritis

Question 26

What is Epiglottitis?

Answer 26

Inflammation and swelling of the epiglottis caused by infection Life threatening emergency

Question 27

Most common causative organism of Epiglottitis

Answer 27

Haemophilus influenza type B

Question 28

In which specific patient group must we have the highest suspicion of Epiglottitis?

Answer 28

Unvaccinated children Routine vaccination programs protect against haemophilus

Question 29

Presenting features suggesting Epiglottitis?

Answer 29

1. Sore throat and stridor 2. Drooling 3. Tripod position 4. Fever 5. Difficulty or painful swallowing Child may have a muffled voice or be scared and quiet. Keep a look out for signs of sepsis

Question 30

Characteristic X-ray sign in acute epiglottitis

Answer 30

Lateral xray of the neck shows “thumb sign” or “thumbprint sign” Caused by the oedematous and swollen epiglottis

Question 31

Management of acute Epiglottitis

Answer 31

1. Do NOT distress the patient - can prompt closure of the airway 2. Alert paediatrician and anaesthetist (incase tracheostomy required) 3. Secure the airway 4. IV antibiotics (e.g. ceftriaxone) 5. Steroids (i.e. dexamethasone)

Question 32

Common complication of Epiglottitis?

Answer 32

Epiglottic abscess Also threatens the airway, treatment similar to epiglottitis