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Foundations of Practise > Resp infections > Flashcards

Resp infections Flashcards

1
Q

Epiglottitis is caused by which bacteria

A

Haemophilus influenzae

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2
Q

Croup is caused by which pathogen

A

parainfluenza

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3
Q

Bronchiolitis is caused by which pathogen

A

respiratory syncitial virus

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4
Q

What are the infective causes of stridor

A 
croup
epiglottitis
bacterial tracheitis
Retropharyngeal abscess
Diptheria
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5
Q

What are inflammatory/non infective causes of stridor

A

Anaphylaxis
Hereditary angiodema
foreign body inhalation
tracheomalacia

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6
Q

What are the features of mild croup

A

occasional barking cough
no/mild accessory muscle use
child appears well, eating, drinking, playing

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7
Q

What are the features of moderate croup

A

frequent barking cough
some stridor at rest
some accessory muscle used
Child can be placated will engage reluctantly

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8
Q

What are the features of severe croup

A

frequent barking cough
prominent stirdor at ret
marked difficulty in breathing
some distress and agitation progressing to lethargy if hypoxic

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9
Q

What should all children with croup be treated with

A

oral dexamethasone

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10
Q

What is the management of severe croup

A
  • oral dexamethasone
  • nebulised adrenaline
  • nebulised budesonide
  • o2 - blow by
  • ICU if worsening
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11
Q

What is the management of moderate croup

A
  • oral dexamethasone

- obsereve for 4 hours - if better can be D/C if worsening or no better treat as severe

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12
Q

Which age group is most commonly effected by croup

A

6 months to 6 years

2-5 most common

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13
Q

When should you admit a child with croup

A
  • Moderate/severe
  • RR >60
  • <3 months old
  • Pre-existing condition
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14
Q

Which pathogen often causes tonsilitis/pharyngitis in children

A

Acute Group A streptococcal

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15
Q

What is the FeverPAIN score

A 
Fever >38
Purulent tonsils
Attend rapidly (< 3 days)
Inflammed tonsils
No cough
Score of 4/5 >65% likely to be strep A
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16
Q

What is the first line Abx for strep A infections

A

phenoxymethylpenicillin

clarithromycin if true penicillan allergy

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17
Q

What advice should you give to parents with children with acute sore through

A
  • paracetamol + ibuprofen
  • salt gargle
  • plenty of water
  • can return to school when fever resolved and or Abx for 24 hours
  • Safety net
  • return in 3-4 days if no improvement
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18
Q

How many episodes of tonsillitis before referring to ENT

A

> 7 episodes a year in 1 year
5 per year for 2 years
3 per year for 3 years

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19
Q

which age group are most likely to present with epiglottitis

A

2-5

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20
Q

Symptoms of epiglotitis

A 
sore throat
hot potato voice
drooling - can't swallow secretions
oodynophagia
fever
stridor/signs of resp distress
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21
Q

What is the gold standard for diagnosing epiglotitis

A

Fibre-optic laryngoscopy - but only in theatre with airway management options

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22
Q

Which age group are most effected by bronchiolitis

A

<3 years, mainly 3-6 months

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23
Q

what are the risk factors for severe bronchiolitis

A 
Prematurity (<37 weeks).
Low birth weight.
Mechanical ventilation when a neonate.
Age less than 12 weeks.
Chronic lung disease (eg, cystic fibrosis, bronchopulmonary dysplasia).
Congenital heart disease
Neurological disease with hypotonia and pharyngeal discoordination.
Epilepsy
Insulin-dependent diabetes
Immunocompromise.
Congenital defects of the airways.
Down's syndrome
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24
Q

What are the symptoms of bronchiolitis

A 
1-3 days history of coryzal symptoms followed by
persistent cough
tachypnoae
wheeze + crackles
fever
poor feeding
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25
Q

What symptoms of bronchiolitis would prompt an urgent hospital referral

A 
Apnoea (observed or reported).
Marked chest recession or grunting.
Respiratory rate >70 breaths/minute.
Central cyanosis.
Oxygen saturation of less than 92%.
The child looks seriously unwell to a healthcare professional.
26
Q

What are the differential diagnoses for bronchiolitis

A 
viral induced wheeze
pneumonia
asthma
bronchitis
foreign body inhlation
reflux
aspiration
27
Q

Which investigations are NOT recommended routinely for bronchiolitis

A

CXR
Blood test
Blood gases
(unless worsening resp distress)

28
Q

What ivnestigations should be carried out for bronchiolitis

A 
pulse oximetry (hosp if persistenly <92%)
RSV throat swabs
29
Q

Management of bronchiolitis in primary care

A

reassurance - self limiting but symptoms tend to peak at 3-5 days of onset
anti-pyretics if baby distressed
safety net

