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1
Q

What are some symptoms of Asthma in paeds?

A

Recurrent cough worse at night/exercise
Expiratory wheeze
SOB

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2
Q

What are some triggers of asthma?

A

Cold
Allergens
Exercise
Smoke

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3
Q

How can suspected asthma be investigated in children?

A

Peak Flow if >5y
Clinical Diagnosis if <5y
CXR - Rule out PTX if suspicious

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4
Q

What are symptoms of an acute asthma attack in paeds?

A 
Acute SOB
Cough
Wheeze
Increased work of breathing
Frightened
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5
Q

How is a mild asthma attack defined for paeds?

A

Breathless
Not distressed
PEF >50%

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6
Q

How is a severe asthma attack defined for paeds?

A

Too breathless to talk/feed
RR>50
Pulse >130
PEF <50%

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7
Q

How is a life-threatening asthma attack defined for paeds?

A 
PEF <33%
Silent chest
Cyanosis
Fatigue
Drowsiness
Confusion
Hypotension
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8
Q

How should Asthma be managed in under 5y?

A
  1. SABA - Salbutamol
  2. Regular LTRA - Montelukast
  3. Low Dose ICS + LTRA
  4. Increasing doses of ICS
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9
Q

How should asthma be managed in over 5y?

A
  1. SABA - Salbutamol
  2. Low dose ICS
  3. Low dose ICS + LABA/LTRA
  4. Increase ICS dose or add LABA/LTRA
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10
Q

What should be used with an inhaler in under 5y?

A

Metered dose inhaler with a spacer

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11
Q

How can acute exacerbations of asthma in kids be managed?

A 
Reliever medication
Aggressive treatment with:
High Flow O2
Beta 2 Agonists
Ipratroprium Bromide
Systemic Corticosteroids
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12
Q

Which gene is responsible for development of Cystic Fibrosis?

A

Mutation of CFTR gene on Chromosome 7

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13
Q

What is the pathophysiology behind Cystic Fibrosis?

A

Excessive thick secretions obstruct small and large airways giving recurrent infections

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14
Q

What are some of the systemic effects of CF?

A 
ENT - Polyps, Sinusitis
Liver - Biliary Stasis
Poor Growth - Malabsorption
GI - Pancreatic insufficiency, DM, Meconium Ileus
Congenital absence of Vas Deferens
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15
Q

What are some complications of CF?

A 
Recurrent chest infections
Malabsorption due to pancreatic insufficiency
DM
Salt loss
Biliary stasis
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16
Q

How is CF diagnosed?

A

Newborn - Bloodspot screening
Gene testing
Sweat Test - Measures NaCl

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17
Q

How should confirmed CF be managed?

A

Nutritional and respiratory support

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18
Q

What is Whooping Cough?

A

Highly infectious notifiable disease due to Bordella Pertussis, particularly in infants under 3m

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19
Q

When are children vaccinated against Pertussis?

A

2m, 4m, 3y4m

20
Q

What are the distinct phases of Whooping cough?

A

Catarrhal Phase
Paroxysmal Phase
Convalescent Phase

21
Q

How does the Catarrhal Phase of Whooping Cough present?

A 
Rhinitis
Conjunctivits
Irritability
Sore Throat
Low-grade fever
Dry cough
22
Q

How does the Paroxysmal of Whooping Cough present?

A

Episodes of severe coughing followed by a characteristic inspiratory “Whoop”

23
Q

How does the Convalescent Phase of Whooping Cough present?

A

Cough decreases in severity over 3m

24
Q

What will be found upon examination with Whooping cough?

A 
Normal 
Low grade fever
Conjunctival haemorrhoage
Facial petichiae
Auscultation - Normal
25
Which investigations are appropriate for suspected Whooping Cough?
Culture of Nasopharyngeal Aspirate IgG Serology FBC
26
How should confirmed Whooping Cough be managed?
Admit if <6m, significant breathing/feeding problems | Clarithromycin to reduce infectivity
27
How long should a Whooping Cough patient avoid school for?
Either until: They've had the cough for 21 days They've taken Clarithromycin for 5 days
28
What is Croup?
A viral URTI leads to mucosal inflammation giving a cough
29
What are common causative organisms of croup?
Parainfluenza Adenovirus Rhinovirus Influenza A+B
30
What are some risk factors for Croup?
Male Autumn/Spring seasons Genetic variation
31
What are some symptoms of Croup?
``` 10-14d history of: Non-specific cough Rhinorrhoea Fever Progression to barking cough ```
32
What are some clinical signs of Croup?
``` Stridor Normal chest/reduced air entry Tachypnoea/Tachycardia Recession Cyanosis Lethargy Reduced Consciousness ```
33
How does mild Croup present?
Occasional cough No stridor at rest No recession
34
How does moderate Croup present?
Frequent cough Audible stridor at rest Suprasternal and Chest Wall retraction at rest
35
How does severe Croup present?
Frequent cough Prominent inspiratory stridor at rest Marked retractiosn Distressed child at rest
36
How should Croup be managed?
Mild - Supportive, NSAIDs | Moderate/Severe - IP admission, Oral Steroids, Nebulised Adrenaline
37
What are some potential complications of Croup?
``` Lymphadenitis Otitis Media Dehydration Pulmonary Oedema Pneumothorax ```
38
What is Bronchiolitis?
A viral infection of bronchioles by Respiratory Syncytial Virus 1 which is common in children under 3y in winter and spring
39
What happens in Bronchiolitis?
Infection leads to mucus hypersecretion, bronchiolar constriction, hyperinflation, increased airway resistance, atelectasis and VQ mismatch
40
What are some risk factors for Bronchiolitis?
Breast fed for <2m Smoke exposure Has siblings that attend nursery Prematurity
41
What are some symptoms of Bronchiolitis?
``` Increasing severity for 2-5d of: Low grade fever Nasal congestion Rhinorrhoea Cough Feeding Difficulty ```
42
What may be found upon examination with Bronchiolitis?
``` Tachypnoea Grunting Nasal Flaring Recessions Inspiratory crackles Expiratory Wheeze Hyperinflated chest Cyanosis/Pallor ```
43
Which investigations are appropriate for suspected Bronchiolitis?
``` Throat swab for RSV Blood/Urine cultures FBC ABG CXR ```
44
How should bronchiolitis be managed?
At home with supportive measures
45
When should bronchiolitis be admitted?
O2 <92% Fluids/NGT needed CPAP
46
What are some complications of bronchiolitis?
``` Hypoxia Dehydration Fatigue Respiratory failure Cough/Wheeze Bronchiolitis Obliterans ```

Paeds (11 decks)

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