INFECTIONS OF THE RESPIRATORY SYSTEM Flashcards
What factors make children more susceptible to the effects of respiratory tract infection than adults?
More compliant chest wall
Fatiguability of respiratory muscles
Increased mucous gland concentration
Poor collateral ventilation
Low chest wall elastic recoil
What is the medical name for the common cold?
Acute nasopharyngitis
What is the main virus to cause acute nasopharyngitis in children?
Rhinovirus
In a child with pharyngitis or tonsillitis, what signs might point to the infective organisms being bacterial rather than viral?
Purulent exudate
Lymphadenopathy
Severe pain
What are the complications of pharyngitis and tonsillitis?
Retropharyngeal abscess
Peritonsillar abscess (quinsy)
Poststreptococcal glomerulonephritis
Rheumatic fever
What are the indications for tonsillectomy?
The indications for tonsillectomy are controversial. NICE recommend that surgery should be considered only if the person meets all of the following criteria:
- Sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
- The person has five or more episodes of sore throat per year
- Symptoms have been occurring for at least a year
- The episodes of sore throat are disabling and prevent normal functioning
Other established indications for a tonsillectomy include:
- Recurrent febrile convulsions secondary to episodes of tonsillitis
- Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
- Peritonsillar abscess (quinsy) if unresponsive to standard treatment
What are the organisms responsible for acute otitis media?
Viral:
- RSV
- Influenza
Bacteria:
- Pneumococcus
- H. influenzae
- group B streptococci
- Moraxella catarrhalis
What are the clinical features of otitis media?
Sore ear
Fever
Vomiting
Distress
Remember that only older toddlers will localize pain to their ear. Therefore ear drums should be checked in all febrile children.
Hearing loss is only really associated with otitis media with effusion
What will examination of the ear reveal in someone with acute otitis media?
Red eardrum Loss of light reflex Bulging eardrum Perforation might have occurred Purulent discharge
Why might someone have hearing loss as a result of otitis media?
In those prone to URTIs, it is common for middle ear fluid to persist (effusion), causing a conductive hearing loss and an increased susceptibility to re-infection.
Why might an effusion of the middle ear occur without otitis media?
Poor eustachian tube ventilation due to enlarged adenoids or allergy.
How do you treat middle ear effusions?
Normally it will clear by itself.
If it is persistent it can be surgically drained through grommet insertion.
What is the medical name for croup?
Acute laryngotracheobronchitis
What is the organism that most commonly causes croup?
Parainfluenza virus
What is the peak age of incidence for croup?
Second year of life
What are the clinical features of croup?
Coryza Fever Barking cough Stridor Typically worse at night
What is the important differential to think about when a child presents with features of croup?
Acute epiglottitis
How do we treat croup?
CKS recommend giving a single dose of oral dexamethasone 0.15mg/kg to all children regardless of severity. Otherwise management is usually supportive and most children will improve within 24 hours.
A child will need hospitalisation if:
- Under 12 months old
- Severe systemic illness (however, must consider acute epiglottitis)
- Signs of fatigue or respiratory failure
In these cases dexamethasone 0.15mg/kg or nebulised budenoside 2mg has been shown to have benefits.
What is the scoring system that separates the severity of croup into mild, moderate and severe?
Westley scoring system
What are the clinical features of diphtheria infection?
Sore throat Fever Lymphadenopathy Respiratory distress (stridor) Thick, grey material covering back of throat
How common is diphtheria infection?
The vaccination programme has made it very rare for children born and raised in the UK to become infected, however, it is still endemic in some countries and imported cases do occur.
What is the organism responsible for acute epiglottitis?
Haemophilus influenzae type B
What is the peak age group for developing acute epiglottitis?
1-6 years old
What are the clinical features of acute epiglottitis?
Rapid onset Intensely painful throat Fever Unable to speak or swallow Muffled voice Soft inspiratory stridor
Child is normally sat up with an open mouth to maximise airway. This may cause drooling.