Paediatric Respiratory Flashcards
(61 cards)
1
Q
paeds resp: viral infections
A
adenovirus influenza A and B parainfluenza I III RSV rhinovirus
2
Q
paeds resp: bacterial infections
A
o Haemophilus influenzae o Moraxella catarrhalis o (mycoplasma) o (s. aureus) o Streptococci B haemolytic, S pyogenes Non haemolytic, S pneumoniae
3
Q
rhinitis: how many a year
A
5-10
4
Q
rhinitis: prodrome to what other conditions
A
pneumonia
bronchiolitis
meningitis
septicaemia
5
Q
otitis media: cause
A
primary viral
secondary with pneumococcus/haemophilus influenzae
6
Q
otitis media: to treat or not?
A
- Severe uni or bilateral > 6 months, severe pain > 48hrs
- Non-severe bilateral 6-23 months
- ? non-severe in older children: “the clinician should either prescribe antibiotic therapy or offer observation with close follow up based on joint decision making with the parent(s)/caregiver”
7
Q
treatment of tonsilitis
A
nothing or 10 days penicillin. Don’t give amoxycillin. 2-7 days.
8
Q
croup: organism
A
parainfluenzae I
9
Q
croup: features
A
coryza
stridor
hoarse voice
barking cough
10
Q
croup: how long does it last
A
2-4 days
11
Q
croup: treatment
A
oral dexamethasone
12
Q
epiglottitis: organism
A
h influenzae B
13
Q
epiglottitis: features
A
stridor
drooling
14
Q
epiglottitis: treatment
A
intubation and antibiotics
15
Q
tracheitis: is often described as?
A
croup which does not get better
16
Q
tracheitis: features
A
fever and sick child
17
Q
tracheitis: organism
A
staph or strep
18
Q
tracheitis: treatment
A
augmentin
19
Q
bronchitis: features
A
endobronchial infection causing a loose rattily cough with URTI. Post-tussive vomit – “glut”. The chest is free of wheeze and creps
20
Q
bronchitis: organism
A
haemophilus
pneumococcus
21
Q
bacterial bronchitis
A
Bacterial bronchitis results from disturbed mucociliary clearance. Minor airway malacia, RSV/adenovirus. There is a lack of social inhibition. Infection secondary.
22
Q
bronchitis: how long do coughs laast for
A
7-25 days
23
Q
bronchitis: natural history of bacterial
A
- Following URTI
- Lasts 4 weeks
- 60-80% respond
- First winter bad
- Second winter better
- Third winter fine
- Pneumococcus/H flu
24
Q
classifying persistent bacterial bronchitis
A
- Wet cough
- More than 1 month
- Remission with antibiotics
With persistent bacterial bronchitis: make the diagnosis, reassure, do not treat.
25
bronchitis red flags
* Age < 6 month, > 4 years
* Static weight
* Disrupts child’s life
* Associated SOB (when not coughing)
* Acute admission
* Other co-morbidities (neuro/gastro)
26
bronchiolitis: organisms
RSV
parainfluenzae III, HMPV
27
bronchiolitis: features
nasal stuffiness, tachypnoea and poor feeding. Crackles +/- wheeze can be heard
28
bronchiolitis: length
16 days
29
bronchiolitis: management
maximal observation minimal intervention
30
bronchiolitis: investiation
NPA
| oxyggen sats
31
medications proven NOT to work in bronchiolitis
* Salbutamol
* Ipratropium bromide
* Adrenalin
* Steroids
* Antibiotics
* Nebulised saline
32
medications PROVEN to work in bronchiolitis
none
33
LRTI: features
* 48 hrs, fever (>38.5 C), SOB, cough, grunting
* Wheeze makes bacterial cause unlikely
* Reduced or bronchial breath sounds
34
LRTI: organism
o Viruses in <35% (higher in younger)
o Bacteria pneumococcus, mycoplasma, chlamydia
o Mixed infection in <40%
35
is a LRTI pneumonia?
