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72 Cards in this Set
- Front
- Back
What is the age with the peak incidence of URTIs in children?
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6-22 months.
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What psychosocial factors exacerbate URTIs in children?
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- Poverty.
- Overcrowding. - Parental smoking. - Education. |
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Respiratory tract infections are the most common reason for GP attendance in Australia. True or false.
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True.
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Winter rate of respiratory infections is ______ the rate in summer.
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Winter rate of respiratory infections is twice the rate in summer.
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At a typical GP, how many cases out of a 1000 would comprise sore throats?
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The incidence is 112/1000.
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Is there any seasonal effect for incidence of sore throats?
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Little seasonal effect.
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How frequently is a presenting sore throat be due to infectious mononucleosis?
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1 in 14.
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At a typical GP, how many cases out of a 1000 would comprise influenza?
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The incidence is 44/1000
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At a typical GP, how many cases out of a 1000 would comprise measles?
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The incidence is 2/1000.
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At a typical GP, how many cases out of a 1000 would comprise pertussis and pertussis like syndrome?
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1/1000.
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How many YLDs (years of life lost due to disability) from acute respiratory infections?
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14.5.
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Infection of the nasal mucosa typically results in what symptoms?
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Dryness, pain, epistaxis (nose bleeds).
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Mucous oedema and oversecretion of the nasal passages typically results in what symptoms?
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- Sniffles.
- Blocked nose. |
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Infection of the pharyngeal mucosa results in what symptoms?
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Dryness, pain.
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Mucous oedema and over-secretion of the pharynx typically results in what symptom?
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Post-nasal drip.
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Infection of the upper bronchial tree mucosa typically results in what symptom?
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Irritating (dry) cough.
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Mucous oedema and over-secretion of the upper bronchial tree typically results in what symptom?
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Loose cough.
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What systemic effects may an upper respiratory tract infection cause?
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- Chills.
- Fever. - Myalgia. |
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What is the probability diagnosis of a sore throat?
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- 50% due to viral pharyngitis.
- Streptococcus pneumoniae is the commonest cause of tonsillitis. |
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What bacteria is the most common cause of tonsillitis?
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Streptococcus pneumoniae is the commonest cause of tonsillitis.
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What serious disorders must not be missed with a sore throat?
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- Epiglottitis.
- Carcinoma. - Quinsy. - Diptheria. - HIV. |
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What is a common pitfall for a sore throat?
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Epstein Barr Virus.
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What investigations can distinguish between a viral and bacterial cause (in particular, streptococcus) of an upper respiratory tract infection?
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- Throat swabs for Group A beta haemolytic strep (PROBLEM: high carrier rates).
- Antigen detection tests. - Anti-streptolysin O titre. |
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What are the clinical features of Group A beta hemolytic strep that can help distinguish it from a virus?
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- Fever (history) > 38 degrees.
- Lack of cough. - Tonsillar exudate. - Anterior cervical lymphadenopathy. |
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How may antibiotics help a sore throat?
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- Reduces risk of complications (suppurative and some non-suppurative).
- Patient satisfaction. - May shorten duration of symptoms. |
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What non-suppurative complications might be avoided if antibiotics are used for a sore throat?
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- Glomerulonephritis - trend for protection by antibiotics.
- Acute rheumatic fever - complication rate reduced to less than a third. |
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90% of the antibiotic treated & untreated patients with a sore throat became symptom free after 1 week. True or false?
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True.
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In a sore throat, antibiotics will reduce headache, sore throat, and fever by a duration of ____. It is most evident in _____.
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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.
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What are effective short-term (<24 hours) alternatives to antibiotics in treating sore throat?
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- Steroids.
- NSAIDs. - Caffeine. - Paracetamol. |
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What are effective long-term (<24 hours) alternatives to antibiotics in treating sore throat?
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- Paracetamol.
- NSAIDs. - Super-colonisation with benign bacteria. - Better communication skills. - Vaccination against pneumococcus and influenza. |
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Acute otitis media has occurred in what percentage of children by the age of 3 months?
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10%.
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What is the peak incidence of acute otitis media?
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9-15 months old.
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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.
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Do antibiotics help the common cold?
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No benefit with antibiotics on symptoms nor duration of illness of the common cold.
