Viral/bacterial respiratory infections Flashcards
1
Q
What is the median number of upper respiratory tract infections that children have per year in the first few years of life?
A
5
2
Q
What proportion of respiratory infections involve only the nose, throat, ears or sinuses?
A
80%
3
Q
What are 4 conditions encompassed by the term URTI?
A
- Common cold (coryza)
- Sore throat (pharyngitis, including tonsillitis)
- Acute otitis media
- Sinusitis (relatively uncommon)
4
Q
What can cause cough in URTI? 2 things
A
- Secondary to postnasal drip
- Attempt to clear upper airway secretions
5
Q
What are 3 relatively serious things that URTIs may cause?
A
- Difficulty in feeding in infants as noses are blocked, obstructs breathing
- Febrile seizures
- Acute exacerbations of asthma
6
Q
When might hospital admission be necessary for URTI?
A
if feeding and fluid intake inadequate
7
Q
What are the classical features of the common cold (coryza)?
A
mucopurulent nasal discharge and nasal blockage
8
Q
What are the most common pathogens causing coryza? 3 examples
A
- Rhinoviruses
- Coronaviruses
- Respiratory syncytial virus (RSV)
9
Q
What are 2 aspects of the management of the common cold (coryza)?
A
- Advise parents they’re self limiting, no specific curative treatment
- Pain can be treated with paracetamol or ibuprofen
10
Q
How long might cough due to coryza continue for?
A
up to 4 weeks
11
Q
What is pharyngitis?
A
pharynx and soft palate are inflamed, local lymph nodes enlarged and tender
12
Q
What are 4 possible causes of pharyngitis?
A
- Adenoviruses
- Enteroviruses
- Rhinoviruses
- Group A beta-haemolytic streptococcus - in older children
13
Q
What is tonsillitis?
A
form of pharyngitis where there is intense inflammation of the tonsils, often with a purulent exudate
14
Q
What are 2 causative agents of tonsillitis in children?
A
- group A beta-haemolytic streptococci
- Epstein-Barr virus (infectious mononucleosis)
15
Q
What are 5 features of tonsillitis that are more common in a bacterial rather than viral tonsillitis?
A
- Headache
- Apathy
- abdominal pain
- White tonsillar exudate
- Cervical lymphadenopathy
16
Q
What is the management for severe pharyngitis and tonsillitis?
A
- 10 day course antibiotics e.g. penicillin V, or erythromycin if allergy
- may hasten recovery for streptococcal infection
- if canot swallow solids or liquids
- hospital admission for IV fluids and analgesia
17
Q
Why should you avoid amoxicillin for a sore throat?
A
can cause widespread maculopapular rash if the tonsillitis is due to infectious mononucleosis (EBV)
18
Q
What can group A streptococcal infection sometimes lead to?
A
scarlet fever
19
Q
What age group is it common for group A streptococcal infection to lead to scarlet fever?
A
children 5-12 years
20
Q
What is the treatment for scarlet fever?
A
penicillin V or erythromycin antibiotics
21
Q
Why is treatment with antibiotics for scarlet fever important?
A
prevent complications including acute glomerulonephritis or rarely, rheumatic fever
22
Q
At what age is an episode of acute otitis media most common?
A
6-12 months
23
Q
Why are infants and young children prone to acute otitis media?
A
Eustachian tubes are short, horizontal and function poorly
24
Q
What are the features of acute otitis media?
A
pain in ear and fever
25
What examination must you do in every child who presents with fever?
examine tympanic membranes
26
What is the appearance of the tympanic membrane in acute otitis media?
bright red and bulging with loss of normal light reflection
occasionally acute perforation of the eardrum with pus visble in the external canal
27
What are 5 causative agents of acute otitis media?
1. RSV
2. Rhinovirus
3. Pneumococcus
4. Nontypeable Haemophilus influenzae
5. Moraxella catarrhalis
28
What are 2 serious complications of AOM?
mastoiditis and meningitis
29
What are 3 aspects of the management of acute otitis media?
1. Regular analgesia - ibuprofen and paracetamol
2. Antibiotics - shorten duration of pain marginally. Give prescription but ask parents to only use if child remains unwell after 2-3 days. Amoxicillin
3. Neither decongestants nor antihistamines are beneficial
30
What causes otitis media with effusion?
recurrent ear infections
31
What are the symptoms of otitis media with effusion?
asymptomatic apart from possible decreased hearing
32
What is the appearance of the eardrum in OME?
eardrum dull and retracted often with fluid level visible
33
What is the most common age that OME occurs?
2-7 years
34
What are 3 possible outcomes of OME?
1. Resolve spontaneously
2. Conductive hearing loss as shown on pure tone audiometry (if 4 years)
3. Flat trace on tympanometry hearing testing in younger children
35
What is a risk of reduced hearing in children with OME?
can interfere with normal speech development and result in learning difficulties in school
36
What is the management of conductive hearing loss due to OME?
insertion of ventilation tubes (grommets) often performed
37
How long are grommets effective for?
