Resp infections Flashcards
Epiglottitis is caused by which bacteria
Haemophilus influenzae
Croup is caused by which pathogen
parainfluenza
Bronchiolitis is caused by which pathogen
respiratory syncitial virus
What are the infective causes of stridor
croup epiglottitis bacterial tracheitis Retropharyngeal abscess Diptheria
What are inflammatory/non infective causes of stridor
Anaphylaxis
Hereditary angiodema
foreign body inhalation
tracheomalacia
What are the features of mild croup
occasional barking cough
no/mild accessory muscle use
child appears well, eating, drinking, playing
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
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
What should all children with croup be treated with
oral dexamethasone
What is the management of severe croup
- oral dexamethasone
- nebulised adrenaline
- nebulised budesonide
- o2 - blow by
- ICU if worsening
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
Which age group is most commonly effected by croup
6 months to 6 years
2-5 most common
When should you admit a child with croup
- Moderate/severe
- RR >60
- <3 months old
- Pre-existing condition
Which pathogen often causes tonsilitis/pharyngitis in children
Acute Group A streptococcal
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
What is the first line Abx for strep A infections
phenoxymethylpenicillin
clarithromycin if true penicillan allergy
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
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
which age group are most likely to present with epiglottitis
2-5
Symptoms of epiglotitis
sore throat hot potato voice drooling - can't swallow secretions oodynophagia fever stridor/signs of resp distress
What is the gold standard for diagnosing epiglotitis
Fibre-optic laryngoscopy - but only in theatre with airway management options
Which age group are most effected by bronchiolitis
<3 years, mainly 3-6 months
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
What are the symptoms of bronchiolitis
1-3 days history of coryzal symptoms followed by persistent cough tachypnoae wheeze + crackles fever poor feeding
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
- once-weekly isoniazid-rifapentine 12 weeks.
- 4 months daily rifampacin
- 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
- mild coryzal symptoms
- dry hacking cough - apnoeas, cyanosis and choking can occur
- 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
