RESPIRATORY

Question 1

What is the most common presenting symptom of asthma in childhood?

How common is this in the background population?

Answer 1

• WHEEZE is the predominate symptom
• 1/2 of children in first 3 years of life will have wheeze at some point but this does not mean they have asthma

Question 2

What are the two types of wheeze and what sort of conditions does each one suggest?

Answer 2

TRANSIENT EARLY WHEEZE:

• wheezing early in the expiration - usually due to infection and normally viral (BRONCHIOLITIS)
• narrower airways more susceptible to obstruction with even small degrees of inflammation (disappears by age 5- bigger airways)
• often accompanies by coryza symptoms

PERSISTENT WHEEZE:

• asthma
• due to environmental trigger
• wheeze peaks later on (4, 5, 6yo)

Question 3

Describe a wheeze classical of asthma

Answer 3

• persistent and recurrent
• relieved by bronchodilators
• Symptoms often worse in morning
• Wheeze following specific trigger

Question 4

Pathophysiology of asthma? (4)

Answer 4

• When child is exposed to allergen there is an IgE mediated immune response causing inflammation of the small airways (ATOPIC).
• Bronchial oedema
• Excessive mucus production
• Infiltration of cells (basophils and eosinophils)

Question 5

Give some examples of asthma triggers

Answer 5

• Cold weather
• exercise
• pet dander
• dust mites
• pollen
• smoking in the home (ALWAYS ASK ABOUT SMOKING IN THE HOME IN Hx)

Question 6

What factors should you include in the assessment/history for asthma?(4)

Answer 6

• reversibility with bronchodilators (strongly suggestive of asthma)
• always plot growth (retardation in severe asthma)
• Ask about / examine for eczema
• Ask about time off school / exercise tolerance

BASELINE PEFR is always good idea

Question 7

What might you find on clinical examination for asthma?

Answer 7

Between exacerbations not a lot…

If long standing and poorly managed:

• Hyperinflation of chest
• Harrison sulcus
• Generalise polyphonic wheeze

Question 8

Management of chronic asthma in community

Answer 8

1. Short-acting beta agonist (SABA)

○ Salbutamol inhaler (blue)

***if they are using inhaler more than 3 times a week/new inhaler once a month then add additional therapy then go to step 2

2. SABA + paediatric low-dose inhaled corticosteroid (ICS)

○ Budesonide

○ Can increase dose depending on effectiveness

○ Usually taken as two puffs twice a day (can do four puffs twice a day if needed)

***if still not responsive then…

3. SABA + paediatric low-dose ICS +LEUKOTRIENE RECEPTOR ANTAGONIST (LTRA)

***if still not covered

4. Discontinue LTRA and ADD LABA e.g. salmeterol SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
5. SABA + maintenance and reliever therapy (MART) that includes a paediatric low-dose ICS
6. SABA + paediatric moderate-dose ICS MART
7. SABA + one of the following options:

• increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
• a trial of an additional drug (for example theophylline-but it has a high incidence of side effects vomiting, insomnia, headaches, poor concentration)
• seek advice from a healthcare professional with expertise in asthma

Question 9

Management of acute asthma in children

Answer 9

1. SALBUTAMOL NEBULISER 2.5-5mg
2. STEROIDS: oral prednisolone or IV hydrocortisone if severe
3. IPRATROPIUM BROMIDE (250-500mg) NEB Repeat bronchodilators every 20-30mins if symptoms persist
4. MAGNESIUM SULPHATE if symptoms are severe and sats are <92% 5.

AMINOPHYLLINE 500-700mcg/kg/hr can be considered if severe or life-threatening

Question 10

What is croup?

Answer 10

• viral infection that causes inflammation and increased secretions in the:

○ Larynx

○ Trachea

○ Bronchi

-Also there is oedema of the subglottic area- dangerous in young children-airway obstruction

Question 11

What organisms most commonly cause croup?

