5. Respiratory Paediatrics

Question 1

What divides the upper and the lower repsiratory tract?

Answer 1

The epiglottis

Question 2

What commensal bacteria do we have in our lungs?

Answer 2

Pneumococcus
Haemophilia
Staphylococcus
Moraxelaa

Question 3

What are the harmful side effects of antibiotics?

Answer 3

Diarrhoea 
Allergic reaction
Oral thrush
Nappy rash
Multi resistance

Question 4

What makes children feel better?

Answer 4

Time
Sugary fluid
Brufen

Question 5

What are some poor prognostic signs used in safety netting children?

Answer 5

Increased breathing effort
Severe vomiting
Loss of shiny patch on tongue due to dehydration

Question 6

What are the signs of otitis media?

Answer 6

Erythema
Bulging drum
No light reflex 
Fever
Ear pain
Discharge 
3-7 days

Question 7

What are the signs of an URTI?

Answer 7

Runny nose
Sniffles
Malaise
Fever
Lasts 14-21 days

Question 8

How do you treat Ottits media?

Answer 8

Analgesia works
Antibiotics work some times to slightly reduce but don’t do enough to justify treating the illness due to side effects
The end point is the same antibiotics or not

Question 9

What is tonsillitis/pharyngitis

Answer 9

Sore throat
Pus on throat 
Swinging fever, Scarlett rash
Lasts 3-7 days
Either EBV (glandular fever) or group A strep

Question 10

What are the symptoms of croup?

What organism causes croup?

Answer 10

Bark seal cough
Para flu 1
Common
Hoarse
Children are still very well
Lasts 2-4 days

Question 11

How do you treat croup?

Answer 11

Oral dexamethasone

Question 12

What is epiglottis?

Answer 12

Cause flu H. Influenzas type B (were vaccinated)
Rare
Stridor
Throat
Drooling as throat is so sore they can’t swallow
High BP, low pulse

Question 13

How do you treat epiglottis?

Answer 13

Intubation and antibiotics

Question 14

What do you do if you’re not sure if a child will get better or worse?

Answer 14

HR
BP
Systemic symptoms
Safety net

Question 15

What bacteria cause respiratory diseases?

Answer 15

Pneumococcus, Haemophilus, Staphylococcus, Haemophilius

Question 16

How do you manage an LRTI?

Answer 16

Diagnose
Assess the patient (oxygenation, hydration, nutrition (chronic))- FIRST!
Antibiotics don’t work straight away, grey area on how to treat

Question 17

What is bronchitis?

What organsism cause it?

Answer 17

Very very common esp in 2 years old
Loose rattly cough, lots of sputum (darth Vader cough)
Chest free of wheezes, crackles
Sample has haemophilus, pnumococcus 
Child well, parent worried
Lasts 7-21 days

Question 18

Describe the pathophysiology of bronchitis?

Answer 18

Bronchitis paralyses cilia,
Cilia reactivates and clears sputum
2-3 weeks later happens again
Bronchitis paralyses cilia

Question 19

What are the red flags for not bronchitis but something more serious?

Answer 19

Age <6month, >4 years- most important
No relapse- remission- most important 
Static weight
Disrupt child’s life
Associates SOB
Acute admission
Other symptoms e.g. neuro/gastro

Question 20

How do you treat bacterial bronchitis

Answer 20

Diagnose
Reassure parents
Don’t treat

Question 21

Who gets bronchiolitis?

Answer 21

Every child born after 1 August with an older symptom

Question 22

What is bronchiolitis?

What are the symptoms

What causes it?

Answer 22

LRTI
Affects 30-40% of all children
Usually RSV, paraflu III, HMPV
Nasal stuffiness, poor feeding, tachypnoea
Crackles +/- wheeze
Lasts 2-3 weeks
Affects children in 1 year
One off thing

Question 23

What is the timespan of bronchiolitis?

Answer 23

Gets worse for 2-3 days, becomes miserable
Stabilises 2 days
Recovers- gradually gets better

Question 24

How do you manage bronchiolitis?

Answer 24

Maximal observations

Minimal interventions

Question 25

What are the characteristics of a LRTI?

Answer 25

48 hours, fever (>38.5), SOB, cough, grunting Wheeze males bacterial cause unlikely Reduced or bronchial breath sounds (loud breath sounds) Infective agents Virus and commensal bacteria bacterium

Question 26

What indicates pneumonia?

