Respiratory Flashcards
(118 cards)
1
Q
What is bronchiolitis?
A
Inflammation and infection in the bronchioles (small airways of the lungs) and is usually caused by a virus.
2
Q
What is the most common cause of bronchiolitis?
A
Respiratory syncytial virus.
3
Q
What is found on examination of a child with bronchiolitis?
A
Tachycardia Tachypnoea Recession Hyperinflation of the chest Fine end Inspiratory crackles High pitched wheezes Tachycardia Cyanosis or pallor
4
Q
When do children usually get bronchiolitis?
A
Generally in children under 1 year and most common in infants under 6 months.
5
Q
What are the symptoms of bronchiolitis?
A
Coryzal symptoms followed by dry cough and breathlessness.
6
Q
What are the signs of respiratory distress?
A
Raised resp rate Use of accessory muscles Intercostal and subcostal recessions Nasal flaring Tracheal tugging Cyanosis Abnormal airway noises
7
Q
What is wheezing?
A
Whistling sound typically heard on expiration, caused by airway narrowing.
8
Q
What is grunting?
A
Caused by exhaling with the glottis partially closed in order to increase positive end expiratory pressure.
9
Q
What is stridor?
A
A high pitched Inspiratory noise which is caused by obstruction of upper airway an example is: croup.
10
Q
What is the course of respiratory syncytial virus?
A
Usually starts as an URTI with coryzal symptoms, from this point around half get better spontaneously, the other half develop chest symptoms which are worse around day 3 or 4. Usually resolved within 2-3 weeks.
11
Q
What are the reasons for admission of infants?
A
Aged under 3 months or any pre existing condition- prematurity, Down’s syndrome or cystic fibrosis.
50-75% of their normal milk intake.
Clinical dehydration
Resp rate over 70
O2 sats below 92%
Moderate to severe resp distress, such as: deep recessions or head bobbing
Apnoeas
Parents not confident in their ability to manage at home or difficulty accessing medical help from home.
12
Q
What is the management of bronchiolitis?
A
Typically only supportive
Ensuring adequate intake- could be either via NG tube or IV fluids depending on severity. But always star with small feeds as a full stomach will restrict their breathing.
Saline nasal drops and nasal suctioning help clear nasal airways before feeding
Supplementary oxygen
Ventilatory support
13
Q
What are the options for ventilatory support?
A
High flow humidified oxygen via. Tight nasal cannula
Continuous positive airway pressure
Intubation and ventilation (inserting an endotracheal tube into the trachea).
14
Q
What can be given to babies to protect them from the respiratory syncytial virus? And what kind of patients would Recieve it?
A
Palivizumab (monthly injection- provides passive protection)
15
Q
What is a viral induced wheeze?
A
Acute wheezy illness caused by a viral infection.
16
Q
What is the pathophysiology behind a viral induced wheeze?
A
Small children have small airways, when these small airways encouter a virus (commonly RSV) they develop inflammation and oedema, swelling the walls of the airways and restricting the space for air to flow. This inflammation also triggers the smooth muscles of the airways to constrict, further narrowing the space for air to flow
Air flowing through the narrow airways causes a wheeze!
17
Q
What distinguishes a viral induced wheeze from asthma?
A
Presenting before 3 years of age
No atopic history
Only occurring during viral infections.
Asthma can also be triggered by viral or bacterial infections, however it has other triggers: exercise, weather, dust, strong emotions.
18
Q
What is the presentation of viral induced wheeze?
A
Shortness of breath
Signs of resp distress
Expiratory wheeze throughout the chest (never focal)
19
Q
What is the presentation of acute asthma?
A
Presents with rapidly worsening symptoms…
SOB
Signs of resp distress
Tachypnoea
Expiratory wheeze (heard throughout chest)
Chest can sound tight on auscultation, with reduced air entry
Silent chest is an ominous sign :(
20
Q
What is the BTS criteria for moderate acute asthma in children?
A
Peak flow >50%
Speech normal
No features listed for severe or life threatening.
21
Q
What is the BTS criteria for severe asthma?
A
Peak flow <50% predicted
Saturation’s <92%
Unable to complete sentences in one breath
Signs of respiratory distress
A resp rate >40 in 1-5 years
Or >30 in 5+
HR
> 140 in 1-5 years
>125 in 5+
22
Q
What is the management of mild acute asthma in children?
