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Paeds resp Flashcards

1
Q

Give 4 symptoms of pneumonia ?

A
  • Cough (wet and productive)
  • High fever (>38.5)
  • Lethargy
  • Delirium
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2
Q

Give 5 signs of pneumonia

A
  • Tachypnoea
  • Tachycardia
  • Increased work of breathing
  • Hypoxia
  • Hypotension
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3
Q

Give 3 investigations for pneumonia

A
  • Sputum cultures and throat swabs for bacterial cultures and viral PCR
  • Blood culture
  • CXR : consolidation
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4
Q

Give 3 chest signs of pneumonia

A
  • Bronchial breath sounds
  • Focal coarse crackles
  • Dullness to percussion
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5
Q

Causes of pneumonia by age

A
  • Newborn : GBS or enterococci
  • Infant + > 5 yrs : strp pneumonia or RSV
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6
Q

Give 3 viral causes of pneumonia

A
  • RSV -> most common
  • Parainfluenza virus
  • Influenzavirus
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7
Q

What is the management for mild pneumonia ?

A

-Oral amoxicillin
- Add macrolide if no response (e.g. erythromycin)
- Co-amoxiclav in pneumonia associated with influenza

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8
Q

What is the management for severe pneumonia?

A

-Iv benzylpenicillin

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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

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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15
Q

What is the most common viral cause of bronchiolitis ?

A

-RSV -> respiratory syncytial virus

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16
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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17
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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18
Q

Give 8 signs of respiratory distress

A
  • Raised resp rate
  • Use of accessory muscles : sternocleidomastoid, abdominal and intercostal muscles
  • Nasal flaring
  • Heading bobbing
  • Tracheal tug
  • Cyanosis
  • Abnormal airway noises
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19
Q

what would suggest a diagnosis of pneumonia over bronchiolitis ?

A
  • High fever (>39 degrees)
  • Persistently focal crackles
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20
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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21
Q

How is bronchiolitis managed in hospital ?

A

Supportive

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22
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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23
Q

What 3 factors suggest viral induced wheeze over asthma?

A

<3 yrs

  • No atopic history
  • Only occurs following a viral infection
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24
Q

What is the presentation of a viral induced wheeze?

A
  • Evidence of a viral illness (fever, cough and coryzal symptoms) before onset of :
  • SOB
  • Expiratory wheeze throughout the chest
  • Signs of respiratory distress
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25
What is cystic fibrosis ?
-Autosomal recessive condition affecting the mucus glands, most commonly caused by Delta-F508 mutation of CFTR gene on chromosome 7
26
what is the most common mutation in CF?
- Delta-F508 mutation of CFTR gene on chromosome 7
27
How is CF diagnosed ?
- Newborn bloodspot test - Sweat test : gold standard
28
What is an early sign of CF
- Meconium ileus
29
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
30
Give 5 signs of CF
- Low weight or height on growth charts - Nasal polyps - Finger clubbing - Crackles and wheeze on auscultation - Abdo distention
31
What is the gold standard test for CF?
- Sweat test - Pilocarpine is applied to a patch on the skin, electrodes are placed either side and a small current passed between the electrodes. - The sweat is absorbed and tested for chloride concentration
32
What chloride concentration is diagnostic for CF on a sweat test
>60mmol/L
33
What are 2 common microbial colonisers in people with CF?
- Staph aureus : long term prophylactic flucloxacillin taken - Psuedomonas aeruginosa : treated with nebulised tobramycin
34
What is epiglottitis ?
-Inflammation and swelling of the epiglottis caused by infection
35
What is the cause of epiglottitis ?
-Haemophilus influenzae type B
36
Give 5 presenting symptoms of epiglottitis
Rapid onset : - High fever - Sore throat - Drooling - Difficulty or painful swallowing - Muffled voice
37
Give 4 signs of epiglottitis
- Tripod position - Scared and quiet child - Septic and unwell appearance - Soft, whispering stridor
38
How is epiglottitis diagnosed?
- Lateral X-ray of the neck -> 'thumb' or 'thumbprint' sign - However if child is acutely unwell, don't waste time with Ix
39
How is epiglottitis managed ?
1) Don't examine throat 2) Call ENT and anaestehtics 3) Intubate and IV 3rd gen cephalosporin (cefuroxime)
40
What is a complication of epiglottitis ?
-Epiglottic abscess
41
What is whopping cough and what causes it ?
- URTI - Bordetella pertussis (gram neg)
42
How does whooping cough present ?
- 1 wk Preceding coryza - 3- 6 wks severe paroxysmal coughing fits with large inspiratory whoop. - Possible apnoea presentation
43
How is pertussis diagnosed ?
- 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
44
How is whooping cough managed ?
- <6 mnths. = admit - Oral macrolide if within 21 days of cough (erythromycin) - Household prophylaxis - School exlusion : 48 hrs after starting Abx
45
What is a key complication of whooping cough ?
-Bronchiectasis
46
How does a moderate acute exaccerbation of asthma present ?
- Peak flow >50% predicated - Normal speech
47
How does a severe asthma exacerbation present ?
- Peak flow <50% predicated - Saturations <92% - Unable to complete sentances in one breath - Signs of resp distress - Resp rate : >40 in 1-5 or >30 in over 5's - HR : >140 in 1-5 yrs or >125 in over 5's.
48
How does a life threatening asthma exacerbation present ? (8)
- Peak flow <33% - Saturations <92% - Exhaustion and poor resp effort - Hypotension - Silent chest - Cyanosis - Altered consciousness / confusion
49
What are the stepwise medications used in viral induced wheeze / acute asthma
- Oxygen (if <94%) - Bronchodilators - Steroids - Antibiotics
50
What is the discharge plan in acute asthma?
-Can be discharged once on 6 puffs 4 hrly of salbutamol
51
What is determined as mild croup
- 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
52
What is defined as moderate croup
- 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
53
What is defined as severe croup
- Frequent barking cough - Prominent inspiratory stridor - Marked sternal wall retractions - Significant distress and agitation, or lethargy or restlessness - Tachycardia and hypoxaemia
54
When is a child admitted with croup
- Moderate or severe - <6 mnths - Known upper airway abnormalities - Uncertainty about diagnosis
55
what can be seen on bloods in whooping cough
Marked lymphocytosis
56
How is asthma diagnosed in >5
-> Peak flow (2/3 times daily for 2 wks) -> Spirometry with reversibility -> FeNO can support
57
What would be seen on spirometry with asthma
- FEV1/FVC : <70% - Reversibility : Improvement of 12% or more
58
what is a common finding in CF in a male
Bilateral absence of vas deferens
59
Give the stepwise management of croup
- Oral dex - Oxygen - Nebulised budenoside - Nebulised adrenaline - Intubation and ventilation
60
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
61
How is a mild asthma attack managed ?
- Salbutamol inhalers via spacer
62
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

3a (45 decks)

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