URTI/LRTI in Children Flashcards
1
Q
What are the symptoms of an viral upper respiratory tract infection?
A
Nasal discharge, sneezing, painful throat/ears, pyrexia, headache, malaise.
2
Q
What are the signs of a viral URTI?
A
Red pharynx +/- pus, bilateral red tympanic membranes, yellow/green discharge.
3
Q
What bugs can commonly cause viral URTI?
A
Rhinovirus>Enterovirus>Coronovirus>RSV >Parvovirus>Adenovirus
4
Q
What are the symptoms of tonsillitis?
A
Sore throat, earache, pyrexia.
5
Q
Pyrexia
A
> 38c
6
Q
What are the signs of tonsilitis?
A
Enlarged, inflamed tonsils +/- pus, lymphadenopathy.
7
Q
What bug commonly causes tonsilitis?
A
Common virus consider Group A Streptococcus.
8
Q
What are the investigations and treatments for tonsilitis?
A
Throat swab.
Analgesia, antibiotics if bacterial.
9
Q
What are the symptoms of croup?
A
Viral illness preceding… barking cough and stridor middle of night
10
Q
Croup
A
Croup is a viral condition that causes swelling around the vocal cords. It’s characterized by breathing difficulties and a bad cough that sounds like a barking seal.
11
Q
Stridor
A
Stridor is a high-pitched, wheezing sound caused by disrupted airflow.
12
Q
What is the main sign of croup?
A
Stridor
13
Q
What bug commonly causes croup?
A
Parainfluenza virus
14
Q
What is the treatment for croup?
A
Dexamethasome (steroid to reduce swelling of airway).
> don’t upset the child as it will upset the child.
15
Q
Epiglottitis symptoms.
A
Very unwell, pyrexia++, soft stridor (severely compromised airflow), little cough, drooling
(can’t swallow secretions).
16
Q
What are the signs of epiglottitis?
A
Drooling, toxic, unwell.
> drooling caused as saliva can’t be swallowed.
17
Q
What bugs cause epiglottitis?
A
Haemophilus influenza type B
18
Q
How is epiglottitis treated and investigated?
A
No investigations - leave the child to relax - investigations likely aggravate the condition.
Treatment: Airway, fluids, antibiotics
19
Q
What are the symptoms of bronchiolitis?
A
Coryzal symptoms preceding, cough, progressive increased work of breathing, poor feeding.
20
Q
What is meant by coryzal symtpoms?
A
Common cold / flu like symptoms.
21
Q
What are the signs of bronchiolitis?
A
Tug, nasal flare, head bob, recession, crackles and wheeze on chest examination.
22
Q
What bugs cause bronchiolitis?
A
Caused by RSV, human metepnuemovirus, adenovirus, influenza
23
Q
What are the investigations for bronchiolitis?
A
Cough swab
24
Q
What age group does bronchiolitis usually affect?
A
0-2years
25
RSV - abbreviation and what disease does it cause?
Respiratory syncytial virus - causes bronchiolitis.
26
How is a viral induced wheeze treated?
Salbutamol
27
Why may salbutamol fail to treat a viral induced wheeze?
Salbutamol causes relaxation of constricted smooth muscle. However in VIW the wheeze may be caused by mucus so salbutamol may not help.
28
What are the signs and symptoms of infleunza?
Symptoms: Pyrexia, muscle ache, headache, cough.
Signs: Red throat.
29
Infleunza most commonly effects children when?
During winter
30
What bugs cause influenza?
Influenza A/B
31
What are the investigations for influenza?
Throat swab or NPA (PCR)
32
What are the symptoms of pneumonia?
Pyrexia, lethargy, breathlessness, cough, chest pain, abdominal pain.
33
What are the signs of pneumonia?
Pyrexia, tachycardia, tachypnoea, desaturation, recession, crepitations, wheeze.
34
What bugs cause pneumonia?
In 40% = no cause found.
In under 5s =RSV, strep pnuemoniae, Mycoplasma.