30
Q

What is the management of bronchiolitis in secondary care

A

oxygen/HFNC
NG feeding
CPAP if impending resp failure

31
Q

What frontal neck x ray features may be seen in croup

A

steeple sign - narrowing of sub-glottic space

32
Q

What frontal neck x ray features may be seen in epiglotitis

A

thickened epiglotis

33
Q

What frontal neck x ray features may be seen in a retropharyngeal abscess

A

soft tissue buldge in the posterior wall

34
Q

What is recurrent croup

A

> 2 episodes in a year - should be viewed as a separate entity from viral croup and requires investigation.
If atopy ruled out, need a laryngo-tracheo-bronchoscopy to rule out anatomical airway problems.

35
Q

Common presentation of congenital tuburculosis

A 
Fever
cyanosis
jaundice
shortness of breath
cough
pulmonary moist rales
 hepatomegaly/splenomegaly 
abdominal distention
36
Q

When should the BCG jab be given?

A

at 3 days if there has been TB in the family in the past 6 months

37
Q

What are the treatment options for latent TB in a child over 2 years

A
  1. once-weekly isoniazid-rifapentine 12 weeks.
  2. 4 months daily rifampacin
  3. 9 months of daily isoniazid.
38
Q

What are the treatment options for active TB in a child over 2 years

A

6-9 months of antibitic therapy

39
Q

How do you diagnose bordella pertussis

A

nasopharyngeal swab - although becomes less sensitive after 2 weeks of symptoms

40
Q

Which pathogen causes whooping cough

A

bordella pertussis

41
Q

What is the presentation of whooping cough

A
  1. mild coryzal symptoms
  2. dry hacking cough - apnoeas, cyanosis and choking can occur
  3. last 2-3 months ‘100 day cough’
42
Q

What is the incubation period of whooping cough

A

7-20 days and is considered non infectious after 3 weeks

43
Q

What advice should be given with regards to staying out of school/work

A

patients should remain at home for 3 weeks or until after 48 hours of antibiotics

44
Q

What is the management of whooping cough

A
  • Admission if <6 months old

- macrolides are first line and are used to reduce infectivity, non reduce illness length

45
Q

what is the antibiotic of choice in babies less than 1 month - whooping cough

A

clarithromycin

46
Q

what is the antibiotic of choice in babies < 1 month - whooping cough

A

azithromycin

47
Q

What is the antibiotic of choice in pregnant woman - whooping cough

A

erythromycin

48
Q

What is the management of whooping cough

A
  • Admission if <6 months old

- macrolides are first line and are used to reduce infectivity, non reduce illness length

49
Q

what is the antibiotic of choice in babies less than 1 month - whooping cough

A

clarithromycin

50
Q

what is the antibiotic of choice in babies < 1 month - whooping cough

A

azithromycin

51
Q

What is the antibiotic of choice in pregnant woman - whoopign cough

A

erythromycin

52
Q

What finding on an FBC can be associated with bordella pertussis

A

lymphocytosis

53
Q

Which infants should receive bordella pertussis prophylaxis

A
  • unimmunised, born <32 weeks gestation and <2months old
  • unimmunised, born >32 weeks but no maternal vaccine between week 16 and 2 weeks before delivery
  • Infants aged 2 months or over who are unimmunised or partially immunised (
54
Q

Which adults should recieve bordella pertussis prophylaxis

A
  • Pregnant women at >32 weeks
  • Healthcare workers who work with infants and pregnant women.
  • People whose work/share a household with infants too young to be fully vaccinated.
55
Q

Is bordella pertussis notfiable

A

yes

56
Q

What is the first line oral antibiotics for CAP

A

amoxicillan

consider cephalosporin or macrolide in pen allergic

57
Q

What is the most common bacteria in childhood pneumonia

A

Streptococcus pneumoniae

58
Q

Which children should be admitted with pneumonia

A
  • Oxygen sats <92%.
  • RR >70 breaths/minute (≥50 breaths/minute in an older child).
  • Significant tachycardia for level of fever.
  • Prolonged central capillary refill time >2 seconds.
  • Difficulty in breathing as shown by intermittent apnoea, grunting and not feeding.
59
Q

Who should you consider admitting to hospital with pneumonia

A
  • All children under the age of 6 months.
  • Children in whom treatment with antibiotics has failed (most children improve after 48 hours of oral)
  • Patients with troublesome pleuritic pain
60
Q

What is the incubation period of pertussis

A

7-14 days

Foundations of Practise (20 decks)

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