Throat Infections and Cough Reflex Quiz

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Questions and Answers

What are the key clinical signs to examine in a patient with suspected throat infection?

Key signs include fever, fast pulse, and swollen, tender cervical lymph nodes.

How do bacterial and viral infections differ in terms of white blood cell (WBC) count?

Bacterial infections typically show WBC counts less than 5 or greater than 15, while viral infections generally have WBC counts between 5 and 15.

In what scenario is a throat swab not routinely recommended?

A throat swab is not routinely recommended for sore throat, except in high-risk groups.

What is a common characteristic of the discharge found in bacterial throat infections?

The discharge is typically thick, dark yellow, or orange and may be purulent. Signup and view all the answers

What are two red flags indicating a potentially severe throat infection?

Two red flags are stridor and drooling. Signup and view all the answers

Which virus is associated with mononucleosis in the context of throat infections?

Epstein-Barr virus is associated with mononucleosis. Signup and view all the answers

What is the primary principle of management for throat infections?

The principle of management is symptomatic relief with antibiotic choice based on culture and sensitivity. Signup and view all the answers

Describe the three phases of coughing.

The three phases of coughing are the inspiratory phase (air inhalation), the compressive phase (contraction of expiratory muscles against a closed glottis), and the expiratory phase (opening of the glottis resulting in high expulsion flow). Signup and view all the answers

What roles do mechanoreceptors and chemoreceptors play in the cough reflex?

Mechanoreceptors detect touch or displacement in the proximal airways, while chemoreceptors sense acid, heat, and irritants in the distal airways, both contributing to the stimulation of the cough reflex. Signup and view all the answers

How does the cough reflex pathway operate starting from the cough receptors?

Cough receptors send impulses via the vagus nerve to the cough center in the medulla, which then generates efferent impulses through various spinal and cranial nerves to activate expiratory muscles. Signup and view all the answers

How can coughs be classified based on duration, and what are the specific time frames for each classification?

Coughs can be classified as acute (less than 2 weeks), subacute (2-4 weeks), or chronic (more than 4 weeks). Signup and view all the answers

What types of cough qualities can be identified, and what do they indicate?

Coughs can be classified as moist/wet/productive or dry, indicating whether mucus is present or not, which helps in determining the underlying issue. Signup and view all the answers

What is the significance of asking about the timing and nature of the cough when diagnosing a child?

Understanding the timing of the cough and its nature helps in identifying specific causes, distinguishing between types of cough like barking or whooping sounds. Signup and view all the answers

What types of exposure might trigger a cough in children?

Common triggers for coughs in children include allergens, irritants, infections, and environmental factors such as smoke or cold air. Signup and view all the answers

Describe the physiological mechanism of airflow during the expiratory phase of coughing.

During the expiratory phase, the glottis opens, resulting in high expulsion flow that facilitates the clearance of airway debris and secretions. Signup and view all the answers

What is the role of the vagus nerve in the cough reflex?

The vagus nerve carries impulses from the cough receptors to the cough center in the medulla and transmits efferent signals to the muscles involved in coughing. Signup and view all the answers

How does edema in the pediatric airway affect airway patency compared to the adult airway?

In the pediatric airway, 1mm of edema results in only 44% patency, whereas the same edema in the adult airway leaves 81% of the area patent. Signup and view all the answers

What are common causes of stridor in newborns?

Common causes include vocal cord paralysis, choanal atresia, laryngeal web, and vascular ring. Signup and view all the answers

What key factor in the history of a pediatric patient should raise suspicion for foreign body aspiration?

Acute onset of stridor in toddlers should raise suspicion for foreign body aspiration. Signup and view all the answers

How does the age of onset impact the differential diagnosis for stridor in pediatric patients?

Age of onset helps identify potential causes, with congenital abnormalities usually presenting in the first few months and other causes like croup or epiglottitis appearing later. Signup and view all the answers

What aspects of past medical history should be evaluated in a pediatric patient with stridor?

Key aspects include prenatal and perinatal history such as prematurity, birth weight, intubation history, and allergies. Signup and view all the answers

What are some signs that can indicate poor growth or failure to thrive in a child with cough?

Growth parameters should be assessed, looking for inadequate weight gain or height development. Signup and view all the answers

What type of cough is characterized by a barking sound in children?

The barking cough is indicative of laryngotracheobronchitis. Signup and view all the answers

How can exposure to smoke affect children's respiratory health according to the presented content?

Passive or active exposure to smoke can exacerbate coughing and respiratory issues. Signup and view all the answers

What cough symptoms might indicate a foreign body aspiration in a child?

A history of choking and sudden onset of coughing may suggest foreign body aspiration. Signup and view all the answers

In the context of chronic cough, what are some potential underlying causes?

