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Paediatric respiratory Flashcards

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1
Q

Explain the different age groups affected by bronchiolitis, viral induced wheeze and asthma

A
  • > Bronchiolitis : 6mns usually (less than <1 yr)
  • > Viral induced wheeze : <3 years
  • > Asthma : >3 years
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2
Q

What is the most common viral cause of bronchiolitis ?

A

-RSV -> respiratory syncytial virus

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3
Q

What can be given to high risk babies to protect against bronchiolitis

A
  • Palivizumab -> monoclonal antibody targeting RSV.

- Given as a monthly IM injection

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4
Q

How does bronchiolitis present ?

A
  • Wheeze and crackles
  • Coryzal symptoms
  • Tachypnoea
  • Dyspnoea
  • Dry cough
  • Poor feeding
  • Mild fever
  • Apnoeas
  • Signs of respiratory distress
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5
Q

what would suggest a diagnosis of pneumonia over bronchiolitis ?

A
  • High fever (>39 degrees)
  • Persistently focal crackles
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6
Q

What 6 factors would suggest admission to hospital for bronchiolitis ?

A
  • Oxygen at 92% or below
  • RR >70
  • Moderate to severe resp distress
  • 50-75% less of nomral milk intake
  • Apnoea
  • Clinical dehydration
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7
Q

How is bronchiolitis managed in hospital ?

A

Supportive

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8
Q

What is the stepwise approach to ventilation support in bronchiolitis ?

A
  1. High-flow humidified oxygen via tight nasal cannula
  2. Continuous positive airway pressure
  3. Intubation and ventilation
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9
Q

Define croup

A

-Acute, infective, URTI causing oedema of the larynx

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10
Q

What age group does croup typically affect?

A

-6mnths to 2yrs

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11
Q

What is the most common cause of croup?

A

-Parainfluenzae

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12
Q

Give 5 symptoms of croup

A
  • ‘Barking’ cough
  • Stridor
  • Low grade fever
  • Hoarse voice
  • Increased work of breathing
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13
Q

How is croup managed if more than supportive care is needed ?

A
  • Oral dexamethasone (single dose of 0.15mg/kg)
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14
Q

What is determined as mild croup

A
  • Occasional barking cough
  • No audible stridor at rest
  • No or mild suprasternal or intercostal recession
  • Child is happy and prepared to eat, drink and play
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15
Q

What is defined as moderate croup

A
  • Frequent barking cough
  • Easily audible stridor at rest
  • Suprasternal and sternal wall retraction at rest
  • No or little distress and agitation
  • Child can be placated and is interest in its surroundings
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16
Q

What is defined as severe croup

A
  • Frequent barking cough
  • Prominent inspiratory stridor
  • Marked sternal wall retractions
  • Significant distress and agitation, or lethargy or restlessness
  • Tachycardia and hypoxaemia
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17
Q

Give the stepwise management of croup

A
  • Oral dex
  • Oxygen
  • Nebulised budenoside
  • Nebulised adrenaline
  • Intubation and ventilation
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18
Q

Give the normal RR based on age

A
  • <1 yr : 30-40
  • 1-2 yrs : 25-35
  • 2-5 yrs : 25-30
  • 5-12 yrs : 20-25
  • > 12 yrs : 15-20
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19
Q

Give 8 signs of resp distress

A
  1. Raised resp rate
  2. Use of accessory muscles
  3. Intercostal and subcostal recessions
  4. Nasal flaring
  5. Head bobbing
  6. Tracheal tug
  7. Cyanosis
  8. Abnormal airway noises : wheeze, stridor, grunting
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20
Q

What is whopping cough and what causes it ?

A
  • URTI
  • Bordetella pertussis (gram neg)
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21
Q

How does whooping cough present ?

A
  • 1 wk Preceding coryza
  • 3- 6 wks severe paroxysmal coughing fits with large inspiratory whoop.
  • Possible apnoea presentation
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22
Q

How is pertussis diagnosed ?

A
  • Nasal swab with PCR testing or bacterial culture within 2 to 3 wks of symptoms
  • If cough present for >2 wks : anti-pertussis toxin immunoglobulin G on oral fluid aged 5-16 and blood if >17
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23
Q

How is whooping cough managed ?

A
  • <6 mnths. = admit
  • Oral macrolide if within 21 days of cough (erythromycin)
  • Household prophylaxis
  • School exlusion : 48 hrs after starting Abx
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24
Q

What is a key complication of whooping cough ?