Answer 11

• Parainfluenza viruses most common (parainfluenza type 1 is most common cause of croup)
• Human metapneumovirus
• RSV
• Adenoviruses
• Influenza A and B

Question 12

Who does croup occur in most commonly? Whats the age peak? Is there a seasonal peak?

Answer 12

• Children aged 6m-3y
• Peak at 2 years
• Seasonal peak in autumn

Question 13

What are the clinical features of croup?

Answer 13

• Barking, ‘seal-like’ cough
• Harsh stridor due to airway obstruction
• Hoarse voice
• Background of preceding coryzal symptoms

***symptoms often worse at night (opposite to asthma)

Question 14

Describe an assessment for a child with croup

Answer 14

The most important factor is making sure you’re assessing for any signs of

AIRWAY OBSTRUCTION (listening for stridor, checking oxygenation)

Check for breathing effort (recession, RR, head bobbing, accessory muscle use)

NEVER EXAMINE THE THROAT OF CHILD WITH CROUP - risk of creating an obstruction

Question 15

What would be concerning features for a child with croup?

Answer 15

• STRIDOR - if this begins to occur at REST then the child absolutely has to be admitted.
• Cyanosis
• Lethargy
• Low threshold for admission for young children, children who aren’t feeding or children at risk of airway obstruction

Question 16

What is the Westley criteria?

Answer 16

Croup scoring Possible scores 0-17 • 0-3 mild croup • 4-6 moderate croup •>6 severe croup

Question 17

How do you treat croup?

How do you treat croup with severe obstruction?

Answer 17

• DEXAMETHASONE 150mcg/kg can be given via mouth or IV depending on severity (prednisolone alternative if dex not available)
• If airway obstruction is SEVERE:
• Nebulised adrenaline with oxygen face mask
• hopefully by the time the adrenaline has worn off the dexamethasone will have started having an affect

Question 18

What is epiglottitis? How serious is it?

Answer 18

Inflammation of epiglottis, VERY SERIOUS. Even higher risk of airway obstruction than croup

Question 19

What organisms cause epiglottitis?

Answer 19

The main cause of haemophius type B

• due to vaccination regime the incidence of this has decreases massively

Question 20

When do children get the Haemophilus B vaccination?

Answer 20

in the 6-in-1 vaccination at 2, 3 and 4 months

-booster dose offered when a child is 1 year old as part of the combined Hib/MenC booster

Question 21

What is the clinical presentation of epiglottitis and what is characteristic about it?

Answer 21

• Fever+++
• toxic looking child
• Intensely painful sore throat
• Cant speak
• Cant swallow>DRIBBLING and this is characteristic
• Soft inspiratory stridor
• child often sat upright to maximise airway/breathing
• DO NOT LIE CHILD DOWN TO ASSESS

Question 22

Management of epiglottitis

Answer 22

• Immediately admit and contact paediatrics
• take blood cultures and start IV CEFUROXIME
• Will likely have to be intubated by experienced anaesthetist (HDU/PICU)
• ET tube can usually be removed after 24 hours when antibiotics have started to work. Abx continued for 3-5 days

Question 23

If a child has Hib what do you need to do?

Answer 23

ALL CONTACTS NEED RIFAMPICIN PROPHYLAXIS

Question 24

What are some causes of stridor?

Answer 24

• Croup
• Epiglottitis
• Foreign body
• Laryngomalacia (congenital softening of cartilage - resolves by 2y)

Question 25

Croup vs. epiglottitis: high fever

Answer 25

Epiglottitis

Question 26

Croup vs. epiglottitis: Stridor

Answer 26

Both but more croup

Question 27

Croup vs. epiglottitis: Speech

Answer 27

E - unable to speak C - hoarse voice

Question 28

Croup vs. epiglottitis: Saliva

Answer 28

Dribbling in epiglottitis

Question 29

What are the most common causes of pneumonia in children of different ages?

Answer 29

In younger children the cause is more often viruses In older children the cause is more often bacteria \*\*clinically the distinction is hard

Question 30

What are the common causatives organisms of pneumonia at different ages?

