Respiratory Disorders Flashcards
What are symptoms of severe respiratory distress
cyanosis
tired out
reduced conscious level
oxygen sat <92%
explain features of STRIDOR
INspiratory
caused by narrowing of the upper airways (above thoracic inlet - extra thoracic)
Upper airway tissues are floppy > make noise on inspiration
Explain features of WHEEZE
EXPIRATORY
compression of bronchioles in lung (intrathoracic airway narrowing)
When you are trying to push air out, the airways become narrower
What are classifications of respiratory infections
URTI Laryngeal/tracheal infection Bronchitis Bronchiolitis Pneumonia
How many URTI do children have on average per year?
5
What are conditions classed as URTI?
Coryza (common cold)
Pharyngitis, tonsillitis (sore throat)
Acute otitis media
Sinusitis
What are features of the common cold
Nasal discharge clear/mucopurulent
Nasal blockage
What are common pathogens causing the common cold
Rhinovirus
Coronavirus
RSV
How do you manage the common cold
Reassure patient:
- self limiting
- symptoms peak after 2-3 days, resolve within 2 weeks
- encourage rest, adequate food and fluidd intake
- Paracetamol / ibuprofen for pain relief
What is pharyngitis
inflammation of the pharynx and soft palate
What are causes of pharyngitis
Viral infection: adenoviruses, enteroviruses, rhinoviruses
in older children: Group A beta-haemolytic strep
What is tonsillitis
Intense inflammation of the tonsils, often with purulent exhudate
What is a common cause of tonsillitis
group A beta-haemolytic strep
EBV
What is ix for pharyngitis/tonsillitis
can do rapid antigen testing if bacterial tonsillitis suspected q
What is mx for pharyngitis/tonsillitis
10 day Phenoxymethylpenicillin if bacterial tonsillitis confirmed
Clarythromycin if allergy
What is advice for pharyngitis/tonsillitis
adequate fluid intake
Paracetamol/ibuprofen as necessary
Salt water gargling, lozenges, anaesthetic spray for temporary pain relief
Return to school after fever has resolved
What antibiotic must be avoided in pharyngitis/tonsillitis and WHY
Avoid AMOXICILLIN
If tonsillitis is from EBV, it will cause widespread ma culopapular rash
What is scarlet fever
Occurs following tonsillitis due to group A strep
What us the presentation of scarlet fever
headache and tonsillitis > fever
Rash: sandpaper like maculopapular rash with flushed cheeks and perioral sparing
Tongue: white, coated, sore, swollen
What is the management of scarlet fever
10 day Phenoxymethylpenicillin 4xD
Or Arythromyci
What else must you do if someone has scarlet fever
Notify PHE - this is a NOTIFIABLE DISEASE
What is another name for Phenoxymethylpenicillin
Penicillin V
Why are children more susceptible to otitis media?
Eustachian tubes aree short, horizontal, function poorly
What is presentationn of otitis media?
Ear pain, fever
Dischharge from yeeatr
What does the tympanic membrane look like in otitis media
bright red, bulging, loss of normal light reflex
What are causative pathogens of otitis media
RSV, rhinovirus, pneumococcus, H influenza, Moraxella catarrhal is
What are complications of otitis media
mastoiditis
meningitis
When would you admit a patient with otitis media?
Severe systemic infection
Complications (meningitis, mastoiditis)
If <3m old with fever >38
How do you manage otitis media
Ibuprofen or paracetamol for pain
No antibiotic prescription
Backup antibiotic prescription - not needed immediately, only use if symptoms have not improved after 3 days or worsen
What antibiotics can you give for otitis media
Amoxicillin / clarythromycin
What is glue year
otitis media with effusion
due to recurrent ear infections
What is the presentation of glue year
asymptomatic
reduced hearing only
What is the eardrum like in glue year
Dull and retracted
Fluid level visible
What is the complication of glue ear
conductive hearing loss > interferes with normal speech development, learning difficulties
How do you manage glue year
Grommet insertion
Grommet is a ventilation tube
Benefit lasts 12 months, then remove
What is the presentation of otitis externna?
