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Paediatrics > Paediatric Upper Airway Issues > Flashcards

Paediatric Upper Airway Issues Flashcards

1
Q

What are some of the symptoms of upper airway obstruction?

A 
Coughing
Drooling
Difficulty Breathing
Gagging
Inspiratory Stridor
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2
Q

Why might stridor be considered a good sign after aspirating a foreign object?

A

Stridor indicates that there is a partial obstruction creating the turbulent flow and audible sound

If there is a complete obstruction there is no ventilation and no breath sounds may be audible

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3
Q

What is the BLS approach for a choking patient?

A

5 Back Slaps
5 Abdominal thrusts

Note- if older ask for two big cough before starting back slaps.

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4
Q

What investigations may be done in a stable child thought to have aspirated something?

A

CXR or Neck Radiograph to locate the object

Laryngoscopy/Bronchoscopy can both visualise and remove the object

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5
Q

What symptoms might be experienced if a foreign object is aspirated into the nasal cavity?

A

Unilateral foul smelling rhinorrhea
Difficulty breathing
Epistaxis
Obstructed air outflow from nose

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6
Q

What is laryngomalacia?

A

Congenital abnormality of the laryngeal cartilage, shortened aryepiglottic folds pull the epiglottis causing airway obstruction. Most common cause of stridor in newborns.

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7
Q

How do most cases of laryngomalacia correct?

A

Many children grow out of it with age

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8
Q

Why is it important to monitor weight and feeding in children with laryngomalacia?

A

Difficulty breathing leads to issues with feeding and so nutrition may be poor.

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9
Q

Why might laryngomalacia lead to or worsen reflux?

A

Negative pressure is created due to obstruction which can draw up stomach acid causing reflux. This causes irritation and swelling which can worsen the laryngomalacia.

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10
Q

How is laryngomalacia diagnosed?

A

Laryngoscopy or bronchoscopy

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11
Q

How can you divide the causes of rhinitis?

A

Infectious and non-infectious

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12
Q

What are some causes of non-infectious rhinitis?

A

Allergic Rhinitis- Pollen, Dust, Dander
Irritant- Tobacco smoke, Cold or dry air
Exercise

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13
Q

What are some of the symptoms of rhinitis?

A

Nasal congestion
Rhinorrhoea
Sneezing
Sniffling

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14
Q

What treatments might be used for non-infection rhinitis?

A 
Avoid the trigger
Intranasal Antihistamines
Intranasal Steroids
Nasal Douching
Oral Antihistamines
Oral Steroids if severe atopic crisis
Ipratropium bromide (antimuscarinic may be used to reduce nasal secretions)
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15
Q

Are the majority of infectious rhinitis cases due to viral or bacterial infections?

A

Viral

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16
Q

What are the common viral causes of infectious rhinitis?

A 
Rhinovirus
Influenza virus
RSV (Respiratory Syncytial Virus)
Parainfluenza Virus
Adenovirus
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17
Q

What are the common bacterial causes of infectious rhinitis?

A

Strep pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis

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18
Q

What can a fungal cause of rhinitis be an indicator of?

A

Immunocompromised child- aspergillus could be the fungal cause

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19
Q

What are the common viral causes of pharyngitis?

A

Rhinovirus
Coronavirus

Infection may begin as rhinitis and then travel to cause infection of the pharynx

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20
Q

What is a common bacterial causes of pharyngitis?

A

Group A Strep

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21
Q

What criteria should be used to differentiate between a viral and a bacterial cause of pharyngitis/tonsillitis?

A

CENTOR Criteria

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22
Q

What are the CENTOR criteria?

A

C- Cough Absent +1
Exudate Visibile +1
Nodes- Tender Cervical Lymphadenopathy +1
Temperature >38 + 1

23
Q

What CENTOR score should an antibiotic prescription be written for?

A

Scores of 3 or More

A score of 0, 1 or 2 should not be offered an antibiotic prescription as the cause is likely to be viral

24
Q

What advice should be given with a back-up antibiotic prescription?

A

Antibiotic is not needed immediately
Use prescription of no improvement in 3 to 5 days or if symptoms worsen
Seek medical help immediately if symptoms worsen rapidly or the person becomes very unwell

25
Q

How do the symptoms of pharyngitis differ between bacterial and viral causes?

A

Cough is more likely to be present in viral causes
Other cold like symptoms are more likely to be present in a viral cause including- rhinorrhoea, nasal congestion
Bacterial causes are associated with fever
Cervical lymphadenopathy is more likely to be tender in bacteria causes
Exudate is more likely to be present if there is a bacterial cause

26
Q

What should be used as the first line antibiotic for suspected bacterial causes of sore throat?

A

Phenoxymethylpenicillin (Penicillin V)

27
Q

What should be used as the antibiotic choice for patients who are allergic to penicillin for suspected bacterial causes of sore throat?

