RESPIRATORY Flashcards
1
Q
What is the most common presenting symptom of asthma in childhood?
How common is this in the background population?
A
- WHEEZE is the predominate symptom
- 1/2 of children in first 3 years of life will have wheeze at some point but this does not mean they have asthma
2
Q
What are the two types of wheeze and what sort of conditions does each one suggest?
A
TRANSIENT EARLY WHEEZE:
- wheezing early in the expiration - usually due to infection and normally viral (BRONCHIOLITIS)
- narrower airways more susceptible to obstruction with even small degrees of inflammation (disappears by age 5- bigger airways)
- often accompanies by coryza symptoms
PERSISTENT WHEEZE:
- asthma
- due to environmental trigger
- wheeze peaks later on (4, 5, 6yo)
3
Q
Describe a wheeze classical of asthma
A
- persistent and recurrent
- relieved by bronchodilators
- Symptoms often worse in morning
- Wheeze following specific trigger
4
Q
Pathophysiology of asthma? (4)
A
- When child is exposed to allergen there is an IgE mediated immune response causing inflammation of the small airways (ATOPIC).
- Bronchial oedema
- Excessive mucus production
- Infiltration of cells (basophils and eosinophils)
5
Q
Give some examples of asthma triggers
A
- Cold weather
- exercise
- pet dander
- dust mites
- pollen
- smoking in the home (ALWAYS ASK ABOUT SMOKING IN THE HOME IN Hx)
6
Q
What factors should you include in the assessment/history for asthma?(4)
A
- reversibility with bronchodilators (strongly suggestive of asthma)
- always plot growth (retardation in severe asthma)
- Ask about / examine for eczema
- Ask about time off school / exercise tolerance
BASELINE PEFR is always good idea
7
Q
What might you find on clinical examination for asthma?
A
Between exacerbations not a lot…
If long standing and poorly managed:
- Hyperinflation of chest
- Harrison sulcus
- Generalise polyphonic wheeze
8
Q
Management of chronic asthma in community
A
- Short-acting beta agonist (SABA)
○ Salbutamol inhaler (blue)
***if they are using inhaler more than 3 times a week/new inhaler once a month then add additional therapy then go to step 2
- SABA + paediatric low-dose inhaled corticosteroid (ICS)
○ Budesonide
○ Can increase dose depending on effectiveness
○ Usually taken as two puffs twice a day (can do four puffs twice a day if needed)
***if still not responsive then…
- SABA + paediatric low-dose ICS +LEUKOTRIENE RECEPTOR ANTAGONIST (LTRA)
***if still not covered
- Discontinue LTRA and ADD LABA e.g. salmeterol SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
- SABA + maintenance and reliever therapy (MART) that includes a paediatric low-dose ICS
- SABA + paediatric moderate-dose ICS MART
- SABA + one of the following options:
- increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
- a trial of an additional drug (for example theophylline-but it has a high incidence of side effects vomiting, insomnia, headaches, poor concentration)
- seek advice from a healthcare professional with expertise in asthma
9
Q
Management of acute asthma in children
A
- SALBUTAMOL NEBULISER 2.5-5mg
- STEROIDS: oral prednisolone or IV hydrocortisone if severe
- IPRATROPIUM BROMIDE (250-500mg) NEB Repeat bronchodilators every 20-30mins if symptoms persist
- MAGNESIUM SULPHATE if symptoms are severe and sats are <92% 5.
AMINOPHYLLINE 500-700mcg/kg/hr can be considered if severe or life-threatening
10
Q
What is croup?
A
- viral infection that causes inflammation and increased secretions in the:
○ Larynx
○ Trachea
○ Bronchi
-Also there is oedema of the subglottic area- dangerous in young children-airway obstruction
11
Q
What organisms most commonly cause croup?
A
- Parainfluenza viruses most common (parainfluenza type 1 is most common cause of croup)
- Human metapneumovirus
- RSV
- Adenoviruses
- Influenza A and B
12
Q
Who does croup occur in most commonly? Whats the age peak? Is there a seasonal peak?
A
- Children aged 6m-3y
- Peak at 2 years
- Seasonal peak in autumn
13
Q
What are the clinical features of croup?
