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72 Cards in this Set

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What is the age with the peak incidence of URTIs in children?
6-22 months.
What psychosocial factors exacerbate URTIs in children?
- Poverty.
- Overcrowding.
- Parental smoking.
- Education.
Respiratory tract infections are the most common reason for GP attendance in Australia. True or false.
True.
Winter rate of respiratory infections is ______ the rate in summer.
Winter rate of respiratory infections is twice the rate in summer.
At a typical GP, how many cases out of a 1000 would comprise sore throats?
The incidence is 112/1000.
Is there any seasonal effect for incidence of sore throats?
Little seasonal effect.
How frequently is a presenting sore throat be due to infectious mononucleosis?
1 in 14.
At a typical GP, how many cases out of a 1000 would comprise influenza?
The incidence is 44/1000
At a typical GP, how many cases out of a 1000 would comprise measles?
The incidence is 2/1000.
At a typical GP, how many cases out of a 1000 would comprise pertussis and pertussis like syndrome?
1/1000.
How many YLDs (years of life lost due to disability) from acute respiratory infections?
14.5.
Infection of the nasal mucosa typically results in what symptoms?
Dryness, pain, epistaxis (nose bleeds).
Mucous oedema and oversecretion of the nasal passages typically results in what symptoms?
- Sniffles.
- Blocked nose.
Infection of the pharyngeal mucosa results in what symptoms?
Dryness, pain.
Mucous oedema and over-secretion of the pharynx typically results in what symptom?
Post-nasal drip.
Infection of the upper bronchial tree mucosa typically results in what symptom?
Irritating (dry) cough.
Mucous oedema and over-secretion of the upper bronchial tree typically results in what symptom?
Loose cough.
What systemic effects may an upper respiratory tract infection cause?
- Chills.
- Fever.
- Myalgia.
What is the probability diagnosis of a sore throat?
- 50% due to viral pharyngitis.
- Streptococcus pneumoniae is the commonest cause of tonsillitis.
What bacteria is the most common cause of tonsillitis?
Streptococcus pneumoniae is the commonest cause of tonsillitis.
What serious disorders must not be missed with a sore throat?
- Epiglottitis.
- Carcinoma.
- Quinsy.
- Diptheria.
- HIV.
What is a common pitfall for a sore throat?
Epstein Barr Virus.
What investigations can distinguish between a viral and bacterial cause (in particular, streptococcus) of an upper respiratory tract infection?
- Throat swabs for Group A beta haemolytic strep (PROBLEM: high carrier rates).
- Antigen detection tests.
- Anti-streptolysin O titre.
What are the clinical features of Group A beta hemolytic strep that can help distinguish it from a virus?
- Fever (history) > 38 degrees.
- Lack of cough.
- Tonsillar exudate.
- Anterior cervical lymphadenopathy.
How may antibiotics help a sore throat?
- Reduces risk of complications (suppurative and some non-suppurative).
- Patient satisfaction.
- May shorten duration of symptoms.
What non-suppurative complications might be avoided if antibiotics are used for a sore throat?
- Glomerulonephritis - trend for protection by antibiotics.
- Acute rheumatic fever - complication rate reduced to less than a third.
90% of the antibiotic treated & untreated patients with a sore throat became symptom free after 1 week. True or false?
True.
In a sore throat, antibiotics will reduce headache, sore throat, and fever by a duration of ____. It is most evident in _____.
In a sore throat, antibiotics will reduce headache, sore throat, and fever by a duration of 1 day. It is most evident in 3.5 days.
What are effective short-term (<24 hours) alternatives to antibiotics in treating sore throat?
- Steroids.
- NSAIDs.
- Caffeine.
- Paracetamol.
What are effective long-term (<24 hours) alternatives to antibiotics in treating sore throat?
- Paracetamol.
- NSAIDs.
- Super-colonisation with benign bacteria.
- Better communication skills.
- Vaccination against pneumococcus and influenza.
Acute otitis media has occurred in what percentage of children by the age of 3 months?
10%.
What is the peak incidence of acute otitis media?
9-15 months old.
What benefit is there for use of antibiotics for acute otitis media in terms of:
- Pain at 24 hours.
- Abnormal tympanometry.
- Perforation.
- Deafness at 3 months.
No difference at all.
Do antibiotics help the common cold?
No benefit with antibiotics on symptoms nor duration of illness of the common cold.
What treatments are available for the common cold that have been proven to work?
Evidence for:
- Echinacea.
- Heat and humidified air.
- Paracetamol.

Inconclusive evidence for:
- Zinc lozenges.
- Vitamin C (?for marathon runners, soldiers undertaking subarctic exercises as prevention).
Acute bacterial sinusitis follows a cold in what percentage of cases?
0.5 to 5%. But 70% are better after 2 weeks.
Consider antibiotics for sinusitis if...
3 of the following are present:
- Persistent mucopurulent nasal discharge (>7 to 10 days).
- Facial pain.
- Poor response to decongestants.
- Tenderness over the sinuses, especially unilateral maxillary tenderness.
- Tenderness on percussion of maxillary molar and premolar teeth that cannot be attributed to a single tooth.
What antibiotics could be used for sinusitis?
- NOT augmentin.
- Amoxycillin.
- Cefaclor.
- Doxycycline.
Why shouldn't decongestants be used for no longer than 7 days in cases of sinusitis?
Rhinitis medicamentosa
Allergic rhinosinusitis may occur as a result of using what medications?
- Intranasal corticosteroids.
- Antihistamines.
With chronic sinusitis, what do you need to consider?
- Smoking.
- Anatomical abnormalities.
- Allergies.
- A CT scan may be required.
Delayed antibiotics may assist in reducing antibiotic prescriptions. What subsequent issue may arise?
- Giving antibiotics early achieve their maximum through modest effect.
- Delayed antibiotics may lose their effect.

