Respiratory Disorders Flashcards by Laura Lazzari

What are symptoms of severe respiratory distress

cyanosis
tired out
reduced conscious level
oxygen sat <92%

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explain features of STRIDOR

INspiratory
caused by narrowing of the upper airways (above thoracic inlet - extra thoracic)
Upper airway tissues are floppy > make noise on inspiration

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Explain features of WHEEZE

EXPIRATORY
compression of bronchioles in lung (intrathoracic airway narrowing)
When you are trying to push air out, the airways become narrower

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What are classifications of respiratory infections

URTI 
Laryngeal/tracheal infection 
Bronchitis 
Bronchiolitis 
Pneumonia

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How many URTI do children have on average per year?

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What are conditions classed as URTI?

Coryza (common cold)
Pharyngitis, tonsillitis (sore throat)
Acute otitis media
Sinusitis

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What are features of the common cold

Nasal discharge clear/mucopurulent

Nasal blockage

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What are common pathogens causing the common cold

Rhinovirus
Coronavirus
RSV

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How do you manage the common cold

Reassure patient:

self limiting
symptoms peak after 2-3 days, resolve within 2 weeks
encourage rest, adequate food and fluidd intake
Paracetamol / ibuprofen for pain relief

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What is pharyngitis

inflammation of the pharynx and soft palate

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What are causes of pharyngitis

Viral infection: adenoviruses, enteroviruses, rhinoviruses

in older children: Group A beta-haemolytic strep

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What is tonsillitis

Intense inflammation of the tonsils, often with purulent exhudate

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What is a common cause of tonsillitis

group A beta-haemolytic strep

EBV

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What is ix for pharyngitis/tonsillitis

can do rapid antigen testing if bacterial tonsillitis suspected q

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What is mx for pharyngitis/tonsillitis

10 day Phenoxymethylpenicillin if bacterial tonsillitis confirmed
Clarythromycin if allergy

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What is advice for pharyngitis/tonsillitis

adequate fluid intake
Paracetamol/ibuprofen as necessary
Salt water gargling, lozenges, anaesthetic spray for temporary pain relief
Return to school after fever has resolved

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What antibiotic must be avoided in pharyngitis/tonsillitis and WHY

Avoid AMOXICILLIN

If tonsillitis is from EBV, it will cause widespread ma culopapular rash

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What is scarlet fever

Occurs following tonsillitis due to group A strep

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What us the presentation of scarlet fever

headache and tonsillitis > fever
Rash: sandpaper like maculopapular rash with flushed cheeks and perioral sparing
Tongue: white, coated, sore, swollen

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What is the management of scarlet fever

10 day Phenoxymethylpenicillin 4xD

Or Arythromyci

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What else must you do if someone has scarlet fever

Notify PHE - this is a NOTIFIABLE DISEASE

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What is another name for Phenoxymethylpenicillin

Penicillin V

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Why are children more susceptible to otitis media?

Eustachian tubes aree short, horizontal, function poorly

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What is presentationn of otitis media?

Ear pain, fever

Dischharge from yeeatr

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What does the tympanic membrane look like in otitis media

bright red, bulging, loss of normal light reflex

What are causative pathogens of otitis media

RSV, rhinovirus, pneumococcus, H influenza, Moraxella catarrhal is

What are complications of otitis media

mastoiditis | meningitis

When would you admit a patient with otitis media?

Severe systemic infection Complications (meningitis, mastoiditis) If <3m old with fever >38

How do you manage otitis media

Ibuprofen or paracetamol for pain No antibiotic prescription Backup antibiotic prescription - not needed immediately, only use if symptoms have not improved after 3 days or worsen

What antibiotics can you give for otitis media

Amoxicillin / clarythromycin

What is glue year

otitis media with effusion | due to recurrent ear infections

What is the presentation of glue year

asymptomatic | reduced hearing only

What is the eardrum like in glue year

Dull and retracted | Fluid level visible

What is the complication of glue ear

conductive hearing loss > interferes with normal speech development, learning difficulties

