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