In over 5s = streppneumoniae, mycoplasma, viruses.
35
What investigations are carried out to detect pneumonia?
Chest X-ray
| Cough swab
36
What is the treatment for pneumonia?
Antibiotics and physiotherapy
37
What are the symptoms of empyema?
Fever, cough, breathlessness, lethargy, malaise, reduced exercise tolerance.
38
What are the signs of empyema?
Reduced chest expansion, reduced breath sounds,
| stony dull on percussion.
39
What bugs cause empyema?
Strep pneumoniae , staph aureas
40
What are the investigations carried out in empyema?
Blood culture, pleural fluid PCR and culture, CXR, USS.
41
What is the treatment for empyema?
Antibiotics and chest drain.
42
Lung abscess
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. This pus-filled cavity is often caused by aspiration, which may occur during anesthesia, sedation, or unconsciousness from injury.
43
What are risk factors for developing a lung abscess?
• Predisposing factors: chronic aspiration, chronic lung
| infection, immunocompromise.
44
Explain the formation of a lung abscess.
• Pneumonitis -> necrosis -> cavitation -> abscess
| formation.
45
Liquefactive necrosis
Liquefactive necrosis (or colliquative necrosis) is a type of necrosis which results in a transformation of the tissue into a liquid viscous mass.
46
What is meant by latent TB?
Immune system can't kill bacteria, but prevents it spreading to body.
47
What is meant by active TB?
Immune system fails to kill or contain the infection, and it spreads within lungs/body, symptoms develop within a few weeks or months.
48
Outline Nontuberculosis Mycobacteria.
* Mycobacteria which do not cause TB
* But resembles TB
* Difficult to eradicate
* Incidence rising in CF patients
49
What is the treatment for bronchiolitis?
Nothing - observation.
50
Sinusitis, acute epiglotitis, laryngitis, common cold are all examples of what?
Upper respiratory tract infection.
51
(RSV) bronchiolitis, measles, pertussis, influenza, bronchitis, pneumonia, empyema and lung abscess are all examples of what?
Lower respiratory tract infections.
52
What are the classic upper and lower respiratory tract infection symptoms respectively?
* Upper respiratory tract symptoms of coryza, sore throat, earache, sinusitis or stridor.
* Lower respiratory tract symptoms of cough, wheeze and respiratory distress.
53
How can you distinguish upper airway narrowing from lower airway narrowing?
Upper airway narrowing results in increased effort and added respiratory noises during inspiration – stridor is harsh but musical whilst snoring (stertor) is rough and lacks a single note!
Lower airway narrowing results in increased effort and added respiratory noises during expiration, such as crepitations and wheeze.
54
Why is decreased feeding observed in babies with an URTI?
There is difficulty in feeding in infants as their noses are blocked and this obstructs breathing.
55
A β-haemolytic streptococci and the Epstein–Barr virus are pathogen that commonly cause what URTI?
Tonsilitis
56
Sinusitis is an infection of where?
Paranasal sinuses
57
Sinusitis is treated with...
Antibiotics and analgesia.
58
What is the most common cause of stridor and what is the major concern?
By far the most common cause is laryngeal and tracheal infection, where mucosal inflammation and swelling can rapidly cause life-threatening obstruction of the airway in young children.
59
Viral laryngotracheobronchitis aka
Croup
60
Stridor suggests what?
Obstruction of the upper respiratory tract.
61
What causes croup / laryngotracheal infections?
Viral croup accounts for over 95% of laryngotracheal infections. Parainfluenza viruses are the most common cause, but other viruses, such as rhinovirus, RSV and influenza, can produce a similar clinical picture.
62
Symptoms of croup?
* hoarseness due to inflammation of the vocal cords
* a barking cough, like a sea lion, due to tracheal oedema and collapse
* harsh stridor
* variable degree of difficulty breathing with chest retraction
* the symptoms often start, and are worse, at night.
