Upper Resp Flashcards
what is croup?
laryngotracheobronchitis
what age is most affected by croup?
2yrs
what commonly causes croup?
parainfluenza virus
state some organisms that cause croup?
parainfluenza (type 1,2,3,4) respiratory syncytial virus adenovirus rhinovirus enterovirus measles influenza A and B mycoplasma pneumoniae (rare)
what are risk factors for croup?
male
autumn and spring season
C/C variant of CD14 C159T gene (have lower prevalence of croup)
how long do viral resp infections usually last?
couple of days
how long does pertussus last ?
3 months
how long does croup last?
1-4 days (since its caused most commonly by parainfluenza virus)
when are symptoms worse for resp infections/conditions?
at night since the child is lying down and they are not able to cough or breath as well as they would when standing up
what are the symptoms of mild croup?
occasional barking cough
child is happy and will drink/eat/play
what are the symptoms of moderate croup?
frequent barking cough
audible stridor at rest
child is not distressed or agitated
what are the symptoms of severe croup?
frequent barking cough
prominent stridor
use of accessory muscles
child is distressed
what are DD for croup?
epiglottis inhaled foreign body acute anaphylaxis bacterial tracheitis diphtheria laryngomalacia peritonsillar abscess retropharyngeal abscess laryngeal web, papillomata
does epiglottis or croup have prior features ?
croup has coryza
will epiglottis or croup have a raised temperature?
epiglottis >38.5
where can mild croup be managed ?
at home
when should mild croup be admitted?
previous Hx of airway obstruction <6months old immunocompromised poor response to treatment diagnosis is uncertain significant parental anxiety
what advice should be given for home managed croup?
symptoms usually resolve within a couple of days
antibiotics aren’t required since it is a viral infection
paracetamol can be used to control pain
ensure adequate fluid intake
seek urgent medical advice if symptoms worsen
what medication can be used for croup?
single dose of oral dexamethasone (0.15mg/kg)
nebulised adrenaline
oxygen
what are some complications of croup?
Lymphadenitis Otitis Media Dehydration bacterial superinfection pulmonary oedema, pneumothorax (very rare)
what age is the peak incidence of croup?
2yrs
what is the voice like in croup?
hoarse
what is the voice like in epiglottitis?
weak/silence
what organism causes whooping cough?
Bordetella pertussis
when are vaccines against pertussis given?
2,3,4 months
booster given at 3yrs and 4 months before school
what type of bacteria is bordetella pertussis ?
gram negative bacillus
what are the three stages for whooping cough?
catarrhal phase
paroxysmal phase
convalescent phase
what occurs in the catarrhal phase of whooping cough ?
rhinitis conjunctivitis irritability low grade fever dry cough
what occurs at the paroxysmal phase of whooping cough?
the classic sign of repeated coughing followed by an inspiratory gasp (producing the classic whoop sound)
may be followed by vomiting as the abdominal pressure has increased so much from coughing and increased mucosal secretions
what occurs at the convalescent phase of whooping cough?
up to 3 months of the cough gradually decreases in frequency
what are the DD of pertussis ?
- all with long natural histories
bronchiolitis asthma mycoplasma pneumonia bacterial pneumonia TB
what does bordetella pertussis do to the airways?
paralyse the cilia and promote inflammation, impairing the clearance of respiratory secretions which leads to a cough
what investigations can be done for pertussis ?
PCR and culture of nasopharyngeal aspirate
anti pertussis toxin IgG serology (if cough is >2weeks and <5yrs)
anti-pertussis toxin detection in oral fluids (if cough >2weeks and >5yrs)
FBC (usually reveals lymphocytosis)
what antibiotic can be given for whooping cough if <21days duration?
clarithromycin
co-trioxazole 2nd line
what are some complications of whooping cough?
secondary bacterial pneumonia
seizures
encephalopathy
what is the commonest chronic resp condition in children?
asthma
