URTI- presentation
fever, painful throat, nasal discharge, earache
URTI- complications
difficulty in feeding, febrile convulsions, acute exacerbations of asthma
commonest pathogens in coryza
RSV, rhinovirus, coronavirus
tonsilitis pathogens
viruses or bacteria- group A b haemolytic strep, EBV
bacterial causes in tonsilitis shown by
constitutional symptoms- headache, apathy, abdominal pain, white tonsillar exudate, cervical lymphadenopathy
what do you treat tonsilitis with
penicillin or erythromycin. avoid amoxicillin as if EBV infection then will lead to maculopapular rash
indications for tonsillectomy
recurrent severe, Quinsy, obstructive sleep apnoea
why are infants prone to acute otitis media
short, horizontal Eustachian tubes which dont function well
what is seen on examination of tympanic membrane in acute otitis media
red bulging tympanic membrane, loss of normal light reflex
complications acute otitis media
mastoiditis and meningitis
what can be given to treat acute otitis media
amoxicillin
indications for adenoidectomy
recurrent otitis media with effusion with hearing loss, obstructive sleep apnoea
presentation of laryngeal/tracheal infection
stridor, hoarseness, barking cough, dyspnoea. chest recession, RR, HR, agitation. do not examine throat
most common pathogen in croup
parainfluenza. others- influenza, RSV
presentation croup
barking cough, hoarse. preceded by coryza. worse at night
treatment moderate croup
oral dexamethasone, prednisolone, nebulised steroids
treatment severe croup
neb adrenaline and warm humidified O2 via face mask
what happens in croup
laryngotracheobronchitis. mucosal inflammation and increased secretions. oedema of subglottic area is the dangerous part as leads to narrowing of trachea
what is bacterial tracheitis (pseudomembranous croup)
similar to croup but fever, appears toxic, copious secretions. caused by staph aureus, treat with IV antibios and intubate and ventilate
what is acute epiglottitis due to
H influenza type b
what happens to patient with epiglottitis
intubation with anaesthetic. then cefuroxime for 3-5 days
what prophylactic drug should be given to household contacts of pt with acute epiglottitis
rifampicin
difference between croup and acute epiglottitis
epiglottitis- more acute onset, no cough, soft insp stridor instead of harsh, no preceding coryza, high grade fever, not able to drink, drooling, toxic very ill appearance
what is whooping cough caused by
bordatella pertussis
phases of whooping cough
catarrhal phase (runny nose, coryza for a week), paroxysmal phase (coughing followed by whoop, can lead to vomiting- lasts 3-6 weeks), convalescent phase (symptoms decline, lasts months)
what happens in infants when whooping is absent
apnoea
treatment of whooping cough
erythromycin but given in catarrhal phase. prophylactic erythromycin to household contacts
what is the commonest serious respiratory infection
bronchiolitis
what age is common in bronchiolitis and what pathogen
1-9 months, rare after 1 year. RSV in 80%
features bronchiolitis
coryzal symptoms, dry cough, SOB, difficulty feeding, recurrent apnoea
those at risk of severe bronchiolitis
premature (bronchopulmonary dysplasia), underlying lung disease, congenital heart disease
signs in bronchiolitis
recession, tachypnoea, fine end inspiratory crackles, wheeze, tachycardia, cyanosis/pallor
investigations in bronchiolitis
PCR analysis of nasopharyngeal secretions, CXR- hyperinflated chest, atelactesis
management in bronchiolitis- when to admit patient
supportive, humidified Ox. fluids assisted ventilation. admit if sats
what is a rare complication of bronchiolitis
bronchiolitis obliterans- permanent damage to airways
what 2 pathogens are the cause in severe bronchiolitis
RSV, metapneumovirus
pathogens implicated in pneumonia in newborn
organisms from mothers genital tract- group B strep
pathogens in pneum- infants and young children
RSV, strep pneum, H influenza, bordatella pertussis, chlamydia trachomatis
pathogens in pneum- children >5 years
mycoplasma pneum, strep pneum, chlamydia pneum
what does the conjugate vaccine in pneum work against
13 of most common serotypes of strep pneum
features pneumonia
fever, difficulty breathing, preceded by URTI, cough, lethargy, poor feeding, unwell child
