Respiratory and ENT Flashcards
What are the symptoms of mild asthma?
- Breathlessness
- PEFR = reduced by still normal (>50%)
What are the symptoms of severe asthma?
- Too breathless to talk or feed
- RR >50
- PR >130
- PEFR <50%
- Tracheal tug
- Head bobbing in infants
What are the symptoms of life-threatening asthma?
- PEFR <33%
- Silent chest
- Fatigue, drowsiness confusion
- HYPOTENSION
After what age is asthma usually diagnosed?
5 years
How would you manage mild- moderate asthma?
- ABCDE
- Up to 10x inhaler puffs of 2.5mg or NEB
- Oral prednisolone
- Reasses in 1 hr
- Swap for salbutamol 5mg NEB
How would you manage severe asthma?
- Ipatropium bromide + salbutamol NEB
- IV hydrocortisone
How would you manage life-threatening asthma?
- IV salbutamol
- IV aminophylline
- IV Magnesium
On discharge, when O2 is no longer required, how would you manage asthma?
- 6-10puffs every 4 hours
- PO prednisolone for several days
- Asthma clinic referral
What alternative medication are there for home use?
- Beclomethasone inhaler
- Salmetrol
- Montelukast
How does Salmetrol work?
- Long acting B-2 agonist
How does Montelukast work?
- Leukotrine receptor antagonist
What differentials are there for ashtma?
- Pertussis
- Croup
- Pneumonia
What is the main cause of bronchiolitis?
Respiratory Syncytial Virus
What are the risk factors for bronchiolitis?
- Premature birth
- Young age <1
- Cardiac/respiratory chronic diseases
What are the main symptoms of bronchiolitis?
- Dry cough
- Coryza
- Low grade fever
- Loss of appetite
- Subcostal recession
- Prominent sternum
- Hyperinflation of chest
What would you expect to find on examination of a child with bronchiolitis?
- Widespread wheeze
- Fine crackles
- Overexpansion of chest
What time of virus is RSV?
Single stranded RNA virus
What main investigation would you perform to diagnose RSV bronchiolitis?
- Nasopharyngeal aspirate to detect RSV by immunofluorescence
Under what circumstances would you admit a child with bronchiolitis?
- Poor feeding
- Apnoea
- Increased respiratory distress sign
- Low O2
How would you manage bronchiolitis?
- Supportive
- O2 if SaO2 <92%
What is croup?
Acute laryngotracheobronchitis
- Inflammation of all the upper airways
What causes croup?
- Mostly Para-influenzae
- RSV
- Rarely measles
What are the symptoms of croup?
- Stridor
- Coryzal
- Barking cough
- Wheeze
- Hoarse voice
What is the main pathology of croup?
Sub-glottic oedema
When would you admit a child with croup?
- Increased work of breathing
- Cyanosis
How would you manage croup?
- Every child has one single dose of oral dexamethasone
- Prednisolone if dexamethasone not possible
- Moderate - NEB budenoside
- In emergency - high-flow O2 and NEB adrenaline and steroids
What is the main cause of Epiglottitis?
- Haemophilus influenzae
What is the difference between the ages of those affected by epiglottitis and croup?
- E = 2-6 years
- C = 6m - 3years
Why have the number of epiglottitis cases reduced?
- Haemophilus influenzae B vaccine introduced as part of routine vaccinations
What is the difference between the areas affected by croup and epiglottitis?
- E = supraglottic
- C = subglottic
What are the main signs/symtoms of epiglottitis?
A - Airway closed I - Increased pulse R - Restlessness R - Retractions A - Anxiety I - Inspiratory stridor D - Drooling
High fever
Severely septic
Leaning forwards
What type of bacteria is Haemophilus?
Gram -ve Coccobacilli
What are the main investigations of epiglottitis?
NONE UNTIL AIRWAY SECURED
- Laryngoscopy
- Blood cultures
How would you manage epiglottitis?
- Call anaesthetist
- Intubate
- IV Cefotaxime
- IV Flucloxillin if cultures -
come back as staph. strain
What are the main bacterial causes of pneumonia?
