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Respiratory Flashcards

1
Q

What is Croup?

A

Viral laryngotracheobronchitis.

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2
Q

What are the risk factors for croup?

A
  • FHx
  • LBW / Prematurity
  • Autumn / Winter
  • M > F
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3
Q

What are the causes of croup?

A
  • Main cause = Parainfluenza
  • Other causes
    • RSV
    • Rhinovirus
    • Influenza
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4
Q

What are the signs and symptoms of croup?

A
  • Affects 6 months to 6 years → 2 years = peak
  • Acute onset of - over days
  • Coryzal symptoms
  • “Barking cough” - from vocal cord impairment
  • Stridor - from inflamed/oedematous airways
  • Hoarse voice
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5
Q

What are the appropriate investigations for suspected croup?

A
  • Clinical
  • Obs
  • Do NOT examine throat
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6
Q

How is croup classified?

A

Westley score

  • Mild = 0-2
  • Moderate = 3-7
  • Severe = 8-11
  • Impending respiratory failure = 12-17
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7
Q

What is the management of croup?

A
  • Mild (Westley 0-2) = Oral Dexamethasone + Discharge
  • Moderate (Westley 3-7) = Nebulised Dexamethasone + Admission
  • Severe (Westley 8-11) = Nebulised Dexamethasone ± Adrenaline + Admission
  • Impending respiratory failure (RR >70 and/or Westley 12-17) = Nebulised Dexamethasone ± Nebulised Adrenaline + O2 Admission ± ITU
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8
Q

What are the complications of croup?

A
  • Secondary bacterial superinfection
  • Pulmonary oedema
  • Pneumothorax
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9
Q

What counselling should be given to child/parents with a child with croup?

A
  • Explain diagnosis -common viral infection of the airways
  • Explain that it gets better over 48 hours and steroids help
    • Paracetamol or ibuprofen if distressed
  • Advise good fluid intake
  • Safety net:
    • Advise regularly checking on the child at night - cough is worse
    • If it gets worse = come back
    • If the child becomes blue or very pale for more than a few seconds, unusually sleepy or unresponsive or serious breathing difficulties call an ambulance
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10
Q

What are the causes of bronchiolitis?

A
  • RSV (80%)
  • Parainfluenza
  • Rhinovirus
  • Adenovirus
  • Influenza
  • Human metapneumovirus (rare → PICU care)
  • Co-infection = more severe illness
  • RSV highly infectious so infection control measures
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11
Q

What is the progression of bronchiolitis?

A

Bronchiolitis (0-1yo) → Viral-induced/episodic Wheeze (1-5yo) → Asthma (>5yo)

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12
Q

What are the risk factors for bronchiolitis?

A
  • Pre-term/BPD
  • Passive smoking
  • LBW
  • Chronic heart disease
  • Hypotonia
  • Winter
  • Protective = BREASTFEEDING
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13
Q

What are the complications of bronciolitis?

A

Can cause permanent airway damage - bronchiolitis obliterans

  • Rare
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14
Q

What are the signs and symptoms of bronchiolitis?

A
  • <1 year old → 2-3% of infants are admitted with it
  • Coryzal symptoms → progressive to below
  • Dry wheezy cough
  • SoB
  • Grunting
  • High RR/HR
  • Subcostal/intercostal recessions
  • Hyperinflation
  • Auscultate – how to differentiate from croup/other ‘-itits’
    • Fine, bi-basal, end-inspiratory crackles
    • High-pitch expiratory wheeze
    • Feeding difficulty → admission
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15
Q

What are the appropriate investigations for?

A
  • Clinical diagnosis with SpO2 → can do NPA to confirm
  • If there is significant respiratory distress + fever = CXR to rule out pneumonia
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16
Q

What is the management of bronchiolitis?

A
  • Supportive
    • Nasal O2 + NG fluids/feeds ± Nebulised 3% saline → CPAP (if respiratory failure)
    • <6m old = no beta receptors in lungs so salbutamol won’t work – would give it if over 1yo
  • If high-risk preterm infant (BPD, congenital HD, immunodeficiency) = Palivizumab (monoclonal Ab vs RSV)
  • Hospital admission
    • <2m = lower threshold as deteriorate quick
    • Apnoea / Central cyanosis / Grunting
    • SpO2 <92% on room air
    • Poor oral fluid intake (≤50% normal in <24hrs)
    • Severe respiratory distress (i.e. RR>70)
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17
Q

Define Rhinitis.

