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Paediatrics > 2: Resp - Acute Otitis Media, Tonsillitis, Cystic Fibrosis > Flashcards

2: Resp - Acute Otitis Media, Tonsillitis, Cystic Fibrosis Flashcards

1
Q

What is otitis media

A

Inflammation of the middle ear

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2
Q

What is the peak incidence of otitis media

A

6-24m

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3
Q

How common is otitis media

A

85% of children will have an episode prior to 1Y

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4
Q

Why is the incidence of otitis media decreasing

A

More children vaccinated with pneumococcal vaccine

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5
Q

What typically causes otitis media

A

URTI

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6
Q

What is the most common cause of otitis media

A

S. Pneumonia

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7
Q

What are three other causes of otitis media aside from S.Pneumonia

A
  1. H. Influenza
  2. M. catarrhalis
  3. Group A B-haemolytic strep
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8
Q

What may cause otitis media in older children

A

Group A, B-haemolytic strep

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9
Q

Give an example of a groupA B-haemolytic streptococcus

A

S. pyogenes

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10
Q

What are 5 risk factors for otitis media

A
  1. Pacifier
  2. Nursery attendance
  3. Bottle fed
  4. Passive smoking
  5. Lower socio-economic status
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11
Q

What are 5 symptoms of otitis media in infants

A
  1. Anorexia
  2. Repeatedly touching ear
  3. Fever
  4. Crying
  5. Irritable
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12
Q

What are 3 symptoms of otitis media in older children

A
  1. Otaligia
  2. Hearing loss
  3. Fever
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13
Q

What is the Eustachian tube

A

A tube that connects the middle ear to the nasopharynx in order to drain secretions from the middle ear

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14
Q

What does obstruction of the Eustachian tube cause

A

means secretions of the middle ear are unable to drain and poor ventilation

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15
Q

Why is there pain and conductive hearing loss in otitis media

A

reabsorption of air in the middle ear causes a negative pressure and retraction of the tympanic membrane

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16
Q

Explain how infection occurs on occlusion of middle ear

A

Accumulation of secretions can cause bacterial infection and bulging

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17
Q

What is first-line investigation for otitis media

A

Rinne and Webers

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18
Q

How will weber’s test present in otitis media

A

Sound will lateralise to the affected ear

SI-CA

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19
Q

How will rinne’s test present in otitis media

A

Bone conduction (mastoid process) over air conduction

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20
Q

What is second-line investigation for otitis media

A

Otoscope

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21
Q

What are early findings of otitis media on otoscope

A
  1. Loss light reflex

2. Retracted tympanic membrane

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22
Q

What are 4 possible late findings of otitis media on otoscope

A
  1. Cartwheel sign
  2. red bulging
  3. Yellow spot
  4. Discharge in canal due to rupture of TM
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23
Q

What is a cartwheel tympanic membrane

A

Distribution of blood vessels on peripheral of TM

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24
Q

How will rupture of TM present

A

Discharge in the ear canal

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25
Q

What are the three criteria to admit a child with otitis media

A
  1. Systemic illness
  2. Suspect serious complication: intracranial abscess, meningitis
  3. < 3 months with T >38
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26
Q

What is first-line management for otitis media

A

Analgesia

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27
Q

What are 5 criteria for antibiotic prescription in otitis media

A
  1. Symptoms persist 5d
  2. Systemically unwell
  3. Immunocompromised
  4. <2Y with bilateral OM
  5. Otitis media w/perforation
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28
Q

What is first-line antibiotic used for otitis media

A

Amoxicillin

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29
Q

If penicillin allergic, what is used to treat otitis media

A

Clarithromycin

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30
Q

How long does otitis media usually present

A

Week

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31
Q

What are two ‘common’ complications of otitis media

A
  1. Recurrent OM

2. Glue ear

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32
Q

What is glue ear

A

Otitis media with effusion

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33
Q

How does glue ear usually present

A

Parents notice hearing loss - may cause behaviour problems during school.