How do you manage glue year

Grommet insertion Grommet is a ventilation tube Benefit lasts 12 months, then remove

What is the presentation of otitis externna?

swollen infected ear canal, pus, no hearing loss q

Who does chronic supportive otitis media present in

Older children / adolescents

Why does CSOM present

Following recurrent OM / trauma as child > perforation of TM > subsequent bacterial infection > painless otorrhoea > 6 weeks OR due to choleosteatoma

What is presentation of CSOM

Painless otorrhoea >6 weeks Hearing loss Afebrile, no pain

What is CSOM management

If <1/3 of TM involved: conservative (antibiotics), as TM will regrow if >1/3 TM involved: replace TM with surgery

What is sinusitis

Infection of the paranasal sinuses due to viral URTI

What aree sx of sinusitis

pain, swelling, tenderness over check

What is management of sinusitis

Advise that it is VIRAL > takes few weeks to resolve Paracetamol / ibuprofen nasal saline / decongestants

What is a possible complication for sinusitis

overlapping bacterial infection

what do you do if sinusitis sx last longer than 10 days q

high dose corticosteroids for 2 weeks | Consider antibiotic back up prescription with Penicillin V

How do tonsils grow

Max size at 8 year s | Then shrink later in childhood

What is the absolute indication for tonsillectomy

Recurrent severe tonsillitis, >7 episodes in previous years

What are other indications to consider for tonsillectomy

Peritonsillar abscess | OSA

What score can you use for tonsillitis

Fever-PAIN score | CENTOR score

What are causes of stridor

``` CROUP (Most common infection) EPIGLOTTITIS (to exclude) Bacterial tracheitis Foreign body Anaphylaxis Laryngomalacia - MOST COMMON OF ALL Trauma to throat ```

What should you NEVER do if child has stridor

AVOID examining the throat As it may precipitate total obstruction Unless full rhesus equipment and team are at hand

What is croup

inflammation of larynx and trachea

What is the main cause of croup

Parainfluenza

What age group does croup occur in

6 months to 6 years

What are symptoms of croup

Coryza, fever, SOB Barking cough STRIDOR

When are symptoms worse in croup

At night

What are features of the 3 categories of croup

barking cough with stridor (mild) sternal/intercostal recession (moderate agitation/lethargy (severe)

Who must you admit with croup

children with moderate / severe croup

How do you treat croup

PO Dexamethasone 0.15mg/kg SINGLE DOSE IMMEDIATELY Consider: - nebuliser adrenalin - oxygen - inhaled budosemide

How long should croup take to resolve

48h

What is acute epiglottitis

Intense swelling of epiglottis and surroundings associated with septicaemia LIFE THREATENING

What is the cause of acute epiglottisi

H influenza type B

Who does acute epiglottis occur in

1-6 years old | ESPECIALLY IF THEY HAVE MISSED IMMUNISATIONS

What is the stridor like in epiglottitis

SOFT | SOFTER than in croup

What are clinical features of epiglottis

very ill looking child intensely painful throat, child cannot speak or swallow, saliva drools down child sits immobile, upright, with open mouth to optimise aairway

Do you get cough in croup / epiglottitis

You get cough with croup only

What is management of epiglottitis

Urgent hospital admission and treatment Transfer to ICU Visualise under GA > intubate > IV ceftriaxone

What is the pathogen causing bacterial tracheitis

S aureus

How is bacterial tracheitis different to epiglottitis

thick airway secretions

How do you treat bacterial tracheitis

IV antibiotics, intubation, ventilation

How does laryngomalacia present

At 4 weeks | With stridor and poor growth + difficulty eating

What is laryngomalacia

COngential abnormality of larynx

what are RF for developing more severe bronchiolitis

born prematurely bronchopulmonary dysplasia lung disease congenital heart disease

explain the three sounds that occur in the resp tract and at what level

STERTOR: nose to larynx STRIDOR: larynx to carina WHEEZE: below carina

what sign to you get on CXR of acute epiglottisis

thumb sign

Respiratory Disorders Flashcards

(75 cards)