L15 - URTI / LRTI in children

Question 1

Presentation of URTIs inchildren

Answer 1

• Coryza (cold)
• sore throat
• ear ache
• sinusitis (uncommon)

Question 2

Presentation of LRTIs in children

Answer 2

• cough
• wheeze
• respiratory dsitress

Question 3

Treating a child with the common cold?

Answer 3

Pain treated with paracetamol or ibuprofen.

Question 4

Describe pharyngitis?

Answer 4

• Pharynx and soft palate inflamed.
• Local lymph nodes are enlarged and tender.
• Usually due to viral infection.

Question 5

Pharyngitis commonly caused by?

Answer 5

Adenoviruses
Enteroviruses
Rhinoviruses

Question 6

What is acute otitis media?

Answer 6

Ear pain and fever.

Most common in children between 6-12 months

Question 7

On examination of a child with acute otitis media, what might be seen?

Answer 7

Tympanic membrane seen to be bright and red, bulging.

Less of normal light reflection.

Question 8

Indications for tonsilectomy?

Answer 8

• Recurrent severe tonsilitis
• Perionsillar abscess (quincy)
• Obstructive sleep apnoea

Question 9

Stridor

Answer 9

Due to partial obstruction of lower portion of upper airway, including upper trachea and pharynx.

Question 10

Croup

Answer 10

• Barking cough like sea lion.
• Harsh stridor.
• Variable degree of difficulty breathing with chest retraction.

Question 11

Whooping cough caused by…

Answer 11

Bacterium bordetella pertussis.

Spread from person to person by airborne droplets.

Sudden attack (paroxysm) of coughs followed by whoop.

Question 12

Acute bronchitis

Answer 12

Inflammatory condition

Question 13

Bronchiolitis

Answer 13

Bronchioles of young child swollen by inflammation.

Passage of air to and from alveoli difficult.

Question 14

Give an example of a cause of bronchiolitis and pneumonia in infants

Answer 14

RSV - Respiratory synctial virus

Question 15

Describe what happens if RSV inhaled

Answer 15

• Virus establishes infection in the nasopharynx and lower respiratory tract.
• Young infant develops cough, rapid respiratory rate and cyanosis.

Question 16

How might a neonate develop interstital pneumonia at birth?

Answer 16

Caused by chlamydia trachomastis acquired from the mother at birth.

Question 17

Pneumonia

Answer 17

Infection that inflames the air sacs in one or both lungs.

Sac’s may fill with fluid or pus.

Question 18

Patients with pneumonia usually present feeling unwell and have…

Answer 18

1. Chest pain: may be pleuritic in nature
2. Cough: may produce sputum
3. Dyspnoea: shortness of breath

Question 19

An X-ray of patient with pneumonia may show…

Answer 19

Shadow’s indicating consolidation.

Question 20

What virus causes measles?

Answer 20

Rubeola virus

Question 21

Incubcation period and symtpoms of measles

what are koplik’s spots?

Answer 21

Incubation period 10-14 days.

Symptoms: fever, runny nose, conjunctivitis, cough

Koplik’s spots: white lesions on buccal mucosa.

Rash 1-2 days after

Question 22

Where does the rubeola virus replicate?

Answer 22

Epithelium of nasopharynx, middle ear and lung

Question 23

TB causes by…

Answer 23

Mycobacterium tuberculosis

Aerosol transmission

Question 24

Broncholitis

Answer 24

Inflammatory condition of tracheobronchial tree.

Characterised by cough and excessive mucus production.

Question 25

B. Pertussis colonises...

Answer 25

Ciliated respiratory epithelium causing the specifically human infection - whooping cough.

Question 26

Empyema

Answer 26

Infection of pleural space

Question 27

What may be given for relief, to patients with severe upper airway obstruction?

Answer 27

Nebulished epinephrine with oxygen

Question 28

Acute epiglotitis often caused by?

Answer 28

Intense swelling of the epiglottis and surrounding tissue. Usually caused by H.influenzae type B. Onset is usually very acute.

Question 29

Describe what symptoms a child with epiglotitis may present with?

Answer 29

- Increased fever - very ill - intensely painful throat that prevents child from speaking or swallowing - soft inspiratory stridor - child sitting immobile, with an open mouth to optimize the airway

Question 30

Symptoms of viral illness (common cold)

Answer 30

``` Nasal discharge Sneezing Painful throat / ears Pyrexia Headache Malaise ```

Question 31

Signs of viral illness

Answer 31

- Red pharynx - pus - bilateral red tympanic membranes - yellow / green discharge

Question 32

Tonsilitis commonly caused by...

Answer 32

Group A streptococcus | - may require throat swab

Question 33

Treatment of tonsilitis

Answer 33

Analgesia Antibiotics is bacterial infection

Question 34

Treatment for croup

Answer 34

Dexamethasone (corticosteroid) | - decreases laryngeal mucosal edema.

Question 35

What score is used evaluate the severity of croup?

Answer 35

Westley score: assesses five factors 1. Level of consciousness 2. Cyanosis 3. Stridor 4. Air entry 5. Retractions

Question 36

Epiglottitis may be caused by

Answer 36

Haemophilus influenza type B

Question 37

Bronchiolitis may be caused by...

Answer 37

Human metepneumovirus Adenovirus Influenza

Question 38

Signs of bronchioitis

Answer 38

``` Tug Nasal flare Head bob Recession Crackles Wheeze on chest examination ```

Question 39

Symptoms of pneumonia

Answer 39

``` Pyrexia Lethargy Breathlessness Cough Chest pain Abdominal pain ```

Question 40

Signs of pneumonia

Answer 40

``` Pyrexia Tachcardia Tachypnoea Desaturation Recession Crepitations Wheeze ```

Question 41

Pneumonia caused by...

Answer 41

Under 5s: RSV, strep pneuomoniae, mycoplasma, viruses Over 5s: strep pneumoniae, mycoplasma, viruses

Question 42

Possible investigations for Pneuomonia

Answer 42

CXR | Cough swab

Question 43

Symptoms of empyema: patient might have?

Answer 43

- Fever - cough - breathlessness - lethargy - malaise - reduced exercise tolerance

Question 44

Signs of empyema

Answer 44

- Reduced chest expansion - reduced breath sounds - stony dull on percussion

Question 45

Causes of empyema

Answer 45

Strep pneuomoniae, staph aureas

Question 46

Investigations for empyema

Answer 46

Blood culture Pleural fluid PCR and culture CXR USS

Question 47

Possible treatment for empyema

Answer 47

antiobiotics, chest drain

Question 48

Describe a lung abscess

Answer 48

Pus in cavity in lung parenchyma.

Question 49

Describe how a lung abscess may form

Answer 49

Pneumonitis Necrosis Cavitation Abscess formation

Question 50

Types of TB

Answer 50

Latent - immune system can't kill bacteria, but prevents it spreading to body Active - immune system fails to kill or contain the infection and it spreads within lungs/ body. symptoms develop. Latent TB can develop into an active TB disease at a later date.

Question 51

Describe nontuberculous mycobacteria

Answer 51

Mycobacteria which do not cause TB. Resembles TB. Difficult to eradicate. Incidence rising in CF patients.