A

Common cold causing acute and self-limiting inflammation of URT mucosa, involving nose, throat, sinuses or larynx.

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18
Q

What is the most common infection in childhood?

A

Rhinitis

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19
Q

What are the causes of rhinitis?

A
  • Rhinovirus (50%)
  • Coronavirus (10%)
  • Influenza (5%)
  • Parainfluenza (5%)
  • Human respiratory syncytial virus (5%)
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20
Q

What are the signs and symptoms of rhinitis?

A
  • Clear/mucopurulent discharge
  • Nasal block
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21
Q

What are the appropriate investigations for suspected rhinitis?

A

Clinical diagnosis

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22
Q

What is the management of rhinitis?

A
  • Health education
    • Self-limiting
    • No Abx - virus
    • May reduce anxiety and unnecessary visits to doctor
    • Cough may last 4 weeks after cold → generally recover after 2 weeks
  • Pain = Paracetamol or Ibuprofen
  • Potentially Decongestants or Antihistamines
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23
Q

What are the complications of rhinitis?

A
  • Otitis media
  • Acute sinusitis
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24
Q

Define Sinusitis.

A

Infection of the maxillary sinuses from viral URTIs which can get a secondary bacterial infection.

  • Unlikely to be frontal sinus → don’t develop until after 10 years old
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25
Q

What are the signs and symptoms of sinusitis?

A
  • Pain, swelling and tenderness on front of face
  • Influenza-like illness
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26
Q

What are the appropriate investigations for suspected sinusitits?

A

Clinical diagnosis

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27
Q

What is the management of sinusitis?

A
  • Symptoms lasting <10 days
    • No antibiotic
    • Advice → virus, takes 2-3 weeks to resolve, only 2% get bacterial complication, simple analgesia, nasal saline or nasal decongestants
  • Symptoms lasting >10 days
    • High-dose nasal corticosteroid for 14 days (if >12yo; e.g. mometasone)
      • May improve symptoms but unlikely to affect duration of illness
    • Abx not indicated → can give back up prescription if symptoms don’t get better in 7 days or if symptoms get rapidly worse
      • 1st line = phenoxymethylpenicillin (clarithromycin if penicillin-allergic)
      • 2nd line: co-amoxiclav
  • Refer to hospital if there are symptoms and signs of
    • Severe systemic infection
    • Intraorbital or periorbital problems
    • Intracranial complications / Features of meningitis
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28
Q

What are the risk factors for viral-induced wheeze?

A
  • Maternal smoking (ante-/post-natal)
  • Prematurity
  • FHx of viral-induced wheeze
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29
Q

What are the signs and symptoms of asthma?

A
  • Wheeze - end-expiratory polyphonic
  • Cough
  • SoB
  • Chest tightness
    • Symptoms worst at night / early morning
    • Symptoms with non-viral triggers
    • Personal or FHx of atopy
    • Positive response to asthma bronchodilator therapy
  • Examination
    • Hyperinflated chest ± accessory muscle use
    • Harrison’s sulci - depressions at base of thorax where diaphragm has grown in muscular size
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30
Q

What are the appropriate investigations in to suspected asthma in a child under the age of 5?

A

Clinical diagnosis

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31
Q

What are the appropriate investigations in to suspected asthma in a child over the age of 5?

A
  • Clinical + Picture
    • Spirometry - FEV1/FVC <70%
    • Bronchodilator - 12% pre/post difference
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32
Q

What are the signs of a moderate asthma attack in a child?

A
  • PEFR = 50-75%
  • Normal speech
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33
Q

What are the signs of a severe asthma attack in a child?

A
  • PEFR = 33-50%
  • RR
    • 2-5 years = >40
    • 5-12 years = >30
    • >12 years = >25
  • HR
    • 2-5 years = >140
    • 5-12 years = >125
    • >12 years = >110
  • SpO2 = >92%
  • Inability to complete sentences in one breath
  • Accessory muscle use
  • Inability to feed
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34
Q

What are the signs of a life-threatening asthma attack in a child?

A
  • PEFR = <33%
  • SpO2 = <92%
  • PaCO2 = >4.8kPa
  • Altered consciousness
  • Exhaustion
  • Cardiac arrhythmia
  • Hypotension
  • Cyanosis
  • Poor respiratory effort
  • Silent chest
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35
Q

What is the management of a moderate asthma attack?