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34
Q

What is the pathophysiology of glue ear

A

Thought that URTI causes enlarged adenoids that occlude to Eustachian tube leading to build-up of effusion.

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35
Q

How is glue ear managed

A

Grommets

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36
Q

Where are grommets inserted

A

Anterior-Inferior

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37
Q

What is tonsillitis

A

Inflammation of the tonsils

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38
Q

What commonly causes tonsillitis in children under 5Y

A

Viral

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39
Q

What causes tonsillitis in children 5-15Y

A

S. pyogenes (Bacterial)

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40
Q

What causes tonsillitis in young adults

A

Viral

41
Q

What percentage of tonsillitis is viral

A

60-80

42
Q

What viruses may cause tonsillitis

A 
EBV
CMV
HSV
Rhinovirus 
Coronavirus
43
Q

What is the most common cause of bacterial tonsillitis

A

S. pyogenes

44
Q

What is streptococcus pyogenes an example of

A

Group A, B-haemolytic streptococci

45
Q

How will tonsillitis present

A 
Red, swollen pharynx 
Tonsillar exudates
Fever 
Sore throat
Dysphagia 
Painful lymph nodes
Foul breath
46
Q

What are three additional features of viral tonsillitis

A

Headache
Earache
Rhinitis

47
Q

Why is tonsillitis more common in children

A

Larger palatine tonsils - means crypts are larger and more likely to trap organisms

48
Q

How is tonsillitis investigated

A

Clinical diagnosis

49
Q

When may anti-streptococcal antibody testing be performed

A

If rheumatic fever or post-streptococcal glomerulonephritis is suspected

50
Q

What is first-line management of tonsillitis

A

analgesia: paracetamol or ibuprofen

51
Q

When may antibiotics be prescribed in tonsillitis

A

if an individual meets 3 out of 4 on the centor criteria

52
Q

What is a mnemonic to remember the CENTOR criteria

A

CENTOR

53
Q

What is the CENTOR criteria

A

CENTOR:

Cough absent
Exudate
Nodes enlarged
Temperature - raised

54
Q

What is first line for tonsillitis

A

Penicillin V

55
Q

How long is penicillin V continued for

A

10d

56
Q

What is someone given if penicillin allergic

A

Clarithromycin

57
Q

what antibiotic is not used to treat tonsillitis and why

A

Amoxicillin - as in individuals with EBV it will cause a rash

58
Q

what is third-line management of tonsillitis

A

Tonsillectomy

59
Q

what are the 4 criteria an individual must meet for tonsillectomy

A

Individual must meet all of the following

  1. Sore throat definitely due to tonsillitis and not secondary cause
  2. > 5 recurrent episodes a year
  3. Symptoms >1Y
  4. Episodes disrupt normal function
60
Q

what is the typical course of tonsillitis

A

Resolves in a few weeks

61
Q

what are 5 complications of tonsillitis

A
  1. Otitis Media
  2. Sinusitis
  3. Peritonsillar abscess (Quinsy)
  4. Parapharyngeal abscess
  5. Lemierre syndrome
62
Q

What is a peri-tonsillar abscess also known as

A

Quinsy

63
Q

how will quinsy present

A
  • Peritonsillar bulge
  • Sore throat
  • Dysphagia
  • Uvular deviation
  • Muffled voice
  • Trismus
64
Q

what is trismus

A

Locked jaw

65
Q

what is lemierre syndrome

A

Septicaemia and jugular vein thrombosis due to infection with Fusiform bacterial species

66
Q

what 3 conditions can streptococcus pyogenes cause

A
  1. Tonsilitis
  2. Rheumatic fever
  3. Post-streptococcal glomerulonephritis
67
Q

in what time frame does post-streptococcal glomerulonephritis usually present

A

7-14d

68
Q

How is CF detected neonatally

A

Blood spot (Gunthrie test): looks for abnormally raised immunoreactive trypsinogen

