Management of URTIs and Sinusitis
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Questions and Answers

What are some common viruses that can cause sinusitis?

Common viruses that can cause sinusitis include rhinoviruses, often as a complication of URTIs.

What are some bacterial causes of sinusitis?

Common bacteria that can cause sinusitis include Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes.

What are the typical clinical features of sinusitis?

Sinusitis is characterized by unilateral facial pain, worsening of symptoms after an initial improvement, and it is rare in patients under one week old.

What is a common initial treatment for sinusitis?

<p>Amoxicillin 500 mg every 8 hours for 7-10 days is a common treatment for sinusitis.</p> Signup and view all the answers

If a dental focus of infection is identified as a potential cause for sinusitis, what is the initial treatment recommendation?

<p>The initial treatment recommendation for a dental focus of infection is extraction of the impacted tooth.</p> Signup and view all the answers

What are two bacterial causes of pharyngitis?

<p>Group A haemolytic Streptococci and diphtheria.</p> Signup and view all the answers

What are two signs and symptoms that suggest a bacterial pharyngitis?

<p>Tonsilar exudates and tender neck glands.</p> Signup and view all the answers

What are three clinical features of pharyngitis?

<p>Abrupt onset, throat pain, and pain on swallowing.</p> Signup and view all the answers

What are two potential complications of untreated streptococcal pharyngitis?

<p>Acute rheumatic fever and retropharyngeal or peritonsillar abscess.</p> Signup and view all the answers

What are two signs and symptoms that suggest a viral pharyngitis?

<p>Runny nose and cough.</p> Signup and view all the answers

What are two things that are important for the management of viral pharyngitis?

<p>Supportive care and analgesics.</p> Signup and view all the answers

What are two investigations that can be done to assess pharyngitis?

<p>Throat examination and throat swab for microscopy.</p> Signup and view all the answers

How long should a course of antibiotics be given for streptococcal pharyngitis?

<p>10 days.</p> Signup and view all the answers

Flashcards

Sinusitis

Inflammation of air sinuses of the skull.

Causes of Sinusitis

Allergy, foreign body, viruses, dental infections, bacteria.

Bacterial Causes

Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes.

Clinical Features

Unilateral facial pain, symptoms worsen after initial improvement, rare in patients < 1 week.

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Treatment for Sinusitis

Amoxicillin 500 mg every 8 hours for 7-10 days; adjust for children.

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Amoxicillin plus Metronidazole

Combination antibiotics used for certain infections, including sinusitis.

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Indications for antibiotics in sinusitis

Antibiotics should be used if there are clear signs of bacterial sinusitis.

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Features of bacterial sinusitis

Signs include purulent nasal discharge, sinus tenderness, and fever.

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Otitis Media (Suppurative)

An infection of the middle ear, common in young children.

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Cause of sore throat

Pharyngitis is often caused by viral infections; bacteria like Group A strep can also be responsible.

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Clinical features of pharyngitis

Symptoms include throat pain, fever, and difficulty swallowing.

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Management of pharyngitis

Supportive care is recommended; antibiotics are not needed in most viral cases.

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Risk of untreated streptococcal pharyngitis

May lead to complications like rheumatic fever or abscesses.

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Study Notes

Management of URTIs

  • URTIs are upper respiratory tract infections
  • Management of URTIs includes treating specific infections like sinusitis, otitis media, and pharyngitis

Sinusitis

  • Inflammation of the air sinuses of the skull
  • Causes: allergies, foreign bodies, viruses (often a complication of URTIs), dental infections, and bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes)
  • Clinical features: rare in patients under 5 years; pain over cheek radiating to the frontal region or teeth; increasing pain with straining or bending down; redness of nose, cheeks, or eyelids; tenderness to pressure over the frontal sinus; referred pain to vertex, temple, or occiput; postnasal discharge; blocked nose; persistent coughing or pharyngeal irritation; hyposmia
  • Differential diagnosis: common cold, allergic rhinitis, foreign body in the nose, nasal polyps, adenoids
  • Management: general measures (e.g., steam inhalation, analgesics like paracetamol, nasal irrigation with normal saline); bacterial infection treatment (Amoxicillin 500 mg every 8 hours for 7-10 days; child dose: 15 mg/kg per dose)
  • Dental focus: Extract the tooth and give antibiotics (e.g., amoxicillin plus metronidazole)
  • Foreign body: Refer to hospital for removal
  • Notes: Do NOT use antibiotics unless clear signs of bacterial sinusitis (persistent (>1 week) purulent nasal discharge, sinus tenderness, facial or periorbital swelling, persistent fever)

