2: Resp - Acute Otitis Media, Tonsillitis, Cystic Fibrosis Flashcards
1
Q
What is otitis media
A
Inflammation of the middle ear
2
Q
What is the peak incidence of otitis media
A
6-24m
3
Q
How common is otitis media
A
85% of children will have an episode prior to 1Y
4
Q
Why is the incidence of otitis media decreasing
A
More children vaccinated with pneumococcal vaccine
5
Q
What typically causes otitis media
A
URTI
6
Q
What is the most common cause of otitis media
A
S. Pneumonia
7
Q
What are three other causes of otitis media aside from S.Pneumonia
A
- H. Influenza
- M. catarrhalis
- Group A B-haemolytic strep
8
Q
What may cause otitis media in older children
A
Group A, B-haemolytic strep
9
Q
Give an example of a groupA B-haemolytic streptococcus
A
S. pyogenes
10
Q
What are 5 risk factors for otitis media
A
- Pacifier
- Nursery attendance
- Bottle fed
- Passive smoking
- Lower socio-economic status
11
Q
What are 5 symptoms of otitis media in infants
A
- Anorexia
- Repeatedly touching ear
- Fever
- Crying
- Irritable
12
Q
What are 3 symptoms of otitis media in older children
A
- Otaligia
- Hearing loss
- Fever
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
14
Q
What does obstruction of the Eustachian tube cause
A
means secretions of the middle ear are unable to drain and poor ventilation
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
16
Q
Explain how infection occurs on occlusion of middle ear
A
Accumulation of secretions can cause bacterial infection and bulging
17
Q
What is first-line investigation for otitis media
A
Rinne and Webers
18
Q
How will weber’s test present in otitis media
A
Sound will lateralise to the affected ear
SI-CA
19
Q
How will rinne’s test present in otitis media
A
Bone conduction (mastoid process) over air conduction
20
Q
What is second-line investigation for otitis media
A
Otoscope
21
Q
What are early findings of otitis media on otoscope
A
- Loss light reflex
2. Retracted tympanic membrane
22
Q
What are 4 possible late findings of otitis media on otoscope
A
- Cartwheel sign
- red bulging
- Yellow spot
- Discharge in canal due to rupture of TM
23
Q
What is a cartwheel tympanic membrane
A
Distribution of blood vessels on peripheral of TM
24
Q
How will rupture of TM present
A
Discharge in the ear canal
25
What are the three criteria to admit a child with otitis media
1. Systemic illness
2. Suspect serious complication: intracranial abscess, meningitis
3. < 3 months with T >38
26
What is first-line management for otitis media
Analgesia
27
What are 5 criteria for antibiotic prescription in otitis media
1. Symptoms persist 5d
2. Systemically unwell
3. Immunocompromised
4. <2Y with bilateral OM
5. Otitis media w/perforation
28
What is first-line antibiotic used for otitis media
Amoxicillin
29
If penicillin allergic, what is used to treat otitis media
Clarithromycin
30
How long does otitis media usually present
Week
31
What are two 'common' complications of otitis media
1. Recurrent OM
| 2. Glue ear
32
What is glue ear
Otitis media with effusion
33
How does glue ear usually present
Parents notice hearing loss - may cause behaviour problems during school.
34
What is the pathophysiology of glue ear
Thought that URTI causes enlarged adenoids that occlude to Eustachian tube leading to build-up of effusion.
35
How is glue ear managed
Grommets
36
Where are grommets inserted
Anterior-Inferior
37
What is tonsillitis
Inflammation of the tonsils
38
What commonly causes tonsillitis in children under 5Y
Viral
39
What causes tonsillitis in children 5-15Y
S. pyogenes (Bacterial)
40
What causes tonsillitis in young adults
Viral
41
What percentage of tonsillitis is viral
60-80
42
What viruses may cause tonsillitis
```
EBV
CMV
HSV
Rhinovirus
Coronavirus
```
43
What is the most common cause of bacterial tonsillitis
S. pyogenes
44
What is streptococcus pyogenes an example of
Group A, B-haemolytic streptococci
45
How will tonsillitis present
```
Red, swollen pharynx
Tonsillar exudates
Fever
Sore throat
Dysphagia
Painful lymph nodes
Foul breath
```
46
What are three additional features of viral tonsillitis
Headache
Earache
Rhinitis
47
Why is tonsillitis more common in children
Larger palatine tonsils - means crypts are larger and more likely to trap organisms
48
How is tonsillitis investigated
Clinical diagnosis
49
When may anti-streptococcal antibody testing be performed
If rheumatic fever or post-streptococcal glomerulonephritis is suspected
50
What is first-line management of tonsillitis
analgesia: paracetamol or ibuprofen
51
When may antibiotics be prescribed in tonsillitis
if an individual meets 3 out of 4 on the centor criteria