A

-Bronchiectasis

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25
What causes laryngomalacia
- Congenital short and soft aryepiglottic folds making the epiglottis 'omega' shaped. - Causes obstruction
26
How does laryngomalacia present ?
- Intermittent inspiratory stridor worse when : upset, lying on back or URTI. Worse on feeding in the exam q. - Peaks at 6 mnths - Usually self resolves
27
What is Primary ciliary dyskinesia? (PCD)
- Autosommal recessive condition causing dysfunction in motile cilia
28
Who does PCD effect ?
- Communities where consanguinity is present
29
what is Kartagner's triad often seen in PCD?
- Paranasal sinusitis - Bronchiectasis - Situs Inversus
30
What kind of hypersensitivity reaction is asthma/other atopic conditions ?
- Type 1 - IgE mediated
31
Explain the pathophysiology behind asthma
- Environmental trigger - Smooth muscle is hypersensitive = bronchospasm and constriction - Increased mucus secretion -- Causes airway obstruction
32
Give the common signs and symptoms of asthma (4)
- Episodic symptoms with intermittent exacerbations - Diurnal variability, typically worse at night and early morning - Dry cough with wheeze and shortness of breath - Bilateral widespread “polyphonic” wheeze
33
Give 6 common triggers of asthma
- Dust - Animals - Cold air - Exercise - Smoke - Food allergens
34
How is chronic asthma managed in an under 5 ?
- Short-acting beta-2 agonist inhaler (e.g. salbutamol) as required. - Add a low dose corticosteroid inhaler or a leukotriene antagonist (i.e. oral montelukast) - Add the other option from step 2. - Refer to a specialist.
35
How is chronic asthma managed in a 5-12 year old child ?
- Salbutamol - Add a regular low dose corticosteroid inhaler - Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). - Titrate up the corticosteroid inhaler to a medium dose. -Consider adding: Oral leukotriene receptor antagonist (e.g. montelukast) or oral theophylline - Increase the dose of the inhaled corticosteroid to a high dose.
36
How is chronic asthma managed in a child over 12?
- Salbutamol - Add low dose ICS - Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). - Titrate up the ICS to a medium dose. - Consider a trial of an oral leukotriene receptor antagonist (i.e. montelukast), oral theophylline or an inhaled LAMA (i.e. tiotropium). - Titrate the inhaled corticosteroid up to a high dose. - Combine additional treatments from step 4, including the option of an oral beta 2 agonist (i.e. oral salbutamol).
37
What is the step up of bronchodilators
1. Inhaled or nebulised salbutamol 2. Inhaled or nebulised ipratropium bromide 3. IV mag sulph 4. IV aminophylline
38
How is a mild asthma attack managed ?
- Salbutamol inhalers via spacer
39
How is a moderate to severe asthma attack managed ?
1. Salbutamol via spacer 2. Nebulised salbutamol / ipratropium bromide 3. Oral pred 4. IV hydrocortisone 5. IV mag sulph 6. IV salbutamol 7. IV aminophylline
40
what is pneumonia and what is seen on a chest X-ray ?
- Infection of the lung tissue - Consolidation due to pus in the lungs
41
Give 2 symptoms of pneumonia
- High fever (>38.5) - Cough : wet and productive
42
Give 3 characteristic chest signs of pneumonia
- Bronchial breath sounds - Focal coarse crackles - Dullness to percussion
43
Give the most common bacterial and viral cause of pneumonia
- Bacterial : strep pneumonia - Viral : RSV
44
How is pneumonia managed ? (dosage in child >11)
- Amoxacillin (500mg 3x daily) - Add macrolide if atypical
45
What was the most common cause of epiglottitis prior to vaccination programmes ?
- Haemophilus influenza type B
46
How does epiglottitis present ?
- Severe sore throat - Inspiratory stridor - Drooling and protruding tongue - Tripod position - High fever - Difficult and painful swallow - Muffled voice
47
How is epiglottitis managed ?
- SECURE AIRWAY - IV antibiotics - Steroids if necessary.
48
What is cystic fibrosis ?
-Autosomal recessive condition affecting the mucus glands, most commonly caused by Delta-F508 mutation of CFTR gene on chromosome 7
49
How is CF diagnosed ?
- Newborn bloodspot test - Sweat test : gold standard
50
What is an early sign of CF
- Meconium ileus
51
Give 6 symptoms of CF
- Chronic cough - Thick sputum production - Recurrent resp tract infections - Steatorrhoea - Abdo pain and bloating - Salty taste to child - Failure to thrive
52
Give 5 signs of CF
- Low weight or height on growth charts - Nasal polyps - Finger clubbing - Crackles and wheeze on auscultation - Abdo distention
53
What is the gold standard test for CF?
- Sweat test
54
What chloride concentration is diagnostic for CF on a sweat test
>60mmol/L
55
What are 2 common microbial colonisers in people with CF?
- Staph aureus : long term prophylactic flucloxacillin taken - Psuedomonas aeruginosa : treated with nebulised tobramycin
56
what is a common finding in CF in a male
Bilateral absence of vas deferens
57
How is epiglottitis confirmed ?
- Direct visualisation (only by senior/airway trained staff). - X ray : lateral = 'thumbprint sign'
58
Explain the basics of paediatric life support
- Unresponsive? - Shout for help - Open airway - Look, listen, feel for breathing - Give 5 rescue breaths - Check for signs of circulation infants use brachial or femoral pulse, children use femoral pulse - 15 chest compressions:2 rescue breaths
59
Explain the key features of chest compressions in children
- Chest compressions should be 100-120/min for both infants and children depth - Depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest
60
What 3 features suggest a diagnosis of viral induced wheeze over asthma ?
- Presenting <3 yrs - NO atopic history - Only occurs during vital infections
61
What is CLDP ?
- Premature babies (usually <28 wks gestation) suffer with respiratory distress syndrome and require O2 therapy or intubation and ventilation
62
Diet recommended in pts with CF
- High calories, high fat and pancreatic enzyme supplementation for every meal
63

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