respiratory infections

Question 1

what commonly causes tonsilitis and pharangitis?

Answer 1

• ussually viral
• can be caused by group A beta haemolytic strep
• can distringuish bacterial from viral if there is pleurelent exudate and lymphadenopathyh

Question 2

what is the scoing system used to catagorise croup?

Answer 2

westly scorring system

Question 3

which children should be admitted to hospital for croup?

Answer 3

Haemodynamically significant congenital heart disease
< 3 months old
Inadequate fluid intake < 50-75%

Question 4

what is the causative organism of croup?

Answer 4

parainfluenza

Question 5

how long does croup last?

Answer 5

5-6 days

Question 6

what is the management of mild croup?

Answer 6

• discharged home with oral dexamethasone

Question 7

what is the management of moderate/severe croup?

Answer 7

• admission to hospital
• oxygen
• oral dexamethasone
  nebulised budenaside and adrenaline

intubation if fatigued

Question 8

what are the complicatins of croup?

Answer 8

• airway obstruction

- superinfection= superimpostion with staphylococcus causing bacterial tracheitis

Question 9

what ate the symptoms of croup?

Answer 9

• barking cough

- stridor

Question 10

how is croup diagnosed?

Answer 10

• clinical diagnosis

Question 11

what is the peak presenting age for epiglotisis?

Answer 11

6-12 years old

Question 12

what are risk factors for epiglotisis?

Answer 12

Male gender
Unvaccinated
Immunocompromised

Question 13

what is the causative organism in epiglotitis?

Answer 13

Haemophylis influenza B (HIB)

Question 14

how to investigatew epiglotitis?

Answer 14

• senior paediatrician and anasthetics
• simply opn mouth- no instruments
• no bloods showing inflamatory markers until the airway has been secured
• can use laryngyscope
• neck radiograph will show thumb sign

Question 15

what are clinical features of epiglotitis?

Answer 15

• stridpor
• tripod position
• drooling
• dyphagia
• pyrexial

Question 16

what are complications of epiglotitis?

Answer 16

Airway obstruction: occurs secondary to significant upper airway inflammation and oedema

Mediastinitis: infection can track along the retropharyngeal space and involve the mediastinum, which is associated with a poor prognosis

Soft tissue involvement: cellulitis or abscess within the neck

Question 17

how is epiglotisis managed?

Answer 17

• secure the airway
• nebulise adrenaline
• IV abx (broad spectrum like cephtriaxone)

dexamethasone is second line

Question 18

how does whooping cough present?

Answer 18

• paroxysmal cough worse at night- lasting 4 days or more (infants may have apneoic episodes)
• leads to ‘whoop in between’
• post tussive vomiting
• cough may cause subconjunctival haemorrhage
• can have marked lymphocytosis

Question 19

what is the causative organism for whooping cough?

Answer 19

gram negative bacteria- pertussis

Question 20

whan are vaccines given against wooping cough?

Answer 20

infants are routinely immunised at 2, 3, 4 months and 3-5 years.

Newborn infants are particularly vulnerable, which is why the vaccination campaign for pregnant women was introduced

but this is not lifelong protection

Question 21

how is whooping cough diagnosed?

Answer 21

per-nasal swab - may take several days or weeks to come back
PCR

Question 22

which patients with whooping cough should be admitted?

Answer 22

• under 6 months

Question 23

what is the management or whooping cough?

Answer 23

• pertussis is a notifiable disease- tell authorities
• use an oral macrolide abx- clarythromycin
• contacts to be given prophylaxis
• school exclusion for 48hrs after abx or 21 days from onset of symptoms

Question 24

what are complications of whooping cough?

Answer 24

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

Question 25

what age range is affected by bronchiolitis?

Answer 25

<1 ... peak incidence 3-6 months, maternal IgG provides protection for newborn babies

Question 26

what is the causative oragansim in bronchiolitis?

Answer 26

RSV

Question 27

what are symptoms of bronchiolitis?

Answer 27

coryzal symptoms (including mild fever) precede: dry cough increasing breathlessness wheezing, fine inspiratory crackles (not always present) feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Question 28

what is the management for bronchiolitis?

Answer 28

humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92% nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth suction is sometimes used for excessive upper airway secretions

Question 29

when should you consider referring to hospital for bronchiolitis?

Answer 29

a respiratory rate of over 60 breaths/minute difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume 'taking account of risk factors and using clinical judgement') clinical dehydration....How are their nappies?