Common causes of
Common cold VS pharyngitis VS sinusitis
VIRAL for both
CC #coryza - rhinov
Pharyngitis - Rhino, Entero, ADeno
Sinusitis - viral > bact
Common causes of tonsillitis VS otitis media
Tonsillitis
2/3 - viral - EVV
1/3 - bacterial - strep A
Otitis media
Viral - RSV + Rhino
Bacterial - H. Influ + Moraxella
What’s wrong with these kids?
Kid comes in with nasal discharge and blocked nose. DX?
Kid comes in with sore throat. ENT examination = soft palate and tonsils inflamed
Kid comes in with fever headache malaise, inflamed tonsils with exudates and cervical lymphadenopathy
Kid comes in with a fever, if pain – kid tugs at affected ear. At otoscope equals red inflamed tympanic membrane. what reflexed does he lose?
Kid comes in with unilateral hearing loss, at otoscope = tympanic membrane is dull and retracted some fluid is visible.
Kid comes in with pain swelling and tenderness over zygomatic cheek area.
Common cold
Sore throat – pharyngitis
Tonsillitis
Acute otitis media - The loss of light reflex
Otitis media with effusion a.k.a. glue ear
Acute sinusitus
Tx for cold?
Tx for pharyngitis and tonsillitis? How long for and why? Why should amoxicillin be avoided?
Tx for AOM? Effect of antibiotics?
Why do most kids suffer from otitis media?
Most common cause of conductive hearing loss in children? It’s effect?
Tx for OME/glue ear?
What surgery could be beneficial?
Tx for acute sinusitus?
Cold – symptomatic – paracetamol ibuprofens
Pharyngitis/tonsillitis – antibiotics EVEN THOUGH only a third infections = bacterial!!!
10 day treatment to remove risk of rheumatic fever.
Avoid amoxicillin = can cause maculopapular rash if tonsillitis is due to EBV
80% of AOM resolves spontaneously BUT Pain=paracetamol/ibuprofen
Antibiotics reduce pain duration BUT do not reduce risk of perforation –> hearing loss
Kids get OM because of short eustachian tube during childhood development
Common cause of conductive hearing loss and kids = O. media with fusion – glue ear
Conductive hearing loss results in delayed development of speech and learning
Use of GROMMET ensures eustachian tube remains patent to allow fuller hearing
Adenoidectomy because adenoids harbour infection that spread to Eustachian tube. Between the years 2–8 adenoids go proportionally faster than airway – > narrow airway lumen occurs then.
Symptomatic – paracetamol/ibuprofens
What are the main features of laryngeal and tracheal infections?
Common and rare causes?
Think about what organs are present in neck:
Vocal chords – horse voice
Trachea – stridor, barking cough, dyspnoea
Causes:
Croup – viral laryngotracheitis//bacterial tracheitis
Rare – epiglottitits//inhaled foreign body//diphtheria
How to assess severity of laryngeal and tracheal infection?
How do you manage acute upper airway obstruction? What not to do?
If severe? If resp failure develops?
SUBCOSTAL, intersternal, sternal recession
Cyanosis, tachycardia, low O2 SATs, agitation
NOT THROAT - can cause complete obstruction
Reduce anxiety – stay calm & look for signs of hypoxia
Severe – nebulised epinephrine
At respiratory failure - INTUBATE + anesthetist
Difference between croup and bacterial tracheitis?
Most common cause of croup?
Common age groups? Peak incidence age?
Treatment for croup?
Treatment for severe croup?
Which healthcare professional needs to be on board?
Croup is viral tracheitis; BT is because of bacteria…
RSV, influenza
6m–6yrs; Peak = 2 years
Keep child calm – avoid upsetting
Oral steds - dexamethasone +prednisone
Neb steds - BUDESONIDE
Severe- Nebulised epinephrine + oxygen
Call Anaesthetist if deteriorating due to risk of rebound symptoms once epinephrine diminishes after 2 hours
How does bacterial tracheitis differ from viral tracheitis (aka croup)?