69
Q

What are two symptoms of CF in infancy

A
  1. Meconium Ileus

2. Jaudnice

70
Q

What are 5 symptoms of CF in childhood

A
  1. Malabsorption:
    - Pale stools
    - Fatty stools
  2. Failure to thrive: weight loss
  3. Recurrent Infection: wheeze, mucus.
  4. Nasal polyps
  5. Rectal prolapse
71
Q

What is the role of the CFTR gene

A

Encodes a protein that is part of ATP-dependent chloride channels

72
Q

What happens to ATP-gated chloride channels in CF

A

Absent on cell membrane of epithelial cells

73
Q

What is the role of chloride channels in sweat glands

A

Chloride channels are responsible for reabsorbing chloride, hence sodium and water to prevent excess sweating

74
Q

What happens at sweat glands in cystic fibrosis

A

Lack of ATP Chloride Channels means that Cl-, Na+ or water cannot be reabsorbed leading to excess sweating

75
Q

What are two exocrine glands affected in CF

A
  • Pancreas

- Reproductive glands

76
Q

Explain pathophysiology of chloride channels at exocrine glands and how they are impacted in CF

A

Chloride channels are responsible for secreting Cl-, Na+ and hence water. Absence of these channels means less Cl- is secreted, causing reabsorption of Na+ and water leading to hyper-viscous secretions. These can occlude tubes and cause chronic inflammation

77
Q

What is first-line investigation for CF

A

Sweat Test

78
Q

What is normal sweat test value

A

<40

79
Q

What does 40-60 in sweat test indicate

A

Possible CF, but NOT diagnostic

80
Q

What dose >60 in sweat test indicate

A

Diagnostic of CF

81
Q

What may cause false positive sweat test

A
  • Glycogen storage disease
  • Atopic eczema
  • Adrenal insufficiency
  • Ectodermal dysplasia
  • Hypothyroidism
  • Dehydration
82
Q

What may cause false negative sweat test

A

Oedema due to hypoalbuminaemia secondary to pancreatic exocrine insufficiency

83
Q

What is second-line investigation of CF

A

CXR

84
Q

What will be seen in CXR in CF

A
  • Hyper-inflation
  • Increased AP diameter
  • Linear shadowing
85
Q

What will be seen on spirometry in CF

A

Restrictive pattern

86
Q

How are respiratory symptoms of CF managed conservatively

A

Chest physiotherapy BD.

Teach patient how to perform exercises

87
Q

What pharmacological agent is given to CF to aid mucus clearance

A

RhDNase - mucoactive agent

88
Q

Why should contact with other cystic fibrosis patients be minimised

A

Prevent transmission Bukholderia Cepacia

89
Q

When is flucloxacillin given in CF patients

A

To patients <3Y to prevent S.aureus infection

90
Q

What is last line for respiratory symptoms of cystic fibrosis

A

Heart-Lung transplant

91
Q

What diet should be adapted in cystic fibrosis

A

High Calorie
High Fat
:CF patients need 1.5x normal requirements

92
Q

What may be used to supplement enzymes in CF

A

Pancrex V Forte (pancreatic enzymes)

93
Q

What vitamin supplementation may CF patients need

A

Fat Soluble Vitamins

94
Q

What can be used to treat patients who are homozygous for F508

A

Lumacaftor or Ivacaftor

95
Q

What is the role of lumacaftor

A

Increases chloride-channel deposition on epithelial cell membranes

96
Q

What is the role of ivacaftor

A

Potentiates chloride channels already on epithelial membranes

97
Q

What is the life expectancy of cystic fibrosis

A

39Y

98
Q

What do the majority of CF individuals pass away from

A

Respiratory failure

99
Q

What are 5 complications of CF

A 
Liver disease
Male Infertility 
Female Subfertility 
Short stature 
Diabetes Mellitus 
Delayed puberty 
Nasal polyps 
Rectal prolapse

Paediatrics (61 decks)

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