52
What is a mnemonic to remember the CENTOR criteria
CENTOR
53
What is the CENTOR criteria
CENTOR:
Cough absent
Exudate
Nodes enlarged
Temperature - raised
54
What is first line for tonsillitis
Penicillin V
55
How long is penicillin V continued for
10d
56
What is someone given if penicillin allergic
Clarithromycin
57
what antibiotic is not used to treat tonsillitis and why
Amoxicillin - as in individuals with EBV it will cause a rash
58
what is third-line management of tonsillitis
Tonsillectomy
59
what are the 4 criteria an individual must meet for tonsillectomy
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
what is the typical course of tonsillitis
Resolves in a few weeks
61
what are 5 complications of tonsillitis
1. Otitis Media
2. Sinusitis
3. Peritonsillar abscess (Quinsy)
4. Parapharyngeal abscess
5. Lemierre syndrome
62
What is a peri-tonsillar abscess also known as
Quinsy
63
how will quinsy present
- Peritonsillar bulge
- Sore throat
- Dysphagia
- Uvular deviation
- Muffled voice
- Trismus
64
what is trismus
Locked jaw
65
what is lemierre syndrome
Septicaemia and jugular vein thrombosis due to infection with Fusiform bacterial species
66
what 3 conditions can streptococcus pyogenes cause
1. Tonsilitis
2. Rheumatic fever
3. Post-streptococcal glomerulonephritis
67
in what time frame does post-streptococcal glomerulonephritis usually present
7-14d
68
How is CF detected neonatally
Blood spot (Gunthrie test): looks for abnormally raised immunoreactive trypsinogen
69
What are two symptoms of CF in infancy
1. Meconium Ileus
| 2. Jaudnice
70
What are 5 symptoms of CF in childhood
1. Malabsorption:
- Pale stools
- Fatty stools
2. Failure to thrive: weight loss
3. Recurrent Infection: wheeze, mucus.
4. Nasal polyps
5. Rectal prolapse
71
What is the role of the CFTR gene
Encodes a protein that is part of ATP-dependent chloride channels
72
What happens to ATP-gated chloride channels in CF
Absent on cell membrane of epithelial cells
73
What is the role of chloride channels in sweat glands
Chloride channels are responsible for reabsorbing chloride, hence sodium and water to prevent excess sweating
74
What happens at sweat glands in cystic fibrosis
Lack of ATP Chloride Channels means that Cl-, Na+ or water cannot be reabsorbed leading to excess sweating
75
What are two exocrine glands affected in CF
- Pancreas
| - Reproductive glands
76
Explain pathophysiology of chloride channels at exocrine glands and how they are impacted in CF
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
What is first-line investigation for CF
Sweat Test
78
What is normal sweat test value
<40
79
What does 40-60 in sweat test indicate
Possible CF, but NOT diagnostic
80
What dose >60 in sweat test indicate
Diagnostic of CF
81
What may cause false positive sweat test
- Glycogen storage disease
- Atopic eczema
- Adrenal insufficiency
- Ectodermal dysplasia
- Hypothyroidism
- Dehydration
82
What may cause false negative sweat test
Oedema due to hypoalbuminaemia secondary to pancreatic exocrine insufficiency
83
What is second-line investigation of CF
CXR
84
What will be seen in CXR in CF
- Hyper-inflation
- Increased AP diameter
- Linear shadowing
85
What will be seen on spirometry in CF
Restrictive pattern
86
How are respiratory symptoms of CF managed conservatively
Chest physiotherapy BD.
| Teach patient how to perform exercises
87
What pharmacological agent is given to CF to aid mucus clearance
RhDNase - mucoactive agent
88
Why should contact with other cystic fibrosis patients be minimised
Prevent transmission Bukholderia Cepacia
89
When is flucloxacillin given in CF patients
To patients <3Y to prevent S.aureus infection
90
What is last line for respiratory symptoms of cystic fibrosis
Heart-Lung transplant
91
What diet should be adapted in cystic fibrosis
High Calorie
High Fat
:CF patients need 1.5x normal requirements
92
What may be used to supplement enzymes in CF
Pancrex V Forte (pancreatic enzymes)
93
What vitamin supplementation may CF patients need
Fat Soluble Vitamins
94
What can be used to treat patients who are homozygous for F508
Lumacaftor or Ivacaftor
95
What is the role of lumacaftor
Increases chloride-channel deposition on epithelial cell membranes
96
What is the role of ivacaftor
Potentiates chloride channels already on epithelial membranes
97
What is the life expectancy of cystic fibrosis
39Y
98
What do the majority of CF individuals pass away from
Respiratory failure
99
What are 5 complications of CF
```
Liver disease
Male Infertility
Female Subfertility
Short stature
Diabetes Mellitus
Delayed puberty
Nasal polyps
Rectal prolapse
```
