Influenza,brochiolitis,tonsilitis Flashcards
What are some complications of influenza?
- Otitis media, sinusitis and bronchitis
- Viral pneumonia
- Secondary bacteria pneumonia
- Worsening chronic health conditions, such as COPD and heart failure
- Febrile convulsions (young children)
- Encephalitis
What are the most common types of influenza?
Type A and B
Which groups of people are at higher risk of developing complications from influenza?
- Aged 65 and over
- Young children
- Pregnant women
- Chronic health conditions, such as asthma, COPD, heart failure and diabetes
- Healthcare workers and carers
What are the clinical presentations of having influenza?
- Fever
- Lethargy and fatigue
- Anorexia (loss of appetite)
- Muscle and joint aches
- Headache
- Dry cough
- Sore throat
- Coryzal symptoms
How can you differentiate between someone having a common cold or the flu?
Flu tends to have abrupt onset, whereas a common cold has a more gradual onset.People with the flu are also “wiped out” with muscle aches and lethargy whereas someone with a cold could continue with everyday activities
How do you test for influenza?
Point of care tests (readily available and detect the viral antigens but do not show the subtype)
Viral nasal/throat swabs can be sent to virology lab for PCR testing to confirm diagnosis
What are the 2 management plan options for somone who has influenza but is at risk of developing complications? State the route of the medication,how many times a day and for how many days?
- Oraloseltamivir(twice daily for 5 days)
- Inhaledzanamivir (twice daily for 5 days)
When does the medication (to manage influenza) need to be given for it to be effective?
Treatment needs to be startedwithin 48 hoursof the onset of symptoms to be effective.
Post-exposure prophylaxis can be given to patients who are at risk of getting influenza, but what criteria must they meet?
Post-exposure prophylaxis may be given where patients meet specific criteria:
- It isstarted within 48 hours of close contact with influenza
- Increased risk(e.g., chronic disease or immunosuppression)
- Not protectedby vaccination (e.g., it has beenless than 14 dayssince they were vaccinated)
What are the options for post-exposure prophylaxis for influenza?
- OralOseltamivir75mg once daily for 10 days
- Inhaledzanamivir10mg once daily for 10 day
What is bronchiolitis usually caused by?
Respiratory syncytial virus (RSV)
Other causes include:
-Mycoplasma
-Adenoviruses
What are some of the clinical presentations of a child with bronchiolitis?
Coryzal symptoms (runny nouse,sneezing,mucus in throat and watery eyes)
Dyspnoea (heavy laboured breathing)
Tachypnoea
Poor feeding
Mild fever
Apnoeas (episodes when the child stops breathing)
Wheeze and crackles on auscultation
What are the signs of respiratory distress? (MUST KNOW THESE FOR EXAMS)
- Raised respiratory rate
- Use ofaccessory muscles of breathing, such as thesternocleidomastoid, abdominal andintercostal muscles
- Intercostal andsubcostal recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis(due to low oxygen saturation)
- Abnormal airway noises
What abnormal ariway sounds may be heard when an infant has bronchiolitis?
May hear:
Wheezing (due to narrowed airway.It is a whistling sound and is continual.Is typically heard during expiration)
Crackles
Grunting
Most infants are managed at home when they have bronchiolitis. But what criteria should be met if the infant/child was to be admitted into hospital? (Quite a few points)
-Aged under 3 months
-Have pre-existing condition like prematurity,Downs syndrome or cystic fibrosis
-Clinical dehydration
-50%-75% or less of their normal intake of milk
-Respiratory rate > 70
-Oxygen saturations < 92%
-Moderate to severe respiratory distress like deep recession or head bobbing
-Apnoeas
-Parents not confident to manage child at home
What investigation can be done if someone has bronchiolitis?
Immunofluoresence of nasopharyngeal secretions may show RSV
What is the management for bronchiolitis?
Typically supportive management
Ensuring adequate intake (orally,via NG tube or IV fluids depending in severity)
Overfeeding can limit breathing
Saline nasal drops and nasal suctioning (to help clear nasal secretions)
Supplementary oxygen if the OS sats are BELOW 92%
Ventilatory support if required
What ventilatory support options are there for a child who has bronchiolitis?
1.High-flow humidified oxygen via a tight nasal cannula
Is called AirVo/Optiflow
Helps prevent their airways from collapsing
It adds PEEP (positive end-expiratory pressure)
2.Continuous positive airway pressure (CPAP)
Involves using a sealed nasal cannula (performs similar way to AirVo/Optiflow but can deliver much HIGHER and more controlled pressures)
3.Intubation and ventilation
Involves inserting an endotracheal tube into the trachea to fully control ventilation
How do you assess ventilation if a child has bronchiolitis?
Capillary blood gases (used in severe respiratory distress and in monitoring children who are having ventilatory support)
What is palivizumab and what is it used for?
It is a monoclonal antibody taht targets RSV and is given to high-risk patients (like ex-premature or those with congenital heart disease) as monthly injections (as the levels in the body deplete over time)
What is acute tonsilitis?
Inflammatory infection of the palatine tonsils
Thetonsilsare collections of lymphatic tissue located within the pharynx. What is the ring arrangement that it forms and what are the different parts of it?
It forms the Waldeyer’s ring and consists of ;
pharyngeal tonsil (also known as the adenoid, only 1 of these)
Tubal tonsils (2 of these)
Palatine tonsils (2 of these)
Lingual tonsil (1 of these)
What are the clinical presentations of someone who has tonsilitis?
Patients typically present with a combination of an acute onset of:
Sore throat (99%)
Fever >38ºC (82%)
Dysphagia (66%)
Nasal congestion, headache, earache, cough (47%)
These 4 symptoms may be present if viral aetiology.
If no cough is present, this is more likely a bacterial cause.
If NO cough is present when a pt has tonsilitis, is it likely to be a bacterial or viral cause?
More likely to be a bacterial cause