A
Mild cases can be managed as an outpatient with regular salbutamol inhalers via. A spacer (4-6 puffs every 4 hours)
23
Q
What is the management of acute asthma which is moderate to severe?
A
Steroids (continue for 3 days)
Oxygen
Salbutamol
24
Q
When the child is looking well consider stepping down the number and frequency of intervention, what is an example of a typical step down regime?
A
10 puffs 2 hourly
10 puffs 4 hourly
6 puffs 4 hourly
4 puffs 6 hourly
25
What should you monitor when treating a patient on high doses of salbutamol?
Potassium as salbutamol causes potassium to be absorbed from the blood into the cells.
26
When you are discharging a child with acute asthma, what should you do?
Discharge when a child is well on 6 puffs 4 hourly and prescribe a reducing regime to continue at home.
Other steps:
. Finish steroid course
. Provide safety net information
. Provide individualised written asthma action plan.
27
What is chronic asthma?
A chronic inflammatory airway disease which leads to variable airway obstruction. The smooth muscle of the airways re hypersensitive and respond to stimuli by constricting and causing airflow obstruction. The airway constriction in asthma is reversible with bronchodilators.
28
What presentation would suggest a diagnosis of asthma?
Dry cough with wheeze and SOB
Episodic symptoms with intermittent exacerbation
Diurnal variability (worse at night and early morning)
Typical triggers
He of other atopic conditions- eczema, hay fever, food allergies
FH of atopy or asthma
Bilateral widespread polyphonic wheeze
Symptoms which improve with bronchodilators.
29
What are the typical triggers of asthma?
Dust (house dust mites)
Animals
Cold air
30
What are the investigations used in asthma?
No gold standard, usually a clinical diagnosis
Children are usually not diagnosed until they are at least 2-3 years old
When there is a low probability of asthma, a trial of treatment can be implemented and if this improves the symptoms then a diagnosis can be made
When there is an intermediate or high probability of asthma, a trial of treatment can be implemented and if this improves symptoms then a diagnosis can be made
Investigations where there is a diagnostic doubt...
Spirometry with reversibility testing
Peak flow variability- diarys
FeNO
Direct bronchial challenge test with histamine or methacholine
31
What is the medical therapy for asthma in under 5’s?
1. SABA- salbutamol, as required
2. Add a low dose corticosteroid inhaler or a leukotriene antagonist (Montelukast)
3. Add the other option from step 2
4. Refer to a specialist
32
What is the medical therapy for ages 5-12?
1. SABA
2. Regular low dose corticosteroid
3. LABA
4. Titrate up corticosteroid and consider adding: oral leukotriene receptor antagonist (montelukast) and oral theophylline
5. Increase the dose or the inhaled corticosteroids to a high dose
6. Refer to specialist, they may require daily oral steroids.
33
What is the treatment of asthma in over 12 years?
This is the same as adults
1. SABA as required
2. Regular low dose corticosteroid inhaler
3. LABA
4. Increase ICS dose to medium, consider addition of oral leukotriene receptor antagonist, oral theophylline, inhaled LAMA (tiotropium)
5. Titrate ICS to a high dose, combine additional treatments from step 4
6. Add oral steroids at the lowest possible dose to achieve good control under specialist guidance.
34
Pneumonia can be caused by virus, bacteria and atypical bacteria, give an example of an atypical bacteria which causes pneumonia...
Mycoplasma
35
What is the presentation of pneumonia?
```
Tachycardia
Tachypnoea
High fever (>38.5)
Lethargy
Delirium (acute confusion associated with infection)
Increased work of breathing
```
36
What derangement sin physical observations, can be seen in pneumonia?
```
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
```
37
What are the characteristic chest signs of pneumonia?
Bronchial breath sounds
Focal coarse crackles
Dullness to percussion
38
What are the bacterial causes of pneumonia?
Strep pneumonia (most common)
Group A strep (strep Pyogenes)
Group B strep (often occurring in pre vaccinated infants, contracted during birth from GBS colonising vagina)
Staph aureus
Haemophilia influenza
Mycoplasma pneumonia (atypical bacteria with extra pulmonary manifestations- erythema multiforme)
39
What are the viral causes of pneumonia?