A
- Barking, ‘seal-like’ cough
- Harsh stridor due to airway obstruction
- Hoarse voice
- Background of preceding coryzal symptoms
***symptoms often worse at night (opposite to asthma)
14
Q
Describe an assessment for a child with croup
A
The most important factor is making sure you’re assessing for any signs of
AIRWAY OBSTRUCTION (listening for stridor, checking oxygenation)
Check for breathing effort (recession, RR, head bobbing, accessory muscle use)
NEVER EXAMINE THE THROAT OF CHILD WITH CROUP - risk of creating an obstruction
15
Q
What would be concerning features for a child with croup?
A
- STRIDOR - if this begins to occur at REST then the child absolutely has to be admitted.
- Cyanosis
- Lethargy
- Low threshold for admission for young children, children who aren’t feeding or children at risk of airway obstruction
16
Q
What is the Westley criteria?
A
Croup scoring Possible scores 0-17 • 0-3 mild croup • 4-6 moderate croup •>6 severe croup
17
Q
How do you treat croup?
How do you treat croup with severe obstruction?
A
- DEXAMETHASONE 150mcg/kg can be given via mouth or IV depending on severity (prednisolone alternative if dex not available)
- If airway obstruction is SEVERE:
- Nebulised adrenaline with oxygen face mask
- hopefully by the time the adrenaline has worn off the dexamethasone will have started having an affect
18
Q
What is epiglottitis? How serious is it?
A
Inflammation of epiglottis, VERY SERIOUS. Even higher risk of airway obstruction than croup
19
Q
What organisms cause epiglottitis?
A
The main cause of haemophius type B
- due to vaccination regime the incidence of this has decreases massively
20
Q
When do children get the Haemophilus B vaccination?
A
in the 6-in-1 vaccination at 2, 3 and 4 months
-booster dose offered when a child is 1 year old as part of the combined Hib/MenC booster
21
Q
What is the clinical presentation of epiglottitis and what is characteristic about it?
A
- Fever+++
- toxic looking child
- Intensely painful sore throat
- Cant speak
- Cant swallow>DRIBBLING and this is characteristic
- Soft inspiratory stridor
- child often sat upright to maximise airway/breathing
- DO NOT LIE CHILD DOWN TO ASSESS
22
Q
Management of epiglottitis
A
- Immediately admit and contact paediatrics
- take blood cultures and start IV CEFUROXIME
- Will likely have to be intubated by experienced anaesthetist (HDU/PICU)
- ET tube can usually be removed after 24 hours when antibiotics have started to work. Abx continued for 3-5 days
23
Q
If a child has Hib what do you need to do?
A
ALL CONTACTS NEED RIFAMPICIN PROPHYLAXIS
24
Q
What are some causes of stridor?
A
- Croup
- Epiglottitis
- Foreign body
- Laryngomalacia (congenital softening of cartilage - resolves by 2y)
25
Croup vs. epiglottitis: high fever
Epiglottitis
26
Croup vs. epiglottitis: Stridor
Both but more croup
27
Croup vs. epiglottitis: Speech
E - unable to speak C - hoarse voice
28
Croup vs. epiglottitis: Saliva
Dribbling in epiglottitis
29
What are the most common causes of pneumonia in children of different ages?
In younger children the cause is more often viruses In older children the cause is more often bacteria \*\*clinically the distinction is hard
30
What are the common causatives organisms of pneumonia at different ages?
NEONATE (from birth tract)
- Group B Strep
- Gram negative enterococci
INFANTS AND YOUNG CHILDREN
- RSV
- Strep Pneumonia
- HiB
- Bordatella Pertussis
- Chlamydia trachomatis
- Staphylococcus - infrequent but SEVERE OLDER
CHILDREN \>5
- Mycoplasam pneumonia
- Strep pneumonia
- Chlamydia pneumonia
\*\*\*consider tuberculosis at all ages in high risk groups
31
Presentation of pneumonia?
Presentation of bacterial infections in children?
- The symptoms of the pneumonia itself have usually been preceded by symptoms of viral illness (URTI: cough, coryza, sore throat etc.) so always make sure you ask about this
- Fever
- Dyspnoea/SOB
- Productive cough (purulent sputum)
- Lethargy
- Poor feeding
- Children with bacterial infections can develop acute abdominal pain, neck stiffness or localised chest pain
32
Clinical examination findings in pneumonia
- Nasal flaring
- recession (intercostal, subcostal, sternal) -accessory muscle use -head bobbing)
- Tachypnoea
- end inspiratory crackles (might not be localised)
- dullness of percussion
- decreased breath sounds/bronchial breathing
- decreased O2 sats (indication for admission)
33
Investigations for pneumonia
CXR can be helpful but unless there is a well defined lobar pneumonia they are not useful at distinguishing bacterial from viral
- Look for empyema or effusions
- Sputum culture
34
What are some indications for admission for pneumonia?
