Paediatrics - respiratory + ENT Flashcards
(179 cards)
1
Q
What respiratory conditions are important in children (9)?
A
- Pneumonia
- Croup
- Asthma
- Virally induced wheeze
- Bronchiolitis
- Cystic fibrosis
- Acute epiglottitis
- Whooping cough
- Laryngomalacia
2
Q
What age is a neonate?
A
A child under 28 days
3
Q
What is an infant?
A
A child under 1 year
4
Q
What is pneumonia?
A
Lower respiratory tract and lung parenchyma infection which leads to consolidation on X-ray
5
Q
What are the signs/ symptoms of a child with pneumonia (6)?
A
- Productive cough
- Fever > 38.5
- Lymphadenopathy
- Tachycardia
- Pain
- Increased work of breathing
6
Q
What are 3 chest signs of pneumonia?
A
- Bronchial breath signs
- Focal corse crackles
- Dullness to percussion
7
Q
What are 6 common bacterial causes of pneumonia?
A
- S. pneumoniae = MC
- Group A strep (strep pyogenes)
- Group B strep (strep agalactiae)
- Staph aureus
- H. influenziae
- Mycoplasma pneumoniae (atypical bacteria)
8
Q
Which bacteria is most common in neonates to cause pneumonia?
A
Group B strep (can live in women’s genital tract)
9
Q
What sign is indicative of staph aureus pneumonia on x ray?
A
Pneumatoceles - air filled cysts
10
Q
What extrapulmonary sign may be seen in those with M. pneumoniae infection?
A
Erythema multiforme
11
Q
What are the common viral causes of pneumonia (3)?
A
- Respiratory syncytial virus (RSV) = MC
- Parainfluenza virus
- Influenza virus
12
Q
What age and what time of year are viral pneumonia most common?
A
Young infants during winter
13
Q
How is pneumonia in children investigated (3)?
A
- Bloods
- CXR
- Sputum culture/ viral PCR
In more severe cases blood cultures
14
Q
How is pneumonia managed in children (3)?
A
- Antibiotics (IV if absorption problem/ severe)
- IV fluids
- Oxygen (sats < 92%)
15
Q
What antibiotics are typically used for pneumonia (2)?
A
- Amoxicillin
- Atypical = macrolide (azithro/erythro/clarithromycin)
…however follow local guidelines
16
Q
What are 2 complications of pneumonia?
A
- Empyema
- SEPSIS
17
Q
What are 6 important conditions to rule out for children with recurrent LRTI ?
A
- Cystic fibrosis
- Reflux/ aspiration
- Neurologic disease
- Asthma
- Immune deficiency
- Primary ciliary dyskinesia (auto recessive)
18
Q
What is croup?
A
Acute laryngotracheobronchitis - infection + oedema in the larynx
19
Q
What age is typically affected by croup?
A
6 months to 3 years
20
Q
What are four risk factors for croup other than age?
A
- Preterm
- Male
- Underlying respiratory disease
- Siblings at school
21
Q
What are the common causes of croup (1 most common 3 others)?
A
- Parainfluenza virus = MC
- Adenovirus
- RSV
- Influenza virus
22
Q
What organism used to commonly cause croup but has decreased in prevalence due to vaccination?
A
Diphtheria - causes inflammation of the mucous membranes
23
Q
What is the presentation of those with croup (5)?
A
- Barking cough occurring in clusters
- Hoarse voice
- Stridor
- Increased work of breathing
- Low fever
24
Q
What criteria are used to assess the serverity of croup and what are some of the criteria (3)?
A
Westley score:
* Extent of stridor
* Difficulty of breathing
* Distressed child
25
How is croup investigated?
Mainly clinical, can do:
* FBC, U&E, CRP
* CXR (AP)
26
What sign is present on x-ray of those with croup?
Steeple sign
27
How can most cases of croup be managed (2)?
* Single dose oral **0.15 mg/kg dexamethasone**
* Supportive management at home
28
How can more severe croup be managed?
Admit to hospital
29
What dose of dexamethasone should be used to treat croup?
0.15 mg/kg
30
What steps should be taken to treat very severe/ life threatening croup (5)?
* Oral dexamethasone
* Oxygen
* Nebulised budesonide
* **Nebulised adrenaline**
* Intubation/ ventilation
31
What is important for children with croup to do?
Stay off school, wash hands, prevent spread
32
What are 2 complications of croup?
* Otitis media
* Dehydration due to reduced intake
33
What are causes of wheezing in children (3)?