Answer 26

If you want to terrify the parents Signs are focal Crepitations High fever

Question 27

What should you not do in LRTI?

Answer 27

White cell count | Chest x-ray

Question 28

How do you manage LRTI with antibiotics?

Answer 28

No symptoms are mild Oral amoxicillin first line Oral macrolides second choice Only for IV if vomiting

Question 29

What is pertussis?

Answer 29

``` Whooping cough Common Vaccine reduces risk and severity, still going to get it Coughing fits leads to Vomiting and colour change ```

Question 30

When DO you give antibiotics in respiratory peadiatrics? What agents are given

Answer 30

Otitis media if under two years and bilateral otitis media- oral amoxicillin Tonsillitis if you know it’s strep- penicillin LRTI/pneumonia- 2 days, fever focal sign, oral amoxicillin

Question 31

What did bob Marley have to say about asthma?

Answer 31

NO WHEEZE NO ASTHMA

Question 32

What decided whether you treat for asthma?

Answer 32

Quality of life affected- treat (not parents QoL, patients QoL) Quality of life not affected- watch and wait

Question 33

What are the characteristics of asthma?

Answer 33

Not a diagnosis of exclusion Wheeze Variability Responds to treatment

Question 34

What causes asthma? What specific genes are associated with asthma?

Answer 34

Genes a moderate contributor (load the gun) ADAM33, ORMDL3 Intact with environment (pull the trigger) Epigenitcs allergy (probably doesn’t cause asthma, allergy and asthma development happen in parallel)

Question 35

What are the different classes of asthma that makes up asthma syndrome?

Answer 35

``` Infant asthma Childhood onset Adult onset Excertional asthma Occupational asthma ```

Question 36

What are the diagnostic tests for asthma

Answer 36

``` There are no tests you idiot Peak flow sucks Allergy tests irrelevant Spirometery lacks specificity Nitric oxide- unproven ```

Question 37

What is the NICE guidelines for investigating asthma?

Answer 37

First need clinical suspicion in child between 5 and 16 Spirometery BDR (bronchodilator reversibility) Exhaled nitric oxide Peak flow (not very good)

Question 38

What is a great sign of a respiratory problem

Answer 38

Shortness of breath at rest (30% of lung function) | Breathing with tummy muscles

Question 39

How does cough diagnose asthma?

Answer 39

Dry cough, just after sleep, comes with exercise

Question 40

What are the asthma signs?

Answer 40

Wheeze SOB at rest Parental asthma Responds to treatment

Question 41

What are the negative aspects Of asthma treatment?

Answer 41

Cost Hassle 0.5-1cm loss in height Oral thrush

Question 42

What are the benefits of asthma treatment?

Answer 42

Helps diagnosis If symptoms respond Improves QoL Reduces risk of attack

Question 43

What are the differentials of asthma in children under 5?

Answer 43

``` Congenital Cystic Fibrosis Primary ciliary dyskinesia Bronchitis Foreign body ```

Question 44

What are the differentials of asthma over 5?

Answer 44

Dysfunctional breathing Vocal cord dysfunction Habitual cough Pertussis

Question 45

How do yiu measure asthma control?

Answer 45

``` SANE Short acting beta agonist/ week? >2 poorly controlled Absence of school nursery Nocturnal symptoms/ week Exceptional symptoms/ week ```

Question 46

What are the goals of asthma treatment?

Answer 46

Minimal symptoms day and night Minimal need for reliever treatment No attacks No limitation of physical activity

Question 47

What do you do if someone’s asthma is well controlled?

Answer 47

Leave as is? | Reduce treatment and hope it goes away

Question 48

What do you do if someone’s asthma isn’t well controlled?

Answer 48

Ask these key questions: Not talking treatment Not taking treatment correctly Not asthma if so increase treatment

Question 49

How do you start asthma treatment?

Answer 49

Step up, step down process. | Started on low dose ICS

Question 50

What are the classes of asthma medications?

Answer 50

``` Short acting beta agonist Inhaled corticosteroids Long acting beta agonist Leukotriene receptor antagonists Theophyllines Oral steroids ```

Question 51

What is different in paediatric vs adulthood hood asthma?

Answer 51

``` Max dose ICS 800mcgs No oral B2 tablet LTRA first line in under 5's No LAMA's Only biological ```

Question 52

What do you do in a child on a brown inhaler who is still poorly controlled?

Answer 52

Long acting beta agonists- slightly better than Increased inhaled corticosteroids and Leukotriene beta agonists Keep an open mind though!