Answer 30

NEONATE (from birth tract) - Group B Strep - Gram negative enterococci INFANTS AND YOUNG CHILDREN - RSV - Strep Pneumonia - HiB - Bordatella Pertussis - Chlamydia trachomatis - Staphylococcus - infrequent but SEVERE OLDER CHILDREN \>5 - Mycoplasam pneumonia - Strep pneumonia - Chlamydia pneumonia \*\*\*consider tuberculosis at all ages in high risk groups

Question 31

Presentation of pneumonia? Presentation of bacterial infections in children?

Answer 31

- The symptoms of the pneumonia itself have usually been preceded by symptoms of viral illness (URTI: cough, coryza, sore throat etc.) so always make sure you ask about this - Fever - Dyspnoea/SOB - Productive cough (purulent sputum) - Lethargy - Poor feeding - Children with bacterial infections can develop acute abdominal pain, neck stiffness or localised chest pain

Question 32

Clinical examination findings in pneumonia

Answer 32

- Nasal flaring - recession (intercostal, subcostal, sternal) -accessory muscle use -head bobbing) - Tachypnoea - end inspiratory crackles (might not be localised) - dullness of percussion - decreased breath sounds/bronchial breathing - decreased O2 sats (indication for admission)

Question 33

Investigations for pneumonia

Answer 33

CXR can be helpful but unless there is a well defined lobar pneumonia they are not useful at distinguishing bacterial from viral - Look for empyema or effusions - Sputum culture

Question 34

What are some indications for admission for pneumonia?

Answer 34

Most cases can be managed at home but indication for admission include: - O2 Sats \<93% on RA - Severe tachypnoea or signs of increase effort (grunting, recessions) - Poor feeding or young age - Family unable to provide appropriate care

Question 35

Management of pneumonia? What do you prescirbe if you suspect mycoplasma?

Answer 35

- Oxygen therapy if hypoxic - Analgesia if pain - IV fluids if dry ABX: - Newborns / infants should be given broad spectrum (co-amox, this can also be given to complicated/unresponsive cases in older children) - Children over age of 5 can be given amoxicillin or erythromycin - If you suspect mycoplasma then use a macrolide = ERYTHROMYCIN

Question 36

How common is bronchiolitis? Most common age group it affects? Who is at extra risk of getting bronchiolitis and what is done to protect them?

Answer 36

VERY COMMON (2-3% of all children every winter) -Most aged between 1-9 months (very rare after 1y) PEAK INCIDENCE 3-6months RISK FACTORS: - pre-term babies - babies with underlying diseases such as CF or congenital heart disease High risk pre-term infants can be given MONOCLONCAL RSV ANTIBODIES (Palivizumab) and this reduces the risk of hospital admission. Maternal IgG provides protection to newborns against RSV

Question 37

What is the main cause of bronchiolitis?

Answer 37

RSV in 80% cases Others: rhinovirus, adenovirus, parainfluenza virus

Question 38

Presentation of bronchiolitis

Answer 38

- Coryza symptoms will usually occur first (runny nose, cough, colds) - Followed by a sharp dry cough - Increasing breathlessness (common cause of admission) - Cyanosis or pallor - FEEDING DIFFICULTIES commonly occur because babies are nasal breathers - Tachycardia and tachypnoea - Recessions - Hyper inflated chest (prominent sternum with liver displaced downward) - Wheezing (more so on expiration) - Fine end inspiratory crackles - Children under the age of 4 months are at risk of developing periods of APNOEA - this is serious

Question 39

Pathophysiology of bronchiolitis? How long will bronchiolitis last?

Answer 39

- Lower respiratory infection (mucus and inflammation of the 2 bronchioles - Usually around 2 weeks - some will have lingering cough or wheeze

Question 40

What investigations should you do for bronchiolitis?

