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Upper respiratory tract symptoms

Clinical Discipline(s)/Organ System(s)
General Practice, Infectious Diseases, Otorhinolaryngology, Paediatrics, Respiratory Medicine, Respiratory System, Microbiology
Progress Test Topic(s)
Child health, Infectious disease, Respiratory
A 4 year old NZ European girl is brought to your practice by her mother because she has had a 'runny nose' for two days and is now complaining of a sore throat. She has presented to the practice with similar problems twice in the last 6 months. On both previous occasions another doctor has prescribed antibiotic treatment (amoxycillin/clavulanate on one occasion and cefaclor on another). Her mother is concerned that there may be something wrong with her immune system. The child is up to date with all her immunisations.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the upper and lower airways
   - Innate immune function of the airways
   - Epidemiology of upper respiratory tract infections from infancy to old age, including usual mechanisms of transmission
   - Microbial causes of upper respiratory tract infections
   - Extent of involvement of upper respiratory tract (including sinuses, Eustachian tubes and middle ear) in viral respiratory tract infections
   - Immune response following immunisation
   - Adverse drug reactions of antimicrobial agents
   - Pharmacology of antivirals (oseltamivir)
Clinical and Communication Skills 
   - Elicit a history from a patient with upper respiratory tract symptoms, screen for risk factors, atopy and elicit daycare history
   - Examination of the upper airway, ears and throat
   - Differentiation of upper respiratory disease from lower respiratory disease
   - Indications for and interpretation of investigations; throat swab, bloods, sputum culture, allergy tests
   - Differential diagnosis of upper respiratory tract symptoms
   - Differentiate self-limiting illness from serious bacterial illnesses
   - Interpret lateral neck X-ray for soft tissue swelling
   - Management of upper respiratory tract infections and atopy
   - Principles of 'point of care' testing including rapid antigen tests and polymerase chain reaction
Personal and Professional Skills 
   - Managing conflict in the therapeutic relationship such as dealing with a patient or parent who requests non-standard treatment
   - Awareness of issues around the health of the clinician and risk of both contraction and spread of infection
   - Antibiotic stewardship
Hauora Māori 
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
   - Awareness of disproportionate impact of socioeconomic deprivation on Māori, and appropriate response
   - Acknowledgement of the disproportionate impact of illness on whānau employment/income, and therefore availability and models of caregiving
Population Health 
   - New Zealand Immunisation Schedule
   - Awareness of resistance as a potential result of antibiotic treatment; relationship between antimicrobial consumption and prevalence of antibiotic resistance at individual and community level
   - Epidemiology of upper respiratory tract infections
   - Epidemiology of influenza, COVID and other respiratory viral illnesses
   - Infection control and prevention of transmission of respiratory pathogens in community and health setting
Conditions to be considered relating to this scenario
viral upper respiratory tract infection, croup, infectious mononucleosis, allergic rhinitis, tonsillitis, pharyngitis, influenza, pneumonia
Less common but 'important not to miss'
peritonsillar abscess/quinsy, epiglottitis/supraglottitis, tracheitis, bacterial meningitis, deep neck space infection
Related Scenarios
[Upper airway disease]