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Last updated on 10 Sep 2015 at 2:35 PM (Resp07)
Upper respiratory tract symptoms
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.
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
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
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 MÄ•ori
Understanding of inequities in access to health services and quality of medical care
for MÄ•ori, and application of this to clinical decision making and management
Awareness of disproportionate impact of socioeconomic deprivation on MÄ•ori, and
appropriate response
Acknowledgement of the disproportionate impact of illness on whĕnau
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
Conditions to be considered relating to this scenario
viral upper respiratory tract infection, croup, infectious
Common
mononucleosis, allergic rhinitis, tonsillitis, pharyngitis,
influenza, pneumonia
peritonsillar abscess/quinsy, epiglottitis/supraglottitis,
Less common but
tracheitis, bacterial meningitis, deep neck space
'important not to miss'
infection