* Asthma
* Virally induced wheeze
* Persistent infantile wheeze
34
What is a bad sign of wheeze that may be heard on the chest (2)?
* Focal wheeze = may be a focal airway obstruction - e.g. foreign object
* Fixed inspiratory/ expiratory wheeze
35
What may be a cause of persistent infantile wheeze?
Smoking in the house
36
What causes a viral induced wheeze?
Swelling of the airways in response to a upper respiratory tract viral infection
37
What age is usually affected by virally induced wheeze?
Under 3s - they have smaller airways so any swelling of the airways significantly reduces flow of air
38
What would suggest a virally induced wheeze as opposed to asthma?
* < 3 years old (resolve by 5 years)
* No atopic history
* Preceding viral infection
39
What is the presentation of a child with virally induced wheeze (3)?
* **Expiratory wheeze** throughout chest
* Viral infection for 1-2 days
* SOB
* Resp distress
40
How is virally induced wheeze managed (3)?
1. SABA
2. ICS (trial for 8 weeks)
3. Consider LTRA
*refer*
41
What is the most common chronic condition in children?
Asthma
42
What is asthma?
Reversible chronic inflammation of the airways leading to variable airway obstruction
43
What are some risk factors for the development of asthma (5)?
* Low birth weight/ prematurity
* Fam history
* Smoking in the house
* Viral bronchiolitis
* Atopic conditions
44
What is the typical presentation of a child with asthma (4)?
* Dry cough
* Bilateral wheeze
* SOB
* Episodic symptoms
45
What time of day is asthma worse?
At night + early morning
46
What conditions are associated with each other and make up the atopic triad?
* Allergic rhinitis
* Asthma
* Atopic dermatitis
47
What are triggers for asthma (7)?
* Pets
* Cold air
* Exercise
* Smoke
* Food allergens e.g. shellfish, eggs
* Dust e.g. house dust mites
* Mould
48
What age does asthma typically present in children?
After age 2-3
49
How is asthma diagnosed in under 5s?
Clinical diagnosis
50
How is asthma diagnosed in those over 5 (3)?
* Spirometry with bronchodilator reversibility (required)
* Peak flow diary
* FeNO test if doubt
51
How are FEV1 and FVC affected in asthma?
FEV1 reduced, FVC usually normal
FEV1:FVC < 70% if poorly controlled
52
How much should FEV1 improve after a bronchodilator if a child has asthma?
More than 12%
53
What FeNO result would suggest asthma?
**> 35 PPB** is considered positive
54
What are the steps in the treatment of asthma in those over 5 years (7)?
1. SABA
2. ICS preventer
3. LTRA
4. Stop LTRA if hasn't helped, add LABA
5. Switch ICS and LABA to MART
6. High dose ICS
7. Refer - they may give muscarinic receptor antagonist/ theophylline
55
What is a MART inhaler?
Maintenance and reliever therapy - containing ICS and fast acting LABA
56
What is an example of a fast acting LABA?
Formoterol
57
What are the steps in the treatment of asthma in those under 5 years (4)?
1. SABA
2. Low dose ICS 8 week trial if symptoms reoccur within 4 weeks, restart ICS
3. LTRA
4. Refer
58
How often should a spacer be cleaned?
Once a month with warm soapy water, do not scrub, air dry
59
What are the criteria for a mild/ moderate asthma attack (2)?
* PEFR > 50% predicted
* Normal speech
60
What are the criteria for a severe asthma attack (5)?
* 33 < PEFR < 50%
* Sats < 92%
* Resp rate > 30 (over 5's)/ >40 (under 5's)
* Can't talk/ feed
* HR > 125 or 140 (over/ under 5's)
61
What are the criteria of a life threatening asthma attack (5)?
* PEFR < 33%
* Sats < 92%
* Altered conciseness/ confusion
* Cyanosis
* Silent chest (not enough air flow to make a wheeze sound)
62
How is a moderate - life threatening asthma attack treated (6)?
* O2
* Nebulised salbutamol
* Ipratropium bromide (nebulised)
* Oral prednisolone / IV hydrocortisone
* IV MgSO4/ aminophylline/ salbutamol
* Escalate - intubate + intensive care
63
How long should oral steroids be given for after an asthma exacerbation?
At least 3 days
64
What is important to monitor during an asthma attack if IV salbutamol is given?
Potassium levels as can cause hypokalaemia
65
How long should a child be off oxygen for before being discharged after an asthma attack?
12-24 hours
66
What is bronchiolitis?
Viral inflammation/ infection of the bronchioles (small airways)
67
What is the most common cause of bronchiolitis?
