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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What should do if think its asthma and QoL is affected?

A

QoL affected confirm diagnosis with a trial of ICS

QoL not affected, watch and see

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2
Q

What is asthma?

A

Chronic

Wheeze, Cough, SOB

Multiple triggers-although in children the predominant trigger is an URTI

Variable/reverisble

RESPONDS TO ASTHMA TX

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3
Q

Is asthma a diagnosis of exclusion?

A

NOOOOO

Key words:
- Wheeze
- Variability
- Respond to treatment

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4
Q

What causes asthma?

A
  • Host response to environment
  • Infection
  • Physiology abnormal before symptoms
  • It is a syndrome
  • Genetics (ADAM33, ORMDL3 (not all people with these genes have asthma))- interact with environment
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5
Q

What are some asthma syndromes (multiple hits)?

A

All go into a final common pathway

  • Infant onset
  • Childhood onset
  • Adult onset
  • Exertional asthma
  • Occupational asthma
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6
Q

Does allergy cause asthma?

A

Thats a nope (not directly related)

Primary epithelial (skin, airway, gut) abnormality results in:
1) Eczema/asthma etc
2) Allergy

Allergy then fuels (sensitisation) eczema/asthma etc

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7
Q

Early environment causes childhood asthma: what are some of these interventions to change environments to reduce exposure?

A
  • Feeding (breast, late weaning
  • Allergen (ante- and post natal)
  • Smoking
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8
Q

Is there a diagnostic test for asthma in children?

A

NO

Tests can be useful (excluding>diagnosing)

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9
Q

What makes spirometery useful?

A

Bronchodilator response to measure the lung function

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10
Q

Asthma diagnosis tests (more for exclusion of other things?

A
  • Spirometry
  • BDR
  • FeNO
  • Peak flow
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10
Q

Asthma diagnosis tests (more for exclusion of other things?

A
  • Spirometry
  • BDR
  • FeNO
  • Peak flow
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11
Q

Why is it hard to diagnose asthma in <5s?

A

Uncertainty greatest in <5s

Tests not reliable in <5s

Tests not great anyway

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12
Q

Does a cough variant asthma exist in children?

A

NOOOOOO

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13
Q

Rattle of … & the whistle of …

A

Rattle of bronchitis and the whistle of asthma

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14
Q

Do you get a Hx of SOB in asthma?

A

YES DUH

  • Sig resp difficult (<30% lung function)
  • Airway obstruction
  • ‘Sooking’ in of ribs with wheeze
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15
Q

What kind of cough is associated with asthma?

A
  • Dry
  • Nocturnal (just after falling asleep)
  • Exertional
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16
Q

What is the treatment/diagnosis of asthma?

A

ICS for 2 months

Remember false positive responses-inhaler holiday

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17
Q

What Hx do you ideally need to diagnose asthma (hindsight diagnosis)

A

Wheeze (with & w/o URTI)

SOB @ rest

Parental asthma

Responds to Tx

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18
Q

What are the harms of a trial of treatment for asthma and what are the benefits?

A

Harm=0.5-1cm loss in height, oral thrush

Benefit=helps diagnosis and if symptoms respond it improves QoL & reduces risk of attacks

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19
Q

What are the harms of a trial of treatment for asthma and what are the benefits?

A

Harm=0.5-1cm loss in height, oral thrush

Benefit=helps diagnosis and if symptoms respond it improves QoL & reduces risk of attacks

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20
Q

Under 18 months respiratory symptoms are most likely infection and >5 most likely asthma but…?

A

If it sounds like asthma & responds to asthma Tx it is asthma regardless of age!

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21
Q

Are asthma & VIW treated the same?

A

Yes-they are the same condition

  • Preschool children
  • Different shades of the same colour
  • Should be treated
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22
Q

Is there a cure for asthma?

A

No, only palliation or spontaneous resolution

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23
Q

How is control measured (what criteria)?

A

SANE

Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Exertional symptoms/week

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24
Q

If patient has been symptom free for 3 months what might you consider in asthma?

A

Stepping down the treatment

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25
Q

What is the starting treatment for asthma?

A

Low dose ICS (severe may respond to minimal treatment)

Review after 2 months (inhaler hol-easter)

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26
Q

ICS is the standard preventer so what is SABA?

A

Blue relieving medication

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27
Q

What is the max dose of ICS in <12 yo?

A

800microg

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28
Q

What is the first line preventer in <5s?

A

LTRA

29
Q

What are the contrasts between child and adult asthma meds?

A
  • No oral B2 tablet
  • No LAMAs
  • Only 2 biologics
30
Q

When should a regular preventer of asthma be used?

A
  • Diagnostic test
  • B2 agonists >2 days a week
  • Symptomatic 2 x a week or more or waking one night a week
31
Q

What can oral steroids cause?

A

HT & Cataracts

32
Q

Higher dose steroids (fluticasone in particular) can cause what?

A

Adrenocortical suppression

33
Q

How are LABAs given?

A

Not used without ICS

Used as a fixed dose inhaler

34
Q

What leukotriene receptor agonist is given?

A

Montelukast only in children

  • Rule of thirds
  • Granules for reluctant todlers
  • Oral - better adherance
35
Q

What should be added to an ICS if a patient is poorly controlled?

A

Add on a LABA but keep an open mind

Additional add on therapies include increase ICS and LTRA

36
Q

What are the 2 types of delivery system?

A

MDI/Spacer

Dry powder device-licensed in over 5s-under 8s cant use them

37
Q

How is a spacer of benefit?