Answer 40

- NASAL SWAB PCR - to identify RSV - CXR - hyperinflation and acute bronchiectasis - BLOOD GAS (usually CBG) - done to identify hypercapnia which would be an indication for ventilatory support

Question 41

What are some criteria for admission with bronchiolitis?(7)

Answer 41

- apnoea - child appears very unwell - Central cyanosis - Severe resp distress (grunting, recessions, RR\>60, persistent O2 sats \<92%) - difficulty feeding (taking \<50-75% feeds) - clinical dehydration - low threshold for younger children

Question 42

Management for bronchiolitis? (6)

Answer 42

SUPPORTIVE TREATMENT - Humidified o2 can be given via nasal cannulae - aim for sats 94-98% - DO NOT GIVE BRONCHODILATORS (Salbutamol, steroids, ipratropium) - have not been shown to help - Maintenance fluid and feeds via NGT if necessary - Ventilatory support if retaining CO2 (CPAP or ventilation) - HIGHLY INFECTIOUS - isolate or group RSV children together - Monitor the infant for apnoea

Question 43

How is cystic fibrosis inherited and how common is it?

Answer 43

- Autosomal recessive - the most common autosomal recessive condition - 1 in 2500 live births - Carrier rate 1 in 25

Question 44

Describe the pathophysiology of cystic fibrosis Which faulty gene is most common? How would you explain it to patients?

Answer 44

- The genetic mutation leads to a faulty chloride channel -meaning salts are not pumped across membranes into secretions - The water content of these secretions therefore drops making them thick and sticky -leads to symptomology - DeltaF508 is most common on chromosome 7 PATIENTS: CF is a genetic condition that affects the movement of salt and water in and out of cells. This causes sticky mucus to build up in the lungs and digestive system. This causes lung infections and problems with digesting food.

Question 45

Clinical effects of CF: respiratory (6)

Answer 45

-Thick secretions cannot be cleared ○Repeated infections (characteristically with pseudomonas aeruginosa) ○Chronic cough (productive of purulent sputum) ○Coarse inspiratory crackles/crepitations -Thick secretions limit gas exchange ○Dyspnoea ○Hyperinflation of chest (air is trapped by secretions) ○Expiratory wheeze

Question 46

Clinical effects of CF: other than resp (7)

Answer 46

MECONIUM ILEUS (thick sticky meconium that is not cleared in the first 48 hrs) -common first identification (in 10-20%) PANCREATIC PROBLEMS - secretions blocking pancreatic duct leads to poor release of digestive enzymes leading to malabsorption and failure to thrive - High concs of sodium and chloride in sweat - SWEAT TEST - FINGER CLUBBING (only in older children) - REPRODUCTIVE TRACT FAILURE - women will have thick mucus plug and will need assistance conceiving. men will have absent vas deferens and be infertile - nasal polyps - allergic bronchopulmonary aspergillosis

Question 47

How is CF detected? (3)

Answer 47

- Meconium ileum at birth - Sweat test (chloride \>60mmol/L....normal is 10-40mmol/L) - GUTHRIE TEST NEWBORN SCREENING (heel prick) looking for immunoreactive trypsinogen (IRT)

Question 48

How is CF managed? (6)

Answer 48

MDT APPROACH (specialist doctors, nurses, physiotherapist, OTs, dieticians, school education) - continuous PROPHYLACTIC FLUCLOXACILLIN for recurrent chest infections - insert PORTACATH (tube under the skin) for administration of continued and acute antibiotics - PHYSIOTHERAPY at least twice a day to clear mucus and prevent infection (percussion). teach the parents. Deep breathing excursuses also useful - MUCOUS THINNERS-nebulised DNAase (dornase alfa/n-acetylcystiene), or hypotonic saline can be given to decrease thickness of mucous - NUTRITIONAL MANAGEMENT: - high calorie diet is essential (150% normal) including high fat intake ○vitamin supplementation (fat soluble AEDK) ○pancreatic enzyme supplements taken with meals ○young children might require gastrostomies so they can be fed overnight. Then they eat normally during day) ○this is because they are fighting infection and also their body cant absorb everything they eat - reduce contact with other CF patients to reduce risk of infection with Burkholderia cepacia complex and Pseudomonas aeruginosa - accapella inhaler - Lung transplant in end-stage disease

Question 49

Pharmacological managment of cyctic fibrosis?

