1 - Paeds - Resp - Chest infections - Pertussis

Question 1

cause? important feature? what happens bc of this?

Answer 1

bordetella pertussis
highly contagious
endemic disease, with epidemics every 3-4 years

Question 2

what are the 3 phases

Answer 2

Catarrhal phase - 1 week of coryzal sx
paroxysmal phase 3-6 weeks
convalescent phase - sx gradually decrease, may persist for months

Question 3

paroxysmal phase - develops characteristic what? when worse? can culminate in? what happens during?

Answer 3

characteristic paroxysmal/spasmodic cough followed by inspiratory whoop
often spasms worse at night
can culminate in vomiting
child goes red/blue in face, mucus flows from nose and mouth

Question 4

what is different in infants? what can occur after vigorous coughing?

Answer 4

infants - whoop maybe absent, bu apnoea is a feature at this stage

epistaxis and subconjunctival heamorrhage can occur after coughing

Question 5

3 compx ? when to admit + isolate?

Answer 5

pneumonia
convulsions
bronchiectasis
- all uncommon

infants/young kids suffereing severe spasms of cough/cyanotic attacks

Question 6

when to worry about compx

Answer 6

sig mortality esp in infants and those who have no completed their primary vaccination schedule at 4 months

Question 7

Ix - how to ID organism? what else to look for?

Answer 7

ID early by culture of per-nasal sab, PCR more sensitive

marked lymphocytosis on FBC >15x10^9

Question 8

mgmt pertussis - what AB? downfall of it?

Answer 8

erythromycin eradicates organism but only reduces Sx if started in catarrhal phase

Question 9

who may get similar cough? what to give them? what else?

Answer 9

siblings, parents, school contacts

give close contacts erythromycin prophylaxis, vaccinate unvaccinated infant contacts

Question 10

what helps reduce risk and severity? doesn’t guarantee what? what happens to this?

Answer 10

immunisation reduces risk and severity if affected, no guarantee of protection
protection level declines steadily during childhood

Question 11

parental advice?

Answer 11

sx will resolve, get prophylaxis/immunity for close contacts, explain the worrying Sx