Paediatric Respiratory Medicine - Inhaled FB, Obstruction, URTI, Whooping cough Flashcards
What signs are associated with inhaled foreign body?
Unequal air entry
Asymmetrical chest movement
Wheeze
How would an effective cough be described?
Loud
Breath in before each cough
Responsive and alert
Verbal
How was a child with an ineffective cough sound?
Quite/silent cough Not breathing LOC Not able to vocalise Cyanosed
When would inhalation of a foreign body be an emergency?
Complete obstruction
Button battery - even if partial obstruction
What can be seen on a CXR of an inhaled FB
Inspiratory and expiratory CXR (air can’t exit so affected lung is hyperlucent and overinflated with depressed hemidiaphragm)
Obvious FB
Lobar collapse
Where is a foreign body most likely to obstruct?
Right main bronchus
What is laryngomalacia?
Cartilage problem meaning larynx is soft and floppy so collapses on breathing
How do children with laryngomalacia present?
Noisy breathing and stridor which is worse when supine, feeding or agitated
GORD
Normal cry
When are children with laryngomalacia picked up?
Within first 6 weeks of life
Describe the appearance of laryngomalacia on laryngoscopy
Omega shaped epiglottis
How is laryngomalacia managed?
Spontaneously resolve by 18-24 months so monitor closely
Tracheostomy if resp distress
What are the complications of laryngomalacia?
Resp distress
Failure to thrive
Cyanosis
What is subglottic stenosis?
Malformed cricoid cartilage narrowing the subglottic airway
What are the categories of subglotic stenosis severity and how would each present?
Mild - may only be picked up if child needs intubating
Moderate - biphasic stridor, hoarse weak voice and resp distress during URTI in first few months of life
Severe - airway obstruction at birth
What are the management options for subglottic stenosis?
Not always needed but 2 surgical options
Laser ablation
Open reconstruction
How does the common cold present?
Colourless nasal discharge
“blocked nose”
Cough
Sneeze
Last 10 days
How is a cold managed?
Paracetamol and ibuprofen
Fluids
Honey and lemon
What causes the common cold?
Rhinovirus
What causes Pharyngitis/tonsillitis?
2/3 EBV
1/3 Group A Beta Haemolytic strep
How does pharyngitis/tonsillitis present?
Sore throat - can refer to ear Painful swallow Tonsillar exudates Headache Abdo pain Fever Cervical lymphadenopathy Red, enlarged tonsils
How are pharyngitis/tonsillitis managed?
Reassure self limiting
Delay abx for 3-5 days - phenoxymethylpenicilillin (depend on centor criteria)
What are the complications of tonsillitis and pharyngitis?
Peritonsillar abscess
Otitis media
Rheumatic fever
What are the differentials for tonsillitis and pharyngitis?
Cold
Hand foot and mouth disease
Glandular fever
What is the Centor criteria?
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
Fever (over 38°C)
Absence of cough
Add one point if child under 15yo
Score <=1 then no antibiotics
Score >=3 then 60% chance bacterial
What causes acute otitis media?
Virus - rhinovirus, RSV
Bacteria - 70%
H inleunzae, Strep pneumonia, Moraxella catarrhalis
How does acute otitis media present?
Fever
Ear pain - tugging
Hearing loss
Red inflamed tympanic membrane with loss of light reflex
How is otitis media treated?
80% self resolve
5 days amor if systemically unwell or not improving after 4 days
What complications are associated with otitis media?
TM perforation
Mastoiditis
Facial nerve palsy
Meningitis
Why is otitis media common in children?
Short flat eustachian tube
What causes acute sinusitis?
Most bacterial:
H Influenzae
Strep pneumoniae
Moraxella Catarrhalis
How does acute sinusitis present?
Non-resolving cold
Pain, swelling and tenderness over zygomatic/cheek region
Hyponasal speech
Mouth breathing
How long does sinusitis normally last?
17 days
How is sinusitis managed?
Symptom relief - fluid, analgesia, rest
7 days amoxicillin if severe or not resolving after 5 dats
Before what age is sinusitis not usually present?
10yo - sinuses don’t develop properly
What symptoms can adenoid hypertrophy present with?
Noisy rattly nose breathing
If nose breathing difficult –> mouth breathe
Runny nose
Snore at night
Glue ear - Eustachian tube blocked
What is the normal life cycle in adenoid hypertrophy?
Grow from birth
Largest at 3yo
Regress and atrophy at 7/8
What is Whooping cough normally caused by (with classification)? What is its other name?
Bordetella Pertussis - gram negative bacilli
Also known as pertussis
How prevalent is the whooping cough?
Was very prevalent but cases have dropped dramatically since the vaccine was introduced
What vaccine is available for whooping cough?
DTP
Given at 2,3 and 4 months of age. Booster at 3 years 4 months.
Temporary vaccination for pregnant women to confer passive immunity until DTP
How long is the incubation period for whooping cough?
7-20 days - off school for 3 weeks after onset of symptoms
What is the pathophysiology of pertussis?
Bacteria paralyse cilia and promote inflammation leading to impaired clearance of resp secretions
What are the phases of whooping cough and how long do each last?
Catarrhal phase - 1-2 weeks
Paroxysmal phase - 2-8 weeks
What happens in the catarrhal phase of pertussis?
Symptoms of mild Resp infection: Rhinitis Conjunctivitis Irritable Sore throat Low grade fever Dry cough
What happens in the paroxysmal phase of pertussis?
Severe episodes of dry hacking cough where child chokes, gasps, flails arms and legs, goes red, eyes water and can vomit - more common at night
Coughing phase followed by classic whoop
What can the coughing phase cause?
Epistaxis
Subconjunctival haemorrhage
How is whooping cough investigated and diagnosed?
Nasopharyngeal swap or aspirate - PCR
If cough >2 weeks - anti-pertussis toxin IgG serology recommended
Marked lymphocytosis is characteristic
Diagnose by ruling out differentials
What are the differential diagnoses for whooping cough?
Bronchiolitis Mycoplasma pneumonia Bacterial pneumonia Asthma TB
Which children with whooping cough are admitted to hospital?
<6months and acutely unwell
Breathing difficulty significant
Feeding difficulty
Complications
What is the purpose of antibiotics in whooping cough management and which antibiotics are used?
Doesn’t alter course of infection - reduce infectivity
<1month - clarithromycin
>1month - azithromycin or clarithromycin
Co-trimoxazole 2nd line if macrocodes CI
What do you have to do if a child has whooping cough?
NOTIFIABLE DISEASE - report to local health protection team
Tell parents the cough can take unto 3 months to resolve
What complications are associated with whooping cough?
Pneumonia - unto 20% of infants Seizures Encephalopathy Apnoea Raised intra-abdominal pressure can cause hernia/prolapse
