Conditions YR2SEM2

Causes & Treatment

Top 10 URT infections

1. common cold

2. pharyngitis

3. diptheria

4. glandular fever

5. acute laryngitis

6. croup

7. acute epiglottitis

8. sinusitis

9. otitis externa

10. otitis media

Common cold

• Rhinovirus + coronavirus (50%) , influenza, parainfluenza, RSV & adenovirus

• runny nose, cough, and sore throat.

• self limiting

Pharyngitis / Tonsilitis

• Inflammation of the pharynx, often caused by viral or bacterial infections.

• Viral - same as cc + Epstein barr virus, coxsackie A16 (hand foot mouth)

• bacterial - Grp A,C& G Strep + neisseria gonorrhoea + strep Pyogenes

• sore throat and difficulty swallowing

GABH Strep Pyogenes (Pharyngitis / Tonsilitis) complications

Group A Beta Haemolytic Strep Pyogenes

• red flags - white puss field lesions + exudate , sudden onset, no cough, high fever

COMPLICATIONS

• Quinsy - peritonsillar abscess

• scarlet fever

• acute glomerulornephritis

• rheumatic fever —> heart disease

Treatment - Penicillin

Diptheria

• Corynebacterium diphtheriae,

• Exotoxin destroys epithelial cells - nectrotic false membrane blocks airway

• medical emergency

• bull neck due to cervical lymphnodes swelling

Treatment = antitoxin and antibiotics + vaccine

Glandular fever ‘mono’

• Epstein-Barr virus (herpes)

• enlarged spleen, severe fatigue, fever, sore throat, and swollen lymph nodes.

Acute Laryngitis

• viral infection or overuse of the voice

• hoarseness, sore throat barking cough

Croup ( Laryngotracheobronchitis )

• Parainfluenza, influenza, Adenovirus + RSV

• 3m-3yrs

• Barking cough, stridor, respiratory distress, Hx of URTIs + fever

• self limiting

Acute Epiglottitis (bacterial)

Haemophilus Influenzae Type B

• medical emergency

• acute onset, stridor, drooling, difficulty breathing, fever

treatment - oxygen + broad spectrum antibiotic

DO NOT ATTEMPT THROAT CULTURE

Otits externa

Staph Aureus, Pseudomonas aeruginosa + other gram -tives (invasive)

• infection of the outer ear, often caused by water exposure or trauma.

• Pain, itching, and discharge from the ear, necrosis (invasive)

Acute Otis media

Viral - RSV

• common in kids following a cold.

• ear pain, fever, and irritability

  Treatment may involve pain management and sometimes antibiotics.

Lymphnodes of respiratory system (PPBT)

• Pulmonary

• Bronchopulmonary hilar

• Tracheo bronchial

• Paratracheal

BALT - Bronchus associated lymphoid tissue (in lamina propria)

Rhinosinitus Treatment

Acute = NSAIDS + paracetamol + decongestants + alpha adrenoreceptor agonists , Phenylephrine, nasal saline drops

Chronic = oral / nasal corticosteroids

Lower respiratory infections (PACT IB)

Bronchitis

Influenza

Pneumonia

Tuberculosis

Asthma

COPD

Bronchitis

Bordetella pertussis → whooping cough, influenza

treatment = macrolids azithromycin, Clarithromycin

Influenza

Type A& B = most common

Oseltamivir —> neuraminadase inhibitor - must take within 48 hrs of onset

Pneumonia

Strep pneumoniae, mycoplasma, chlamydia, legionella pneumoniae

• lung consolidation , cough, fever

Low severity Pneumonia treatment

Amoxicillin , doxycycline, clarithromycin

or combination

Amox + dox or cefuroxime + dox

Moderate Pneumonia treatment

Benzylpencillin + Dox or Clarithromycin

High severity Pneumonia treatment

managed in ICU - imperical broad spectrum antibiotic / identify causative agent

Tuberculosis

Mycobacterium Tuberculosis

• unexplained weight loss, fever + 3wks, night sweats e.c.t

Tuberculosis Treatment

• ALWAYS COMBINATION THERAPY

• Rifampicin - antimycobacterial

• isoniazid - activated by m. tuberculosis

• Pyrazinamide (not in aus)

• Ethambutol- optic neuritis x

T2 Type Asthma = Allergic Asthma

Chronic inflammatory lung disease → reversible narrowing of the airways

• starts in childhood

• excercised induced

• late onset+ eosinophilic

• exacerbated by aspirin

Non- type 2 Asthma

• obesity associated

• smoking + neutrophilic paucigranulocytic

• smooth muscle mediated airway hyper-responsiveness

• less responsive to steroids

Asthma treatment

1. SABA

2. Low dose daily ICs + SABA or LABA as needed

3. Daily maintenance dose ICs+LABA & SABA, ICS or SABA as needed

4. Medium - Daily high dose ICs + LABA & SABA, ICS or SABA as needed

5. + another dialator eg. tiotropium

6. add on specialized treatment - Biologics or Bronchial thermoplasty.

COPD

Emphysema - alveolar break dowwn - Pink puffer - hyper inflation, muscle waisting, quiet chest

Bronchitis - Blue bloater - overweight, cynotic + high Hg fibrosis, high neutrophil and macrophage profile

• risk factors = smoking , alpha-1 Antitrypsin deficiency & age

FEV1

Mild = 60-80%

Moderater = 40- 59%

Severe < 40%

COPD Treatment

1. Short term = SABA & SAMA (block para sympathetic activity)

2. Longterm = LABA (formoterol) + LAMA (tiotropium)

If elevated eosinophil use TRIPLE THERAPY

3. LABA+LAMA+ICs

4. O2 therapy

5. Transplantation

Dysentery

gram neg rods - enteric bacteria

• blood and pus in faeces

• pain,fever,cramping