63
What are the symptoms of acute epiglottitis?
* high fever in a very ill, toxic-looking child
* an intensely painful throat that prevents the child from speaking or swallowing; saliva drools down the chin
* soft inspiratory stridor and rapidly increasing respiratory difficulty over hours
* the child sitting immobile, upright, with an open mouth to optimize the airway.
64
What is the basic management of upper airway obstruction in paediatrics?
* reduce anxiety by being calm, confident, and well organized
* observe carefully for signs of hypoxia or deterioration – agitation or fatigue or drowsiness or cyanosis. Provide oxygen if required and tolerated
* do not examine the throat with a spatula! It may precipitate upper airway obstruction
* oral, nebulized or intravenous steroids are beneficial in croup and have similar speed of onset (90–120 min)
* if severe, administer nebulized epinephrine (adrenaline) and contact an anaesthetist
* if respiratory failure develops from increasing airways obstruction, exhaustion or secretions blocking the airway, urgent tracheal intubation is required.
65
What can cause acute wheeze?
Acute wheeze is due to a partial obstruction of the intrathoracic airways. This is from mucosal inflammation and swelling as in bronchiolitis or bronchoconstriction as in asthma or mechanical obstruction (e.g. with foreign body or mucus).
66
What are the main symptoms of bronchiolitis?
* dry wheezy cough
* tachypnoea and tachycardia
* subcostal and intercostal recession
* hyperinflation of the chest
* fine end-inspiratory crackles
* high-pitched wheezes – expiratory > inspiratory.
67
If a child has abrupt onset of stridor without an apparent infection, consider what?
If a child has an abrupt onset of stridor without apparent infection, consider anaphylaxis or inhaled foreign body.
68
A moist cough is suggestive of what?
A moist cough suggests that there is either increased mucus secretion or infection in the lower airway.
69
A barking cough is suggestive of what?
A barking cough suggests a degree of tracheal inflammation, narrowing or collapse.
70
A dry cough with a prolonged expiratory phase suggests what?
A dry cough with a prolonged expiratory phase suggests that there is some narrowing of the small-sized to moderate-sized airways.
71
What are the most common pathogens that cause pneumonia in children?
The most common pathogens causing pneumonia vary according to the child's age:
* Newborn – organisms from the mother's genital tract, particularly group B streptococcus, but also Gram-negative enterococci and bacilli.
* Infants and young children – respiratory viruses, particularly RSV, are most common, but bacterial infections include Streptococcus pneumoniae or H. influenzae . Bordetella pertussis and Chlamydia trachomatis can also cause pneumonia at this age. An infrequent but serious cause is Staphylococcus aureus.
* Children over 5 years – Mycoplasma pneumoniae, Streptococcus pneumoniae , and Chlamydia pneumoniae are the main causes.
* At all ages Mycobacterium tuberculosis should be considered.
72
What are the most common presenting symptoms of pneumonia?
Fever, cough and rapid breathing are the most common presenting symptoms. These are usually preceded by a URTI. Other symptoms include lethargy, poor feeding, and an ‘unwell’ child. Some children do not have a cough at presentation.
Tachypnoea.
73
Localised chest, abdominal or neck pain associated with pneumonia suggest what?
Localized chest, abdominal, or neck pain is a feature of pleural irritation and suggests bacterial infection.
74
Bronchiecstasis
Permanent dilation of the bronchi.
75
Explain primary ciliary dyskinesia.
Impaired structure / function of the cilia leading to impaired mucociliary clearance.
76
What can primary ciliary dyskinesia lead to?
Recurrent infection of the upper and lower respiratory tracts, which if untreated may lead to severe bronchiectasis.
77
What are the symptoms of primary ciliary dyskinesia?
```
Recurrent productive cough
Purulent nasal discharge
Chronic ear infections
Dextrocardia
Situs invertus
```
78
Dextrocardia
Dextrocardia is a rare heart condition in which your heart points toward the right side of your chest instead of the left side. Dextrocardia is congenital.
