Other infections + Asthma

Question 1

what do you see normally on inspection of the eardrum?

Answer 1

light reflex

Question 2

what do you see in otitis media on inspection of the eardrum?

Answer 2

• absent light reflex
• bulging eardrum
• erythema

Question 3

pathophysiology of OM?

Answer 3

• primary viral infection
• secondary bacterial infection with pneumococcus / H influenza

Question 4

treatment of OM?

Answer 4

self-limiting

but treat if:

• severe uni/bilateral pain if > 6 months for >48 hours
• non-severe bilateral pain in 6-23months
• non-severe bilateral pain in older children

Question 5

complications of OM?

Answer 5

spontaneous rupture of eardrum

Question 6

investiagation for tonsillitis?

Answer 6

throat swab

to determine if viral or bacterial

Question 7

treatment of tonsillitis?

Answer 7

• nothing (if viral)

or

• penicillin for 10 days
  
  • DO NOT GIVE AMOX

Question 8

what is croup?

Answer 8

laryngotracheobronchitis

Question 9

peak age of croup?

Answer 9

common < 4

Question 10

symptoms of croup?

Answer 10

• stridor
• coryza
• barking cough
• hoarse voice

Question 11

main causative agent of croup?

Answer 11

parainfluenza virus

Question 12

treatment of croup?

Answer 12

Oral dexamethsone or nebulised budenoside

nebulised adrenaline in severe cases

Question 13

causative agent, symptoms and rx of epiglottitis?

Answer 13

agent - H Infleunza B

symptoms- high fever, stridor and drooling

Rx- IV antibiotics + intubation

Question 14

what must you not do in a child w epiglottitis?

Answer 14

examine w a tongue depressor- may cause obstruction

Question 15

tracheitis:

causative organisms

symptoms

treatment

Answer 15

staph or strep

symptoms: fever, rapidly progressive airway obstruction

Rx: Augmentin

Question 16

pathophysiology of bacterial bronchitis?

treatment?

Answer 16

primary viral infection, which causes disturbance of mucociliary escalator & hence clearance

–> secondary bacterial infection

self-limiting

Question 17

when is it pneumonia?

Answer 17

• focal signs
• crepitations
• high fever
• tachypnoea
• SOB
• off feed
• cough

Question 18

treatment for pneumonia?

Answer 18

1st- Amoxicillin

2nd-Macrolide

macrolide 1st line in mycoplasma pneumonia

Question 19

aetiology of pertussis?

Answer 19

bronchitis caused by bordetella pertussis

Question 20

presentation of pertussis?

Answer 20

coryzal symptoms followed by episodic coughing fits that are very severe

loud inspiratory whoop when coughing ends

vomiting / fainting

Question 21

Mx of pertussis?

Answer 21

• vaccine
• Abx - erythromycin

Question 22

prognosis of pertussis?

Answer 22

resolves within 8 weeks –> several months

Question 23

complications of pertussis?

Answer 23

• pneumonia
• bronchiectasis

Question 24

outline key symptoms/features of asthma

Answer 24

• wheeze
• cough
  
  • dry
  • nocturnal
  • exertional
• SOB
• reversible
• variable

Question 25

what is the characteristic feature of asthma?

Answer 25

repsonds to asthma treatment (reversible)

Question 26

outline some triggers of asthma?

Answer 26

* exercise * cold weather * infections

Question 27

aetiology of asthma?

Answer 27

genetic + environmental inherently abnormal lungs early onset atopy

Question 28

DDx of asthma?

Answer 28

* viral induced wheeze * variant of asthma * CF * foreign body * infection

Question 29

when is it most likely NOT Asthma?

Answer 29

if \< 18 months--\> most likely to be infection

Question 30

aims of asthma treatment?

Answer 30

* minimise symptoms * no exacerbations * lung function to normal * FEV1 & PEFR \>80%

Question 31

how do you measure control of asthma?

Answer 31

* Short acting beta agonist use per week * Avoidance of school/nursery * Nocturnal symptoms per week * Exertional symptoms per week

Question 32

steps in asthma mx \<5 years ?

Answer 32

1. SABA 2. inhaled corticosteroid or LRA 3. add other option from 2

Question 33

steps in asthma management 5-12years?

Answer 33

1. SABA 2. inhaled corticosteroid 3. LABA 4. titrate up inhaled corticosteroid dose to medium * consider adding LRA/theophylline 5. titrate up corticosteroid to high dose

Question 34

side effects of ICS?

Answer 34

* height suppression (only up to 1cm when used for longer than 12 months) * oral candidiasis * adrenocortical suppression

Question 35

when is LABA given?

Answer 35

ONLY if concomitant use of ICS- cannot be taken without ICS

Question 36

compare Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI) effectiveness

Answer 36

MDI: - reaches 5% deposition on its own - reacher 20% deposition with spacer DPI: reaches 20% deposition on its own

Question 37

how to determine severity of an acute exacerbation of asthma?

Answer 37

Question 38

Mx of mild acute exacerbation of asthma

Answer 38

as an outpatient w regular salbutamol inhalers

Question 39

Mx of moderate /severe acute exacerbation of asthma

Answer 39

* oxygen - if \<94% sats * bronchodilators * salbutamol * ipratropium * mag sulphate * steroids * prednisolone * hydrocortisone * IV Abx if infection

Question 40

stepwise approach for moderate/severe exacerbations of asthma

Answer 40

1. Salbutamol inhalers via a spacer device 2. Nebulisers with salbutamol / ipratropium bromide 3. Oral prednisone 4. IV hydrocortisone 5. IV magnesium sulphate 6. IV salbutamol 7. IV aminophylline