Answer 49

MUCOUS THINNERS - Nebulised DNAase (n acetylcysteine or dornase alpha) or hypertonic saline can be given to try and decrease the viscosity of the mucus - Lumacaftor/Ivacaftor to decrease effects of faulty sodium channels

Question 50

In which patients does TB commonly occur? (4)

Answer 50

- Usually in patients who are not of British descent - FOREIGN TRAVEL - HIV/immunocompromised - In those with an infective contact (always ask about infection in home contacts, this is most common cause for chilldren)

Question 51

How does TB present initially?

Answer 51

- The vast majority will be asymptomatic - They might have a cough in the primary phase but this will subside as the child enters the latent phase...The TB will then resurface when there is another infection that might cause strain on immune system

Question 52

If the child develops symptoms of TB then what does this mean and what would these symptoms be? (7)

Answer 52

-This suggests that the body has failed to keep bacilli sealed in the tubercles in the lungs... Sx include: - Cough - Fever - Anorexia - Weight loss - Haemoptysis - Lymphadenopathy + Lung lesions - Symptoms from other organs (kidneys, bones, joints and CNS)

Question 53

How do we investigate possible TB infection? (3)

Answer 53

MANTOUX TESTis a type 4 hyepersensitivity reaction (inject tuberculin purified protein derivative) to determine whether they've had prior TB exposure - if the person has a positive reaction then they've probably already been exposed (don't give BCG as little effect, unless \>15cm) - if there is a negative test you can have the BCG CXR - tubercles - peri-bronchiole lymphadenopathy - collapse and consolidation in affected lungs - pleural effusions INTEFERON GAMMA RELEASE ASSAY (extracting T cells and seeing how much of a response they have to tuberculin antigens in vitro) Also gastric washing can be done to wash out the stomach and obtain a sample of septum from a child (cant cough up sputum)

Question 54

How do we treat TB? How long is full treatment of TB?

Answer 54

- TRIPLE OR QUADRUPLE THERAPY: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol - AFTER 2 MONTHS: Reduce to just rifampicin and isoniazid - TREATMENT USUALLY LASTS 6 MONTHS (adherence is essential) - ?Pyridoxine in children to prevent peripheral neuropathy (complication of isoniazid)

Question 55

How do we treat children presenting with tuberculosis meningitis?

Answer 55

Dexamethasone

Question 56

How do we manage contact preventing in cases of TB?

Answer 56

- PHE should be informed - BCG should be offered to all high risk individuals at birth - DO NOT give BCG to HIV+ or other individuals at risk of immune compromise due to risk of dissemination - ALWAYS SCREEN FAMILY MEMBERS

Question 57

What is the causative organism of whooping cough?

Answer 57

Whooping cough is a highly infectious resp disease caused by the bacteria Bordatella Pertussis (gram negative)

Question 58

How does whooping cough present?

Answer 58

There will be a one week history of coryzal symptoms (runny nose, sore throat) and then the cough will start... - The cough is SPASMODIC - it is so intense that when the child is finished they will GULP for air (whoop) - Children often change colour (might go red or blue) - Secretions from nose/mouth - Post cough vomiting In very young infants APNOEA might occur rather than whoop

Question 59

What would happen if whooping cough were not treated?

Answer 59

- It is SELF-LIMITING - The spasmodic cough would usually last somewhere between 3-6 weeks and then the intensity of the cough would drop - HOWEVER a low-intensity cough will often linger for months afterwards (convalescent phase)

Question 60

What are some common complications of whooping cough? (5)

Answer 60

- Pneumonia -seizures - bronchiectasis (imagine the pressure widening the lungs) - Sub-conjunctival hemorrhages and epistaxis can happen because of forceful cough

Question 61

How do we investigate whooping cough? (2)

Answer 61

- Peri-Nasal swab and PCR can be done to identify the organism - FBC should be done as part of routine bloods as there will often be a marked lymphocytosis (weird cos not a virus)

Question 62

How do we treat whooping cough?