A
  • No admission needed
  • Salbutamol - 4-hourly up to max 4/day
  • Oral prednisolone - for 3d
  • Follow-up in 48hrs
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36
Q

What is the management of a severe to life-threatening asthma attack?

A
  • Admit to hospital/A&E
    1. Burst step
      * O2 therapy (maintain SpO2 >92%)
      * 3x Salbutamol nebs / 10 inhales on a pump
      * 2x Ipratropium bromide nebulisers
      * 1x oral Prednisolone (benefit after 4-6h)
    1. IV bolus step
      * IV bolus MgSO4 + one of the below
      * IV bolus Salbutamol
      * IV bolus Aminophylline
      • Monitor ECG → both can cause arrhythmias
    1. IV infusion step – one of the below
      * IV Salbutamol
      * IV Aminophylline
    1. Panic step
      * Intubate and ventilate + Transfer to ICU
  • Once stabilised = Salbutamol 1-hourly → 2-hourly → 3-hourly → 4-hourly → Home when:
    • Stable on 4-hourly treatment - further wean at home
    • Peak flow at 75% of best predicted
    • SpO2>94%
  • Follow-up within 2 days of discharge
  • Patient Education
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37
Q

What are the contraindications for beta-agonists (salbutamol)?

A
  • Beta blockers
  • NSAIDs
  • Adenosine
  • ACEi
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38
Q

What is the outpatient management of asthma in a child?

A
  • SABA - Salbutamol PRN → Step up when using inhaler ≥3x a week
    • Can use a spacer if young or difficulty using
    • Do not exceed 4-hourly puffs (i.e. 4 puffs a day)
  • Low dose ICS - Becotide (Beclomatsone dipropionate)
  • Leukotriene Receptor Antagonist - Oral Montelukast
    • Review after 4-8w
      • 5-16yo = if fail on review, switch LTRA to LABA
      • <5yo = if fail on review, stop LTRA and refer to specialist
  • Increased ICS dose - Flixotide (Fluticasone propionate)
    • Consider reducing dose once asthma controlled
  • Oral steroid - Prednisolone
    • Lowest dose to maintain control
    • Managed by specialist
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39
Q

How common is acute otitis media?

A
  • Very common - Most children have 1 episode
  • Young eustachian tubes are short, horizontal and function poorly → middle ear infection
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40
Q

What are the risk factors for acute otitis media?

A
  • 6-12 months
  • FHx
  • Male
  • Cleft palate
  • Down’s
  • Most children have at least one episode
41
Q

What are the signs and symptoms acute otitis media without effusion?

A
  • Pain in the ear
  • Fever
42
Q

What are the appropriate investigations for suspected acute otitis media without effusion?

A
  • Temperature check
  • Otoscopy
    • Bright red bulging tympanic membranes
    • Loss of normal light reaction
    • Perforation
    • Pus
43
Q

What is the management of acute otitis media without effusion?

A
  • Advice
    • Acute otitis media lasts about 3 days (up to 1 week)
    • Most recover without Abx
    • Use regular ibuprofen/paracetamol
    • No evidence for decongestants or antihistamines
  • Medical Management / Antibiotic regimen
    • No antibiotic prescription → seek help if symptoms haven’t improved after 3 days or clinical deterioration
      • Delayed antibiotic prescription used at this point
    • Immediate antibiotic prescription if systemically unwell, age <2yo
    • Amoxicillin (5 days) → penicillin allergy = clarithromycin, erythromycin
44
Q

What is the management of acute otitis media with perforation?

A
  • Oral Amoxicillin - 5 days
  • Review in 6 weeks to ensure healing
45
Q

What are the signs and symptoms of otitis media with effusion?

A
  • Asymptomatic except for possible reduced hearing - conductive hearing loss
  • Can interfere with normal speech development → learning difficulties
46
Q

What are the appropriate investigations for suspected otitis media with effusion?

A
  • Tympanometry
  • Audiometry
  • Otoscopy - eardrum is dull and retracted, often with a fluid level visible
47
Q

What is the management of otitis media with effusion?

