Upper respiratory tract infections Flashcards
What ear infections can occur in a child?
Otitis externa
Acute otitis media
What is Otitis Externa and how does it present?
Inflammation of outer ear due to bacteria
Ear pain, itchy and discharge
Can have a red, swollen or eczematous canal on otoscopy
What can trigger otitis externa?
Recent swimming
What is seen on otoscopy for otitis externa?
Red, swollen, eczematous canal
may see dishcarge (pus)
How to manage otitis externa?
Topical aceitic acid - try for 1 week then it becomes inefective
- topical antibiotics
What about otitis externa requires a referal to ENT?
Unresponsive to antibiotics
When does otitis externa warrant oral antibiotics instead of topical?
Cellulitis
Cervical lymphadenopathy
What is acute otitis media?
Infection of middle ear (typanic membrane affected)
How does acute otitis media present?
Very common in young children:
- preceded by URTI
- otalgia, fever, **hearing loss **
- most common cause of hearing loss in children because of glue ear
What is glue ear
about acute otitis media
otitis media with effusion
What does it mean if a child presents with otitis media and discharge?
The tympanic membrane has perforated
What is seen on otoscopy for acute otitis media?
red and bulging tympanic membrane with loss of cone of light
How to manage uncomplicated acute otitis media?
self limiting within 3 days
follow up if not better after 3 days
How to manage a perforated acute otitis media?
5 day course of oral amoxicillin
review after 6 weeks to check healing
What would indicate admission for acute otitis media?
Child <3 months + temp 38
Systemic unwell
Complications :mastoiditis, meningitis, facial nerve palsy
What is mastoiditis and what is it a complication of?
Discharge and swelling before ear in acute otitis media
Otitis media with effusion?
This is different to acute otitis media
No inflammation
hearing loss, may cause delay in speech and language
otoscopy : fluid behind ear so lack of light reflex, opacification of drum, air fluid level behind drum
Observed for 6-12 weeks to check for resolution
Must do pure tone audiometry and tympanometry during this period
if persisting - ENT
What is tonsilitis according to the CENTOR criteria?
Tonsillar exudate
Tendor anterior cervical lymphadenopathy
Fever >38
Absence of a cough
3/4 = need to treat
FeverPAIN score for tonsilitis?
Fever
Purulence (exudate)
presented within 3 days
inflammed tonsols
no cough or coryza
need 4/5 for treatment
If positive for tonsilitis on CENTOR or FeverPAIN score, how to manage?
Phenoxymethylpenicillin 5-10 days
clarithro if allergic
What abx to avoid in tonsilitis and why?
amoxillin - if causative organism is EBV ir can cause widespread maculopapular rash
When to admit for tonsilitis?
Difficulty breathing
peri-tonsillar abscess
systemic / sepsis
if taking DMARDS or carbimazole at the same time
How will a peri-tonsillar abscess present?
Severe unilateral throat pain
- admit and ent review
What to do if someone who is taking a DMARD or carbimazole has tonsilitis?
urgent fbc
How to investigate for tonsilitis if CENTOR score 3/4
Throat culture
or
rapid streptococcal antigen test
What is acute epiglottitis?
Serious infection by haemophilus influenza B
what immunisations work to prevent acute epiglottitis?
Hib immunisation at 8,12,16w and 1 year
Symptoms of acute epiglottitis?
High temperature
soft inspiratory stridor
drooling of saliva
no cough!
tripid position
How to diagnose acute epiglottitis?
flexible laryngoscopy by senior
DO NOT examine the throat
CXR : thrumbprint sign
How to manage acute epiglottitis
Immediate refer ENT and ITU admission
Requires endotracheal intubation
IV abx : cefuroxime
prophylaxis against acute epiglottitis for close contacts
rifampicin