swollen infected ear canal, pus, no hearing loss q
Who does chronic supportive otitis media present in
Older children / adolescents
Why does CSOM present
Following recurrent OM / trauma as child > perforation of TM > subsequent bacterial infection > painless otorrhoea > 6 weeks
OR due to choleosteatoma
What is presentation of CSOM
Painless otorrhoea >6 weeks
Hearing loss
Afebrile, no pain
What is CSOM management
If <1/3 of TM involved: conservative (antibiotics), as TM will regrow
if >1/3 TM involved: replace TM with surgery
What is sinusitis
Infection of the paranasal sinuses due to viral URTI
What aree sx of sinusitis
pain, swelling, tenderness over check
What is management of sinusitis
Advise that it is VIRAL > takes few weeks to resolve
Paracetamol / ibuprofen
nasal saline / decongestants
What is a possible complication for sinusitis
overlapping bacterial infection
what do you do if sinusitis sx last longer than 10 days q
high dose corticosteroids for 2 weeks
Consider antibiotic back up prescription with Penicillin V
How do tonsils grow
Max size at 8 year s
Then shrink later in childhood
What is the absolute indication for tonsillectomy
Recurrent severe tonsillitis, >7 episodes in previous years
What are other indications to consider for tonsillectomy
Peritonsillar abscess
OSA
What score can you use for tonsillitis
Fever-PAIN score
CENTOR score
What are causes of stridor
CROUP (Most common infection) EPIGLOTTITIS (to exclude) Bacterial tracheitis Foreign body Anaphylaxis Laryngomalacia - MOST COMMON OF ALL Trauma to throat
What should you NEVER do if child has stridor
AVOID examining the throat
As it may precipitate total obstruction
Unless full rhesus equipment and team are at hand
What is croup
inflammation of larynx and trachea
What is the main cause of croup
Parainfluenza
What age group does croup occur in
6 months to 6 years
What are symptoms of croup
Coryza, fever, SOB
Barking cough
STRIDOR
When are symptoms worse in croup
At night
What are features of the 3 categories of croup
barking cough with stridor (mild)
sternal/intercostal recession (moderate
agitation/lethargy (severe)
Who must you admit with croup
children with moderate / severe croup
How do you treat croup
PO Dexamethasone 0.15mg/kg SINGLE DOSE IMMEDIATELY
Consider:
- nebuliser adrenalin
- oxygen
- inhaled budosemide
How long should croup take to resolve
48h
What is acute epiglottitis
Intense swelling of epiglottis and surroundings
associated with septicaemia
LIFE THREATENING
What is the cause of acute epiglottisi
H influenza type B
Who does acute epiglottis occur in
1-6 years old
ESPECIALLY IF THEY HAVE MISSED IMMUNISATIONS
What is the stridor like in epiglottitis
SOFT
SOFTER than in croup
What are clinical features of epiglottis
very ill looking child
intensely painful throat, child cannot speak or swallow, saliva drools down
child sits immobile, upright, with open mouth to optimise aairway
Do you get cough in croup / epiglottitis
You get cough with croup only
What is management of epiglottitis
Urgent hospital admission and treatment
Transfer to ICU
Visualise under GA > intubate > IV ceftriaxone
What is the pathogen causing bacterial tracheitis
S aureus
How is bacterial tracheitis different to epiglottitis
thick airway secretions
How do you treat bacterial tracheitis
IV antibiotics, intubation, ventilation
How does laryngomalacia present
At 4 weeks
With stridor and poor growth + difficulty eating
What is laryngomalacia
COngential abnormality of larynx
what are RF for developing more severe bronchiolitis
born prematurely
bronchopulmonary dysplasia
lung disease
congenital heart disease
explain the three sounds that occur in the resp tract and at what level
STERTOR: nose to larynx
STRIDOR: larynx to carina
WHEEZE: below carina
what sign to you get on CXR of acute epiglottisis
thumb sign