A
  • Co-existent cleft palate, Down’s, hearing loss, structurally abnormal tympanic membrane or cholesteatoma discharge → refer to ENT
  • No co-morbidities à active observation for 6-12 weeks
    • 1) Two hearing tests (pure tone audiometry) 3 months apart
    • 2) If persistent past 6-12 weeks → refer to ENT
  • Non-surgical = Hearing aids, Active monitor for 3m, Auto-inflation
  • Surgical = Myringotomy and Grommets
    • Benefits don’t last longer than 12 months
48
Q

What are the complications of acute otitis media?

A
  • Perforation
  • Mastoiditis
  • Meningitis
  • Facial nerve palsies
  • Febrile convulsions
49
Q

Describe Mastoiditis.

A

Chronic otitis media → honeycomb structure behind ear inflamed → Discharge + Swelling behind ear

50
Q

What are the diagnosis for the following otoscopy examinations?

A
51
Q

What counselling should be given to child/parents with a child with pneumonia?

A
  • Explain the diagnosis - chest infection
  • Explain whether admission is needed
  • Explain treatment - antibiotics
  • Advise:
    • Paracetamol used if distressed
    • Adequate fluid intake
    • Against parental smoking
  • Check the child regularly during the day and night
  • Safety net
    • ↑ RR
    • Apnoea
    • Cyanosis
    • ↑ WOB
    • Dehydration
    • Fever does not settle 48h+ of AbX
    • ↑ Drowsy
52
Q

What are the consequences of Group A Strep tonsillitis?

A

Scarlet Fever → can progress to Rheumatic fever

53
Q

What are the signs and symptoms of Scarlet fever?

A
  • After 2-4 day incubation
    • Fever
    • Headache
    • Vomiting
    • Myalgia
    • Rash (12-48 hours later) ± erythroderma
      • Neck + chest → spread to trunk + legs
      • Characteristic ‘sandpaper’ texture
      • ‘Pastia’s lines’ (rash in prominent skin creases)
      • Strawberry tongue
      • May progress to Rheumatic Fever with a week latency period
54
Q

What are the appropriate investigations for suspected Scarlet fever?

A
  • Clinical
    • FBC (polymorphonuclear lymphocytosis, eosinophilia)
    • ELISA
    • Rapid antigen test
55
Q

What is the management of Scarlet fever?

A
  • Phenoxymethylpenicillin
    • 2nd line = Azithromycin
  • Notify PHE
56
Q

What are the causes of pneumonia in children?

A
  • Neonate = Mother’s genital tract commensals = GBS, gram -ve enterococci
  • Infants / Young children = RSV, S. pneumoniae, H. influenzae, Bordetella pertussis, C. trachomatis, S. aureus
  • >5yo = M. pneumoniae, S. pneumoniae, Chlamydia pneumoniae
  • All ages = Mycobacterium tuberculosis should be considered
57
Q

What are the signs and symptoms of pneumonia?

A
  • Fever
  • Cough
  • SoB
  • Preceding URTI
  • Auscultation
    • Consolidation - stony dull, bronchial breathing, decreased breath sounds
    • Coarse crackles
58
Q

What are the appropriate investigations for suspected pneumonia?

A
  • Basic obs - temperature, O2 saturations, RR, respiratory exam
  • Bloods - FBC, U&Es
  • Cyanosis and hydration status
  • VBG
  • CXR
59
Q

What are the appropriate investigations for suspected childhood TB?

A
  • Manteaux test → if -ve = excludes → IGRA test (if -ve, prophylaxis; if +ve, treat)
    • Manteaux >5mm = +ve in immunodeficiency
    • Manteaux >10mm = +ve in at-risk groups (child <4yo, healthcare workers, IVDU)
    • Manteaux >15mm = +ve in normal population
60
Q

What is the management of childhood TB?

A
  • RIPE = 6m Rifampicin, 6m Isoniazid, 2m Pyrazinamide, 2m Ethambutol
  • RiCES = Rifampicin, Clarithromycin, Ethambutol ± Streptomycin/amikacin
  • Prophylaxis = isoniazid
61
Q

What examination findings can distinguish between pneumonia and bronchiolitis?

A
  • Pneumonia = coarse crackles
  • Bronchiolitis = fine crackles
62
Q

What is the management of pneumonia?