Most cases can be managed at home but indication for admission include:
- O2 Sats \<93% on RA
- Severe tachypnoea or signs of increase effort (grunting, recessions)
- Poor feeding or young age
- Family unable to provide appropriate care
35
Management of pneumonia?
What do you prescirbe if you suspect mycoplasma?
- Oxygen therapy if hypoxic
- Analgesia if pain
- IV fluids if dry
ABX:
- Newborns / infants should be given broad spectrum (co-amox, this can also be given to complicated/unresponsive cases in older children)
- Children over age of 5 can be given amoxicillin or erythromycin
- If you suspect mycoplasma then use a macrolide = ERYTHROMYCIN
36
How common is bronchiolitis?
Most common age group it affects?
Who is at extra risk of getting bronchiolitis and what is done to protect them?
VERY COMMON (2-3% of all children every winter)
-Most aged between 1-9 months (very rare after 1y)
PEAK INCIDENCE 3-6months
RISK FACTORS:
- pre-term babies
- babies with underlying diseases such as CF or congenital heart disease
High risk pre-term infants can be given MONOCLONCAL RSV ANTIBODIES (Palivizumab) and this reduces the risk of hospital admission. Maternal IgG provides protection to newborns against RSV
37
What is the main cause of bronchiolitis?
RSV in 80% cases
Others: rhinovirus, adenovirus, parainfluenza virus
38
Presentation of bronchiolitis
- Coryza symptoms will usually occur first (runny nose, cough, colds)
- Followed by a sharp dry cough
- Increasing breathlessness (common cause of admission)
- Cyanosis or pallor
- FEEDING DIFFICULTIES commonly occur because babies are nasal breathers
- Tachycardia and tachypnoea
- Recessions
- Hyper inflated chest (prominent sternum with liver displaced downward)
- Wheezing (more so on expiration)
- Fine end inspiratory crackles
- Children under the age of 4 months are at risk of developing periods of APNOEA - this is serious
39
Pathophysiology of bronchiolitis? How long will bronchiolitis last?
- Lower respiratory infection (mucus and inflammation of the 2 bronchioles
- Usually around 2 weeks - some will have lingering cough or wheeze
40
What investigations should you do for bronchiolitis?
- NASAL SWAB PCR - to identify RSV
- CXR - hyperinflation and acute bronchiectasis
- BLOOD GAS (usually CBG) - done to identify hypercapnia which would be an indication for ventilatory support
41
What are some criteria for admission with bronchiolitis?(7)
- apnoea
- child appears very unwell
- Central cyanosis
- Severe resp distress (grunting, recessions, RR\>60, persistent O2 sats \<92%)
- difficulty feeding (taking \<50-75% feeds)
- clinical dehydration
- low threshold for younger children
42
Management for bronchiolitis? (6)
SUPPORTIVE TREATMENT
- Humidified o2 can be given via nasal cannulae - aim for sats 94-98%
- DO NOT GIVE BRONCHODILATORS (Salbutamol, steroids, ipratropium) - have not been shown to help
- Maintenance fluid and feeds via NGT if necessary
- Ventilatory support if retaining CO2 (CPAP or ventilation)
- HIGHLY INFECTIOUS - isolate or group RSV children together - Monitor the infant for apnoea
43
How is cystic fibrosis inherited and how common is it?
- Autosomal recessive
- the most common autosomal recessive condition
- 1 in 2500 live births
- Carrier rate 1 in 25
44
Describe the pathophysiology of cystic fibrosis Which faulty gene is most common? How would you explain it to patients?
- The genetic mutation leads to a faulty chloride channel -meaning salts are not pumped across membranes into secretions
- The water content of these secretions therefore drops making them thick and sticky -leads to symptomology
- DeltaF508 is most common on chromosome 7
PATIENTS: CF is a genetic condition that affects the movement of salt and water in and out of cells. This causes sticky mucus to build up in the lungs and digestive system. This causes lung infections and problems with digesting food.
