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Year 4 PAEDS > Resp and ENT 2 > Flashcards

Resp and ENT 2 Flashcards

1
Q

List some causes of cough in infancy

A

Infections:

  • URTI
  • Bronchiolitis
  • Pneumonia

Congenital malformations of the airway
GORD
CF

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2
Q

List some causes of cough in preschool children

A

Infections:

  • URTI
  • Croup
  • Acute bronchitis
  • Pneumonia

Foreign body
Asthma
CF
Passive smoking

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3
Q

List some causes of cough in school-age to adolescence

A 
Asthma
Infections - URTI
Smoking
Postnasal drip
Psychogenic
CF
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4
Q

List some red flags of a serious lower respiratory infection in children

A

Productive cough which improves with abx but quickly recurs

Restriction of activity

Failure to grow or gain weight

Clubbing

Persistent tachypnoea

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5
Q

Ddx of a loose, productive cough (3)

A

1) Bronchitis
2) CF
3) Bronchiectasis

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6
Q

Ddx of a wheezy cough (2)

A

1) Asthma

2) Bronchitis

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7
Q

What does a barking cough suggest?

A

Croup

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8
Q

What is paroxysmal cough?

A

Frequent and violent coughing that can make it hard for a person to breathe

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9
Q

Ddx of cough with vigorous exercise (3)

A

1) Exercise-induced asthma
2) CF
3) Bronchiectasis

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10
Q

What should be included on examination of a child presenting with a cough?

A

1) Growth
2) Signs of respiratory distress
- In an infant, tachypnoea or expiratory grunting may be only signs
3) Chest examination
4) Other signs - eg clubbing, signs of atopy eg eczema

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11
Q

What investigations can be done for a child presenting with a cough and what may they show?

A

FBC

  • Raised WCC in infection
  • Possible eosinophilia in asthma

Blood culture - LRTI

Pernasal swab - Pertussis

CXR - LRTI

CXR + barium swallow - Congenital anomalies of airway / GORD

Sweat test - CF

Videofluoroscopy and bronchcoscopy - Inhaled foreign body

Trial of bronchodilators and peak flow measurements - Asthma

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12
Q

Which children are most at risk of inhaling a foreign body?

A

Toddlers - their behaviour of putting things in their mouths

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13
Q

How may an inhaled foreign body present?

A

Depends on location, ranges from no symptoms to complete obstruction

Larynx:

  • Croupy cough and stridor
  • Hoarseness
  • Dyspnoea

Bronchus:
- Chest pain or no symptoms for a few days until development of pneumonia infection, collapse, or obstructive emphysema

Oesophagus:

  • Drooling
  • Dysphagia

NB ask about foreign body inhalation when persistent cough or chest infection not resolving

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14
Q

What is the most common location for an inhaled foreign body?

A

Right main bronchus

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15
Q

What may be seen on examination of a child with an inhaled foreign body?

A

Monophonic wheeze or absent breath sounds on affected side

Unilateral chest expansion

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16
Q

What investigations may be done for an inhaled foreign body?

A

CXR and neck radiographs with lateral views
- Inspiratory and expiratory films
Bronchoscopy
ABG if in severe distress

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17
Q

What is the management of an inhaled foreign body?

A

ABCDE

Effective cough:
- Encourage cough and continue to check for deterioration to ineffective cough or until obstruction relieved

Ineffective cough, conscious:
- 5 back blows
- 5 thrusts
(Chest for infant, abdo for child <1yr)

Ineffective cough, unconscious:

  • Open airway
  • 5 breaths
  • Start CPR (15:2)
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18
Q

What is otitis media? Give 5 subtypes

A

OM = umbrella term of acute inflammation of the middle ear

1) Acute otitis media
2) Otitis media with effusion (glue ear)
3) Chronic suppurative otitis media
4) Mastoiditis
5) Cholesteatoma

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19
Q

What is the pathophysiology of AOM? Why are children more prone to it?