A
  • Antibiotics
    • Child <2yo with mild LRTI → do not have pneumonia usually = No antibiotics
    • 1st line = Amoxicillin (7-14 days)
    • 2nd line = Co-amoxiclav + Macrolides (clarithromycin)
      • Alternative = cefaclor
      • Macrolides for pen-allergic patients
      • In pneumonia associated with influenzae → co-amoxiclav
  • Supplementary O2 - if SpO2 <92%
63
Q

What are the indications for hospital admission of a child with a respiratory condition?

A
  • SpO2 <92% on air
  • Grunting
  • Marked chest recession
  • RR >60/min (severe tachypnoea)
  • Cyanosis
  • T >38oC
  • Child <3months
  • Low feeding
  • Low consciousness
64
Q

What counselling should be given to parents with a child with tonsillitis?

A
  • Explain that this is tonsillitis → Centor score the child
  • Explain that importance of taking antibiotics correctly for 10 days even if symptoms get better in that time
  • Avoid school until 24 hours after starting antibiotics and the child is feeling well
  • Advise on the use of paracetamol, lozenges, saltwater gargling and Difflam for symptomatic treatment
65
Q

What are the causes of tonsillitis?

A
  • Bacterial → Group A β-haemolytic streptococcus – rare under 3yo or ≥45yo, common 3-14yo
  • Viral → EBV
66
Q

What shouldn’t be given to patients with EBV?

A

Amoxicillin → can get generalised maculopapular eruption

67
Q

What are the signs and symptoms of tonsillitis (pharyngitis and laryngitis)?

A
  • Sore throat
  • Fever
  • Dysphagia/odynophagia
  • Hoarseness
  • GORD
  • Rhinitis
  • Lethargy / fatigue
  • Post-nasal drip
  • Laryngitis - dysphonia, aphonia
68
Q

What are the appropriate investigations for suspected tonsillitis?

A
  • ENT exam + temperature
  • Rapid strep test
  • Centor score - likelihood of bacterial cause
    • +1 = Exudate/swelling on tonsils
    • +1 = Tender/swollen anterior cervical lymph nodes
    • +1 = Temperature >38C
    • +1 = Cough absent
    • +1 = Age 3-14yo → -1 if age ≥45yo
  • Consider swabs
69
Q

What is the management of tonsillitis?

A
  • Medical Management
    • Bacterial tonsillitis confirmed using rapid streptococcal antigen testing = Phenoxymethylpenicillin
      • 10 days, QDS → prevent sequelae like rheumatic fever
      • Avoid amoxicillin = widespread maculopapular rash if due to mono
      • Clarithromycin if pen-allergic
  • Advice
    • Adequate fluid intake
    • Paracetamol or ibuprofen when necessary
    • Saltwater gargling
    • Lozenges or anaesthetic sprays (e.g. Difflam)
70
Q

What are the indicators for tonsillitis admission?

A
  • Difficulty breathing
  • Clinical dehydration
  • Peri-tonsillar abscess or cellulitis
  • Marked systemic illness or sepsis
  • Suspected rare cause → e.g. Kawasaki disease, diphtheria
71
Q

What is Cystic Fibrosis?

A
  • Defective CFTR – cAMP dependent chloride channel due to a mutation on chromosome 7
    • >900 different gene mutations of CFTR → 78% are F508
      • Class 2 mutation = incorrect folding of CFTR protein
72
Q

What are the signs and symptoms of cystic fibrosis?

A
  • Meconium ileus
  • Recurring chest infections, wheezing, coughing, SoB, damage to the airways (bronchiectasis)
  • Growth faltering (difficulty putting on weight)
  • ABPA, nasal polyps, sinusitis
  • Jaundice (cirrhosis, portal HTN)
  • Diarrhoea or constipation
  • Diabetes mellitus
  • Male sterility (absence of the vas deferens)
  • Clubbing of the fingers
73
Q

What are the appropriate investigations for suspected cystic fibrosis?

A
  • Screening at birth = heel prick test for IRP / Immunoreactive Trypsinogen (if +ve, further tests are done) →
    • Sweat test (abnormally high NaCl in sweat) → 60-115mmol/L (10-40mmol/L)
    • Genetic tests
  • CXR → hyperinflation, peri-bronchial shadowing, bronchial wall thickening, ring shadows
74
Q

What is the management of cystic fibrosis?