- Increased pain and malaise may occur for children with otitis media.
- Increased fever for patients with sore throat.
How frequently does bronchitis occur in GP consultation?
3.5 per 100 consultations in Australia.
What is the incidence of community acquired pneumonia occuring in GP consultation?
2 cases per 1000 per year.
What is the case fatality of community acquired pneumonia?
8.8%.
In cases of bronchitis, when should a chest x-ray be ordered?
If the patient has one of the following:
- HR>100.
- RR>24.
- Temp>38.
- Chest signs.
What is the usual cause of bronchitis?
Viral.
Should antibiotics be prescribed for bronchitis?
Evidence suggests that antibiotics provide modest benefit probably offset by their side effects. Most benefit with antibiotics occur with smokers, the elderly and the very unwell.
Should beta-agonists be prescribed for bronchitis?
Little evidence supporting its use. Side effects probably outweight the small benefits.

There are some evidence that they are beneficial for chronic airflow limitation.
Do cough suppressants work?
Apparently not.
What are the main symptoms to look for with community acquired pneumonia?
- Fever.
- Productive cough.
- Shortness of breath.
- Chest pain.
What investigations may be done for possible community acquired pneumonia?
- CXR.
- FBC.
- Blood cultures.
- Serology for atypical pneumonia.
In possible pneumonia, this about aspiration pneumonia in the following populations...
- Alcoholics.
- Epileptics.
- Oesophageal disease.
- Altered consciousness.
- Terminal illness.
A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used?
- Amoxycillin AND one of the following:
- Doxycycline.
- Roxithromycin.

If allergic to penicillin, the patient could use oral cefuroxime instead.
A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used if the patient is allergic to penicillins?
Cefuroxime.
What are the 3 main bacterial causes of atypical pneumonia?
- Mycoplasma pneumoniae - occurs in outbreaks with fever, cough and headache prominent.
- Chlamydia pneumoniae.
- Legionella - spread by water droplets (e.g. cooling towers) causing high fever, diarrhoea and hyponatremia.
A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used?
- Amoxycillin AND one of the following:
- Doxycycline.
- Roxithromycin.

If allergic to penicillin, the patient could use oral cefuroxime instead.
A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used if the patient is allergic to penicillins?
Cefuroxime.
What are the 3 main bacterial causes of atypical pneumonia?
- Mycoplasma pneumoniae - occurs in outbreaks with fever, cough and headache prominent.
- Chlamydia pneumoniae.
- Legionella - spread by water droplets (e.g. cooling towers) causing high fever, diarrhoea and hyponatremia.
What advice would you provide for a patient with acute bronchitis?
- Return for review if gotten worse (fever, tightness in chest, dyspnoea, increased severity of cough).
- Bed rest.
- Drink plenty of fluids.
- Take paracetamol/aspirin.
- Steam inhalation.
- Reassure/explain nature of the illness.
What organisms are most likely to cause acute bronchitis?
It is most often associated with respiratory viruses such as rhinoviruses, coronaviruses, influenza, parainfluenza, adenovirus and
respiratory syncytial virus. A very small proportion may be caused by Bordetella
pertussis, Mycoplasma pneumoniae or Chlamydia pneumoniae.
If a cough lasted longer than 3 weeks, what investigation would be indicated?
Chest x-ray to rule out potential pathology.
What is the definition of acute bronchitis?
Acute cough of less than 14 days duration with at least one other respiratory tract symptom:
• URTI symptoms, eg. rhinitis or sore throat.
• Sputum production.
• Dyspnoea.
• Wheeze.
• Chest discomfort.
There should be no other obvious cause, eg. asthma, sinusitis, COPD.
Aspiration pneumonia due to anaerobic organisms
should be considered in coughing patients with...
- Neurological disorders (eg. mysthenis gravis).
- Dysphagia or oesophageal disease.
- Dental sepsis.
- Altered consciousness, or
- Terminal illness.
What are the features of mycoplasma atypical pneumonia?
Occurs in outbreaks with an
incubation period 2–3 weeks. Fever, headache and cough prominent. Chest signs may be
minimal despite radiographic changes.
Does chlamydia occur in epidemics?
No, it generally doesn't.
Does legionella occur in epidemics?
Spread via water droplets (potable water and cooling towers), symptoms include
diarrhoea, high fever, hyponatraemia, neutrophils but no organisms in gram stain of respiratory secretions.
What patients with acute bronchitis and chest signs should be checked for CAP and considered with antibiotics?
- Very unwell.
- Older (>55).
- Smokes.
- Comorbidities.
How long should antibiotic treatment duration be with a bacterial CAP?
5-10 days.
How long should antibiotic treatment duration be with a mycoplasma/chlamydia CAP?
14 days.
How long should antibiotic treatment duration be with a legionella CAP?
21 days.
How do you normally treat CAP?
Amoxycillin 1 g orally, 8 hourly for 7 days
Plus either:
Doxycycline 200 mg orally, for the first dose, 100 mg per day for a further 7 days
OR
Roxithromycin 300 mg, daily for 7 days.

In patients allergic to penicillin, amoxycillin should be replaced with
cefuroxime 500 mg orally, 12 hourly for 7 days.