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What treatments are available for the common cold that have been proven to work?
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Evidence for:
- Echinacea. - Heat and humidified air. - Paracetamol. Inconclusive evidence for: - Zinc lozenges. - Vitamin C (?for marathon runners, soldiers undertaking subarctic exercises as prevention). |
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Acute bacterial sinusitis follows a cold in what percentage of cases?
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0.5 to 5%. But 70% are better after 2 weeks.
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Consider antibiotics for sinusitis if...
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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. |
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What antibiotics could be used for sinusitis?
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- NOT augmentin.
- Amoxycillin. - Cefaclor. - Doxycycline. |
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Why shouldn't decongestants be used for no longer than 7 days in cases of sinusitis?
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Rhinitis medicamentosa
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Allergic rhinosinusitis may occur as a result of using what medications?
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- Intranasal corticosteroids.
- Antihistamines. |
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With chronic sinusitis, what do you need to consider?
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- Smoking.
- Anatomical abnormalities. - Allergies. - A CT scan may be required. |
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Delayed antibiotics may assist in reducing antibiotic prescriptions. What subsequent issue may arise?
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- 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. |
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How frequently does bronchitis occur in GP consultation?
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3.5 per 100 consultations in Australia.
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What is the incidence of community acquired pneumonia occuring in GP consultation?
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2 cases per 1000 per year.
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What is the case fatality of community acquired pneumonia?
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8.8%.
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In cases of bronchitis, when should a chest x-ray be ordered?
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If the patient has one of the following:
- HR>100. - RR>24. - Temp>38. - Chest signs. |
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What is the usual cause of bronchitis?
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Viral.
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Should antibiotics be prescribed for bronchitis?
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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.
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Should beta-agonists be prescribed for bronchitis?
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Little evidence supporting its use. Side effects probably outweight the small benefits.
There are some evidence that they are beneficial for chronic airflow limitation. |
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Do cough suppressants work?
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Apparently not.
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What are the main symptoms to look for with community acquired pneumonia?
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- Fever.
- Productive cough. - Shortness of breath. - Chest pain. |
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What investigations may be done for possible community acquired pneumonia?
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- CXR.
- FBC. - Blood cultures. - Serology for atypical pneumonia. |
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In possible pneumonia, this about aspiration pneumonia in the following populations...
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- Alcoholics.
- Epileptics. - Oesophageal disease. - Altered consciousness. - Terminal illness. |
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A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used?
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- Amoxycillin AND one of the following:
- Doxycycline. - Roxithromycin. If allergic to penicillin, the patient could use oral cefuroxime instead. |
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A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used if the patient is allergic to penicillins?
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Cefuroxime.
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What are the 3 main bacterial causes of atypical pneumonia?
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- 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. |
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A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used?
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- Amoxycillin AND one of the following:
- Doxycycline. - Roxithromycin. If allergic to penicillin, the patient could use oral cefuroxime instead. |
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A patient has been diagnosed with streptococcus community acquired pneumonia. What antibiotics could be used if the patient is allergic to penicillins?
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Cefuroxime.
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What are the 3 main bacterial causes of atypical pneumonia?
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- 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. |
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What advice would you provide for a patient with acute bronchitis?
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- 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. |
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What organisms are most likely to cause acute bronchitis?
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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. |
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If a cough lasted longer than 3 weeks, what investigation would be indicated?
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Chest x-ray to rule out potential pathology.
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What is the definition of acute bronchitis?
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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. |
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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. |
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What are the features of mycoplasma atypical pneumonia?
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Occurs in outbreaks with an
incubation period 2–3 weeks. Fever, headache and cough prominent. Chest signs may be minimal despite radiographic changes. |
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Does chlamydia occur in epidemics?
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No, it generally doesn't.
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Does legionella occur in epidemics?
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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. |
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What patients with acute bronchitis and chest signs should be checked for CAP and considered with antibiotics?
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- Very unwell.
- Older (>55). - Smokes. - Comorbidities. |
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How long should antibiotic treatment duration be with a bacterial CAP?
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5-10 days.
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How long should antibiotic treatment duration be with a mycoplasma/chlamydia CAP?
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14 days.
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How long should antibiotic treatment duration be with a legionella CAP?
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21 days.
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How do you normally treat CAP?
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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. |