Croup and tonsilitis

Question 1

what is croup?

Answer 1

• viral URTI causing nasopharyngeal inflammation

- can spread to the larynx and trachea

Question 2

what adverse effects can croup cause?

Answer 2

• Subglottal inflammation, which compromises the airway

Question 3

what is the main cause of croup?

what age does it commonly affect?

Answer 3

• parainfluenza virus
• most commonly older than bronchiolitis (6 months to 3 years)
• more common in boys

Question 4

what clinical features are associated?

Answer 4

• BARKING COUGH
• hoarseness
• stridor
• decreased air entry but normal sounds
• respiratory distress

Question 5

what clinical scoring system is used in croup?

what are the parameters?

what does a score above 12 indicate?

Answer 5

• Wesley system
• air entry
• cyanosis
• stridor
• intercostal recession
• level of consciousness
• impending respiratory failure

Question 6

where should moderate and severe croup be treated?

what might make you want to admit croup patients?

Answer 6

• hospital admission
• epiglottitis
• peritonsillar abscess
• diphtheria
• bacterial tracheitis
• saturations <95% suggest respiratory impairment

Question 7

how is croup managed?

Answer 7

• ABCDE, symptomatic treatment and good fluid intake
• oxygen therapy to maintain sats >93%
• 150mg of dexamethasone PO or prednisolone 1mg/kg
• nebuliser adrenaline in very severe cases

Question 8

complications of croup?

Answer 8

• bacterial superinfection by staph aureus and group A strep.
• Complications are rare and only 1 in 4500 need intubation

Question 9

What are the clinical features of tonsillitis?

Answer 9

• sore throat referred to ears
• dysphagia, headache
• abdo pain
• swollen lymph nodes (anterior cervical glands)
• red throat with or without exudate

Question 10

What other differentials should be considered in tonsillitis?

Answer 10

• coxsackie (producing blisters)
• HSV
• Epiglottitis

HIV can present with ENT symptoms

Question 11

what are the centor criteria?

Answer 11

• fever
• exudate on tonsils
• no cough
• tender anterior cervical adenopathy

predicts likelihood of strep pharyngitis

Question 12

What is the management for tonsillitis (if not bacterial)?

Answer 12

• reassurance mostly, as most are viral

- anti paretics and salt water gargles

Question 13

When do NICE suggest antibiotics?

Answer 13

• unilateral peritonsilitis
• history of rheumatic fever
• 3 or more centor criteria

Question 14

when should you refer for tonsillectomy?

Answer 14

• child has 5+ acute sore throat per year
• symptoms occurring for at least a year
• affects day to day functioning

Question 15

how do you treat epiglottitis?

Answer 15

• cefuroxime 7-10 days

- IV fluids