12 months
38
What is the next step if problems due to OME recur after grommet extrusion?
reinsertion of grommets with adjuvant adenoidectomy often advocated - evidence adenoidectomy can offer more long-term benefit
39
What is the management of acute sinusitis in children?
antibiotics and analgesia
40
What happens to the size of children's tonsils with time?
many children have large tonsils, usually reach maximum size at about 8 years
shrink spontaneously in late childhood
41
What are 3 of the indications for tonsillectomy?
1. recurrent severe tonsillitis (as opposed to recurrent URTIs)
2. a peritonsillar abscess (quinsy)
3. obstructive sleep apnoea (the adenoids will also often be removed)
42
How effective is tonsillectomy for recurrent severe tonsillitis?
reduces the number of episodes of tonsillitis by a third, e.g. from three to two per year but is unlikely to benefit mild symptoms
43
What happens to the size of adenoids with time?
increase in size until about the age of 8 years and then gradually regress
In young children, the adenoids grow proportionately faster than the airway, so that their effect of narrowing the airway lumen is greatest between ages 2–8 years
44
When is the size of adenoids enough to justify adenoidectomy?
if they narrow the posterior nasal space sufficiently to justify adenoidectomy
45
What are 2 indications for removal of both the tonsils and the adenoids?
1. recurrent otitis media with effusion with hearing loss, where it gives a significant long-term additional benefit
2. obstructive sleep apnoea (an absolute indication)
46
What is the most common cause of pneumonia in children?
viruses in younger children, vacteria in older children
47
What are 3 of the commonest causes of pneumonia in the newborn?
1. Group B streptococcus
2. Gram-negative enterococci
3. Bacilli
48
What are 6 causes of pneumonia in infants and young children?
1. respiratory viruses, particularly RSV
2. Streptococcus pneumoniae
3. H. influenzae
4. Bordetella pertussis
5. Chlamydia trachomatis
6. Staphylococcus aureus
49
What are 3 main causes of pneumonia in children over 5 years?
1. Mycoplasma pneumoniae
2. Streptococcus pneumoniae
3. Chlamydia pneumoniae
50
What cause of pneumonia should be considered in all ages?
Mycoplasma tuberculosis
51
What are 8 clinical features of pneumonia in children?
1. Preceding URTI
2. Fever
3. Cough
4. Rapid breathing
5. Lethargy
6. Poor feeding
7. Unwell child
8. Localised chest, abdominal or neck pain - bacterial
52
What clinical feature of pneumonia suggests a bacterial cause?
localised chest, abdominal or neck pain - feature of pleural irritation
53
What are 5 signs on examination in children with pneumonia?
1. Tachypnoea
2. Nasal flaring
3. Chest indrawing
4. End-inspiratory coarse crackles over affected area
5. Reduced sats
54
How can a diagnosis of pneumonia be confirmed?
CXR (but doesn't distinguish between bacterial and viral reliably)
55
What is a way that viral and bacterial pneumonia can sometimes be distinguished?
nasopharyngeal aspirate may identify viral causes
(blood tests e.g. FBC, acute phase reactants unhelpful)
56
What complication may develop as a result of children with pneumonia?
pleural effusion - may develop into empyema and fibrin strands may form, leading to septations
57
How can pleural effusion from pneumonia appear on CXR?
blunting of the costophrenic angle
septations due to fibrin strands can indicate empyema
58
Where can most chilren with pneumonia be managed?
at home
59
What are 4 reasons for admission and management of pneumonia in hospital?
1. sats \<92
2. recurrent apnoea
3. grunting
4. inability to maintain adequate fluid/feed intake
60
What are 4 aspects of the management of pneumonia in children?
1. Oxygen
2. Analgesia if pain
3. IV fluids to correct dehydration and maintain adequate hydation and sodium balance
4. Antibiotics
61
What 2 things determine the type of antibiotics for pneumonia in children?
1. child's age
2. severity of illness
62
What antibiotics are given for pneumonia in newborns?
broad-spectrum IV antibiotics
63
What antibiotics are given for pneumonia in older infants?
oral amoxicillin, with broader-spectrum antibiotics such as co-amoxiclav reserved for uncomplicated or unresponsive pneumonia
64
What antibiotics are given for pneumonia in children over 5 years?
either amoxicillin or oral macrolide such as erythromycin
no advantage in giving VI rather than oral if mild/moderate
65
What proportion of chidlren with pneumonia develop parapneumonic effusions?
up to 1/3
66
What is the management of parapneumonic effusions?
* may resolve with appropriate antibiotics
* if persistent fever despite 48h of antibiotics suggest pleural collection which requires drainage under US guidance
67
What are 2 possible approaches to draining a parapneumonic effusion?
1. Percutaneous placement of small bore chest drain and regular instillation of a fibrinolytic agent to break down fibrin strands, under US guidance
2. Video-assisted thoracoscopic surgery
3. Thoracotomy and decortication
68
What are 2 situations when follow up of pneumonia may be required and how should this be performed?
1. Evidence of lobar collapse
2. Atelectasis
repeat chest x-ray after 4-6 weeks
69
What is the prognosis for children with pneumonia?
virtually all, even with empyema, make full recovery