Answer 62

ORAL MACROLIDE (ERYTHROMYCIN ) ERADICATES THE ORGANISM BUT ONLY IF IN FIRST 21 DAYS (catarrhal phase) -In practice it is often given anyway to reduce spread an it can be given prophylactically to close contacts

Question 63

Will children with whooping cough require exclusion from school?

Answer 63

They WILL REQUIRE exclusion from school/play groups for 2 days after the erythromycin has been given OR up to 21 days/3 weeks after symptoms have started

Question 64

How do you catorgorise croup in an easy way?

Answer 64

Mild croup: * Occasional barking cough * No stridor at rest * No or mild recessions * Well looking child (eat, dink, play) Moderate croup: * Frequent barking cough * Stridor at rest * Recessions at rest * No/little distress Severe croup: • Frequent barking cough - Prominent inspiratory stridor at rest - Marked recessions - Distress, agitation or lethargy - Tachycardia (as a result of hypoxaemia)

Question 65

Fore moderate/severe croup requiring hospital admission, what should you do while you wait for transfer?

Answer 65

• While awaiting hospital admission for moderate/severe: - Oxygen to maintain SaO2 above 93% - Oral steroid to reduse severity/duration (one dose given before transfer) ○ Dexamethasone: 150 micrograms /kg ○ OR Prednisolone: 1-2 micrograms/kg by mouth \*\*If the child is too unwell to take oral steroid, nebulized budesonide (2mg for 1 dose) or IM dex are alternatives

Question 66

Do children with croup need to come to hospital?

Answer 66

MANAGEMENT of Croup * Hospital admission only considered for moderate/severe * Unless: - PMH of sever obstruction or known structural abnormality (e.g. downs syndrome) - \<6 months - Inadequate fluid intake - Night presentation/severe parent anxiety - Immunocompromised - Uncertain diagnosis (e.g. could be epiglottitis) - Risk of complications

Question 67

What should you give a child with severe airway obstruction?

Answer 67

- Nebulized adrenaline with oxygen via face mask 1 in 1,000 (1 mg/mL) - Dose of 400 micrograms/kg (maximum 5 mg) repeated after 30 minutes if necessary. - In the mean time start steroid therapy for when adrenaline wears out

Question 68

Home management tips for parent with child with croup?

Answer 68

REASSURE - the symptoms usually resolve within 48 hours - Keep child calm (keep in parents arms) - Keep good fluid intake - Paracetamol/ibuprofen for fever/discomfort - No not advise humidified air (no evidence and risk of scalding) - Don’t undressing or sponging child to cool down - Check through the night SAFETY NET take to hospital if: ○ Inspiratory noise can be heard at rest ○ Skin between ribs is pulling in at every breath ○ Child is restless or agitated ○ Sleepy more than usual ○ Nostrils flaring ○ Pale/blue ○ Drooling/swallowing problems ○ Want to sit instead of stand FOLLOW UP

Question 69

what are the signs of a moderate asthma attack for children? (3)

Answer 69

MODERATE ASTHMA ATTACK - SpO2 \> 92% - PEF \> 50% best or predicted - No clinical features of severe asthma

Question 70

what are the signs of a severe asthma attack for children? (3)

Answer 70

SEVERE ASTHMA ATTACK - SpO2 \< 92% - PEF 33-50% best or predicted - Too breathless to talk or feed - Heart rate * \>125 (\>5 years) * \>140 (1-5 years) -Respiratory rate * 30 breaths/min (\>5 years) * \>40 (1-5 years) -Use of accessory neck muscles

Question 71

what are the signs of a life threatening asthma attack for children? (3)

Answer 71

LIFE THREATENING ASTHMA ATTACK - SpO2 \< 92% - PEF \< 33% best or predicted - Silent chest - Poor respiratory effort - Altered consciousness - Cyanosis

Question 72

What is MART therapy

Answer 72

Maintenance and reliever therapy made of ICS and LABA

Question 73

How do we prevent whooping cough? (2)