Aetiology?
Treatment?
Child has high fever
Appears toxic
Rapidly progressive every obstruction due to THICKER airway secretions
Viral doesn’t have that shit
Staph aureus
IV antibiotics
intubation/tracheostomy + ventilation
What causes acute epiglottitis aetiology?
What exactly happens to the tissues?
What age group most common?
Difference between croup and epiglottitis in terms of: Appearance/fever Breathing stridor/Boice Cough/Coryza Drink/Drool
H influenza
Massive swelling of epiglottis and septicaemia
1–6 years
Appearance: Croup – unwell; Epiglottitis - toxic
Fever: Croup - <38.5; Epiglottitis - >38.5
Strider: Croup - HARSH RASP; Epiglottits - SOFT WHISPER
Voice: Croup - hoarse; epiglottitis - muffled sound
Cough: croup - BARK; epiglottitis - minimal
Coryza: croup - YES(like viral colds); epiglottitis-NO!!
Drink: Croup - yes; Epiglottitis - no
Drool: Croup - no; epiglottis - yes
Treatment for epiglottitis? What NOT to do?
Prophylaxis?
Do you not lie kid down; examine throat with spatula —— precipitate total of obstruction = death
Call anaesthetist, ENT, paediatrician – ICU transfer
Intubate/tracheostomy – >
THEN DO blood culture + IV antibiotics cefuroxime
After 24 hours remove tracheal tube
Antibiotics 3 to 5 days
Prophylaxis – rifampicin household contacts
Aetiology of whooping cough VS bronchiolitis?
Signs of whooping cough?
What can occur during spasmodic phase?
Complications of whooping cough?
Investigations or whooping cough
Treatment and prophylactics treatment?
Effects of vaccination?
Bordetella pertussis - whooping cough
RSV - bronchiolitis
CORYZA COUGH WHOOP
Catarrhal Coryza -> spasmodic coughing – > inspiratory whoop
Vomit, nosebleed, subconjunctival haemorrhage
Pneumonia bronchiectasis; sleep apnoea
FBC – increased white blood cells
Nasal swab
Admit to hospital
Antibiotics – erythromycin
Prophylactic erythromycin for close contact
Does not provide immunity – only reduce risk of contracting condition and severity
Aetiology of whooping cough VS bronchiolitis?
In whom and when?
Pathophysiology?
Bordetella pertussis - whooping cough
RSV - bronchiolitis
Less than 12 months – autumn and spring
Inflammation of bronchioles #EpithelialNecrosis
Symptoms of bronchiolitis
Signs of bronchiolitis?
Signs and symptoms of bronchiolitis on examination
Investigations?
Treatment?
Complications?
Cough and coryza – >
Difficulty breathing + poor feeding
Inspection: –
Hypoxia
Increased work of breathing (tachypnoea / tracheal tug/ subcostal recession)
Palpation – downwardly displaced liver
Auscultation – crepitations and wheeze
PCR from nasopharyngeal secretion – RSV
CXR – hyperinflation lungs
Blood gas – low O2; high CO2
Supportive – O2; NG/IV fluids&feeds; CPAP
Palivizumab = prophylaxis - reduce risk of hosp admission
Risk factors for pneumonia?
Signs? Symptoms?
Treatment?
Investigation?
Complications?
Low-birth-weight
Vitamin a deficiency
Not breastfed
Signs:
Mouth – cyanosis and tachypnoea
Inspection – increased work of breath (subcostal recession): bronchial breathing; accessory muscles
Palpation/Percussion: Consolidation dull
Auscultation: crepitations bronchial breathing
Symptoms:
Fever shortness of breath productive cough
Pleuritic chest pain (neck, chest, abdominal pain)
BAP
Breathing – maintain SATS O2
Antibiotics – Amoxicillin
Pain – analgesia
Investigation – sputum & blood culture MCS
FBC – raised WCC
CXR – infiltrates
Resp failure – >ARDS
Empyema
Septic shock – >hypotension
Pleural effusion
Ax pneumonia?