Otitis Media (Suppurative)

  • Definition: An acute or chronic infection of the middle ear, most common in children under two years old
  • Causes: Eustachian tube dysfunction (associated with upper respiratory tract infections and allergies), viruses (often together with bacteria), bacterial infection (e.g., Streptococcus pneumonae, Haemophilus influenzae)
  • Clinical features (acute): acute onset pain in the ear; redness of the eardrum; fever; pus discharge (<14 days); bulging of the eardrum
  • Clinical features (chronic): on and off pus discharge (from one or both ears) for >14 days; no systemic symptoms
  • Differential diagnosis: foreign body in the ear; otitis externa; otitis media with effusion; referred ear pain (e.g., from toothache)
  • Investigations: Good history and physical examination; pus swab for microscopy and C&S
  • Acute treatment: Amoxicillin 500 mg every 8 hours for 5 days (child dose: 15 mg/kg per dose) or erythromycin 500 mg every 6 hours if penicillin allergy (child dose: 10-15 mg/kg per dose); Analgesics (e.g., paracetamol) as needed. Review after 5 days
  • Chronic treatment: Systemic antibiotics NOT recommended; aural irrigation (1 spoon hydrogen peroxide in a glass of lukewarm water, gently irrigate ear using a syringe without needle) 2-3 times a day; dry ear with wicking 3 times daily; apply 2-4 drops of ciprofloxacin ear drops 0.5% into the ear after drying; do not allow water to enter ear
  • Complications: meningitis; mastoid abscess; infection in adjacent areas (e.g., tonsils, nose)
  • Prevention: health education (recognizing otitis media discharge); early diagnosis and treatment of acute otitis media and upper respiratory tract infections; treat infections in adjacent areas

Glue Ear (Otitis Media with Effusion)

  • Definition: A non-suppurative otitis media
  • Causes: Eustachian tube blockage (e.g., adenoids, infection, thick mucus, tumors of the postnasal space); unresolved acute otitis media; viral infection of the middle ear; allergy
  • Clinical features: hearing impairment (often fluctuant in children); presence of non-purulent fluid in the middle ear; buzzing noise in ears/head; retracted or bulging eardrum; loss of usual colour of eardrum (dull eardrum)
  • Management: eliminate known predisposing causes; chlorpheniramine (dose based on age); xylometazoline/ephedrine nasal drops; chewing/blowing exercises; if effusion persists >6 weeks, refer to ENT specialist.

Pharyngitis (Sore Throat)

  • Definition: Inflammation of the throat
  • Causes: Most cases are viral; bacterial (e.g., Group A haemolytic streptococci, diphtheria in non-immunized children); gonorrhoea (often from oral sex); ingestion of undiluted spirits; candidiasis in immunosuppressed
  • Clinical features: abrupt onset; throat pain; pain on swallowing; mild fever; loss of appetite; malaise; In children: nausea, vomiting, diarrhea; runny nose, hoarseness, cough, conjunctivitis, viral rash; tonsilar exudates; tender neck glands; high fever, absence of cough (suggests bacterial pharyngotonsillitis)
  • Differential diagnosis: tonsillitis; epiglottitis; laryngitis; otitis media (if referred pain)
  • Investigations: Throat examination; throat swab for microscopy/culture; blood tests (full blood count); serological tests for haemolytic streptococci (e.g., ASOT)
  • Management: supportive care; most cases do not require antibiotics; keep patient warm; plenty of warm fluids (e.g., tea); analgesics (e.g., paracetamol) for 3 days; review patient for progress
  • Important note: if streptococcal pharyngitis is not treated properly, it can lead to acute rheumatic fever and retropharyngeal/peritonsillar abscess; therefore, ensure 10-day antibiotic courses are completed, when needed.

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Description

This quiz covers the management of upper respiratory tract infections (URTIs), focusing specifically on sinusitis. Learn about the causes, clinical features, differential diagnosis, and management strategies related to sinusitis. Test your understanding of URTIs and their implications for health.

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