Chronic cough can be caused by asthma, gastroesophageal reflux, or chronic infections. Signup and view all the answers

What associated symptoms should be assessed during a cough evaluation in children?

Other symptoms to assess include shortness of breath, associated vomiting, and hemoptysis. Signup and view all the answers

What is one key consideration when evaluating a child’s cough duration?

Cough duration helps categorize it as acute, subacute, or chronic, guiding differential diagnosis. Signup and view all the answers

Name at least two conditions that could cause a subacute cough lasting 2-4 weeks.

Post viral cough and acute bronchitis are conditions that can cause a subacute cough. Signup and view all the answers

Why is it important to listen to a child’s cough during a physical examination?

Listening to the cough can provide insight into the type and severity of respiratory issues. Signup and view all the answers

What signs should be looked for on the chest wall during a physical examination of a coughing child?

Signs of hyperinflation and deformities should be inspected on the chest wall. Signup and view all the answers

What does a chest X-ray help identify in a patient with suspected lung disease?

Infiltrations, consolidations, hyperinflation, peribronchial thickening, and atelectasis. Signup and view all the answers

What are the distinguishing characteristics of stridor compared to wheezing?

Stridor is a high-pitched, monophonic sound from the upper airways, while wheezing is a polyphonic sound from the lower airways. Signup and view all the answers

Why is the evaluation of respiratory compromise the first priority in a child with stridor?

Respiratory compromise can indicate life-threatening airway obstruction that requires immediate intervention. Signup and view all the answers

What factors are essential in determining the cause of stridor in pediatric patients?

Age of onset, patient history, tonal quality, and relation to the timing of the respiratory cycle. Signup and view all the answers

How do the Venturi Effect and Bernoulli Principle relate to stridor?

They describe how decreased airway area increases airflow velocity, creating a low-pressure vacuum that exacerbates airway collapse. Signup and view all the answers

What is the role of pulmonary function tests in respiratory diagnosis?

They help differentiate between obstructive and restrictive lung disease. Signup and view all the answers

What does the presence of nasal polyps indicate in a patient with respiratory symptoms?

They may indicate nasal passage obstruction or chronic inflammatory conditions. Signup and view all the answers

What are the main indications for performing a bronchoscopy?

High suspicion for a foreign body in the airway. Signup and view all the answers

Describe the characteristic of inspiratory stridor and its likely cause.

Inspiratory stridor is a high-pitched sound likely caused by extrathoracic obstruction to airflow. Signup and view all the answers

What clinical signs should be examined in a patient with suspected chronic disease?

Edema, cyanosis, clubbing of fingers/toes, and skin lesions. Signup and view all the answers

What is croup, and how does it typically manifest in children?

Croup is a common childhood illness characterized by a barking cough, hoarseness, and difficulty breathing, usually caused by viral infections. Signup and view all the answers

What can be a sign of airway obstruction in a child with croup?

Stridor, a high-pitched whistling sound during breathing, can indicate airway obstruction. Signup and view all the answers

What is the primary difference between croup and epiglottitis in terms of symptom onset?

Croup symptoms appear gradually, while epiglottitis symptoms have a rapid onset. Signup and view all the answers

What position might a patient with epiglottitis adopt to ease breathing?

The patient may sit in the 'tripod' position, leaning forward with an extended neck. Signup and view all the answers

What is a significant complication of untreated epiglottitis?

Untreated epiglottitis can lead to airway obstruction and respiratory distress. Signup and view all the answers

Which antibiotic is typically crucial for treating bacterial epiglottitis caused by Haemophilus influenzae?

Prompt treatment with appropriate antibiotics is crucial for managing bacterial epiglottitis. Signup and view all the answers

How can mild croup symptoms generally be managed at home?

Mild croup symptoms can be managed with rest, fluids, and humidified air. Signup and view all the answers

What role do vaccines play in preventing epiglottitis?

Vaccines against Haemophilus influenzae have significantly reduced the incidence of epiglottitis. Signup and view all the answers

What are common initial symptoms of epiglottitis?

Common initial symptoms include high fever, sore throat, and difficulty swallowing. Signup and view all the answers

Study Notes

Sore Throat, Cough, and Stridor

This presentation discusses sore throat, cough, and stridor, focusing on pediatric anatomy and physiology.
Pediatric airways are characterized by a larger head and shorter neck, with the occiput prominent.
The tongue is large and occupies the entire oropharynx; the absence of teeth further increases the risk of airway obstruction.
Sore throats can be caused by infectious processes, typically originating in the pharynx.
A sore throat is frequently a symptom of an infection; it may begin with swallowing difficulties.
Sore throats can happen at any age, and sometimes allergies are a cause.

