Other infections + Asthma Flashcards
what do you see normally on inspection of the eardrum?
light reflex
what do you see in otitis media on inspection of the eardrum?
- absent light reflex
- bulging eardrum
- erythema
pathophysiology of OM?
- primary viral infection
- secondary bacterial infection with pneumococcus / H influenza
treatment of OM?
self-limiting
but treat if:
- severe uni/bilateral pain if > 6 months for >48 hours
- non-severe bilateral pain in 6-23months
- non-severe bilateral pain in older children
complications of OM?
spontaneous rupture of eardrum
investiagation for tonsillitis?
throat swab
to determine if viral or bacterial
treatment of tonsillitis?
- nothing (if viral)
or
- penicillin for 10 days
- DO NOT GIVE AMOX
what is croup?
laryngotracheobronchitis
peak age of croup?
common < 4
symptoms of croup?
- stridor
- coryza
- barking cough
- hoarse voice
main causative agent of croup?
parainfluenza virus
treatment of croup?
Oral dexamethsone or nebulised budenoside
nebulised adrenaline in severe cases
causative agent, symptoms and rx of epiglottitis?
agent - H Infleunza B
symptoms- high fever, stridor and drooling
Rx- IV antibiotics + intubation
what must you not do in a child w epiglottitis?
examine w a tongue depressor- may cause obstruction
tracheitis:
causative organisms
symptoms
treatment
staph or strep
symptoms: fever, rapidly progressive airway obstruction
Rx: Augmentin
pathophysiology of bacterial bronchitis?
treatment?
primary viral infection, which causes disturbance of mucociliary escalator & hence clearance
–> secondary bacterial infection
self-limiting
when is it pneumonia?
- focal signs
- crepitations
- high fever
- tachypnoea
- SOB
- off feed
- cough
treatment for pneumonia?
1st- Amoxicillin
2nd-Macrolide
macrolide 1st line in mycoplasma pneumonia
aetiology of pertussis?
bronchitis caused by bordetella pertussis
presentation of pertussis?
coryzal symptoms followed by episodic coughing fits that are very severe
loud inspiratory whoop when coughing ends
vomiting / fainting
Mx of pertussis?
- vaccine
- Abx - erythromycin
prognosis of pertussis?
resolves within 8 weeks –> several months
complications of pertussis?
- pneumonia
- bronchiectasis
outline key symptoms/features of asthma
- wheeze
- cough
- dry
- nocturnal
- exertional
- SOB
- reversible
- variable
what is the characteristic feature of asthma?
repsonds to asthma treatment (reversible)
outline some triggers of asthma?
- exercise
- cold weather
- infections
aetiology of asthma?
genetic + environmental
inherently abnormal lungs
early onset atopy
DDx of asthma?
- viral induced wheeze
- variant of asthma
- CF
- foreign body
- infection
when is it most likely NOT Asthma?
if < 18 months–> most likely to be infection
aims of asthma treatment?
- minimise symptoms
- no exacerbations
- lung function to normal
- FEV1 & PEFR >80%
how do you measure control of asthma?
- Short acting beta agonist use per week
- Avoidance of school/nursery
- Nocturnal symptoms per week
- Exertional symptoms per week
steps in asthma mx <5 years ?
- SABA
- inhaled corticosteroid or LRA
- add other option from 2
steps in asthma management 5-12years?
- SABA
- inhaled corticosteroid
- LABA
- titrate up inhaled corticosteroid dose to medium
- consider adding LRA/theophylline
- titrate up corticosteroid to high dose
side effects of ICS?
- height suppression (only up to 1cm when used for longer than 12 months)
- oral candidiasis
- adrenocortical suppression
when is LABA given?
ONLY if concomitant use of ICS- cannot be taken without ICS
compare Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI) effectiveness
MDI:
- reaches 5% deposition on its own
- reacher 20% deposition with spacer
DPI:
reaches 20% deposition on its own
how to determine severity of an acute exacerbation of asthma?
Mx of mild acute exacerbation of asthma
as an outpatient w regular salbutamol inhalers
Mx of moderate /severe acute exacerbation of asthma
- oxygen - if <94% sats
- bronchodilators
- salbutamol
- ipratropium
- mag sulphate
- steroids
- prednisolone
- hydrocortisone
- IV Abx if infection
stepwise approach for moderate/severe exacerbations of asthma
- Salbutamol inhalers via a spacer device
- Nebulisers with salbutamol / ipratropium bromide
- Oral prednisone
- IV hydrocortisone
- IV magnesium sulphate
- IV salbutamol
- IV aminophylline
