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The One Deck To Rule Them All > Paeds: Resp + ENT > Flashcards

Paeds: Resp + ENT Flashcards

1
Q

Respiratory red flags in paeds

when to admit via ambulance

A 
Apnoea
Looks unwell (mottled/blue)
Severe respiratory distress (grunting, chest recession, RR >70bpm)
Central cyanosis
Persistent SpO2 < 92% (air)
Decreased skin turgor
Does not wake if roused
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2
Q

Amber red flags in paeds

when to consider admitting

A 
RR > 60 bpm
Difficulty breastfeeding 
decreased oral intake (50-75% of usual)
Clinical dehydration
Crackles on auscultation
Nasal flaring
Dry mucous membranes 
Pallor
Decreased nappy wetting
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3
Q 
"Whooping cough" caused by vomiting
Coryza (2-3 days)
Cyanosis
Subconjunctival haemorrhages (from persistent coughing)
Paroxysmal cough
Apnoeic attacks
A

Pertussis

  • caused by bordetella pertussis (gram neg)
  • can last 10 weeks
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4
Q

Cause of Pertussis

A

bordetella pertussis

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5
Q

Investigations for pertussis

A

nasal swab

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6
Q

Management of pertussis

A

< 6 months old: Admit

Azithromycin/ Clarithromycin/ erythromycin
- if cough onset in 21 days

Can return to school 48hr from starting ABx

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7
Q

Respiratory distress in premature babies

A

Respiratory distress syndrome (RDS)
“Hyaline membrane disease”

Surfactant deficiency in alveoli leads to:

  • alveolar collapse
  • reduced lung volumes
  • reduced lung compliance
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8
Q

Surfactant is produced at

A

24weeks gestation

  • not sufficient quality until 34 weeks (hence why RDS affects premature babies)
  • produced in T2 alveolar cells
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9
Q

Risk factors for RDS

A 
Males
Maternal diabetes
IUGR <29w
C-section
Second twin delivered
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10
Q

Management for RDS

A
  • Give mother dexamethasone to induce foetal lung maturation
  • Surfactant (Curosurf) via ETT, given in first 6 hours since birth (pig lung extract)
  • CPAP
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11
Q

Most common cause of respiratory distress in newborns

A

Transient tachypnoea of the newborn (TTN)

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12
Q
  • Delayed reabsorption of the fluid into the lungs
  • Common in C-sections
  • XR: Hyperinflation of the lungs
    fluid in the horizontal fissure
A

Transient tachypnoea of the newborn (TTN)

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13
Q

Management of TTN

A

O2

Self resolves in a few days

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14
Q

Age: 6 months - 3 years
Barking cough
Stridor
Common in Autumn

A

Croup

  • caused by Human Parainfluenza viruses (HPIVs)
  • don’t examine airway due to risk of obstruction
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15
Q

Cause of croup

A

caused by Human Parainfluenza viruses (HPIVs)

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16
Q

CXR: Steeple sign

A

Croup

17
Q

Management of Croup

A

Dexamethasone (oral) + O2
- 0.15mg/kg

Severe: Nebulised adrenaline + O2

18
Q

The 3 Ds

  • Drooling
  • Dysphagia
  • Distress

Tripod position:

  • learning forward
  • extending neck
  • seated

Rapid increasing fever
High pitched sound on inspiration

A

Acute epiglottitis

  • caused by Haemophilus influenzae Type B
  • seen in unvaccinated kids
19
Q

Cause of acute epiglottitis

A

caused by Haemophilus influenzae Type B

20
Q

Lateral CXR: Thumb print sign

A

Acute epiglottitis

21
Q

Management of Acute epiglottitis

A

Senior help
O2
IV ABx

22
Q

Management of pneumonia in paeds

A
  1. Amoxicillin
  2. Macrolides (Erythromycin)

If associated with flu: Co-amoxiclav
If mycoplasma pneumoniae/ chlamydia: Macrolides

23
Q

Cause of pneumonia in paeds

A

Strep pneumoniae

24
Q 
Age: <12 months (usually 3-6m)
Grunting 
Corzyal symptoms 
SOB
Common in winter months
A

Bronchiolitis

  • caused by
    1. Respiratory Syncytial virus (RSV) - 80%
    2. Mycoplasma
  • worse symptoms if VSD
25
Q

CXR: Overinflated lungs
Perihilar haze
Scattered atelectasis
Immunofluerence of nasopharyngeal secretions

A

Bronchiolitis

26
Q

Bronchiolitis is caused by

A
  1. Respiratory Syncytial virus (RSV) - 80%

2. Mycoplasma

27
Q

Risk factors of bronchiolitis

A

Downs syndrome
Formula milk
<3m old
Premature

28
Q

Management to reduce future episodes of bronchiolitis

A

RSV Immunoglobin

Palivizumab

29
Q

Management of bronchiolitis

A

Humidified O2
NG feeds
Suction for airway secretions

30
Q

Heavy breathing
Stridor
Congenital softening of the cartilage of larynx

A

Laryngomalacia

Tx: Self resolving

31
Q

Cyanosis when feeding

Posterior airway is occluded by soft tissue or bone

A

Choanal atresia

Tx: Fenestration procedure

32
Q

Respiratory distress in newborn
Meconium in trachea
Common in post term babies

Risk factors:

  • maternal HTN
  • Pre-eclampsia
  • chorioamnionitis
  • smoking/ drug abuse
A

Meconium aspiration syndrome

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