RTis Flashcards
What are respiratory tract infection symptoms and signs?
Symptoms - fever, cough, SOB, wheeze
Signs - stridor, wheeze, clubbing, lymphadenopathy, cyanosis, tachynoea, chest wall deformity, decreased expansion, dull to percussion, dec air entry, crepitations
Common cold
URTI
40% rhinovirus and 30% coronaviruses, enterovirus, parainfluenza virus
Transmission - aerosol and viral-contaminated hands
Pharyngitis
Infection of pharynx
Usually due to viral infection with resp viruses (mostly adenoviruses, coronaviruses, enteroviruses and rhinoviruses)
Pharynx and soft pallate inflamed and local lymph nodes enlarged and tender
Management - symptomatic
Tonsillitis
Form of pharyngitis whwere intense inflammation of tonsils
Most viral
Most common bacterial organism is group A beta-haemolytic streptococcus (GABHS) - consider antibiotic if this
Transmission airborne and contact
Symptoms - tonsillar exudate, tender anterior cervical lymph nodes, fever, absence of cough
When should antibiotics be given in tonsilitis?
In severe cases where the practitioner is concerned about clinical condition of patient
Pen V 500mg QID for 10 days
Macrolide as alternative first line tx
What is GABHS?
Scarlet fever - pink/red rash that feels like sandpaper and looks like sunburn, white coating on tongue which peels leaving redness/swelling
Streptococcus pyogenes
Antibodies to bacteria cross react with host
Clinical presentation varies from asymptomatic to full blown acute nephrotic syndrome characterised by red/brown urine, proteinuria, oedema, HTN and AKI
Acute otitis media
Infection of cavity of middle ear
Viruses - RSV and rhinovirus
bacteria - Streptococcus pneumoniae and H.influenza
Symptoms - fever, pain, d&v
Signs - bulging ear drum and dilated vessels
Diagnosis is clinical - auroscope may show fluid levels, an inflamed tympanic membrane or a purulent discharge associated with perforation
Lasts for about a week and most get better in 3 days without antibiotics
Serious complications rare
May be complicated by perforation, recurrent or chronic infection or development of ‘glue ear’
Otitis media with effusion
Recurrent ear infections can lead to OME - very common in ages 2-7
Possible decreased hearing
Eardrum dull and retracted, often with a fluid level visible
No evidence of LT benefit from use of antibiotics, steroids or decongestants
Observation appropriate for most children as spontaneous resolution common - re-evaluate after 2 hearing tests
Grommets have been shown to improve hearing in ST but not shown to improve other aspects of development
Sinusitis
Infection of paranasal sinuses may occur with viral URTIs. Occasionally there is secondary bacterial infection with pain, swelling, tenderness over cheek from infection of maxillary sinus
Aetiology - S.pneumoniae, H.influenza, S.milleri
Mucosal swelling prevents muco-ciliary clearance of infection, blockage of eustachian tube or sinuses
Clinical - pain and headache, usually maxillary and frontal
X-rya (not often done) can show thickening of cavity
management - ampicillin/amox and analgesia and decongestant
Laryngotracheobronchitis
Incidence - 3 months - 6years
95% viral - parainfluenza RSV and influenza
Mucosal inflammations and increased secreteions, oedema of subglottic area that is dangerous as it may narrow trachea
Often worse at night
Treatment of croup pre-hospital
Moderate - single dose of ora dexamath
Severe - oxyegn, dexamath or if too unwell to receive meds then inhaled budenoside nebs or IM dex
Epiglottis
Life-threatening emergency Caused by H.influenzae Most common in children 1-6y/o Blood cultures to isolate H.influenzae Life-threatening emergency, needs urgent endotracheal intubation, IV antibiotics
How do you differentiate between croup and epiglottitis?
Croup - onset over days, severe/barking cough, able to drink, no drooling saliva, unwell appearance, temp less than 38.5, harsh/rasping stridor, horase voice
Epiglottitis - onset over hours, absent/slight cough, not able to drink, droowling saliva, appearnce is very ill, temp high, soft/whimpering stridor, muffled/reluctant to speak
Tracheitis
Infections may spread down from URTI
Usually viral in origin, parainfluenza virus, influenza virus, adenovirus
Hoarseness and retrosternal pain in adults
Dry cough, croup (inspiratory stridor) in children
Bronchiolitis
Dry cough, inc SOB, feeding difficulty associated with inc dyspnoea
laboured breathing, inc RR, expiratory grunting, use of accessory muscles esp sternomastoids, difficulty speaking.hearing
CXR unessary in most cases but shows hyperinflation of lungs due to small airways obstruction
Oxygen and possibly fluids for management