45
Clinical effects of CF: respiratory (6)
-Thick secretions cannot be cleared
○Repeated infections (characteristically with pseudomonas aeruginosa)
○Chronic cough (productive of purulent sputum)
○Coarse inspiratory crackles/crepitations
-Thick secretions limit gas exchange
○Dyspnoea
○Hyperinflation of chest (air is trapped by secretions)
○Expiratory wheeze
46
Clinical effects of CF: other than resp (7)
MECONIUM ILEUS (thick sticky meconium that is not cleared in the first 48 hrs)
-common first identification (in 10-20%)
PANCREATIC PROBLEMS
- secretions blocking pancreatic duct leads to poor release of digestive enzymes leading to malabsorption and failure to thrive
- High concs of sodium and chloride in sweat - SWEAT TEST
- FINGER CLUBBING (only in older children) -
REPRODUCTIVE TRACT FAILURE - women will have thick mucus plug and will need assistance conceiving. men will have absent vas deferens and be infertile
- nasal polyps
- allergic bronchopulmonary aspergillosis
47
How is CF detected? (3)
- Meconium ileum at birth
- Sweat test (chloride \>60mmol/L....normal is 10-40mmol/L)
- GUTHRIE TEST NEWBORN SCREENING (heel prick) looking for immunoreactive trypsinogen (IRT)
48
How is CF managed? (6)
MDT APPROACH (specialist doctors, nurses, physiotherapist, OTs, dieticians, school education)
- continuous PROPHYLACTIC FLUCLOXACILLIN for recurrent chest infections
- insert PORTACATH (tube under the skin) for administration of continued and acute antibiotics
- PHYSIOTHERAPY at least twice a day to clear mucus and prevent infection (percussion). teach the parents. Deep breathing excursuses also useful
- MUCOUS THINNERS-nebulised DNAase (dornase alfa/n-acetylcystiene), or hypotonic saline can be given to decrease thickness of mucous
- NUTRITIONAL MANAGEMENT: - high calorie diet is essential (150% normal) including high fat intake
○vitamin supplementation (fat soluble AEDK)
○pancreatic enzyme supplements taken with meals
○young children might require gastrostomies so they can be fed overnight. Then they eat normally during day)
○this is because they are fighting infection and also their body cant absorb everything they eat
- reduce contact with other CF patients to reduce risk of infection with Burkholderia cepacia complex and Pseudomonas aeruginosa
- accapella inhaler
- Lung transplant in end-stage disease
49
Pharmacological managment of cyctic fibrosis?
MUCOUS THINNERS
- Nebulised DNAase (n acetylcysteine or dornase alpha) or hypertonic saline can be given to try and decrease the viscosity of the mucus
- Lumacaftor/Ivacaftor to decrease effects of faulty sodium channels
50
In which patients does TB commonly occur? (4)
- Usually in patients who are not of British descent
- FOREIGN TRAVEL
- HIV/immunocompromised
- In those with an infective contact (always ask about infection in home contacts, this is most common cause for chilldren)
51
How does TB present initially?
- The vast majority will be asymptomatic
- They might have a cough in the primary phase but this will subside as the child enters the latent phase...The TB will then resurface when there is another infection that might cause strain on immune system
52
If the child develops symptoms of TB then what does this mean and what would these symptoms be? (7)
-This suggests that the body has failed to keep bacilli sealed in the tubercles in the lungs...
Sx include:
- Cough
- Fever
- Anorexia
- Weight loss
- Haemoptysis
- Lymphadenopathy + Lung lesions
- Symptoms from other organs (kidneys, bones, joints and CNS)
53
How do we investigate possible TB infection? (3)
MANTOUX TESTis a type 4 hyepersensitivity reaction (inject tuberculin purified protein derivative) to determine whether they've had prior TB exposure
- if the person has a positive reaction then they've probably already been exposed (don't give BCG as little effect, unless \>15cm)
- if there is a negative test you can have the BCG
CXR
- tubercles
- peri-bronchiole lymphadenopathy
- collapse and consolidation in affected lungs
- pleural effusions
INTEFERON GAMMA RELEASE ASSAY (extracting T cells and seeing how much of a response they have to tuberculin antigens in vitro)
Also gastric washing can be done to wash out the stomach and obtain a sample of septum from a child (cant cough up sputum)
54
How do we treat TB? How long is full treatment of TB?
- TRIPLE OR QUADRUPLE THERAPY: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol
- AFTER 2 MONTHS: Reduce to just rifampicin and isoniazid
- TREATMENT USUALLY LASTS 6 MONTHS (adherence is essential)
- ?Pyridoxine in children to prevent peripheral neuropathy (complication of isoniazid)
55
How do we treat children presenting with tuberculosis meningitis?
Dexamethasone
56
How do we manage contact preventing in cases of TB?