signs of examination in child with pneumonia
nasal flaring, tachypnoea, chest indrawing, increased resp rate
classic signs pneum
dullness to percuss, decreased breath sounds and bronchial breathing- over consolidation. may be missed in children
what does CXR show in pneumonia
in strep pneum- lobar consolidation
investigations pneumonia
nasopharygeal aspirate for viral
complications of pneumonia
effusion, empyema,
management pneumonia- indications for admission
sats
management pneumonia
oxygen, analgesia, IV fluids
choice of antibiotic in pneumonia
newborn- broad spec IV antibiotics, older infant- oral amoxicillin, child >5 years- amoxicillin or erythromycin
how are parapneumonic effusions managed in pneumonia
antibiotics but small proportion that develop empyema need drainage- chest drain with fibrinolytic agent (urokinase) or surgical decortication
causes of childhood wheeze
transient early wheezing, atopic asthma (IgE mediated), non atopic asthma, recurrent aspiration of feeds, foreign body, CF
what is the pathophysiology of asthma
bronchial inflammation (oedema, mucus, infiltration with cells), hyperresponsiveness, airway narrowing, symptoms
symptoms of asthma
polyphonic wheeze, cough, SOB, chest tightness, symptoms worse at night and early in morning, symptoms that have triggers, interval symptoms, personal or family history, positive response to asthma therapy
assessment of child with asthma
how freq are symptoms, what triggers the symptoms, how often is sleep affected, how severe are interval symptoms, how much school has been missed
investigations in asthma
skin prick testing, CXR, PEFR- should be 10-15% improvement after bronchodilator
what happens to PEFR if uncontrolled asthma
increased variability in peak flow diurnal and day to day variability
what are SABAs
salbutamol, terbutaline
what is ipratropium bromide
anticholinergic bronchodilator
examples of inhaled corticosteroids
budesonide, beclametasone, fluticasone, mometasone
examples of LABA and when should they be used
salmeterol, formoterol- should be used with inhaled corticosteroid
what is montelukast
leukotriene inhibitor
what are the 5 steps in asthma management
1- SABA; 2- add inhaled steroid; 3- >5 add LABA, 5 increase inhaled steroid dose; 4- add extra eg montelukast; 5- add oral steroids
what age should you refer to paediatrician if asthma
signs severe asthma attack
sats 50 >5 >30; pulse >130 2-5 or >120 >5; peak flow
signs life threatening asthma attack
silent chest, poor resp effort, altered conciousness, cyanosis, sats
signs TB
anorexia, low fever, failure to thrive, malaise. cough common but may be absent.
diagnosis TB
tuberculin tests. culture + ziehl neelsen stain of sputa and gastric aspirate. CXR- consolidation, cavities
treatment TB
isoniazid, rifampicin, pyrazinamide, ethambutol
inheritance CF and carrier rates
autosomal recessive, 1 in 25. mutation CFTR gene on chromosome 7
how many CF infants present with meconium ileus. presentation of meconium ileus
10%. vomiting, abdominal distension, failure to pass meconium
what can CF patients be chronically infected with
staph aureus, H influenza, pseudomonas
features CF
recurrent chest infections, poor growth, malabsorption, persistent loose cough, purulent sputum, clubbing, steatorrhoea
how does pancreatic insufficiency present in CF
maldigestion and malabsorption- leads to failure to thrive. freq offensive and greasy stools. low elastase in faeces
diagnosis CF
sweat test- incr Cl
management CF
physio 2x a day- chest percussion and draining; continuous antibiotic prophylaxis- flucloxacillin. take pancreatic enzymes (creon) with every meal- oral enteric coated pancreatic replacement therapy. high caloric diet. fat soluble vitamins.
what are some complications CF
diabetes mellitus. infertility in males as absent vas deferens
what should be considered in any patient with recurrent infections, loose stools, failure to thrive
CF
features CF infant
meconium ileus, neonatal jaundice, FTT, recurrent chest infections, malabsorption
features CF young child
bronchiectasis, rectal prolapse, sinusitis, nasal polyp
features CF older child
diabetes, cirrhosis, portal hypertension, pneumothorax, sterility, aspergillosis