79
Why does primary ciliary dyskinesia cause dextrocardia?
Ciliary action is responsible for normal organ situs, 50% have dextrocardia and situs inversus (Kartagener syndrome, where major organs are in mirror position of normal).
80
Kartagener syndrome
Kartagener's syndrome is a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis. The basic problem lies in the defective movement of cilia, leading to recurrent chest infections, ear/nose/throat symptoms, and infertility.
81
How is primary ciliary dyskinesia diagnosed and treated?
The diagnosis is made by examination of the structure and function of the cilia of nasal epithelial cells brushed from the nose. The cornerstones of management are daily physiotherapy to clear secretions, proactive treatment of infections with antibiotics, and appropriate ENT follow-up.
82
What does an IgG immunodeficiency predispose one too?
IgG deficiency predisposes to infections with polysaccharide-capsulated bacteria such as S. pneumoniae
83
What do cell-mediated immunodeficiencies make one more susceptible to?
Cell-mediated immunodeficiencies make one susceptible to opportunistic infections such as Pneumocystis jirovecii and fungi
84
What do neutrophil-killing defects predispose one too?
Neutrophil-killing defects predispose to staphylococcal infection.
85
How is tuberculosis diagnosed?
All children with a persistent productive cough should have a chest X-ray and either a tuberculin skin test or tuberculosis blood tests (IGRA, interferon-gamma release assays). Marked hilar or paratracheal lymphadenopathy is highly suggestive of tuberculosis.
86
Tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis.
87
How does the measles virus spread?
Airborne virus that spreads when someone sneezes / coughs.
88
Pertussis
Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis. Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe.
89
What are the symptoms of measles?
Fever, Koplik's spots on buccal mucosa, maculopapular rash, blanching, erythematous rash, cough and conjunctivitis.
90
What are crackles a sign of?
Fluid in the alveoli.
- sounds like rubbing your hairs together on auscultation.
- localise where you can hear the crackles.
91
Rhonchi
Large airway sounds - clears with an effective cough.
92
What are the two causes of acute onset of stridor?
Croup
| Epiglottitis
93
Pleural friction rub
Associated with chest wall pain “Pluerisy”
| > sounds like “Footsteps in the snow” on auscultation - localised to the chest wall.
94
Dyspnoea
Difficulty breathing
95
What is the normal cause for chest pain in children.
Usually associate with acute infection:
• Costochondritis
>Pain and tenderness at parasternal joints.
>Common, cause unknown, though may follow viral infection
>Presumed Inflammation of rib cage cartilage
>Typically age 12 to 14 years old, girls > boys
• Tietze Syndrome
>Pain, swelling and tenderness at parasternal joints
>Rare, cause unknown. Not associated with movement.
>Adolescents and adults < 40 years old
96
Otitis media is an infection of where?
Middle ear
97
Outline the LRTI's and their auditory presentations.
Bronchitis = large airway inflammation with cough, rhonci, may be productive.
• Bronchiolitis = smaller airways inflammation with cough, crackles and wheeze
• Pneumonia = infection of the alveoli space, crackles and wheeze, dullness.
• Pneumonitis = infection of the alveoli wall, crackles.
98
What is the viral pathogenesis of bronchiolitis?
Decreased surfactant production increasing the work of breathing.
99
What is the management for children with bronchiolitis?
No treatment - just manage with ventilation and oxygen.
100
PNEUMONIA = COUGH + RAPID/DIFFICULT BREATHING
PNEUMONIA = COUGH + RAPID/DIFFICULT BREATHING
101
What are the signs of severe pneumonia?
Not able to drink, persistent vomiting, convulsions, lethargic or unconscious, stridor in a calm child or severe malnutrition.
Central Cyanosis use Sat’s if available, <90% = severe
Severe Distress e.g. Head bobbing and grunting.
102
Pertussis (whooping cough) infection may lead to the development of which respiratory condition in the future?
Bronchiectasis
