Resp infections Flashcards by Zoe Tomlinson

Epiglottitis is caused by which bacteria

Haemophilus influenzae

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Croup is caused by which pathogen

parainfluenza

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Bronchiolitis is caused by which pathogen

respiratory syncitial virus

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What are the infective causes of stridor

croup
epiglottitis
bacterial tracheitis
Retropharyngeal abscess
Diptheria

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What are inflammatory/non infective causes of stridor

Anaphylaxis
Hereditary angiodema
foreign body inhalation
tracheomalacia

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What are the features of mild croup

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

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What are the features of moderate croup

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

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What are the features of severe croup

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

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What should all children with croup be treated with

oral dexamethasone

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What is the management of severe croup

oral dexamethasone
nebulised adrenaline
nebulised budesonide
o2 - blow by
ICU if worsening

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What is the management of moderate croup

oral dexamethasone

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

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Which age group is most commonly effected by croup

6 months to 6 years

2-5 most common

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When should you admit a child with croup

Moderate/severe
RR >60
<3 months old
Pre-existing condition

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Which pathogen often causes tonsilitis/pharyngitis in children

Acute Group A streptococcal

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What is the FeverPAIN score

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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What is the first line Abx for strep A infections

phenoxymethylpenicillin

clarithromycin if true penicillan allergy

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

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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How many episodes of tonsillitis before referring to ENT

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

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which age group are most likely to present with epiglottitis

2-5

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Symptoms of epiglotitis

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

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What is the gold standard for diagnosing epiglotitis

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

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Which age group are most effected by bronchiolitis

<3 years, mainly 3-6 months

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what are the risk factors for severe bronchiolitis

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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What are the symptoms of bronchiolitis

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

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What symptoms of bronchiolitis would prompt an urgent hospital referral

``` 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. ```

What are the differential diagnoses for bronchiolitis

``` viral induced wheeze pneumonia asthma bronchitis foreign body inhlation reflux aspiration ```

Which investigations are NOT recommended routinely for bronchiolitis

CXR Blood test Blood gases (unless worsening resp distress)

What ivnestigations should be carried out for bronchiolitis

``` pulse oximetry (hosp if persistenly <92%) RSV throat swabs ```

Management of bronchiolitis in primary care

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

What is the management of bronchiolitis in secondary care

oxygen/HFNC NG feeding CPAP if impending resp failure

What frontal neck x ray features may be seen in croup

steeple sign - narrowing of sub-glottic space

What frontal neck x ray features may be seen in epiglotitis

thickened epiglotis

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

soft tissue buldge in the posterior wall

What is recurrent croup

>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.

Common presentation of congenital tuburculosis

``` Fever cyanosis jaundice shortness of breath cough pulmonary moist rales hepatomegaly/splenomegaly abdominal distention ```

When should the BCG jab be given?

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

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

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

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

6-9 months of antibitic therapy

How do you diagnose bordella pertussis

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

Which pathogen causes whooping cough

bordella pertussis

What is the presentation of whooping cough

1. mild coryzal symptoms 2. dry hacking cough - apnoeas, cyanosis and choking can occur 3. last 2-3 months '100 day cough'

What is the incubation period of whooping cough

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

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

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

What is the management of whooping cough

- Admission if <6 months old | - macrolides are first line and are used to reduce infectivity, non reduce illness length

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

clarithromycin

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

azithromycin

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

erythromycin

What is the management of whooping cough

- Admission if <6 months old | - macrolides are first line and are used to reduce infectivity, non reduce illness length

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

clarithromycin

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

azithromycin

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

erythromycin

What finding on an FBC can be associated with bordella pertussis

lymphocytosis

Which infants should receive bordella pertussis prophylaxis

- 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 (

Which adults should recieve bordella pertussis prophylaxis

- 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.

Is bordella pertussis notfiable

yes

What is the first line oral antibiotics for CAP

amoxicillan | consider cephalosporin or macrolide in pen allergic

What is the most common bacteria in childhood pneumonia

Streptococcus pneumoniae

Which children should be admitted with pneumonia

- 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.

Who should you consider admitting to hospital with pneumonia

- 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

What is the incubation period of pertussis

7-14 days

Resp infections Flashcards

(60 cards)