URTI

Question 1

Why is URTI worse in infants

Answer 1

Breath more through their nose
Airways are smaller
Blocked runny nose can be big issue

Question 2

What are viral causes of URTI

Answer 2

RSV
Parainfluenza virus
Adenovirus
Rhinovirus = common cold 
Influenza A, B

Question 3

What are bacterial causes of URTI

Answer 3

Strep pneumonia
Strep A 
H. influenza
Mycoplasma pneumonia 
S.Aureus
M. catarrhalis

Question 4

How can you differentiate between causes of URTI

Answer 4

Throat swab
Nasal swab
Blood culture

Question 5

What are signs of respiratory distress

Answer 5

Increased HR +RR
Low sats
Grunting
Nasal flaring
Recession - sternal / intercostal / subcostal / supraclavicular
Cyanosis 
Sweating 
Tracheal tug
Head bob
Wheeze
Exhaution

Question 6

What must you think of with an URTI and what is key to Rx

Answer 6

Will it become a serious illness / become invasive

Is child going to get
worse, at worst or past the worst ? = REVEIW

Oxygen
Hydration
Nutrition
Suction / saline (mucolytic) may be needed

Question 7

What is Rhinitis

Answer 7

Runny nose in winter

Typically 5-10 / year

Question 8

What causes Rhinitis

Answer 8

RSV

Question 9

What is important with Rhinitis

Answer 9

Could be a prodrome to a more serious illness so review

Meningitis/ sepsis / pneumonia / bronchiolitis

Question 10

How do you treat Rhinitis

Answer 10

Anti-histamine
Decongestant
NSAID

Question 11

What is otitis media

Answer 11

Self limiting ear infection

Question 12

What ae the symptoms of otitis media

Answer 12

Painful red ear
Bulging ear drum
Can rupture
Lasts about a week

Question 13

What causes otitis media and what makes you more at risk

Answer 13

Virus = most common
S.pneumonia
H.influenza

Scarlet fever / reflux / cleft palate

Question 14

How do you treat otitis media

Answer 14

Analgesia best

Amoxicillin if <2 or bilateral

Question 15

What causes croup (Laryngotracheabronchitis) and who is it common in

Answer 15

Para influenza 1
RSV
Common in <4 / LBW / premature

Question 16

What are the symptoms of croup

Answer 16

Stridor (wheeze on inspiration) - due to oedema + secretion - often minimal
Hoarse voice
Barking cough
Coryza / URTI - few days prior
Likely pyrexial / low grade fever
Can get 2 bacterial infection leading to tracheitis

Question 17

What are more severe signs of croup

Answer 17

Resp distress or stridor at rest

• Increased HR or RR
• Low sat
• Restless child
• Recessions
• Cyanosis

Question 18

What is CI in croup

Answer 18

Airway examination due to risk of obstruction

Question 19

What do you give to all children with croup

Answer 19

Oral dexamethasone
Pred if not available
Nebulised or iM if necessary
Supportive treatment at home if not severe
Hygiene to avoid spread / stay off school

Question 20

When do you admit

Answer 20

<6 month
Abnormal airway
Severe / uncertain

Question 21

What can you do in hospital

Answer 21

High flow O2
Fluid
Nebulised adrenaline if severe
Intubation if severe

Question 22

Ddx of stridor

Answer 22

Foreign body
Any obstruction
Laryngomalcia in babies
Tracheitis
Epiglotitis
Peritonsillar abscess
Choking

Question 23

How does foreign body present

Answer 23

Sudden onset 
Cough
Choking
Vomit
Stridor
Wheeze
Onesided reduced air entry 
SOB

Question 24

What causes tracheitis

Answer 24

S.Aureus
Strep
M.catarrhalis

Question 25

How does tracheitis present

Answer 25

``` Stridor Hoarse Barking cough High fever Toxic Airway may obstruct Viral prodrome ```

Question 26

How do you treat

Answer 26

Urgent airway protection IV steroid IV Ax - Fluclox +- ceftriaxone

Question 27

When do you think tracheitis

Answer 27

Stridor recurs despite steroid therapy

Question 28

What causes epiglottis

Answer 28

``` H. influenza - More rare due to vaccination Group A strep S. pneumonia S.aureus ```

Question 29

How does epiglottis present

Answer 29

``` Sudden onset Stridor Drooling as can't swallow Recession Cyanotic High RR and low sats Difficulty swallowing Dysphonia Swelling can block whole airway Tripod position Hx - high fever / sore throat Very unwell ```

Question 30

How do you treat

Answer 30

DO NOT TOUCH ITU / anaethetist ABCDE A = priority so endotracheal intubation due to risk of obstruction No examination or cannula as may obstruct X-ray to exclude foreign body / show oedema Secure airway Intubation - most don't need Tracheostomy if not able to intubate Ax and culture when stable - ceftriaxone and vanc

Question 31

When do you suspect

Answer 31

Unvaccinated child

Question 32

Complication

Answer 32

Epiglottis abscess

Question 33

What is laryngomalacia

Answer 33

Part of larynx above vocal cords has tendency to cause partial obstruction

Question 34

How does it present

Answer 34

Chronic stridor on inhalation when larynx flops across airway NO associated resp distress

Question 35

How do you Rx

Answer 35

Resolves by age 2 | Surgery / tracheostomy = rare

Question 36

What can cause snoring in children

Answer 36

``` Obesity Nasal problems Recurrent tonsillitis Down's Hypothyroid ```

Question 37

If child choking

Answer 37

Encourage coughing + sit upright Back slap + abdominal thrust if ineffective If cyanosed or airway obstruction = BLS