Answer 73

MATERNAL VACCINATION -Women between 20-32 weeks pregnant will be given vaccine BABY VACCINATION - 6 in 1 vaccination (2, 3 and 4 months) - 4 in 1 (3 years 4 months) ADMIT AND ISOLATE CHILDREN (neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations)

Question 74

differential diagnoses for wheeze? (7)

Answer 74

- BRONCHIOLITIS (common aged 1-9 months, dry cough, poor feeding and breathing, end-inspiratory fine crakcles, liver displaced down) - PNEUMONIA (end inspiratory coarse crackles over affected area) - ATOPIC ASTHMA - FORIGN BODY/ASPIRATION OF FEEDS - CYSTIC FIBROSIS - CONGENITA LLUNG ABNORMALITY - CARDIAC FAILURE

Question 75

Examples or upper resp tract infection in children? (4)

Answer 75

- Common cold (coryza) - Sore throat (pharyngitis, including tonsillitis) - Acute otitis media - Sinusitis (uncommon in children)

Question 76

URTI are normally self limiting, but can cause problems such as? (3)

Answer 76

- Exacerbation of asthma - Febrile convulsions - Difficulty in feeding because children breath through their nose while they're feeding and if their nose is blocked they will fail to do this

Question 77

Causative organism for common cold? Treatment?

Answer 77

- rhinoviruses, coronaviruses and RSV - supportive only (calpol and ibuprofen best for fever)

Question 78

Causative organism for tonsilitis?

Answer 78

- tonsillitis is normally caused by virus (e.g. EBV) - however the most common bacterial cause is group A streptococcus (strep pyogenes).

Question 79

Bacterial vs viral tonsilitis?

Answer 79

bacterial= pus on tounsils, NO COUGH, swollen lymph nodes

Question 80

treatment for bacterial tonsillitis? what AB should we avoid and why?

Answer 80

-Antibiotics are often given (usually phenoxymethypenicillin penV, or erythromycin if pen allergy) \*\*Avoid amoxicillin because it will cause a widespread maculopapular rash if the infection is caused by EBV

Question 81

features of otitis media? (3)

Answer 81

- Pain in the ear (if the child is not able to tell you this you might notice them tugging at their ear or clutching it) - Fever - Preceding or concurrent coryzal symptoms

Question 82

Otitis media on examination? (3)

Answer 82

- Red tympanic membrane - Loss of normal light reflection - You might also see a perforation to the eardrum and there might be pus visible in the canal of the ear

Question 83

Treatment of otitis media?

Answer 83

- Usually just supportive (calpol/ibo) - If AB are needed amoxicillin is used (gram positive pneumococcus)

Question 84

complication of repeated otitis media infections?

Answer 84

- otitis media with effusion AKA Glue ear (grommets can be put in to ease these symptoms) - this is the most common cause of conductive hearing loss in the child

Question 85

how common is otitis media

Answer 85

very common -most children will get it at least once in first year (small eustachian tubes)

Question 86

Common causative organisms for otitis media?

Answer 86

RSV, rhinovirus, pneumococcus, HiB and moraxella catarrhalis

Question 87

most common cause of acute stridor in children?

Answer 87

foreign body inhalation

Question 88

What condition has a chronic stridor? How do children with this condition present? How is it treated?

Answer 88

- A chronic stridor in an infant could be suggestive of a completely benign condition known as a LARYNGOMALACIA - This is congenital softening of the cartilage of the larynx which causes partial collapse during inspiration PRESENTATION: Noisy breathing, however children are otherwise well TREATMENT: Usually completely self-resolving by the age of 2years

Question 89

What is seen in foriegn body inhalation?

Answer 89

- Hyperinflation and hyper translucency of affected lung (air can enter but not leave) - diagphram low and flattened - mediastinal shift AWAY from FB

Question 90

Risk factors for SIDS (sudden infant death syndrome)?

Answer 90

- smoking - front sleeping (back to bed campaign) - premiturity - too many blankets/toys - un firm matress - co sleeping