A

Infecting organisms reach the middle ear from the nasopharynx to the ear

As children grow bigger, the angle between the Eustachian tube and the wall of the pharynx becomes more acute so that coughing or sneezing tends to push it shut

In small children, the less acute angle facilitates infected material being transmitted through the tube to the middle ear

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20
Q

What is the most common cause of AOM?

A

Bacterial:

  • Haemophilus influenze
  • Strep pneuomniae
  • Moraxella catarrhalis
  • Strep pyogenes

Viral:

  • RSV
  • Rhinovirus
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21
Q

List some RF for AOM (5)

A

1) Young
2) Male
3) Smoking in household
4) Formula feeding - breast milk protective
5) Craniofacial abnormalities eg Down’s syndrome, cleft palata

22
Q

What symptoms may AOM present with?

A 
Pain (young children may pull at ear)
Malaise
Irritability / crying / poor feeding 
Fever
Coryza
Vomiting
23
Q

What signs may be noted on examination of a child with AOM?

A

1) High temp - febrile convulsions my be associated with temperature rise in AOM
2) Red, yellow or cloudy tympanic membrane
3) Bulging tympanic membrane
4) An air-fluid level behind the tympanic membrane
5) Discharge in auditory canal secondary to perforation of tympanic membrane (may obscure view completely)

+/- red pinna

24
Q

A distressed child with AOM suddenly settles quickly, what do you suspect has happened? What may you see?

A

Perforation of the eardrum relieves pain

The ear may then start to discharge green pus

25
Q

What is otitis media with effusion (OME)?

A

= glue ear

Collection of fluid in the middle-ear cleft. Chronic inflammatory condition without acute inflammation, often following AOM

26
Q

What is the treatment of AOM?

A

Usually no treatment required - paracetamol and ibuprofen

Abx if <4 days no improvement / systemically unwell . perforation and/or discharge in ear canal:

  • 5 day course of amoxicillin
  • If penicillin allergy = erythromycin / clarithromycin

Warm compress over ear can help to reduce pain

27
Q

How does OME present?

A

Hearing loss (most common cause of hearing loss in childhood)

Ear pain with fullness / popping
+/- hx or recurrent ear infection or URTI

On examination:
No signs of inflammation or discharge
Loss of light reflex
Presence of bubbles or fluid level

Can progress to a red, bulging TM which can perforate and discharge

28
Q

What is the prognosis of OME?

A

Self-limiting illness and 90% have complete resolution within one year but recurrence is common

Surgery recommended for those with persistent bilateral OME lasting 3/more months, hearing loss or those with LD

29
Q

What is the surgical management of OME?

A

1st line = insertion of grommets (ventilation tubes)
- Remain in place for 6-12 months after which they fall out naturally

Adenoidectomy only if recurrent URTI is a feature

30
Q

In broad terms, list 3 causes of SOB

A

1) Airway obstruction
2) Abnormal lung mechanics
3) Hypoxia

31
Q

List some causes of abnormal lung mechanics leading to SOB

A

Restrictive lung disease:
- Chest wall deformity

Parenchymal lung disease:

  • Pneumonia
  • Pulmonary HTN

Muscle weakness:

  • Duchenne muscular dystrophy
  • Diaphragmatic paralysis
32
Q

List some causes of hypoxia leading to SOB

A

Ventilation perfusion mistmatch:

  • Lung disease
  • Pneumonia
  • Pneumothorax
  • PE

Heart disease:

  • Cyanotic CHD
  • Pericarditis
  • Myocarditis
33
Q

List some causes of stridor (5)

A

Acute:

1) Croup
2) Acute epiglottitis
3) Foreign body

Chronic:

4) Laryngomalacia
5) Subglottic stenosis

34
Q

What is important to ask when taking a history of a child with stridor?

A

Coryza and fever?

Nature of stridor
- Degree of stridor depends on respiratory effort of inspiratory breath (louder when crying, quieter when sleeping)

Aspiration?