A
  • MDT - all should be specialists in CF
  • Routine specialist reviews
    • Weekly in 1st month
    • Every 4w in 1st year
    • Every 6-8w when 1-5yo
    • Every 2-3m when 5-12yo
    • Every 3-6 months from then on
  • RESPIRATORY Management:
    • Monitoring with spirometry and symptoms watches
    • Physiotherapy twice a day → airway clearance manoeuvres and devices + encourage physical activity
    • Mucolytic therapy
      • 1st line = rhDNase
        • If too young use mannitol dry powder
      • 2nd line = rhDNase + hypertonic saline
      • Orkambi - Lumacaftor with Ivacaftor (potentiators and correctors) → may be effective in prolonging life in F508 mutation
    • Trikafta - 3 drug combination → 2 drugs allow F508del-misfolded CFTRs to get to cell surface, the 3rd allows the protein to fold properly
      • Available on NHS but is expensive and not in NICE guidlines
    • Lung transplant
  • NUTRITIONAL Management:
    • High calorie + high fat diet (150% of normal) + fat-soluble vitamin supplements
    • Pancreatic enzyme replacement
  • PYCHOLOGICAL Management
  • GENERAL TEENAGERS and ADULTS Management:
    • DM therapy - becoming more common as CF live longer
    • Liver problems (i.e. cirrhosis, portal HTN) = Ursodeoxycholic acid, laxatives → may ultimately require transplantation
    • Sterility → intracytoplasmic sperm injection (only affects men)
75
Q

What is the management of infection in CF?

A
  • Prophylaxis oral antibiotics (flucloxacillin and azithromycin to reduce exacerbation chance)
  • Rescue packs → prompt IV Abx with any symptoms or signs of infection
  • Appropriate Abx for sensitivity
  • Minimise contact with other CF sufferers when infected
76
Q

What are the common infections in cystic fibrosis?

A
  • S. aureus
  • P. aeruginosa
  • Burkholderia cepacia complex
  • H. influenzae
  • Non-tuberculosis mycobacterium
  • Aspergillus fumigatus
  • Prophyla
77
Q

What counselling should be given to parents with a child with cystic fibrosis?

A
  • Explain the diagnosis - thick secretions
  • Explain it is lifelong
  • Explain that that management requires an MDT approach
  • Explain that they will be referred to a specialist cystic fibrosis centre to discuss the ongoing management
  • Offer to outline the aspects of management
    • Pulmonary – physiotherapy, mucolytics
    • Infection – prophylactic antibiotics, monitoring
    • Nutrition – enzyme tablets, high-calorie diet, monitor growth
    • Psychosocial – provide support for child and carers
  • Offer information on genetic counselling if considering having more children
  • Support groups - Cystic Fibrosis Trust
78
Q

Define Acute Epiglottis.

A

Intense swelling of epiglottis associated with sepsis → Medical Emergency

79
Q

What are the signs and symptoms of acute epiglottis?

A
  • High fever - ‘toxic-looking’ child
  • Drooling → child cannot swallow as too sore
  • Stridor - soft inspiratory with high RR
  • Tripod sign
    • Immobile
    • Upright
    • Open mouth
80
Q

What is the management/investigations for acute epiglottis?

A
  • MEDICAL EMERGENCY
    • Do not lie the child down - immobile and upright stance is optimal
    • Do not examine the child’s throat → may precipitate total obstruction
  • Immediate referral to ENT, paediatrics and anaesthetics → Transfer to ITU/anaesthetics
    • Secure airway
  • Blood cultures
  • Empirical ABx ± Dexamethasone
  • Most children recover in 2-3 days
  • Rifampicin given to close household contacts as prophylaxis
81
Q

Define Otitis externa.

A

Inflammation of the outer ear – auricle, external auditory canal and outer surface of eardrum

82
Q

What are the types of otitis externa?

A
  • Acute diffuse otitis externa (Swimmer’s ear)
    • Moderate temperature and lymphadenopathy, diffuse swelling, variable pain and pruritus, moving ear/jaw is painful, impaired hearing
    • Bacterial infection common
  • Chronic otitis externa
    • Discharge and itch are common
    • Fungal and associated with underlying skin conditions, diabetes, immunosuppression
  • Necrotising otitis externa = Life-threatening extension into mastoid and temporal bones → urgent ENT referral
    • Pain, oedema, exudate, micro abscess, granulation tissue, pseudomonas culture
    • Mainly due to P. aeruginosa or S. aureus
    • Mainly in elderly
83
Q

What are the risk factors for otitis externa?