Respiratory syncytial virus (RSV)
68
What age are affected by bronchiolitis?
Under 2 years, most commonly under 6 months
69
What time of year is bronchiolitis most common?
Winter
70
Why are adults not affected by bronchiolitis?
They have much wider airways so are not affected as much by build up of mucous and inflammation
71
What are some risk factors for bronchiolitis (6)?
* Breastfed < 2 months
* Smoke exposure
* Older siblings attending school
* Chronic lung disease of prematurity
* CHD
* Immunodeficient
72
What is the presentation of a child with bronchiolitis (6)?
* Coryzal symptoms (typical of viral URTI)
* Signs of respiratory distress
* Dyspnoea/ tachypnoea
* Apnoea
* Mild fever < 39
* Wheeze/ crackles on auscultation
73
What are coryzal symptoms (4)?
* Snotty nose
* Sneezing
* Mucous in throat
* Watery eyes
74
What are the signs of respiratory distress (8)?
* Tachypnoea
* Accessory muscle use
* Intercostal + subcostal recession
* Nasal flaring
* Head bobbing
* Tracheal tugging
* Cyanosis
* Abnormal airway noises
75
What are three abnormal airway noises?
* Wheezing
* Grunting
* Stridor
76
What is a wheeze?
Whistling sound causes by narrow airways usually during expiration
77
What is grunting noise?
Exhaling with the glottis partially closed to increase end respiratory pressure
78
What is stridor?
High pitched inspiratory noise caused by obstruction of upper airway
79
What is the corse of infection of RSV causing bronchiolitis?
9 days of symptoms, worst around d 5
80
What investigations may be done in those with bronchiolitis (3)?
* Nasopharyngeal aspirate for RSV culture
* Bloods or CXR if more unwell
81
What would indicate a need for admission in children with bronchiolitis (7)?
* < 3 months
* Another condition e.g. prematurity, CF, downs
* Significantly reduced feeding
* Clinically dehydrated
* RR > 70
* Sats < 92%
* Apnoeas
82
How is bronchiolitis managed (4)?
* O2
* Fluids
* CPAP
* Secretion suctioning
*no evidence for bronchodilation, steroids or Abx*
83
What medication can be used to directly treat bronchiolitis?
Ribavirin (antiviral)
84
What investigation can be helpful in severe respiratory distress?
Capillary blood gas
85
What would a capillary blood gas show if there is poor ventilation (2)?
* Rising pCO2 - airways can't clear CO2
* Falling pH - due to high CO2
*type 2 resp failure*
86
What 'vaccine' can be used to prevent bronchiolitis in those at higher risk due to, for example prematurity or immunodeficiency?
Palvizumab
*not a true vaccine as it is just a monoclonal antibody against RSV*
87
What is a complication of those with bronchiolitis?
Bronchiolitis obliterans
88
What organism most commonly causes bronchiolitis obliterans?
Adenovirus
89
What is cystic fibrosis?
Autosomal recessive genetic condition affecting mucous glands
90
What gene and chromosome are affected by cystic fibrosis?
CFTR (cystic fibrosis transmembrane conductance regulator gene) on chromosome 7
91
What cellular channel is particularly affected in CF?
Chloride channels
92
What are the three main areas affected/ consequences in the body of those with CF?
* Thick pancreatic and biliary secretions resulting in blockage of the ducts
* Low volume thick airway secretions
* Bilateral absence of vas deferens = infertility
93
What are the signs/ symptoms of CF (6)?
* Chronic cough
* Thick sputum
* Loose greasy stools
* Low weight/ height
* Finger clubbing
* Crackles/ wheeze
94
What may children with CF present with during early childhood (3)?
* Failure to thrive
* Meconium ileus
* Recurrent LRTI
95
What are the signs/ symptoms of meconium ileus?
* Not passing meconium within 24 hours
* Abdo distension
* Vomiting
96
What are causes of clubbing in children (7)?
* Hereditary clubbing
* Cyanotic heart disease
* Infective endocarditis
* CF
* TB
* IBD
* Liver cirrhosis
97
How is CF diagnosed (3)?
* At birth with the newborn bloodspot test
* Sweat test = gold standard
* Genetic testing (before birth - amniocentesis/ chorionic villous sampling)
98
What organisms commonly infect those with CF?
* Staph aureus
* H. influenziae
* Pseudomonas aeruginosa
99
What antibiotic is used to treat p. aeruginosa (2)?