Features of onset

  • Laryngomalacia (floppy larynx) is a congenital condition that improves with age
  • Subglottic stenosis can develop after a previous intubation
35
Q

What does a hx of coryza and fever in a child presenting with stridor suggest?

A

Croup

= acute laryngotracheobronchitis

36
Q

What is the main ddx of croup?

A

Acute epiglottitis = life-threatening illness

Rare following HiB vaccination

37
Q

What should be included on examination of a child with stridor?

A

Chest signs
- Crepitations and wheeze suggest croup (rare with acute epiglottitis or foreign body obstruction)

Do not examine throat of a child with severe stridor

  • Acute airway obstruction may occur
  • Signs of increasing airway obstruction = cyanosis, confusion, reduction in stridor with exhaustion, drooling with increasing dysphagia
38
Q

What parts of the body can TB affect? (4)

A

Lungs
Meninges
Bones
Joints

39
Q

What are the symptoms of TB? (6)

A

1) Cough
2) Tiredness
3) Weight loss
4) Night sweats
5) Haemoptysis
6) Lymphadenopathy

40
Q

What is the most serious complication of TB in childhood?

A

Miliary TB = primary infection is not adequately contained and invades the bloodstream, resulting in severe disease

41
Q

What is found in on examination of a child with TB?

A

Depends on focus of infection

Primary in lung:
- Bronchial obstruction, pleural effusion etc

Primary in tonsils:
- Cervical adenitis

Primary in small bowel:
- Malabsorption, peritonitis

Miliary TB:
- Mengitis, chest signs, hepatosplenomegaly

42
Q

What investigations are done for TB?

A

Confirmatory tuberculin sensitivity by Heaf or Mantoux testing

CXR for pulmonary TB

Culture of gastric washings

43
Q

What is the management of TB?

A

Even in asymptomatic, tuberculin positive require treatment

Pulmonary:

  • 2 months of isoniazid, rifampicin and pyrazinamide
  • Then 4 months of isoniazid and rifampicin

Miliary spread:

  • 3 months of isoniazid, rifampicin, ethambutol and pyrazinamide
  • Then 12-28 months of isoniazid and rifampicin

Notifiable disease

44
Q

What is the are some complications of TB?

A

Postprimary TB may present as local or disseminated (miliary) disease, affecting:

  • Bones
  • Joints = arthritis
  • Kidneys = haematuria, renal failure
  • Pericarium = constrictive pericarditis
  • CNS = mental retardation, hydrocephalus morbidity and mortality is significant if TB detected late
45
Q

How is TB prevented?

A

Bacile Calmette-Guérin (BCG) = live attenuated virus given intradermally at birth to high risk families

46
Q

What causes whooping cough?

A

Bordetella pertussis

47
Q

How is whooping cough prevented?

A

Immunisation with killed organism given at 2, 3 and 4 months and at school entry

48
Q

How does whooping cough present?

A

3 stages:

1) Catarrhal = 1-2 weeks
- Mild cough, fever and coryza

2) Paroxsymal = 2-6 weeks
- Severe paroxsymal cough, followed by inspiratory whoop +/- vomiting +/- seizures +/- fever
- Coughing usually worse at night
- Babies usually don’t whoop, apnoea may be found in place of whoop
- Conjunctival haemorrhage (capillary rupture) due to cough
3) Convalescent - 2-4 weeks
- Lessening symptoms which may take month to reover

49
Q

What is found on examination of whooping cough?

A 
Very distressed at end of paroxysm
Infant very unwell
Dyspnoea
Nasal discharge
Apathetic
Weight loss
50
Q

How is whooping cough confirmed?

A

Diagnosis is clinical

Confirmed by pernasal swab culture in early disease

51
Q

What is the management of whooping cough?

A

14 day course of erythromycin given early shortens illness, but is ineffective later

Avoid school or nursery for 48hrs if taking abx, 3 weeks if no treatment

Notifiable disease

Prophylactic erythromycin to close contacts

Year 4 PAEDS (23 decks)

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