URTI Flashcards
What conditions are included in URTI?
Common cold (coryza)
Sore throat (pharyngitis, tonsilitis)
Acute otitis media
Sinusitis
What are possible complications of URTI?
Difficulty in feeding in infant as their noses are blocked and this obstructs breathing
Febrile seizures
Acute exacerbation so fasthma
What are the features of common cold?
What pathogens cause common cold?
What is management of common cold?
Clear or mucopurulent nasal discharge and nasal blockage
Rhinovirus
Coronavirus
Respiratory Syncytial Virus
Self limiting so supportive management
Pain treatment with paracetamol or ibuprofen
Cough may persist up to 4 weeks - reassure parents
What is pharyngitis? Common cause?
Pharynx and soft palate are inflamed and local lymph nodes are large and tender.
Viral infection (adenovirus, enterovirus, rhinovirus)
In older children, group A beta-haemolytic streptococcus
What is tonsillitis? Common cause?
Intense inflammation of tonsils often with purulent exudate
Group A beta-haemolytic strep
Epstein Barr virus (infection mononucleosis)
How to differentiate between viral and bacterial tonsillitis?
It is not possible to distinguish clinically between viral and bacterial causes.
2/3 are viral.
Centor score and feverPAIN score can be used to predict which patients will culture positive for streptococcus pharyngitis.
Headache, abdominal pain, white tonsillar exudate, anterior cervical lymphadenopathy but asset cough are more common in bacterial
GAS is rare under 3yo
What is management of tonsillitis/pharyngitis?
Antibiotics prescribed for severe cases - 10 day treatment to eradicate organism and prevent rheumatic fever (GAS).
If severe, children may require hospital for IV fluids and analgesia if unable to swallow.
Avoid amoxicillin as can cause widespread maculopapular (flat red area covered in small bumps) rash if tonsillitis due to infection mononucleosis (glandular fever, EBV)
What is scarlet fever? Describe clinical features.
GA strep infection can result in scarlet fever
Most common in 5-12
Fever precedes the presence of tonsillitis and headache by 2-3 days
Appearance of rash (exanthema - rash with fever) is variable although typically, sandpaper like maculopapular rash with flushed cheeks and perioral sparing.
Tongue white and coated, sore swollen
Treat with antibiotics - penicillin V or erythromycin
to prevent acute glomerulonephritis or rheumatic fever (GAS)
What is acute otitis media? Why are children prone to it?
Inflammation o middle ear leading to pain in ear and fever.
Infants and young children have short, horizontal and poorly functioning Eustachian tubes allowing infection to track up to middle ear.
Every child with fever must have tympanic membranes examined
What is seen on examination in acute otitis media?
Tympanic membrane is bright red and bulging with loss of normal light reflection.
Occasionally there is acute perforation of the eardrum with pus visible in external canal
What are causes of acute otitis media?
Respiratory Syncytial virus\Rhinovirus
Haemophilus influenza
Moraxella catarrhalis
What are complications of acute otitis media?
Mastoiditis
Meningitis
What is management of acute otitis media?
Analgesia - paracetamol, ibuprofen
Regularly
Most cases resolve spontaneously
Give parents prescription of antibiotics, amoxicillin, but only use if child remains unwell after 2-3 days
What can recurrent ear infections lead to? Symptoms?
Examination?
Otitis media with effusion
asymptomatic apart from possible decreased hearing
Eardrum is seen to be dull and retracted often with a fluid level visible.
What is a complication of otitis media with effusion? How is this prevented?
Conductive hearing loss (tympanometry hearing testing/pure tone audiometry)
Can interfere with normal speech development and result in learning difficulties in school
Insertion of ventilation tubes (grommets) for 12 months is often performed, also in chronic otitis media with effusion and recurrent URTI
If problems recur after grommet extrusion, reinsertion of grommets and adjuvant adenoidectomy