A

<5% lung deposition w/o spacer

<20% lung deposition with spacer

MDI/spacer=4xMDI
Shake=2x no shake
Wash to reduce static charge=2x no wash

Shake, wash and use spacer

38
Q

Are nebulisers indicated for day to day use?

A

NO

39
Q

What is some other management for asthma that are not meds?

A
  • Stop tobacco smoke exposure
  • Remove environmental triggers
40
Q

What can air ionisers do?

A

Increase cough

41
Q

How in an acute setting is it worked out what meds to give?

A

Look at RR, work of breathing and O2 saturations

  • Confusion
  • Air entry
  • Ability to complete sentences

The level of treatment is determined by symptoms and sats (be guided by sats/oxygen requirement)

42
Q

What should you do in acute asthma after you have started treatment?

A

Reassess in 1 hr

Step up or down as appropriate

43
Q

What is the difference in the use of steroids for chronic and acute asthma?

A

Chronic/maintenance= inhaled steroids (NOT oral)

Acute= oral steroids

44
Q

What are some side effects of Abx?

A
  • Diarrhoea
  • Oral thrush
  • Nappy rash
  • Allergic reaction
  • Multi-resistance
45
Q

What are some examples of anti-pyretics?

A

Paracetamol and ibuprofen for fever

46
Q

Rhinitis is usually a self limiting condition but what could it be a predrome to?

A
  • Pneumonia, bronchiolitis
  • Meningitis
  • Septicaemia
47
Q

What is ottitis media?

A

Infection in the middle ear

  • Erythema
  • Bulging drum
  • Common and self limiting
  • Spontaneous rupture of drum
  • Abx Tx doesn’t usually help
48
Q

What is the secondary infection of otitis media?

A

Pneumococcus/H’flu

49
Q

How is otitis managed?

A
  • ANALGESIA
  • Abx may work >24hrs
50
Q

With tonsilitis/pharyngitis how is it managed?

A

Throat swab-bacterial or viral

Viral=nothing
Bacterial=10 days penicillin

(Don’t use amoxycillin-EBV get rash)

51
Q

What is characteristics of strep throat?

A
  • Scarlet fever-faint pink rash - sandpaper like feel
  • Pallor around the mouth
  • Temp & poor energy
52
Q

What is the treatment for croup (LTB)?

A

Oral dexamethasone

Duration of croup 1-2 days

53
Q

What are the signs and treatment of epiglottits?

A
  • Stridor, drooling
  • Intubation & Abx
54
Q

What is tracheitis, what is it caused by and how is it managed?

A

Fever, sick child-‘croup which doesn’t get better’

Staph or strep invasive infection

Augmentin

55
Q

Bronchitis is an endobronchial infection where the child is very well but the parent is worried. How does it present?

A
  • Loose rattly cough with URTI
  • Post tussive vomit-‘glut’
  • Chest free of wheeze/creps
  • Haemophilus/pneumococcus
  • Mostly self limiting
56
Q

What is the mechanism of bacterial bronchitis?

A
  • Disturbed mucocilliary clearance-mild airway malacia, RSV/adenovirus

Bacterial infection is secondary

57
Q

What is the natural Hx of bacterial bronchitis?

A
  • Lasts 4 weeks following an URTI
  • Third winter fine
  • Pneumococcus/H flu
58
Q

How to manage persistent bacterial bronchitis?

A

Make the diagnosis-reassure-do not treat

59
Q

What causes bronchiolitis (LRTI of infants) & how does it present?

A

Usually RSV-others incl. paraflu III, HMPV

  • Nasal stuffiness, tachypnoea, poor feeding
  • Crackles +/- wheeze

Bronchiolitis is very predictable

RSV for XMAS!!

  • <12 months old
  • One off (NOT recurrent)
  • Typical Hx
60
Q

How do we investigate Bronchiolitis?

A
  • NPA
  • Oxygen sats (severity)

No routine need for CXR, Bloods & bacterial cultures

61
Q

What are the main characteristics of a LRTI?

A

48 hrs, fever (>38.5), SOB, cough, grunting

  • Wheeze makes bacterial cause unlikely
  • Reduced or bronchial breath sounds
62
Q

Only call pneumonia instead of LRTI if have…?

A
  • Signs are focal (ie in one area (LLZ))
  • Creps
  • High fever
63
Q

Is CRX indicated in CAP?

A

NO, CXR & inflam markers are NOT ‘routine’

64
Q

What is the management for CAP?

A
  • Nothing if symptoms are mild
  • Oral Amoxycillin 1st line
  • 2nd line=Oral macrolide
  • Only for IV if vomiting
65
Q

When should oral Abx be used and not IV?

A
  • Abx are indicated (48 hrs etc)
  • In non severe LRTI
  • When child is not vomiting
66
Q

What is the difference between LRTI & Bronchiolitis?

A

LRTI= In all ages, more rapid onset of symptoms, fever

Bronchiolitis=<12 months, 3 days before reach peak, fever rarely >38 degrees

67
Q

Is pertussis common?

A

YES

Vax reduces risk and severity

68
Q

What are the symptoms of Pertussis?

A
  • Coughing fits
  • Vomiting & colour change
69
Q

What is empyema and what is it a complication of?

A

Complication of pneumonia

Extension of infection into pleural space

70
Q

How does empyema present and how is it treated?

A

Chest pain & very unwell

Abx +/- drainage

Good prognosis (in contrast with adults)

Paediatrics (17 decks)

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