Respiratory Disease

Question 1

Name six important viral pathogens causing respiratory infection in childhood

Answer 1

1) Respiratory syncytial virus
2) Rhinoviruses
3) Parainfluenza
4) Influenza
5) Human Metapneumovirus (hMPV)
6) Adenoviruses

Question 2

Name six important bacterial causes of respiratory infection in childhood

Answer 2

1) Streptococcus pneumoniae
2) Other strep infections
3) Haemophilus influenzae
4) Moraxella catarrhalis
5) Bordetella pertussis
6) Mycoplasma pneumoniae

Question 3

Which pathogen remains important cause of resp infections globally? (as opposed to in the UK)

Answer 3

Mycobacterium tuberculosis

Question 4

What condition does bordetella pertussis cause?

Answer 4

Whooping cough

Question 5

What factors cause an increased risk of respiratory infection? (x7)

Answer 5

1) Parental smoking (espec maternal)
2) Poor socioeconomic status - large family size, overcrowding, damp housing.
3) Poor nutrition
4) Underlying lung disease such as bronchopulmonary dysplasia, CF, asthma
5) Male gender
6) Haemodynamically significant congenital heart disease
7) Immunodeficiency

Question 6

How is respiratory infection classified?

Answer 6

According to the level of the respiratory tract most involved.
Working your way down: URTI, laryngeal/tracheal infection, bronchitis, bronchiolitis and pneumonia.

Question 7

Give an example of an infection affecting the laryngeal/tracheal region.

Answer 7

Croup

Causes a barking cough and occurs most commonly in children 1-3 yrs old.

Question 8

What pathogens most commonly cause coryza/common cold?

Answer 8

Rhinoviruses, coronaviruses and RSV

Question 9

Which bacterial infection is a common cause of pharyngitis and tonsillitis in older children?

Answer 9

Group A beta-haemolytic streptococcus

Question 10

Only a third of cases of tonsillitis are caused by bacteria so antibiotics are often not necessary. When antibiotics are indicated, which antibiotic is best avoided and why?

Answer 10

Amoxicillin - because it may cause a widespread maculopapular rash if the tonsillitis is due to infectious mononucleosis (EBV)

Question 11

What criteria is used to assess the likelihood of whether pharyngitis/tonsillitis is caused by Group A beta-haemolytic streptococci? Give the name and explain it.

Answer 11

The centor criteria. The 4 criteria are:

1) Presence of tonsillar exudate.
2) Presence of tender anterior cervical lymphadenopathy or lymphadenitis.
3) History of fever.
4) Absence of cough.

The presence of three or four of these clinical signs (Centor score 3 or 4) suggests that the person may have GABHS (40–60% chance) and may benefit from antibiotics treatment.

Question 12

At what age is acute otitis media most likely to occur in children?

Answer 12

6-12 months

Question 13

Why are young children prone to acute otitis media?

Answer 13

Because their Eustachian tubes are short, horizontal and function poorly.

Question 14

Describe the appearance of the tympanic membrane in acute otitis media

Answer 14

The tympanic membrane is bright red and bulging with the loss of normal light reflection

Question 15

Which pathogens most commonly cause acute otitis media?

Answer 15

RSV, Rhinoviruses, Pneumococcus, H.influenzae and Moraxella Catarrhalis

Question 16

What serious complications can result from acute otitis media

Answer 16

Mastoiditis and meningitis (but they are now uncommon)

Question 17

What antibiotic is widely used for acute otitis media?

Answer 17

Amoxicillin

Question 18

What % of childhood respiratory infections are caused by viruses?

Answer 18

80-90%

Question 19

What can recurrent ear infections lead to?

Answer 19

Otitis media with effusion (OME) also known as glue ear

Question 20

How does otitis media with effusion present?

Answer 20

Hearing loss (which may present as behavioural problems) - children are otherwise asymptomatic.

Question 21

Describe the appearance of the eardrum in otitis media with effusion (OME)

Answer 21

The ear drum is seen to be dull and retracted and often there is a fluid level visible

Question 22

What type of hearing loss does OME result in?

Answer 22

Conductive hearing loss

Question 23

How can you confirm a diagnosis of OME in

a) Children > 4 years?
b) Children

Answer 23

a) A flat trace on tympanometry in conjunction with evidence of conductive hearing loss on pure tone audiometry
b) Reduced hearing on a distraction hearing test in younger children

Question 24

In which age range is OME very common?

Answer 24

2-7 years (peak incidence 2.5 to 5 years)

Question 25

What adverse consequences may result from conductive hearing loss caused by OME?

Answer 25

Interference with normal speech development and and learning difficulties

Question 26

What can be done for children with chronic glue ear?

Answer 26

• Insertion of ventilation tubes i.e. grommets. This is what happens in practice.
• Research suggests adenoidectomy would provide more long term benefit

Question 27

What is done for children with glue ear if the problems recur after grommet extrusion?

Answer 27

Reinsertion of grommets with adjuvant adenoidectomy

Question 28

Name the three indications for tonsillectomy

Answer 28

1) Recurrent severe tonsillitis
2) A peritonsillar abscess (quinsy)
3) Obstructive sleep apnoea (adenoids will also be removed)

Question 29

Name the three indications for removal of tonsils and adenoids

Answer 29

1) Recurrent OME & hearing loss, where it gives significant additional long term benefit.
2) Obstructive sleep apnoea (an absolute indication)

Question 30

What is the other name for croup?

Answer 30

Laryngeotracheobronchitis

Question 31

What treatment should be given to all children with croup, regardless of severity?

Answer 31

A single dose of dexamethasone (0.15mg/kg)