Is it pneumonia or not? This question is totally academic but causes anxiety in parents. Call it pneumonia of signs are focal, there are creps and a high fever. Otherwise call it a LRTI. CXR should only confirm clinical findings.
36
BTS Guidelines – Community Acquired Pneumonia: investigations
CXR and inflammatory markers NOT routine
37
BTS Guidelines – Community Acquired Pneumonia: managment
```
o Nothing if symptoms are mild
o (always offer to review if things get worse)
o Oral amoxycillin first line
o Oral macrolide second choice
o Only for IV if vomiting
```
38
Antibiotics and RTI (RACH Guidelines): bronchiolitis
not indicated
39
Antibiotics and RTI (RACH Guidelines): croup
not indicated
40
Antibiotics and RTI (RACH Guidelines): acute LRTI
o Often not indicated
o Children < 2 with mild presentation rarely require antibiotics and have had pneumococcal vaccine thus further reducing their need for antibiotics
o Amoxicillin should be first line
41
Antibiotics and RTI (RACH Guidelines): otitis media
o Usually not indicated
| o Consider amoxicillin if <2 and bilateral infection
42
Antibiotics and RTI (RACH Guidelines): pharyngitis/tonsillitis
o Not usually indicated
| o Consider penicillin
43
pertusis
Pertussis is common, but vaccination reduces risk and severity. Coughing fits and vomiting and colour change. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment
44
empyaema: what is it
Empyaema is a complication of pneumonia resulting in extension of infection into the pleural space.
45
empyaema: treatment
antibiotics and drainage
| maintain oxygenation, hydration and nutirion
46
empyaema: prognosis
children good
47
triggers for asthma
URTI, exercise, allergen, cold weather
48
features of a cough in asthma
dry
nocturnal
exertional
49
DDx for asthma
```
• ?viral induced wheeze (=asthma)
• Foreign body
• Secretions causing noise
o Cystic fibrosis
o Immune deficiency
o Ciliary dyskinesia
o Aspiration, ? GOR
o Tracheo-bronchomalacia
```
50
management of asthma - goals
```
The goals of treatment are:
• Minimal symptoms during day and night
• Minimal need for reliever medication
• No attacks (exacerbations)
• No limitation of physical activity
• Normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best
```
51
how to measure asthma controle
```
SANE
o Short acting beta agonist/week
o Absence school/nursery
o Nocturnal symptoms/week
o Exertional symptoms/week
```
52
classes of medications used in asthma
```
• Short acting beta agonists
• Inhaled corticosteroids (ICS)
• Add ons
o Long acting beta agonist
o Leukotriene receptor antagonists
o Theophyllines
• Oral steroids
```
53
step up/down approach to management of asthma
• Start on low dose inhaled corticosteroid
o Severe may respond to minimal treatment
• Review after 2 months
o No routine test to monitor progress
o Stepping up easier than down
54
management of childhood asthma: step 1
SABA
| spacer/MDI or dry poweder
55
management of childhood asthma: step 2
regular preventer
These should be added when using an inhaled B2 agonist three times a week or more. Symptomatic three times a week or more, or waking one night a week. Exacerbations of asthma in the last two years. Start with a very low dose of inhaled corticosteroids (or LTRA in the under 5s).
56
management of childhood asthma: step 3
* Add on LABA (BTS/SIGN)
* Add on LTRA (NICE)
* Increase ICS dose (GINA)
57
use of a spacer
Shake inhaler between puffs and wash spacer monthly to reduce static. Each increases delivery by 100%
58
nebulisers vs spacers
These are not indicated for day to day use. A spacer is quieter, quicker, valve mechanism, don’t break, portable and cheaper than a nebuliser.
59
acute asthma management: 1st line
SABA via spacer
| SABA via spacer + prednisolone
60
acute asthma management: 2nd line
SABA via neb _ prednisolone
| SABA + ipratropium via neb + prednisolone
61
acute asthma management: 3rd line
```
o IV salbutamol
o IV aminophylline
o IV magnesium
o IV hydrocortisone
o Intubate and ventilate
```
