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Upper Respiratory Tract Infection URTI ?
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Upper Respiratory Tract Infection URTI
Common Cold / Influenza Sore Throat Acute Otitis Media Sinusitis
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Common Cold = Influenza?
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Pharyngotonsillitis Tonsillophayngitis
Acute Pharyngitis Pharyngotonsillitis Tonsillophayngitis
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Inflammation of the Pharynx and Tonsils
One of the most common pediatric infections.
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Pathogens:
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Pathogens: Viral: Rhino/Adeno/Corona/EBV/CMV HSV Bacterial:
Streptococcus spp. (GAS,GCS,GGS) Cor. Diphth, Gonococcus, Tularemia etc. Mycoplasma. Toxoplasmosis.
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Pathogens: 0-2 years Viral ++++ GAS+ 5-above Viral GAS++ (15-20%)
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A Study in Makkah showed 40% GAS and high resistance to Penicillin
Telmesani/Ghazi 2002
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Presentation: Cough Sore throat Dysphagia Fever
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O/E: Erythemetous Throat Enlarged tonsils Exudates Palatine Petechiae
Ant. Cervical Lymphadenopathy Ulceration&vesiculation(HSV/Coxack) Conjuncitvitis(adenovirus) Gray-white fibrinous pseudomem (diphtheriae) Macular rash/white tongue(GAS)
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Complications: Peritonsillar abcess
Internal jugular vein septic thrombophlebitis (Lemierre Synd.) Lymphadenitis and abcess Nonsuppurative e.g. rheumatic fever
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Diagnosis: Throat culture Rapid GAS antigens testing
EBV (heterophil/serology) Cold agglutinations (mycoplasma)
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TTT: Penicillin for GAS
Macrolides (alternative/Mycoplasma) Erytheromycin/Clarithomycin/ Azethromycin
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TTT: Lactamase producing bacteria needs Amoxicillin-clavulanate acid
or 2nd generation Cephalosporin's e.g. Cefuraxim, Cefaclor
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TTT: Aspiration or Derainage for abscess
Proper management for any other complications
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Tonsillectomy
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Tonsillectomy Recurrent tonsillitis Peritonsillar Abscess (Quinsy)
Obstructive Sleep Apnea (Kissing Tonsils)
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Adenoidectomy
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Adenoidectomy Chronic Secretory Otitis Media
Upper Airway Obstruction (Snoring)
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Ottits Media
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Suppurative infection of the middle ear cavity
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Epidemiology 6/12 to 2 y High risk group Boys Cleft Palate
Formula Feeding Down Eskimos Winter- Low Socioeconomic
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Pathogenesis
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Pathogenesis Blocked estachian canal Micro-organism
Viral RSV CMV Rhino etc Streptococcus Pneumonia H.Influenzae Moraxella Catarrhalis Mycoplasma Staphylococcus
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Presentation Preceding URTI Fever, irritability, pulls ears
V/D,bulging A/F Bulging, immobile injected T.M Loss of land marks Perforation
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Normal ear drum and other one with central perforation
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large central perforation in the right ear of a patient
who had suffered a long standing ear infection.
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Therapy Antibiotics ( Beta Lactamase) Amoxycillin-Clavulenic acid
Cephalosporins TMP-SMX Macrolides Oral/nasal decongestants Tympanocentesis
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Prevention S. Pneumoniae conjugated vaccine (small effect)
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Chronic Secretory Otitis Media (Glue Ear)
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Chronic Secretory Otitis Media (Glue Ear)
Secondary to recurrent O.M Treatment Prevents conductive Deafness -Long term Antibiotics -Insertion of ventilation tubes (Grommets)
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Sinusitis Suppurative infection of the sinuses
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Predisposition Common cold, Allergic rhinitis
Nasotracheal/nasogastric intubations Cyanotic heart disease C.F, Ig disorders ,immotile cilia syndrome HIV, immune compromised patients
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Sinus Formation At birth Maxillary ,Ethmoid and Sphenoid are present.
At one year Frontal sinus Pneumotization comes later
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Pathogenesis
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Pathogenesis Mucociliary flow obstruction Bacterial growth
S. peunoniae H.Influenzae (nontypable) M.Catarrhalis Anaerobic bacteria Strept/Staph Gm –ve (nosocomial) Aspergillus (nutropenic pt.)
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Presentation Mucopurulent rhinorrhea. Night cough. Nasal speech.
Facial swelling (pain,headache,tenderness). X-Ray/CT shows clouding/air fluid level.
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Therapy Amoxicillin /Amox+clavulenic acid
Cephalosporin(2nd generation)
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Complications orbital cellulitis (read it) epidural/subdural empyema
brain abscess dural sinus thrombosis Meningitis Pott’s puffy tumor
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TTT of complications Drainage Broad spectrum antibiotics.
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8/12 comes to your clinic with the problem of not growing well?
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5 years boy comes to E/R with the problem of high fever and crying?
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