A
  • Hot and humid climates
  • Swimming
  • Older age
  • Immunocompromised
  • Diabetes
  • Wax build-up
  • Narrow external canal
  • Obstruction of canal
  • Insufficient wax - predispose infection
84
Q

What are the appropriate investigations for suspected otitis externa?

A

Swabs and Culture

85
Q

What is the management of acute otitis externa?

A
  • Topical drops of
    • Acetic acid - only effective for 1 week
    • Antibiotics - neomycin or clioquinol
  • Wicking and removal of debris
  • If the above fails → reconsider diagnosis
  • If cellulitis or cervical lymphadenopathy → oral antibiotics
86
Q

Define Laryngomalacia.

A

Congenital abnormality of larynx cartilage predisposing to supraglottic collapse during inspiration.

87
Q

What are the signs and symptoms of laryngomalacia?

A
  • 2-6 weeks old = Noisy respiration and Inspiratory stridor
    • Worse → supine, when feeding or if agitated
    • Not present at birth
  • GORD ± feeding difficulties
  • Cough/choking
  • Normal cry → no abnormality with vocal cords
  • Baby otherwise comfortable
88
Q

What are the appropriate investigations for laryngomalacia?

A
  • O2 monitor
  • Flexible laryngoscopy
89
Q

What is the management of laryngomalacia?

A
  • Conservative → close observation and monitoring of growth
    • Usually resolve by 18-24 months (70% by 1-year-old)
    • May initially worsen with age, max at 6-8 months
  • Endoscopic supraglottoplasty - if airway compromise or feeding disrupted sufficiently to prevent normal growth
90
Q

What are the complications of laryngomalacia?

A
  • Respiratory distress
  • Failure to thrive
  • Cyanosis
91
Q

What is chronic lung disease (Bronchopulmonary dysplasia)?

A
  • Lung damage in the newborn / child due to:
    • Delay in lung maturation (i.e. premature)
    • Pressure and volume trauma from artificial ventilation
    • Oxygen toxicity
    • Infection
92
Q

What are the appropriate investigations for suspected chronic lung disease (Bronchopulmonary dysplasia)?

A

Chest X-Ray = widespread opacification

93
Q

What is the management of chronic lung disease (Bronchopulmonary dysplasia)?

A
  • O2 requirements
    • Artificial ventilation (in bad CLD)
    • CPAP or high-flow nasal cannula (normal CLD)
  • Corticosteroids
    • Low-dose for short course
94
Q

What causes Whooping cough?

A

Bordetella pertussis → gram -ve bacteria

95
Q

What are the risk factors for whooping cough?

A

Unvaccinated → included in the 6-in-1

96
Q

What are the signs and symptoms of whooping cough?

A
  • 1-week coryzal symptoms followed by
    • Continuous coughing followed by inspiratory whoop
    • Vomiting
    • Epistaxis
    • Conjunctival haemorrhages
    • Child = worst at night, may go red/blue
    • Infants = apnoea rather than a whoop
97
Q

What are the appropriate investigations for suspected whooping cough?

A
  • Culture ± PCR - Naso-Pharyngeal Aspirate for Bordetella pertussis
  • Notify HPU
98
Q

What is the management of whooping cough?

A
  • Antibiotics
    • <1 month = oral clarithromycin
    • >1 month = oral azithromycin
      • 2nd line = co-amoxiclav
  • Advice
    • Rest, fluids, paracetamol or ibuprofen
    • Educate parents
      • Disease is likely to cause a protracted non-infectious cough → may take weeks to resolve
      • Complete any outstanding immunisations
      • Cose contacts prophylaxis macrolides
    • Avoid nursery until 48 hours of antibiotics or until 21 days after the onset of the cough if not treated
  • Admit
    • <6mo
    • Acutely unwell
      • Significant breathing difficulty
      • Significant complications → e.g. seizures, pneumonia
99
Q

What counselling should be given to parents with a child with whooping cough?

A
  • Explain the diagnosis - cough that lasts for a reasonably long time
  • Explain it’s uncommon because of the immunisation - discuss concerns about immunisation with the parent
  • Explain you can have it again
  • Explain the treatment = antibiotics but cough often persists for a long time
  • Exclude from school until 48 hours after starting antibiotics

a Paediatrics by themes (26 decks)

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