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Paediatrics > Paediatrics: Respiratory and ENT > Flashcards

Paediatrics: Respiratory and ENT Flashcards

1
Q

What is the general management pathway for acute asthma attack?

A
  1. Inhaled salbutamol - 10 puffs max
  2. Seek urgent medical attention
  3. Salbutmol nebs in ambulance (2.5 mg)
  4. High flow oxygen (15L/mins via NRBM)
  5. Salbutamol and Ipratopium bromide (250mcg) nebs
  6. Consider magnesium sulphate (150mg) with each salbutamol + ipratropium bromide nebs
  7. PO prednisolone early (all pts) - continue for at least 3 days post
  8. Consider IV salbutamol nebs (15mcg/kg over 10mins)
  9. Aminophylline
  10. Consider IV magnesium sulphate
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2
Q

What is the discharge criteria for an acute asthma patient?

A
  1. Sats > 94% on air
  2. Inhaled salbutamol 4-6hrly that can be continued at home
  3. PEF/FEV1 > 70% predicted
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3
Q

What are the follow up appointments for paediatric acute asthma attacks?

A

Primary care in 2 d
Paeds clinic in 2 months
Paeds respiratory referral if life threatening symptoms occurred

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4
Q

When are most cases of asthma diagnosed?

A

50% diagnosed before age 10

Asthma can be diagnosed in children age > 2 yo

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5
Q

What are the pulmonary function test results for asthma?

A
  1. Spirometry
    - FEV1 significantly reduced
    - FVC normal or reduced
    - FEV1/FVC < 80% (0.8)
    - FEV1 increases by >15% post-B2 agonist inhaler
  2. PEFR
    - Reduced (often can be < 70% predicted)
    - improves by > 15% post-B2 agonist inhaler
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6
Q

What are the features of acute severe asthma in children?

A 
Sats < 92% 
PEFR 33-50% of predicted 
HR > 140 if <5yo or >125 if > 5yo 
RR > 40 if < 5yo or >30 if > 5yo 
Inability to complete sentences or feed due to breathlessness
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7
Q

What are the features of life threatening asthma in children?

A 
Sats < 92%
PEFR < 33% 
Silent chest
Cyanosis 
Exhaustion 
Poor respiratory effort 
Hypotension 
Confusion
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8
Q

What is step 1 of asthma control

A

Very low dose ICS AND

B2-agonist (or LTRA if < 5yo)

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9
Q

What is step 2 of asthma control

A

Add a LABA OR

LTRA if < 5yo (Montelukast)

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10
Q

What is step 3 of asthma control

A

LABA works?

  • Low dose ICS or
  • Trial of LTRA (Montelukast)

LABA does not work?
- Low dose ICS

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11
Q

What is step 4 of asthma control

A

Refer to specialist

  • Medium dose ICS or
  • Trial with 4th drug usually SR Theophylline
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12
Q

What is step 5 of asthma control

A

Refer to specialist

  • PO Steroid tablet (minimum dose to gain control)
  • Addition of other drugs to reduce steroid
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13
Q

When do you decide to go up the asthma management ladder?

A

If child is using B2-agonist inhaler > 3 times per week

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14
Q

What is the typical presenting age of bronchiolitis and what is the causative organism?

A

1-9 months (90%)

Respiratory syncytial virus (RSV)

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15
Q

What is the clinical presentation of bronchiolitis?

A

Prodrome:
- Coryza (typically 3d before)

Presentation (respiratory distress):

  • Mild fever
  • Dyspnoea + Tachypnoea
  • Persistent dry cough
  • Wheeze
  • Fine-end inspiratory crepitations
  • IC/SC recession, tracheal tug, accessory muscle use,
  • grunting, nasal flaring, head bobbing (rare + severe)
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16
Q

How would you manage a patient with bronchiolitis?

A

ABCDE - rule out other causes

  1. Reassure parents
  2. Supportive therapy
    - Humidified oxygen with nasal cannula if sats are < 94% (vapotherm provides oxygen and flow)
    - Paracetamol to control fever
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17
Q

What is the criteria for hospital admission with bronchiolitis?

