Respiratory disorders Flashcards
What organisms cause most childhood respiratory infections?
Viruses cause 80-90%.
Most commonly: respiratory syncytial virus, rhinoviruses, parainfluenza, influenzas, adenoviruses
Most important bacteria: strep, pneumoniae, haemophilus influnzae
What host and environmental factors increase the risk of getting a respiratory infection?
Parental smoking, especially maternal Poor socioeconomic status - large family size, overcrowding, damp housing Poor nutrition Underlying lung disease Male gender Congenital heart disease Immunodeficiency
What are the classifications of respiratory infection according to the level of the respiratory infection?
Upper respiratory tract infection Laryngeal/tracheal infection Bronchitis Bronchiolitis Pneumonia
What does the term upper respiratory tract infection encompass (URTI)?
Common cold (coryza)
Sore throat (pharyngitis, including tonsillitis)
Acute otitis media
Sinusitis
What is the commonest presentation of an URTI?
Nasal discharge and blockage Fever Painful throat Earache Cough Difficult in feeding in infants Febrile convulsions Acute exacerbations of asthma
What is a classic feature of the common cold (coryza)?
A clear or mucopurulent nasal discharge and nasal blockage.
What are the commonest organisms that cause the common cold (coryza)?
Rhinoviruses
Coronaviruses
RSV
How do you treat the common cold (coryza)?
Fever and pain are treated with paracetamol or ibuprofen
What is pharyngitis?
The pharynx and soft palate are inflamed and local lymph nodes are enlarged and tender
What are the common pathogens that cause pharyngitis?
Adenoviruses, enteroviruses and rhinoviruses. In the older child, group A beta-haemolytic streptococcus is a common pathogen
What is tonsillitis?
A form of pharyngitis, where there is intense inflammation of the tonsils, often with a purulent exudate.
What are the common pathogens that cause tonsillitis?
Group A strep, EBV
What are some symptoms associated with bacterial tonsillitis?
Marked constitutional disturbances, such as headache, apathy and abdominal pain, white tonsillar exudate and cervical lymphadenopathy is more common with bacterial infection
How would you treat tonsillitis?
Often penicillin or erythromycin, in severe cases children may require admission for IV fluid and analgesia if they are unable to swallow solids or liquids
What would you NOT use to treat tonsillitis?
Amoxicillin is best avoided as it may cause a widespread maculopapular rash if the tonsillitis is due to infectious mononucleosis
What age is acute otitis media most common?
At 6-12 months old
What are infants and young children at increased risk of acute otitis media?
Their Eustachian tubes are short, horizontal and function poorly.
How does acute otitis media present?
Pain in the ear and fever. The tympanic membrane is seen to be bright and red and bulging with loss of the normal light reflection.
What pathogens cause acute otitis media?
Viruses, especially RSV and rhinovirus and bacteria including pneumococcus, H.influenzae.
How would you treat acute otitis media?
Pain should be treated with paracetamol or ibuprofen. Most cases resolve spontaneously. Amoxicillin is widely used.
What can recurrent ear infections lead to and what does this look like?
Otitis media with effusion. The eardrum is seen to be dull and retracted, often with a fluid level visible.
In what age is otitis media with effusion very common?
Between the ages of 2 and 7 years old, with a peak incidence between 2.5 and 5 years.
How do you treat otitis media with effusion?
It is usually self-resolving, but it can cause hearing loss, in which case insertion of ventilation tubes (grommets) or adenoidectomy can be beneficial.
How can you diagnose otitis media with effusion?
Flat tract on tympanometry, in conjunction with evidence of a conductive loss on pure tone audiometry or reduced hearing on a hearing test.