* Nebulised tobramycin
* Oral ciprofloxacin
100
What antibiotic is sometimes taken long term by those with CF to prevent staph aureus infection?
Flucloxacillin
101
How is CF managed (7)?
* Physio
* Pancreatic enzyme replacement (CREON tablets for lipase)
* Vaccinations
* Bronchodilators
* Mucolytics
* High calorie, high fat diet
* Fertility treatments
102
What are some examples of mucoactive agents used for CF (3)?
* DNase
* Lumacaftor
* Hypertonic saline
103
What other more extreme way can CF be treated?
Transplants - liver and lungs
104
What conditions are those with CF at risk of developing (6)?
* Liver failure
* Diabetes
* Pancreatic insufficiency
* Vitamin D deficiency
* Osteoporosis
* Bowel Ca
105
What is the most common cause of epiglottitis?
H. influenzae type B
106
What has helped decrease the prevalence of epiglottitis?
Vaccination programme
107
What are the signs/ symptoms of epiglottitis (7)?
* Sore throat
* Stridor
* Drooling
* Tripod position - sat forward, hands on knees
* Tongue out
* Difficulty swallowing
* Fever
108
How is epiglottitis diagnosed (2)?
* Lateral X-ray = thumb sign
* Experiences anaesthetist visualise epilottitis (diagnostic)
*DO NOT EXAMINE AIRWAY OTHERWISE*
109
How is epiglottitis treated (3)?
* Secure airway - intubation/ cricothyroidostomy
* IV Abx (e.g. ceftriaxone)
* Nebulised adrenaline
110
What is a complication of epiglottitis?
Epiglottic abscess
111
What is whooping cough and what causes it?
Upper respiratory tract infection caused by bordetella pertussis
112
What does the characteristic whooping cough sound like?
Loud inspiratory whoop
113
How is whooping cough diagnosed (2)?
* Nasal swab + PCR/ culture
* If > 2 weeks test for anti-pertussis toxin immunoglobulin G in oral fluid/ blood
114
How is whooping cough treated?
**Macrolides** < 21 days of cough onset
*azithromycin; erythromycin (pregnant); clarithromycin (under 1 month)*
115
What is important to do if a patient tests positive for bordetella pertussis?
Inform public health England as it is a notifiable disease
116
What is a complication of whooping cough?
Bronchiectasis
117
What is primary ciliary dyskinesia (kartagners syndrome)?
Autosomal recessive condition affecting motile cilia around the body
118
What is included in kartagners triad (presentation of those with PCD)?
* Situs inversus - organs on opposite side of body
* Bronchiectasis
* Paranasal sinusitis
119
How is PCD diagnosed?
Sample of ciliated epithelium of the upper airway is analysed
120
How does PCD present?
Similar to CF due to mucous/ excretions not being expelled effectively
121
How is PCD managed?
Similar to CF
122
What is laryngomalacia?
The larynx is structured in such a way it causes a partial upper airway obstruction, resulting in **stridor**
123
What is otitis media?
Infection of the middle ear
124
Where/ what is the middle ear?
The space between the tympanic membrane and inner ear
125
How does infection enter the middle ear?
Pathogens enter though the eustachian tube
126
What infection often precedes otitis media?
Viral upper respiratory tract infection
127
What is the most common cause of otitis media?
Steptococcus pneumoniae
128
Other than S. pneumoniae, what other bacteria sometimes cause otitis media (2)?
* H. influenziae
* Staph aureus
129
What are the signs/ symptoms of otitis media (3)?
* Ear pain
* Hearing loss
* Upper resp infection Sx
*balance problems and vertigo usually only if inner ear affected (labyrinthitis)*
130
What can discharge from the ear mean (2)?
* Perforated eardrum
* Outer ear infection
131
What would be seen on otoscopy of those with otitis media?
Bulging, red, inflamed tympanic membrane
132
How is otitis media generally treated?
Analgesics
133
Should antibiotics be prescribed for otitis media?
Generally not. Most cases get better within 3 days without antibiotics.
134
When should antibiotics be used to treat otitis media (4)?
* Systemically unwell
* Symptoms not improving after 3 days
* Bilateral in < 2 years
* Perforation w/ discharge
135
What antibiotic is first line for otitis media?
Amoxicillin
*Co-amoxiclav/ ceftriaxone usually second line*
136
When should a child with otitis media be referred to hospital (2)?
* 3 months or younger fever > 38
* 3-6 months with a fever > 39
137
What are some complications of otitis media (6)?
* Mastoiditis
* Perforated eardrum
* Hearing loss
* Recurrent infection
* Effusion
* Abscess
138
What is glue ear?