A

Age < 3 months with fever (must rule out other causes)
Sats < 94%
Signs of severe respiratory distress: severe recession, nasal flaring, grunting, RR > 70
Reduced oral fluid intake < 50%
Apnoea - observed or reported
Diagnosis unclear

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18
Q

What is croup, its causative organism and the age range it affects?

A

Laryngo-tracheo-bronchitis
Parainfluenza virus
6 months - 3/6years (peak at 2 years)

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19
Q

What is the presentation of a patient with croup?

A

Classic (symptoms are worse nocturnal)

  • Prodrome: Coryza
  • Barking cough - seal or crow like
  • Harsh stridor
  • Hoarseness
  • Dyspnoea
  • Can drink, Cant eat
  • Respiratory distress (if severe)
20
Q

How would you manage a patient with croup?

A

ABCDE

  1. Reassure parents
  2. Manage from home - keep child upright, minimise distress, steroids, observe for signs of resp distress
  3. Dexamethasone to all patients (0.15mg/kg) regardless of severity
    - Prednisolone as alternative
  4. Humidified oxygen if sats <92%
  5. Adrenaline if airway is threatened
  6. Intubation if airway is compromised
21
Q

What is the typical age range of epiglottis and the causative organism?

A

1-6 years

Haemophilus influenza type B (HiB)

22
Q

What is the typical presentation of a child with epiglottis?

A 
HIGH Fever 
Toxic child 
Soft stridor 
Cant eat or drink 
Drooling 
Increased respiratory distress and HR 
Anxiety
23
Q

What is the management of a child with epiglottis?

A

ABCDE

  1. Manage airway
    - do not examine throat, can compromise
    - call anaesthetist
    - Intubate and consider tracheostomy if required
  2. Provide 100% oxygen and prevent desaturation
  3. IV Cefuroxime or Cefotaxime (3-5d post tube removal)
  4. Rifampacin for household
24
Q

What are the causative organisms of pneumonia in neonates, children < 5yo and children >5yo

A

Neonates - Group B strep (from mother GU tract)
Infants + children < 5yo - S.Pneumonia, Chlamydia, RSV, HiB
Children > 5yo - S.Pneumonia, M.Pneumonia, S.Aureus (rare + severe)

25
Q

What are the clinical symptoms and signs of pneumonia?

A 
Productive cough - green + purulent 
Dyspnoea + tachypnoea (most sensitive sign) 
Fever 
End-inspiratory coarse crepitations 
Dull percussion - localised 
Decreased expansion 
Decreased air entry 
Respiratory distress if young
26
Q

What is the investigative ladder for pneumonia in children?

A
  1. CXR
    - Consolidation patchy and localised or generalised
    - Bronchograms
  2. Sats may be reduced
  3. Nasopharyngeal aspirate - culture
27
Q

What is the management of Pneumonia for children < 5yo and those > 5yo?

A

< 5yo
1st line = amoxicillin
2nd line = co-amoxiclav (complicated typical)
1st line = erythromycin, clarithromycin, azithromycin (if atypical)

> 5yo
1st line = amoxicillin
1st line = erythromycin, clarithryomycin (if M.pneumo, Chlamydia or S.Aureus)

28
Q

What are the signs and symptoms of atypical pneumonia .e.g mycoplasma pneumonia?

how is it treated?

A 
Fever > 38
Headache 
Vomiting
Vague upper abdominal pain 
Non-productive cough 
Miserable and lused

Erythromycin or clarithrymycin (macrolides)

29
Q

What is the criteria for bacterial tonsillitis?

A

Centor

  • Age: <3yo (0), 3-14 (1), >48 (-1)
  • Fever > 38 (1)
  • Cough absent (1) present (0)
  • White exudate on tonsils or furry tongue (1)
  • Cervical lymphadenopathy tender and swollen (1)

Score ≥ 3 = group B strep, treat accordingly

30
Q

What are the red flag viruses causing pharyngitis?

