respiratory disorders Flashcards
types of URTI?
- common cold
- pharyngitis and tonsillitis (sore throat)
- acute otitis media
- sinusitis
common causes of tonsillitis?
- group A B-haemolytic streptococci
- EBV
a) treatment of group A strep tonsillitis?
b) why?
a) 10 days of penicillin
b) to prevent rheumatic fever
features of tonsillitis?
- red, swollen tonsils
- may be white exudate
- headache
- apathy
- abdominal pain
- cervical lymphadenopathy
peak age for otitis media?
6-12 months
why are children prone to otitis media?
their eustachian tube is short, and horizontal
presentation of otitis media?
- pain in ear
- fever
- bright red bulging tympanic membrane
pathogens that cause otitis media?
- RSV
- rhinovirus
- H. influenzae
- Moraxella catarrhalis
serious complications of otitis media?
- mastoiditis
- meningitis
management of otitis media?
- paracetamol or ibuprofen for pain relief
- otherwise just wait
- amoxicillin helps with severe pain
presentation of otitis media with effusion
- asymptomatic, or slightly reduced hearing
- eardrum looks dull and retracted
- visible fluid in it
peak incidence of otitis media with effusion?
2.5-5 years old
management of otitis media with effusion?
- nothing at all
- if hearing loss, grommets
main complication of otitis media with effusion?
conductive hearing loss
indications for tonsillectomy?
- recurrent tonsillitis
- NOT large tonsils alone
- peritonsillar abscess
- obstructive sleep apnoea
commonest cause of acute upper airway obstruction?
CROUP!!!!
rarer causes of acute upper airway obstruction?
- epiglottitis
- bacterial tracheitis
- inhalation of smoke
- trauma to throat
- laryngeal foreign body
signs of upper airway obstruction?
- stridor (inspiration)
- hoarse voice
- barking cough
- dyspnoea (varies)
management of upper airway obstruction?
- do NOT examine throat
- look for signs of hypoxia
- if there is resp failure, get urgent tracheal intubation
commonest cause of croup?
parainfluenza virus?
age for presentation of croup?
6 months - 6 years old
peak age for croup?
2nd year of life
which season is croup most common in?
autumn
features of croup?
- barking cough
- harsh stridor
- hoarse voice
- prodrome of fever + coryza
- symptoms worse at night
- symptoms disappear at rest if mild croup
management of croup?
- inhaled warm, moist air
- oral steroids
presentation of bacterial tracheitis?
- high fever
- toxic appearance
- rapidly progressive obstruction
- stridor, cough, resp distress
causative organism in bacterial tracheitis?
staph aureus
management of bacterial tracheitis?
- do ABCDE
- IV ceftriaxone and cloxacillin for 5 days
- then oral co-amoxiclav for 7-10 days
causative organism in acute epiglottitis?
- H. influenzae b
- incidence really low now due to vaccination against Hib
features of epiglottitis?
- high fever (>38.5C) in toxic-looking child
- painful throat, struggling to swallow (drooling)
- soft inspiratory stridor
- reluctant to speak
- no cough
management of acute epiglottitis?
- treat it ASAP - every minute counts
- intubation under GA
- if this not possible, then tracheostomy
- IV cefuroxime
- rifampicin for all close contacts
presentation of whooping cough?
1 week coryza, followed by:
- paroxysmal cough, worse at night
- may vom from coughing
- older children whoop
- infants have apnoea
- red / blue in face during paroxysm
- epistaxis
- subconjunctival haemorrhage
age for whooping cough?
<4 months, they have not been immunised yet
management of whooping cough?
- highly infectious, so child should be isolated
- erythromycin prophylaxis for unimmunised close contacts
how is whooping cough diagnosed
- culture of bordetella pertussis on per-nasal swab
- lymphocytosis on blood film
age of presentation for bronchiolitis?
1-9 months, rare after 1 year old
causative organism in bronchiolitis?
respiratory syncytial virus (RSV)
features of bronchiolitis?
1 week coryza, followed by:
- sharp, dry cough
- increasing SOB
- tachypnoea
- tachycardia
- recession
- prominent sternum (hyperinflated chest)
- difficulty feeding
- cyanosis / pallor
- expiratory and inspiratory wheeze
investigations in bronchiolitis?
- PCR of nasopharyngeal secretions
- CXR (unusual) shows hyperinflated lungs
- O2 sats (keep monitoring)
management of bronchiolitis?
- supportive
- humidified O2 in nasal cannula
- ventilation and fluids both as needed