A

Clarithromycin

Erythromycin

28
Q

Where can abscesses form following bacterial infection of the pharynx?

A 
Peritonsillar space (Over 10 years)
Retropharyngeal space (Under 10 years)
29
Q

What are some symptoms of a pharyngeal abscess formation?

A

High fever
Drooling
Dysphagia
Odynophagia
Trismus- difficulty opening mouth for peritonsillar
Torticollis- stiff neck for retropharyngeal abscess
Unilateral swelling with uvula deviation may be visible on examination
Hot potato voice- muffled voice with distorted vowels

30
Q

What are some of the symptoms of a retropharyngeal abscess?

A 
High fever
Neck stiffness- torticollis
Dysphagia
Stridor
Malaise
Tender cervical lymph nodes

Difficult to see of physical examination but concerns may be raised when there is neck stiffness and feature of infection. It is a complication of untreated bacterial pharyngitis.

31
Q

Why can a retropharyngeal abscess cause potential fatal infections further down the line?

A

The retropharyngeal space communicates with the mediastinum and so infection can spread here

Also, the abscess can grow to cause airway obstruction and death from this

32
Q

What investigations should be done to check for a retropharyngeal abscess?

A

CT Head and Neck is diagnostic

Side profile/lateral head and neck radiograph

33
Q

What is the treatment for an peritonsillar/retropharyngeal abscess?

A

Incision and drainage

IV ABx

34
Q

What is the most common cause of croup?

A

RSV
Parainfluenza
Adenovirus
Influenza

35
Q

What are the signs of croup?

A

Stridor
Barking cough
Hoarse Voice

36
Q

During what time of year is croup more common?

A

Autumn

37
Q

What are the symptoms of croup?

A

Prodrome of fever and nasal congestion
Barking cough
Hoarse voice
Inspiratory stridor

38
Q

What scoring system may be used to grade the severity of croup?

A

Westley Croup Score

Grades croup as mild, moderate, severe or at risk of imminent respiratory failure

39
Q

What is the medical name for croup?

A

Laryngotracheobronchitis

40
Q

What is the treatment for mild croup?

A

If mild can be managed at home- anti pyrexial (e.g. paracetamol), keeping hydrated
Single dose of dexamethasone may be given

41
Q

What features might suggest croup is mild?

A 
Limited signs of respiratory distress
No IC, SC or Sternal Recession
No tracheal tug
Maintaining oxygen saturations
Alert Child
Good air entry
42
Q

What are some signs that croup is severe?

A 
Stridor at rest
Tracheal tug
IC or SC or Sternal Recession
Restlessness
Cyanosis
Tachypnea
Tachycardia 
Altered Consciousness
43
Q

What is the management for severe croup?

A

Nebulised Adrenaline
Dexamethasone

If risk of respiratory failure or PEWS very high transfer to ITU, may need to be intubated

44
Q

Failure to respond to initial treatment for croup (dexamethasone nebulized adrenaline) should raise concern of what?

A

Bacterial tracheitis- thick mucopurulent exudate is difficult to clear and can cause airway obstruction

45
Q

What are some signs of epiglottis?

A 
Sudden onset
Continuous stridor
Muffled voice
high fever
Cough not prominent (barking cough is seen with croup and bacterial tracheitis)
46
Q

What should be avoided in children with suspected epiglottitis?

A

Avoid examining the throat as it can cause laryngospasm and occlude the airway. Avoid anything that stresses out the child. Get senior help with ENT/Anaesthetics. May need inhalational induction in theatre or a tracheotomy.

47
Q

What is the most common cause of epiglottitis?

A

Haemophilus Influenzae B- rates have fallen as it is one of the routine vaccinations for newborns

48
Q

What is the treatment of epiglottitis?

A

ABC approach and ensure patent airway
Get senior help from ENT/Anaesthetics
Cefotaxime Abx

Note- Cough is absent unlike croup and bacterial tracheitis

49
Q

What sign is seen on x-rays for epiglottitis?

A

Thumbprint sign- thickened epiglottis and aryepiglottic folds visible on a lateral x-ray

Note- An x-ray should not be done in suspected cases, it is an emergency and an ENT/Anaesthetic senior should be sought

50
Q

How does diphtheria cause harm?

A

Production of the toxin by the corynebacterium diptheria

51
Q

What are some of the features of diphtheria initially?

A

Tonsillitis
False membrane at the back of the throat
Dysphagia
Neck swelling

Note- Diphtheria means leather in Greek because the membrane looks a bit like leather

52
Q

What are some of the serious features of diphtheria?

A

Myocarditis
Neuritis leading to paralysis
Neck swelling- bull neck appearance

53
Q

How is diphtheria prevented?

A

Vaccinate

54
Q

How should diphtheria be treated?

A

Diphtheria antitoxin
Erythromycin

Give contacts erythromycin syrup before swab results are known.

Isolate until 3 negative cultures separated by 48 hours.

Paediatrics (6 decks)

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