A

EBV (can also cause white exudate)

31
Q

What is the management of tonsillitis?

A
  1. Paracetamol - reduce temperature

2a. Viral (common)
- Reassure and provide supportive therapy
- Self-limiting, it will resolve in 1 week

2b. Bacterial
- Pencillin V or erythromycin
- Clarithromycin if pen allergic
- avoid amoxicillin as if EBV can cause rash

  1. tonsillectomy if recurrent
32
Q

What is the presentation of an infant with CF?

A 
FTT and malabsorption 
Meconium ileus 
Steatorrhoea 
Prolonged neonatal jaundice 
Recurrent chest infections
33
Q

What are the features of bronchiectasis in a child with CF?

A 
Fine end inspiratory crackles 
Productive cough 
Recession 
Recurrent chest infections 
Finger clubbing and rectal prolapse 
Nasal polyps
34
Q

What is causative mutation in CF?

A

ΔF508 on chromosome 7 (CFTR gene)

35
Q

how is CF diagnosed?

A

Blood spot analysis via Guthrie card (day 5 of life)

  • Increase IRT (immunoreactive trypsinogen)
  • CFTR gene mutation reactions

Sweat test
- Cl- count > 60ml

FISH
- ΔF508 mutation

36
Q

What is the chronic management for CF?

A
  1. Manage in tertiary centre
  2. Physiotherapy - daily breathing exercises and acapella/flutter device
  3. Prophylactic Abx when well - flucloxacillin (protect against staph.aureus) may be given IV through porta-cath
  4. Annual influenza vaccination
  5. Saline nebs
  6. Regular sputum samples
  7. Regular r/v every 6-8 wks in outpatients
  8. High calorie and fat diet
37
Q

What is the typical age range of otitis media? What are the causative organisms?

A

3-6 years
Viral - RSV, rhinovirus
Bacterial - pneumococcus, group B strep, HiB,

38
Q

What are the differences in presentation between acute and secretory OM?

A

Acute

  • Sudden onset pain
  • Fever + irritable
  • TM bursts eventually –> visible purulent pus in external canal (resolves in 48hrs)
  • Drum is bright red, bulging and loses natural light reflection

Secretory

  • Middle ear effusion
  • No pain
  • Hearing loss
  • Behavioural issues in class
  • Dull retracted TM
39
Q

What is the treatment for OM?

A
  1. Abx if bacterial
    - Amoxicillin or Co-Amoxiclav
  2. Analgesia (ibuprofen) and paracetamol
  3. Myringotomy with tympanovstomy insertion
    - i.e. grommets
40
Q

What are the features of pertussis infection?

A 
Prodrome phase (1-2 weeks)
- Cough, coryza, fever

Paroxysmal phase (2-6 week)

  • Coughing fits followed by inspiratory whoop
  • Causes vomiting
  • Cough and vomit worse nocturnally
  • Facial erythema or cyanosis
  • Rhinorrhoea
41
Q

What are the investigative findings of pertussis infection?

A
  1. Subconjunctival haemorrhage in eyes
  2. Pernasal swab (Diagnostic) - pertussis culture
  3. Bloods
    - Leuko/lymphocytosis
42
Q

What is the treatment for pertussis infection?

A

Antibiotics

  • Erythromycin (14 d) or Clarithromycin (7d)
  • Erythromycin for close contracts
43
Q

what is the clinical presentation of TB?

A 
Weight loss 
Fever 
Night sweats 
Cough absent or present with haemoptysis 
Focal signs of infection
Anorexia 
Malaise
44
Q

What are the investigative findings for TB?

A
  1. Mantoux test
    - +ve
  2. CXR
    - Focal opacification (coin lesions)
    - Consolidation
    - Effusion
    - Hilar lymphadenopathy
    - Cavitation
  3. Sputum sample
    - Acid fast bacilli (will resist ZN stain)
45
Q

What is the treatment for TB?

A 
RIPE:
- Rifampacin 
- Isoniazid 
- Pyrazinamide 
± Ethambutol

Paediatrics (10 decks)

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