- PHE should be informed
- BCG should be offered to all high risk individuals at birth
- DO NOT give BCG to HIV+ or other individuals at risk of immune compromise due to risk of dissemination
- ALWAYS SCREEN FAMILY MEMBERS
57
What is the causative organism of whooping cough?
Whooping cough is a highly infectious resp disease caused by the bacteria Bordatella Pertussis (gram negative)
58
How does whooping cough present?
There will be a one week history of coryzal symptoms (runny nose, sore throat) and then the cough will start...
- The cough is SPASMODIC - it is so intense that when the child is finished they will GULP for air (whoop)
- Children often change colour (might go red or blue)
- Secretions from nose/mouth
- Post cough vomiting
In very young infants APNOEA might occur rather than whoop
59
What would happen if whooping cough were not treated?
- It is SELF-LIMITING
- The spasmodic cough would usually last somewhere between 3-6 weeks and then the intensity of the cough would drop
- HOWEVER a low-intensity cough will often linger for months afterwards (convalescent phase)
60
What are some common complications of whooping cough? (5)
- Pneumonia -seizures
- bronchiectasis (imagine the pressure widening the lungs)
- Sub-conjunctival hemorrhages and epistaxis can happen because of forceful cough
61
How do we investigate whooping cough? (2)
- Peri-Nasal swab and PCR can be done to identify the organism
- FBC should be done as part of routine bloods as there will often be a marked lymphocytosis (weird cos not a virus)
62
How do we treat whooping cough?
ORAL MACROLIDE (ERYTHROMYCIN ) ERADICATES THE ORGANISM BUT ONLY IF IN FIRST 21 DAYS (catarrhal phase)
-In practice it is often given anyway to reduce spread an it can be given prophylactically to close contacts
63
Will children with whooping cough require exclusion from school?
They WILL REQUIRE exclusion from school/play groups for 2 days after the erythromycin has been given OR up to 21 days/3 weeks after symptoms have started
64
How do you catorgorise croup in an easy way?
Mild croup:
* Occasional barking cough
* No stridor at rest
* No or mild recessions
* Well looking child (eat, dink, play)
Moderate croup:
* Frequent barking cough
* Stridor at rest
* Recessions at rest
* No/little distress
Severe croup:
• Frequent barking cough
- Prominent inspiratory stridor at rest
- Marked recessions
- Distress, agitation or lethargy
- Tachycardia (as a result of hypoxaemia)
65
Fore moderate/severe croup requiring hospital admission, what should you do while you wait for transfer?
• While awaiting hospital admission for moderate/severe:
- Oxygen to maintain SaO2 above 93%
- Oral steroid to reduse severity/duration (one dose given before transfer)
○ Dexamethasone: 150 micrograms /kg
○ OR Prednisolone: 1-2 micrograms/kg by mouth
\*\*If the child is too unwell to take oral steroid, nebulized budesonide (2mg for 1 dose) or IM dex are alternatives
66
Do children with croup need to come to hospital?
MANAGEMENT of Croup
* Hospital admission only considered for moderate/severe
* Unless:
- PMH of sever obstruction or known structural abnormality (e.g. downs syndrome)
- \<6 months - Inadequate fluid intake
- Night presentation/severe parent anxiety
- Immunocompromised
- Uncertain diagnosis (e.g. could be epiglottitis)
- Risk of complications
67
What should you give a child with severe airway obstruction?
- Nebulized adrenaline with oxygen via face mask 1 in 1,000 (1 mg/mL)
- Dose of 400 micrograms/kg (maximum 5 mg) repeated after 30 minutes if necessary.
- In the mean time start steroid therapy for when adrenaline wears out
68
Home management tips for parent with child with croup?
