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Flashcards in Respiratory Deck (118)
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What pathogen causes most resp infections in childhood?



Which are the important viruses in resp infections? X6

RSV (respiratory syncytial virus), rhino viruses, parainfluenza, influenza, metapneumovirus and adenoviruses


Most important bacterial pathogens in resp infections x5

Streptococcus pneumoniae (pneumococcus), haemophilus influenzae, moraxella catarrhalis, bordetella pertussis (whooping cough), mycoplasma pneumoniae


Environmental risk factors for resp infection x3

Parental smoking - especially maternal, poor socio-economic status (overcrowding, large family, damp), poor nutrition


Host risk factors for resp infections x4

Underlying lung disease, male gender, haemodynamically significant congenital heart disease, immunodeficiency


Underlying lung disease which increase risk for resp infection x3

Bronchopulmonary dysplasia (preterm infants), cystic fibrosis or asthma


What is encompassed by URTI? X4

Common cold (coryza), sore throat (pharyngitis including tonsillitis), sinusitis


What can URTI cause in infants?

Poor feeding as blocked nose obstructs breathing
Febrile convulsions
Acute exacerbations of asthma


Classic features of common cold

Blocked nose and clear/mucopurulent nasal discharge


Commonest pathogenic causes of common cold

Viruses - rhinoviruses, corona viruses, RSV


Treatment of common cold

Self-limiting and no curative treatment
Fever and pain - treat with paracetamol and ibuprofen


What is pharyngitis?

Inflammation of pharynx and soft palate
Local lymph nodes enlarged and tender


What usually causes sore throat/pharyngitis? And in older children

Viruses - adenoviruses, enteroviruses and rhinoviruses
In older children group a b-haemolytic streptococcus


Common pathogens for tonsillitis?

Group a b-haemolytic strep and EBV


How do you tell between viral and bacterial tonsillitis

Clinically you can't!
EBV exudate meant to be more membranous
Bacterial may have more constitutional disturbance (headache, apathy and abdominal pain, white exudate and cervical lymphadenopathy)


What is treatment for pharyngitis and tonsillitis - how long?

If severe often antibiotics even though only 1/3 are bacterial
To eradicate organism (b-haem strep) and prevent rheumatic fever need 10days of treatment


What antibiotic should be used in pharyngitis/tonsillitis and what should be avoided?

Penicillin and erythromycin (if penicillin allergy) usually used
Avoid amoxicillin because can cause maculopapular rash if due to EBV


When is acute otitis media most common?



Symptoms and signs of acute otitis media?

Pain in ear and fever
Tympanic membrane bright red and bulging - loss of normal light reflection
May be visible pus if perforation of eardrum


Pathogens of acute otitis media

Viruses especially RSV and rhinovirus
Bacterial include pneumococcus, h.influenzae and moraxella catarrhalis


Serious complications of acute otitis media

Mastoiditis and meningitis


Treatment of acute otitis media

Paracetamol or ibuprofen for pain - constant rather than as required - more effective - may be needed for up to a week


Significance of antibiotics in acute otitis media

Shown to reduce the duration of pain but not affect risk of hearing loss - if no improvement after 4 days - give 5days of amoxicillin (erytho/clarithro if pen allergic)
Don't wait for 4days if bilateral AOM or perforation in children


What can recurrent ear infections lead to?

Otitis media with effusion


Symptoms and signs of otitis media with effusion

Children asymptomatic apart from possible decreased hearing
Eardrum is retracted and dull and can often see a fluid level


Diagnosis of otitis media with effusion

Flat trace on tympanometry
Conductive hearing loss on pure tone audiometry (if >4) or reduced hearing on distraction hearing test in younger children


When is otitis media with effusion common

Age 2-7
Peak incidence 2.5-5


Treatment of otitis media with effusion

No evidence for benefit of long term antibiotics, steroids or decongestants
Condition usually resolves spontaneously
If affecting hearing - grommet insertion


What surgery can be useful for otitis media with effusion

Adenoidectomy because believed adenoids can harbour organisms contributing to infection spreading up Eustachian tubes
Also hypertrophied adenoids can obstruct and affect function of Eustachian tubes - poor ventilation of Middle ear


Another name for otitis media with effusion

Glue ear