Respiratory Flashcards
Upper respiratory tract infections (URTI)
Examples
- Common Cold (coryza)
- Sore throat (Pharyngitis, including tonsilitis)
- Acute otitis Media
- Sinusitis (Relatively uncommon) - Headache, Facial pain
Upper respiratory tract infections (URTI)
Commonest Presentation
- Nasal Discharge and blockage
- Fever
- Painful throat
- Earache
May cause -
* Difficulty in feeding in infants, as their noses are blocked and this obstructs breathing.
* FEbrile convulsions
* Acute exacerbations of asthma
Sore throat (Pharyngitis)
Causes
- Usually due to viral infections with respiratory viruses - Mostly adenovirus, enterovirus, rhinovirus. EBV, Corona
- In older children, group A beta-hemolytic streptococcus is a common pathogen.
Tonsilitis
Causes
A form of pharyngitis where there is intense inflammation of the tonsils, often with a purulent exudate.
Common Pathogens:
* Group A beta- hemolytic streptococci
* EBV
Often difficult to distinguish between the two.
If bacterial - High fever, exudates
Tonsilitis
Mx
- Antibiotics - Often prescribed for severe pharyngitis and tonsilitis
Penicillin - 6hrly, dose depends on weight for children, 500mg for adults.
Erythromycin if penicillin allergy. - In order to eradicate the organisms to prevent rheumatic fever, 10days of Rx is required.
- Amoxicillin is best avoided.
Tonsilitis
Why is Amoxicillin best avoided?
It may cause a widespread maculopapular rash if the tonsilitis is due to infectious mononucleiosis.
Infectious Mononucleiosis (IMN)
Cause and C/F
Caused by EBV. Also known as kissing disease.
C/F:
* Fever
* Tonsilitis (Pharyngitis + generalised lymphadenopathy)
* May be associated with splenomegaly and less commonly hepatomegaly.
* Palletal petechiae - red spots in mouth
Infectious Mononucleiosis (IMN)
Ix
- Increased Lymphocytes (atypical lymphocytes)
- Positive Monospot test - Antibodies against EBV
- Ab against EBV & heterophil Ab
- Bone marrow biopsy - Normal
Infectious Mononucleiosis (IMN)
What is often similar to IMN?
ALL
Infectious Mononucleiosis (IMN)
Similarities & Differences between IMN and ALL
Similarities -
* Atypical lymphocytes
* Generalised lymphadenopathy
* Tonsilitis
* Hepatomegaly
Differences -
* Bone marrow biopsy is normal in IMN, abnormal in ALL, Blast cells present.
* LN are tender and soft in IMN, LN are non-tender and firm/ hard in ALL.
* ESR is normal in IMN, ESR high in ALL
Infectious Mononucleiosis (IMN)
Indications for tonsillectomy
Children with recurrent tonsilitis are often refferred for removal of their tonsils, one of the commonest operations performed in children.
* Recurrent severe tonsilitis (as opposed to recurrent URTIs - atleast 4/year or >3times/year
* Peritonsilar abscess (quinsy)
* Obstructive sleep apnea (the adenoids will also normally be removed) - snoring
Generally tonsillectomy is avoided until 5yrs.
Many children have large tonsils but this in itself is not an indication for tonsillectomy, as they shrink spontaneously in childhood.
The adneoids increase in size until about the age of 8yrs and then gradually regress.
Infectious Mononucleiosis (IMN)
Indications for the removal of adenoids
- Recurrent otitis media with effusion and hearing loss
- Obstructive sleep apnea (an absolute indication)
Infectious Mononucleiosis (IMN)
Mx
Supportive care - PCM for pain, Salt H20 gargling.
Acute Otitis Media (OM)
Causes
Most common at 6-12M of age.
* Infants and young children are prone to acute OM because their eustachian tubes are short, horizontal and function poorly.
* Causative Organisms:
Viruses - Respiratory Syncytyl Virus (RSV), rhinovirus
Bacteria - pneumococcus (Strep. pneumoniae), H. influenza, Moraxella catarrhalis.
Acute Otitis Media (OM)
C/F
- Fever and Ear pain (Every child with fever should have their ear examined)
- Tympanic membrane is seen to be bright red and bulging with loss of the normal light reflection (Shiny appearance)
- Occasionally, there maybe acute perforation of the ear drum with pus visible in the external canal.
- There maybe ear discharge and even hearing loss due to conductive deafness.
Acute Otitis Media (OM)
Rx
- Most cases of acute OM resolve spontaneously (Commonly when viral)
- Pain should be treated with analgesics such as PCM or ibuprofen (NSAID, can cause peptic ulcers, Should be given with an antacid/PPI)
- Antibiotics - Amoxicillin, Co-amoxiclav - 8hrly for 7days.
Acute Otitis Media (OM)
Complications
- If recurrent, may result in otitis media with effusion (Glue ear), which may cause speech and learning difficulties from hearing loss.
- Recurrent OM can also lead to chronic OM.
- Serious complications are mastoiditis and meningitis (brain abcesses), but are now uncommon.
What is the most common chronic respiratory disorder in childhood?
Asthma