Otitis media with effusion - middle ear becomes full of fluid due to blockage in Eustachian tube
139
How is glue ear usually treated and how long does it typically last?
Usually resolves with conservative treatment within 3 months
140
What is a treatment that can be offered if glue ear persists beyond 3 months?
Grommets
141
Where should children be referred if glue ear is suspected?
**Audiometry** - establish diagnosis and extent of hearing loss
142
What is the most common cause of otitis externa?
Staph aureus
143
What activity commonly causes otitis externa?
Swimming pool
144
How is otitis externa treated?
Flucloxacillin drops + steroid drops
145
How does mastoiditis present (3)?
* Otalgia (ear pain)
* Swollen, tender mastoid
* Systemically unwell
146
How is mastoiditis managed?
IV Abx in hospital
147
What is pharyngitis?
Inflammation of the pharynx +/- tonsils
148
What are the most common causes of pharyngitis (2)?
* EBV
* S. pyogenes/ GAS
149
What criteria can be used to determine weather antibiotics should be given for pharyngitis?
Fever pain score
*Abx if 4 or more; consider if 2-3*
150
What are the criteria in fever pain score (5)?
* Fever > 38
* Purulent exudate (on tonsils)
* Absence of cough
* Symptoms onset < 3 days
* Severe tonsil inflammation
151
What can happen if penicillin is given for EBV?
Widespread maculopapular rash
152
What is important to advice people with EBV not to do?
Avoid contact sports for at least 4 weeks due to risk of **spleen rupture**
153
How is pharyngitis investigated (2)?
* Pharyngeal swab (viral PCR, MC&S)
* Monospot test (for EBV)
154
How is pharyngitis treated?
Phenoxymethylpenicillin (pen V) if fever score indicates bacterial
155
What is a complication of pharyngitis?
Quinsy (peritonsillar abscess) - IV Abx + surgical drainage
156
What are the three broad ways a child might have hearing loss?
* Congenital
* Perinatal
* Acquired after birth
157
What does congenital mean?
Present from birth
158
What are some congenital causes of hearing loss (3)?
* Maternal infection
* Genetic deafness (autosomal dom or recess)
* Associated syndromes e.g. Down's
159
What maternal infections most commonly cause congenital deafness (2)?
* Rubella
* Cytomegalovirus
160
What are some perinatal causes of hearing loss (2)?
* Hypoxia during/ after birth
* Prematurity
161
What are some causes of hearing loss after birth (4)?
* Jaundice
* Meningitis
* Otitis media
* Chemo
162
How might hearing loss be picked up early on in childhood?
**Newborn hearing screening programme** - tests all neonates, looking for response to sounds
163
What is recorded on an audiogram?
* Left ear
* Right ear
* Bone conduction
* Air conduction
164
What are the 3 types of hearing loss?
* Sensorineural
* Mixed
* Conductive
165
What is the difference between sensorineural and conductive hearing loss?
* Sensorineural = nerve damaged so bone and air conduction decrease by similar amounts
* Conductive = problem conducting through ear so bone conduction normal and air decreased
166
What is mixed hearing loss?
Sensorineural and conductive element - air and bone conduction decrease, but air decreases more than bone
167
What professionals would be involved in a child with hearing loss (3)?
* Speech and language therapy
* Educational psychology
* ENT specialist
168
What is the medical term for a nose bleed?
Epistaxis
169
What is the most common area to be affected by epistaxis?
**Littles area** (area most affected by little finger) - at the front of the nose
170
What may a child who has swallowed blood during epistaxis present with?
Vomiting blood
171
What should a child be advised to do if they have a nose bleed (3)?
* Tilt head forward
* Squeeze soft parts of nose
* Spit any blood instead of swallowing
172
When should a child go to hospital with epistaxis (2)?
* Continues for more than 15 minutes
* Very severe/ from both nostrils
173
What is tongue tied known as?
Ankyloglossia
174
What does tongue tied usually present as?
Difficulty feeding/ attaching to nipple
175
What three cysts are most commonly found in the area around the neck?
* Cystic hygroma
* Thyroglossal cyst
* Branchial cyst
176
Where is a cystic hygroma?
Posterior triangle of neck
177
Where is a thyroglossal cyst?
Midline of the neck
178
Where is a branchial cyst?
Anterior border of sternocleidomastoid
179
What are do these 3 neck cysts typically present?
* Cystic hygroma = present from birth
* Thyroglossal cyst = age 2
* Branchial cyst = after age 10