Kids: viruses; strep pneumonia; Mycoplasma
Community and hospital:
Strep pneumonia, H. influenza, staph aureus
Immunodeficient:
PCP, staph aureus
Give 4 causes of wheeze
Pathophysiology of asthma?
Congen – CF; lung heart abnormality;
Infect/immune - atopic IgE ASTHMA
Cancer – there is none
Environ – inhale foreign object; aspiration of feed
Allergen – >TH2 cells – >
Stimulates IL-4:
Stimulate B cell –>
make IgE -> mast cell degran + release histamine -> b.constriction
Stimulates IL-13: stimulate mucous secretion
Take a history of asthma patient
O: when? How long? T: how often? Come and go/sudden? E: triggers?! Cold air/exercise Dust Pollen/chemicals Day VS night Work VS home(school) -> sport affected
PMH of atopy
Dx – asthma treatment makes better?//ALLERGIES
Fx – of atopy
Sx - ADL; pets allergy; travel
Examination of chronic asthma
Peripheral – finger clubbing (CF/bronchiectasis – chronic condition)
Eyes and mouth – cyanosis; wet cough/horse voice; sputum
Chest – tightness/tachycardia/tachypnoea
Inspection – hyper inflation//HARRISON SULCI
Auscultation – wheeze
How to ask parents how well controlled kids asthma is
Severity-frequency of symptoms-exacerbation
Hospital admissions for exacerbation
School Time off//exercise limitations//smoking exposure
How Often use inhaler//inhaler technique//oral steroid use
Peak flow diary//sleep affected
Steps for chronic asthma control
How to treat exercise-induced-asthma and aspirin-induced-asthma?
- SABA reliever - mild intermittent
- +Beclametasone - inhaled sted - regular preventer
- Add-on therapy
<2yrs - RESP DOC
<5yrs - Montelukast/Theophylline
>5yrs - + LABA (Montelukast if LABA doesn’t work) - Persistent poor control - Increased BECKY!! Max dose recommended
- Continuous use of oral steds Prednis //RESP doc//immunosupp
Exercise induced –
SABA before exercise
Becky + LABA if symtopms worse
Aspirin induced – montelukast
How would you assess the following asthmas?
12-year-old kid PEFR >50%; SATS > 92%; no clinical signs of asthma
12yr old Kid with PEFR 33–50% predicted
Sats<92%;
Can’t complete sentence in one breath; use of accessory muscle
RR >25; HR > 110
12yr old Kid with PEFR <33% predicted
Sats<92%;
Confused; bradycardic; hypotensive; auscultation can’t hear chest
RESP ACIDOSIS - low pH; low HCO3; high CO2
- Moderate
- Severe
- Life threatening
How to treat a moderate, severe, life-threatening asthma?
What to do if not responding?
If responding?
Moderate – > SABA up to 10 puffs
Severe ->
OSHIT - O2 (cos sats<92%), SABA, Hydrocortisone, Ipratropium, Theophylline
Life-threatening – > OSHIT+seniorDoc
Moderate/Severe/Life threatening–>
Assess RR/HR/PEFR/SAT’s
Not responding?
Sent to HDU/PICU;
Ix: CXR // PEFR// blood gas if <92%
Tx: IV MgSO4 bolus // IV aminophylline
Responding?
Continue bronchodilation + Oral STEDS 3days
How to assess patient education on asthma?
How to assess how well controlled asthma is?
What do if asthma gets worse?
What drugs do? Reliever VS preventer
When to use drug?
How often use inhaler frequency VS dose?
How to use inhaler technique?
What is bronchiectasis?
Causes?
Pathophysiology?
Permanent dilation of Airways due to inflammation and inability to clear secretion
Congenital: CF / Kartagener syndrome
Infect/immune: IBD; rheumatoid arthritis
Environment: smoking
Cause –> infection of small distal away –> inflammation release inflammatory mediators –> ciliary reaction impaired ->
bacterial proliferation + tissue damage – > bronchodilation
