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27 Cards in this Set
- Front
- Back
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What are some different upper and lower respiratory tract infections? |
• Upper - Coryza, pharyngitis, tonsillitis, acute otitis media, sinusitis • Lower - Bronchitis, croup, epiglottitis, tracheitis, bronchiolitis, pneumonia |
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At what age is the peak incidence of each of the following: • Pneumonia • Bronchiloitis • Croup • Epiglottitis • URTI |
• 3 years • <1 year • 2-4 years • 2 years • 1-3 years and 6-8 years |
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What are the most common cause of the following: • Coryza • Pharyngitis • Tonsillitis |
• Rhinovirus, coronavirus, respiratory syncitial virus • Viral (most common): Adenovirus, enterovirus, rhinovirus. Bacterial: Strep pyogenes (Group A beta haemolytic) • Group A beta haemolytic strep (strep pyogenes) or Epstein Barr Virus |
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What is an important cause of pharyngitis to rule out? How is pharyngitis usually managed? |
• Diphtheria • Conservative management, oral abx (penicillin/erythromycin) if group A strep grown on swabs |
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What is the criteria that predicts the likelihood that a tonsil infection is bacterial? |
Centor criteria: • History of fever • Tonsilar exudate • No cough • Tender anterior cervical lymphadenopathy If there is a score of 3 or 4 then should treat empirically with abx |
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What are the NICE indications for treatment of tonsillitis with antibiotic therapy? What is the usual treatment regime? |
• Symptoms of marked systemic upset secondary to the sore throat • Unilateral peritonsillitis • History of rheumatic fever • Increased risk of infection (DM/immunocompromised) • ≥3 centor criteria • 10 day course of amoxicillin / erythromycin |
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What are the criteria regarding the number and frequency of infections for performing a tonsillectomy for tonsillitis? What else should you consider? |
SIGN: • 7 or more well documented episodes in the preceding year • 5 or more in each of the 2 preceding years • 3 or more in each of the 3 preceding years Other considerations: • Symptoms interfere with daily life, patient has guttate psoriasis that is exacerbated by sore throat, and if the child has a history of sleep apnoea |
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What might you suspect if a child has a fever and their tympanic membrane is red, bulging, and dull? |
Acute otitis media |
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What is 'glue ear'? How can it be managed?
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• Otitis media with effusion (OME). Recurrent OM causing serous inflammation. It can cause reduced hearing and so needs investigating with hearing tests. • Management: Usually resolve spontaneously but occasionally require adenoidectomy or grommet insertion |
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What is croup? What are some common causes? |
• Viral laryngotrachobronchitis
• Parainfluenza, human metapneumovirus, RSV, influenza |
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What are the characteristic clinical features of croup? How is it managed? |
• Barking cough, fever, coryza, increased work of breathing, harsh rasping stridor • Mild - managed at home with steroids (oral or nebulised) • Severe - O2 and nebulised adrenaline + steroids |
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What is the cause of pseudomembranous croup? How might it present? |
• Staph aureus • High fever, toxic appearance, rapidly progressing airway obstruction, copious thick secretions |
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What is the cause of acute epiglottitis? Why has the incidence reduced? |
• H. influenzae B • Introduction of the HiB vaccine (given at 2 months, 3 months, 4 months, and 12 months) |
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How might you expect acute epiglottitis to present? |
• High fever, toxic looking child • Speech and/or swallowing impaired (child may be drooling) • Soft inspiratory stridor and respiratory difficulties • Child may be sat upright and immobile with open mouth to maintain airway |
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How is acute epiglittitis treated? |
• May require intubation to maintain airway • Cefataxime and penicillin • Rifampicin for unvaccinated family members / close contacts |
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How would you treat a pertusis infection? When is it vaccinated against? |
• Erythromycin during coryzal / catarrhal phase • 2 months, 3 months, 4 months, 3 years and 4 months |
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What are the characteristic features of bronchiolitis? What histiological / pathophysiological changes occur? |
• Coryza / catarrhal inflammation of the mucous membranes of upper airway followed by a bronchiolitic dry wheezy cough, breathlessness, poor feeding, hyperinflation of the chest, and expiratory wheeze. • Necrosis of the cilliated epithelium and oedema of the sub-mucosa |
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What are some risk factors for bronchiolitis? |
• Prematurity • Congenital / acquired lung disease • Congenital heart defects • Immunocompromised • Breastfeeding is protective |
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What are some indications that a baby with bronchiolitis may need hospital admission? |
• Poor feeding • Decreased SpO2 • >50 breaths per minute • Apnoea • Dehydration • Subcostal/intercostal recessions • Patient/parental exhaustion |
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How is the cause of the bronchiolitis usually determined? What is the prophylaxis and who should receive it? |
• Nasopharyngeal aspirate immunofluorescent staining or RSV serilogy • RSV monoclonal antibodies - children with congenital or acquired lung disease, congenital heart disease, or extreme prematurity |
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What is the definition of pneumonia? |
• Inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses, bacterial or irritants |
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What are the most common causative organisms of pneumonia in each of the following age groups: • Newborn • Infants and young children • Children over 5 |
• E. coli, group B strep (occasionally chlamydia) • Viral: RSV, influenza A & B, parainfluenza. Bacterial: Strep. pneumoniae, H. influenzae, Bordatella pertussis • Mycoplasma pneumoniae, strep pneumoniae, klebsiella pneumoniae |
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How are pneumonias caused by the following treated: • Strep pneumoniae • Staph aureus • Klebsiella pneumoniae • E coli • Psudomonas aeruginosa • H influenzae • Mycoplasma pneumoniae |
• Oral amoxicillin / erythromycin (IV if severe) • IV flucloxacillin or vancomycin • IV cefotaxime or imipenem • IV gentamicin or cefotaxime • IV gentamicin or cefotaxime (metronidazole if aspiration pneumonia) • Oral amoxicillin / erythromycin (IV if severe) • IV Clarythromycin |
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What are the phases of lobar pneumonia? |
• Congestion • Red hepatisation • Grey hepatisation • Resolution |
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What are the WHO diagnostic criteria for pneumonia? |
History of cough and difficulty breathing with increased respiratory rate for age |
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What are some causes of recurrent or persistent coughs in children? |
• Recurrent infection (immunodeficiency) • Post-infectious (pertussis, RSV) • Asthma • Suppurative lung disease (CF, primary ciliary dyskinesia) • Recurrent aspiration (GORD, tracheo-oesophageal fistula, neurological problems) • Inhaled foreign body • Cigarette smoke (active or passive) • TB • Habit • Airway malformation (tracheo-bronchomalacia) |
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What might you expect to see on CXR of someone with bronchiectasis? CT chest? |
• Tramtracks and signet rings • Bronchus within 1cm of pleural surface, lack of tapering, and increased bronchial:arterial ratio |