REASSURE
- the symptoms usually resolve within 48 hours
- Keep child calm (keep in parents arms)
- Keep good fluid intake
- Paracetamol/ibuprofen for fever/discomfort
- No not advise humidified air (no evidence and risk of scalding)
- Don’t undressing or sponging child to cool down
- Check through the night
SAFETY NET take to hospital if:
○ Inspiratory noise can be heard at rest
○ Skin between ribs is pulling in at every breath
○ Child is restless or agitated
○ Sleepy more than usual
○ Nostrils flaring
○ Pale/blue
○ Drooling/swallowing problems
○ Want to sit instead of stand
FOLLOW UP
69
what are the signs of a moderate asthma attack for children? (3)
MODERATE ASTHMA ATTACK
- SpO2 \> 92%
- PEF \> 50% best or predicted
- No clinical features of severe asthma
70
what are the signs of a severe asthma attack for children? (3)
SEVERE ASTHMA ATTACK
- SpO2 \< 92%
- PEF 33-50% best or predicted
- Too breathless to talk or feed
- Heart rate
* \>125 (\>5 years)
* \>140 (1-5 years)
-Respiratory rate
* 30 breaths/min (\>5 years)
* \>40 (1-5 years)
-Use of accessory neck muscles
71
what are the signs of a life threatening asthma attack for children? (3)
LIFE THREATENING ASTHMA ATTACK
- SpO2 \< 92%
- PEF \< 33% best or predicted
- Silent chest
- Poor respiratory effort
- Altered consciousness
- Cyanosis
72
What is MART therapy
Maintenance and reliever therapy made of ICS and LABA
73
How do we prevent whooping cough? (2)
MATERNAL VACCINATION
-Women between 20-32 weeks pregnant will be given vaccine
BABY VACCINATION
- 6 in 1 vaccination (2, 3 and 4 months)
- 4 in 1 (3 years 4 months)
ADMIT AND ISOLATE CHILDREN (neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations)
74
differential diagnoses for wheeze? (7)
- BRONCHIOLITIS (common aged 1-9 months, dry cough, poor feeding and breathing, end-inspiratory fine crakcles, liver displaced down)
- PNEUMONIA (end inspiratory coarse crackles over affected area)
- ATOPIC ASTHMA
- FORIGN BODY/ASPIRATION OF FEEDS
- CYSTIC FIBROSIS
- CONGENITA LLUNG ABNORMALITY
- CARDIAC FAILURE
75
Examples or upper resp tract infection in children? (4)
- Common cold (coryza)
- Sore throat (pharyngitis, including tonsillitis)
- Acute otitis media
- Sinusitis (uncommon in children)
76
URTI are normally self limiting, but can cause problems such as? (3)
- Exacerbation of asthma
- Febrile convulsions
- Difficulty in feeding because children breath through their nose while they're feeding and if their nose is blocked they will fail to do this
77
Causative organism for common cold? Treatment?
- rhinoviruses, coronaviruses and RSV
- supportive only (calpol and ibuprofen best for fever)
78
Causative organism for tonsilitis?
- tonsillitis is normally caused by virus (e.g. EBV)
- however the most common bacterial cause is group A streptococcus (strep pyogenes).
79
Bacterial vs viral tonsilitis?
bacterial= pus on tounsils, NO COUGH, swollen lymph nodes
80
treatment for bacterial tonsillitis? what AB should we avoid and why?
-Antibiotics are often given (usually phenoxymethypenicillin penV, or erythromycin if pen allergy)
\*\*Avoid amoxicillin because it will cause a widespread maculopapular rash if the infection is caused by EBV
81
features of otitis media? (3)
- Pain in the ear (if the child is not able to tell you this you might notice them tugging at their ear or clutching it)
- Fever
- Preceding or concurrent coryzal symptoms
82
Otitis media on examination? (3)
- Red tympanic membrane
- Loss of normal light reflection
- You might also see a perforation to the eardrum and there might be pus visible in the canal of the ear
83
Treatment of otitis media?
- Usually just supportive (calpol/ibo)
- If AB are needed amoxicillin is used (gram positive pneumococcus)
84
complication of repeated otitis media infections?
- otitis media with effusion AKA Glue ear (grommets can be put in to ease these symptoms)
- this is the most common cause of conductive hearing loss in the child
85
how common is otitis media
very common
-most children will get it at least once in first year (small eustachian tubes)
86
Common causative organisms for otitis media?
RSV, rhinovirus, pneumococcus, HiB and moraxella catarrhalis
87
most common cause of acute stridor in children?
foreign body inhalation
88
What condition has a chronic stridor? How do children with this condition present? How is it treated?
- A chronic stridor in an infant could be suggestive of a completely benign condition known as a LARYNGOMALACIA
- This is congenital softening of the cartilage of the larynx which causes partial collapse during inspiration
PRESENTATION: Noisy breathing, however children are otherwise well
TREATMENT: Usually completely self-resolving by the age of 2years
89
What is seen in foriegn body inhalation?
- Hyperinflation and hyper translucency of affected lung (air can enter but not leave)
- diagphram low and flattened
- mediastinal shift AWAY from FB
90
Risk factors for SIDS (sudden infant death syndrome)?
- smoking
- front sleeping (back to bed campaign)
- premiturity
- too many blankets/toys
- un firm matress
- co sleeping