Common Causes of Sore Throat

Viral pharyngitis: Caused by viruses, including common cold viruses, other upper respiratory tract viruses, and adenovirus.
Streptococcal pharyngitis: Caused by group A streptococci bacteria. It's most common in children over three years old. Symptoms include fever, a red and swollen throat with white pus-coated tonsils, swollen glands, and reduced appetite.

Less Common Causes of Sore Throat

Infectious mononucleosis: Caused by the Epstein-Barr virus (EBV). It often presents in teenagers and young adults but can also affect younger children with milder symptoms. Symptoms include high fever, sore throat, swollen tonsils with pus, fatigue, an enlarged spleen, and tender swollen glands.
Herpangina: Caused by the Coxsackie virus, resulting in painful blisters on the back of the throat.
Gingivostomatitis: Caused by a herpes virus; it can also cause blisters in the mouth.

Other Less Common, Severe Infections

Pharyngeal swelling or abscess formation: This condition can sometimes lead to surgical emergencies.
Epiglottitis: This is an inflammation of the epiglottis, a structure in the throat.
Retropharyngeal abscesses: A collection of pus in the back of the throat.
Lateral pharyngeal abscesses: A collection of pus on the sides of the throat.
Peritonsillar abscesses: A collection of pus around the tonsils.

Taking the History and Duration

Duration of sore throat (rapid or slow onset)
Associated symptoms (colds, coughs, discoloured sputum, earache, runny nose)
Presence of fever
Family history of sore throat
Immunization schedule
Allergies
Other illness factors (fatigue, medications, immunosuppression)

Examination Findings

Observe for fever, fast pulse, difficulty breathing or swallowing, swollen/tender cervical lymph nodes, oral mucosal ulcers, blisters, swollen/purulent tonsils, potential foreign bodies, red/painful pharynx, nasal stuffiness, swollen ear drums, stridor, drooling, wheezing, oral/dental health assessment, and a complete chest exam (if needed).

Clinical Findings:

Information on fever, white blood cell (WBC) counts, discharges (nasal or throat), presence of seasonal petechiae, Gram stains, cultures, blood tests (if required), sputum analysis, and urinalysis.

Investigations

Throat swabs are not routinely recommended for sore throat, except for high-risk groups.
Investigations may be needed in cases of suspected suppurative complications (relevant imaging), hepatosplenomegaly (full blood examination, monospot test, and/or EBV serology), or streptococcal confirmation in specific cases; streptococcal serology is not routinely used in general cases.

Laboratory Findings:

Bacterial causes (approximately 30%): GABHS (Group A β-hemolytic Streptococcus), Staphylococcus aureus, Moraxella, Branhamella catarrhalis, and various types of Bacteroides.
Viral causes (approximately 40%): Rhinovirus, Adenovirus, Parainfluenza, Influenza virus, Coxsackie virus, Coronavirus, Echovirus, Herpes simplex virus, Epstein-Barr virus (EBV for mononucleosis), and Cytomegalovirus (CMV).
In approximately 30% of cases, no pathogen will be isolated.

Principle of Management

Treatment for sore throat typically involves symptomatic relief.
Antibiotic choice depends on culture and sensitivity results, and any potential drug allergies in the child.
Urgent or emergency care is required if respiratory symptoms are severe or worsen.

Treatment Decision Flowchart (Based on information provided):

A flowchart outlining steps for evaluating airway threat severity, presence of Group A Streptococcus in relevant pediatric populations, immediate supportive care, and consultations with ENT specialists is important.

Red Flags

Unwell/Toxic appearance
Respiratory distress
Stridor
Trismus
Drooling
Muffled voice (related to pharyngeal/peritonsillar pathology)
Torticollis (neck stiffness or twisting)
Neck stiffness/fullness

Cough: Background

Cough is a common symptom of respiratory illnesses.
Coughs in children can lead to significant parental stress and patient discomfort.

Coughing Physiology/Mechanics

Coughing involves three phases: an inspiratory phase, a compressive phase, and an expiratory phase.

Cough Pathway

Cough receptors, the afferent endings of the vagus nerve, initiate the cough reflex.
Mechanoreceptors are sensitive to touch or displacement in proximal airways.
Chemoreceptors respond to stimuli like acid, temperature changes, or related chemicals in distal airways.
Signals from the receptors trigger the cough center in the medulla and nucleus tractus solitaris.
Signals from the cough center travel via spinal motor, phrenic, and vagal nerves to the expiratory muscles/organs, initiating the cough.