- Strep. pneumoniae
- Mycoplasma pneumoniae
- Haemophilus influenzae
What are the main causes of viral pneumonia?
- RSV
- Influenza
- Parainfluenza
- Adenovirus
- Coxsackie virus
What are major risk factors for pneumonia?
- CF
- tracheo-oesophageal fistula
What are the main signs/symptoms of pneumonia?
- Short history of fever
- Tachypnoea, cyanosis, grunting, cough
- Respiratory distress
- Anorexia
What would you expect to hear on auscultation of a child with pneumonia?
- Localised crackles
- Bronchial breathing
How would you investigate suspected pneumonia?
- Blood cultures
- CR and MSU before ABx
- Monitor temperatures closely
How would you manage pneumonia?
- O2 if required
- Erythromycin + Co-Amoxiclav
- IV Gentamicin and ampicillin
In an URTI, why would you avoid amoxicillin?
In tonsillitis/pharyngitis may causes maculopapular rash if causative agent is EBV
What is Co-Amoxiclav particularly effective against?
B-lactamase-producing H.influenzae
How common is CF?
1 in 3000 births
What is the cause of CF?
- Genetic mutation
- CFTR gene on chromosome 7
- F508 mutation
What is meconium ileus?
- Bowel obstruction that occurs when the meconium in the intestine is even thicker and stickier than normal
- Creates a blockage in a part of the small intestine
What bacterial colonisation is common in CF
- Pseudomonas Aeruginosa
- S. Aureus
How do you treat a pseudomonas aeruginosa infection?
- Tazocin
What pancreatic insufficiency signs present with CF?
- Fat malabsorption
- Steatorrhoea
- Failure to thrive
- Diabetes
What symptoms are present with CF?
- Clubbing
- Respiratory distress
- Biliary stasis
- Nasal polyps
- Meconium ileus
- Pancreatic insufficiency
How can you test for CF?
- Heel prick to test for raised immunoreactive trypsinogen
- Sweat test - increased Na and Cl
- Genetic testing
How is CF managed?
- Physiotherapy
- Prophylactic Abx
- Steroids/beta agonists
- Pancreatic enzyme supplementation
- Fat soluble vitamin supplementation
- Biliary stasis - Ursodeoxycholic acid
What is Ursodeoxycholic acid used for?
To improve bile flow
What is Creon?
Pancreatic enzyme supplement
Which vitamins are needed to be supplemented in CF?
A,D,E,K
When may a lung transplant be indicated in CF?
When FEV1 <30%
Which organism is most likely to cause Otitis Media?
Streptococcus Pneumonia
What is the treatment for secretory otitis media?
Grommets
What is the incubation period for whooping cough?
7-14 days
What is the management for whooping cough?
Oral macrolide if onset within 21 days
Erythromycin for prophylaxis of others
Which organism causes tuberculosis?
Mycobacterium tuberculosis
What is the main investigation for suspected tuberculosis?
Mantoux skin testing
What are the guidelines for surgical tonsillectomy?
- 7+ episodes in 1 year OR
- 5+ in each of previous 2 years OR
- 3+ in each of previous 3 years
What score is used for the indication of antibiotics in tonsillitis?
- Centor score
- >3 or 4 = Penicillin V
Which bacteria most commonly cause tonsillitis?
- Group A strep
- Staphylococcus
- Moraxella catarrhalis
What is bacterial trachieitis?
- Rare but dangerous condition similar to severe viral croup except that the child has a high fever, appears toxic and has rapidly progressive airways obstruction with copious thick airway secretions.
- It is caused by infection with Staphylococcus aureus.
- Treatment is by IV antibiotics and intubation/ventilation if required.
What commonly causes Pharyngitis?
- Adenoviruses
- Enteroviruses
- Rhinoviruses
In older children - Group A Beta haemolytic streptococcus
What is given to premature babies with chronic lung disease?
Palivizumab - Monoclonal antibody to RSV surface protein - monthly IM injections for 6 months
