Flashcards in Respiratory Deck (118)
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
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
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