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Paediatrics > Paediatric respiratory conditions > Flashcards

Paediatric respiratory conditions Flashcards

1
Q

Bronchiolitis : Definition

A

Acute bronchiolar inflammation - most commonly secondary to RSV virus (75-80%) of cases

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2
Q

Bronchiolitis : Incidence

A

< 1 year olds } most commonly peaks 3-6 months

  • Most common cause of a serious lower respiratory tract infection in < 1yr olds
  • Newborns have maternal IgG which provides protection against RSV
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3
Q

Bronchiolitis : Cause

A

Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases
- May also be 2nd to bacterial infection

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4
Q

Bronchiolitis : Clinical symptoms

A

Intially : Coryzal sx (Runny nose/sneezing) + Mild fever
1) Dry cough
2) Increased breathlessness
3) Feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

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5
Q

Bronchiolitis : Clinical signs

A

Auscultation : wheezing, fine inspiratory crackles

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6
Q

Bronchiolitis : Criteria for immediate referral to ED

A
  1. Apnoea (observed or reported)
  2. Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
  3. Central cyanosis
  4. Persistent oxygen saturation of less than 92% when breathing air.
  5. Child looks seriously unwell to a healthcare professional
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7
Q

Bronchiolitis : Management

A

Largely supportive management
- If low <92% O2 sats : Humidified oxygen

  • NG tube if cannot be fed by mouth
  • Excess airway secretions : Suction
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8
Q

Whooping cough : Definition

A

Whooping cough (pertussis) is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis

  • Notifiable disease in the UK
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9
Q

Whooping cough : Clinical phases of disease

A
  1. Catarrhal phase ( Sx of viral upper respiratory tract infection)
    - Lasts 1-2 weeks
  2. Paroxysmal phase : coughing bouts
    - Lasts 2-8 weeks
  3. Convalescent phase : Cough subsides
    - Lasts weeks to months
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10
Q

Whooping cough : Clinical features of Catarrhal phase

A

Symptoms of Upper respiratory tract infection :
- Runny nose, fever, fatigue

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11
Q

Whooping cough : Clinical features of Paroxysmal Phase

A
  • Cough
    1. Increases in severity
  1. Paroxysmal cough - worse at night
  2. End with vomitting (Post tussive vomiting) or Cynosis/Apnea
  3. Classic ‘Inspiraotry whoop’ - forced inspiration against a closed glottis
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12
Q

Whooping cough : Diagnostic criteria of symptoms

A

*Whooping cough should be suspected if *
- a person has an acute cough that has lasted for 14 days or more without another apparent cause
** and**
- has one or more of the following features:
1. Paroxysmal cough.
1. Inspiratory whoop.
1. Post-tussive vomiting.
1. Undiagnosed apnoeic attacks in young infants.

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13
Q

Whooping cough : Investigation for diagnosis

A
  1. Nasal swab culture
  2. PCR/Serology if available
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14
Q

Whooping cough : Management

A

1. Infant < 6 months : Hospital admission

2. < 21 days since onset of cough : Oral macrolide antibiotic - Clarithromycin, Azithromycin

3 . Prophylactic Antibiotics : Household contacts

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15
Q

Whooping cough : Complications

A
  1. Subconjunctival haemorrhages } 2nd to high pressure coughing
  2. Anoxia leading to syncope & seizures
  3. Pneumnoa and Bronchiectasis
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16
Q

Whooping cough : Vaccinations

A

Immunisation does not guarantee lifelong protection
1. Pregnant women : 16-32 weeks - to protect newborn
2. 2 months, 3 months and four month
3. 3 years to 5 years

17
Q

Acute Epiglottitis : Definition

A

Rapid onset of Inflamamtion and swelling of the epiglottis secondary to an infection - most commonly caused by Haemophilius influenza B

18
Q

Acute Epiglottitis : Cause

A

Haemophilius influenza B

19
Q

Acute Epiglottitis : Clinical features

A

Rapid onset of symptoms such as;
1. High temperature / Generally unwell

  1. Difficulty breathing ;
    - Stridor
    - Tripod position : leaned forwards and neck extended

3 . Difficulty swallowing : Drooling of Saliva

20
Q

Acute Epiglottitis : Management

A
  1. O2
  2. IV Abx
  3. Avoid examining throat - risk of acute airway obstruction } Endotracheal intubation
21
Q

Croup : definition

A

Upper respiratory tract infection which is characterised by stridor

22
Q

Croup : Cause

A

Parainfluenza virus

23
Q

Croup : Pathophysiology

A
  • Immune response to epithelial viral infection
  • ‘Laryngo-tracheitis’ : inflammation of the larynx and tachea which narrow due to swelling
24
Q

Croup : Incidence

A
  • Peak incidence 6 month - 3 years
  • More common in autumn
25
Q

Croup : Clinical features

A
  • Corzyal symptoms;
    1. Fever
    2. Runny nose etc
  • Laryngeal oedema and inflammation causes
    1. Stridor
    2. Barking cough (worse at night)
26
Q

Croup : Ix

A

CXR : Steeple sign
* Signified subglottic narrowing

27
Q

Croup : Criteria for severe croup

A
  1. Frequent barking cough
  2. Stridor is audible at rest
  3. Sternal wall retraction at rest
  4. Distress/agitation/lethargy/restlessness
28
Q

Croup : Criteria for admission

A
  1. Features of severe croup
  2. < 6 months of age
  3. Upper airway abnormalities : Laryngomalacia, Down’s syndrome
29
Q

Croup : Management

A
  1. Oral dexamethasone (0.15mg/kg) } all patients

(can also give nebulised epinephrine if acutely unwell)

30
Q

Laryngomalacia : Definition

A
  • Congential abnormality of the larynx
  • where the part of the larynx above the vocal cords (the supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction.
31
Q

Laryngomalacia : Pathophysiology

A
  1. Supraglottic larynx - tissue surrounding it is softer and less tone
  2. During inspiration - air is moving through the larynx
  3. Supraglottic larynx flots across the airway and partially occludes it
  4. Partial obstruction - generates a whistling sound
32
Q

Laryngomalacia : Incidence

A

Infants present at 4 weeks with : Stridor

33
Q

Laryngomalacia : Clinical features

A
  • Inspiratory stridor : harsh whistling sound when breathing in, intermittent
  • No associated respiratory distress
34
Q

Laryngomalacia : Management

A

Self resolves - larynx matures and grows, increases in tone

35
Q

Asthma : Mx in < 5 year old

A

1 . Newly diagnosed asthma : SABA
2 . SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)
After 8 weeks
* No improvement - consider alternative diagnosis
* Sx reoccur < 4 weeks } ICS low dose as maintainace
* Sx reoccur >8 weeks } Repeat 8 week trial

3 . SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)

4 . Stop the LTRA and refer to an paediatric asthma specialist

Paediatrics (13 decks)

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