Cough Classifications

Based on duration: acute (<2 weeks), subacute (2-4 weeks), chronic (>4 weeks)
Based on quality: moist/wet/productive vs. dry
Based on etiology: specific (attributable to an underlying problem) vs. non-specific (absence of identifiable cause)

Questions to Ask About Cough

Age/duration of onset (congenital causes)
Nature of cough (acute, subacute, chronic, paroxysmal, productive, crackling sounds, whooping, barking sounds, staccato, honking)
Associated symptoms (fever, shortness of breath, vomiting, weight loss, exposure to smoke or other irritants)
Potential triggers (exposure to pets or animals, allergens, or other environmental factors).
What relieves the cough (medications, positions, etc.)?

Differential Diagnosis of Cough

Includes various conditions such as:
Laryngotracheobronchitis
Chlamydia
Pertussis
Para-pertussis
Psychogenic cough
Acute/Chronic respiratory infections
Foreign body aspiration
Exposure to irritants (smoke, irritants, inhaled substances)
Acute Bronchitis
Post-viral cough
Non-specific cough
Increased cough receptor response
Asthma
Gastroesophageal reflux
Upper airway problems
Subacute Bronchitis
Bronchiectasis
Recurrent pneumonia
Cystic fibrosis
Ciliary dyskinesia
Immunodeficiency

Physical Examination for Cough

Assess vital signs (including O2 saturation) and growth parameters, observing for respiratory effort, performing chest wall inspections and nasal checks, examining for obstruction and auscultating for symmetric air entry and adventitious sounds such as crackles, crepitations, and wheezing. Listening to heart sounds and checking for edema, cyanosis, or clubbing in fingers/toes/skin.

Investigations for Cough

Includes chest X-rays, Pulmonary function tests, Bronchoscopy, and Mantoux testing.

Stridor: General Information

Stridor is a harsh, high-pitched, monophonic sound, distinct from the polyphonic sounds of a cough or wheeze. It originates from the upper airways.
Stridor is a significant finding in children, demanding prompt evaluation. Respiratory compromise is the priority concern.
Key factors to consider are age of onset, patient history, tonal quality of the stridor, and its relationship to the respiratory phase.
Stridor can be inspiratory, expiratory, or biphasic, providing clues about the site of airway obstruction.

Stridor: Pathophysiology

Narrowed airways reduce airflow velocity, causing low-pressure vacuum and worsening airway collapse (Bernoulli principle). This leads to increased airway resistance and the need for greater breathing effort.
Pediatric airways are smaller than adult airways; therefore, even modest changes in dimension can significantly affect airflow.

Stridor: Etiology

Congenital anomalies (laryngeal, tracheal, bronchial).
Traumatic causes (injuries).
Infectious causes (viral infections of the airway, etc).

Stridor: Age of Onset

Age of onset is critical.
Congenital abnormalities (frequent in infants): Vocal cord paralysis, choanal atresia, laryngeal webs, and vascular ring.
Laryngomalacia, tracheomalacia, and subglottic stenosis are frequent causes in the early weeks of life.
After the initial weeks, infectious diseases, foreign body aspiration, and croup become prominent causes.
Infectious causes can develop at any age.

Stridor: Acuity of Onset

Acute onset stridor in toddlers suggests potential foreign body aspiration.
Delayed-onset stridor could be indicative of an issue demanding thorough assessment; potential inflammatory airway conditions should be investigated.

Stridor: Past Medical History

Prenatal and perinatal history, including prematurity, birth weight, mode of delivery, intubation/ventilation procedures, presence of infections, allergies, or genetic disorders is relevant.
Intubation history (number, duration, ETT size) can indicate potential airway trauma.

Stridor: Physical Examination

Vital signs are critical for assessing impending respiratory collapse.
Constant pulse oximetry monitoring is needed.
Assessing respiratory effort is equally important.
Auscultation helps identify the location of obstruction (inspiratory stridor often points to epiglottis, expiratory stridor may hint at intrathoracic obstruction, while biphasic stridor may be indicative of larynx/cricoid obstruction.)

Stridor: Diagnostic Testing

Neck X-rays (AP and lateral views) are useful to evaluate epiglottis, retropharyngeal area, and tracheal anatomy.
Chest X-rays might show foreign bodies or evidence of air trapping.
Flexible fiberoptic laryngoscopy is often essential to precisely determine the airway obstruction type.
A complete blood count (CBC) can aid in assessing the presence of an infectious condition.
Arterial blood gases are necessary in cases involving significant respiratory distress and are critical to evaluating the potential for hypoxia.

Treatment for Stridor

Treatment is varied based on the cause of stridor, but oxygen and close monitoring are always central to these cases.

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Description

This quiz covers critical aspects of throat infections, including clinical signs, differences between bacterial and viral infections, and management principles. Additionally, it explores the cough reflex, including its phases, classification, and the roles of receptors involved. Test your knowledge on these key medical concepts!