Respiratory syncytial virus
Parainfluenza virus
Influenza virus
40
What are the investigations for pneumonia?
Capillary blood gas can be useful sometimes
CXR (although this isn’t required)
Throat swabs and sputum culture for bacterial cultures and viral PCR
41
What is the treatment of pneumonia in children?
ABx according to local guidelines
Usually amoxicillin and a macrolide can be added (erythromycin, clarithromycin)
Macrolides can be used as mono therapy
42
If a child is experiencing recurrent lower respiratory tract infections, what investigations should be done?
. FBC- checks WBC
. Chest X-ray (shows structural abnormalities)
. Immunoglobulin G for previous vaccinations (looks for immunoglobulin class switch recombination deficiency)
. Sweat test for CF
. HIV test (if mums is unknown or positive)
. If suspecting PCD then nasal brushing or bronchoscopy to get a sample of ciliated epithelium and examine the cilia.
43
What is croup?
Croup, also known as laryngotracheobronchitis, is an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough
Most common in children aged 6 months- 2 years
44
What are the causes of croup?
Parainfluenza virus (most common)
Influenza
Adenovirus
Respiratory syncytial virus
Croup was also previously caused by diphtheria however this has a high mortality.
45
What is the presentation of croup?
Classically presents with a barking, seal-like cough. There can also be stridor if the child is upset. This is why it is important to keep the child calm and to avoid putting in cannulas if possible.
46
What is the management of croup?
```
Admit if:
Child is under 6 months old
Graded severe stridor at rest
Resp distress
Child looks unwell
```
In these patients the following treatment is required:
Can be memorised as ODA
O= oxygen
D= dexamethasone PO 0.15kg/kg or budesonide neb 2mg
A= adrenaline nebulised (5ml 1:5000)
47
What is epiglottitis?
Inflammation and swelling of the epiglottis caused by infection.
48
What pathogens cause epiglottitis?
Usually a bacterial infection- HIB, group A beta haemolytic streptococci, pseudomonas, pneumococcus
Viruses (HSV)
Fungi (Candida albicans)
(Also traumatic insults such as heat or chemical injury can cause it!)
49
What is the presentation of epiglottitis?
Symptoms: can be remembered as the 4 Ds
Dysphagia (and odynophagia), dysphonia, drooling, dyspnoea
A rapidly progressing sore throat should prompt this diagnosis
Signs:
Looking unwell
Tripod position (child leans forward with both arms outstretched and their tongue out)
Baseline observations show a high temperature
Cervical lymphadenopathy
Respiratory distress
INSPIRATORY STRIDOR is a late sign and indicates upper airway narrowing
50
What investigations should be done for epiglottitis?
As epiglottitis is an emergency, diagnosis is often based on history and examination.
Laryngoscopy is the gold standard but not really done and should be performed in an area that has access to an emergency airway,
Very rarely a pan X-ray of the lateral cervical neck may be done which will show enlarged, swollen epiglottis- the thumbprint sign
Swabs are taken from the throat for MC and S
Bloods:
Culture
Blood gases (if sepsit their would be raised lactate and a metabolic acidosis)
FBC, CRP and U&Es
51
What is the management of epiglottitis?
Do not distress child! Keep well away make sure child is comfortable and inform most senior paediatrician and anaesthetist.
Most children don’t need to be intubated but make sure the airway is secure.
Additional treatment once the airway is secure= IV ABx (ceftriaxone) and steroids (dexamethasone)
52
What is a complication of epiglottitis which is really serious?
Epiglottic abscess
53
What is whooping cough?
Pertussis (whooping cough) is a severe URTI characterised by severe bouts of spasmodic coughing, which may lead to apnoea in infants, followed by characteristic gasping for breath.
It is caused by bordetella pertussis and there has been a recent resurgence even in vaccinated countries due to lower vaccination uptake.
54
What is the presentation of percussis ?
Symptoms seen in pertussis infection:
```
Cough
Inspiratory whooping
Rhinorrhoea
Post-tussive vomiting
Decreased food intake
```
55
How do you diagnose whooping cough?
Nasopharyngeal or nasal swab with PCR testing or bacterial culture to confirm the diagnosis within 2 to 3 weeks of the onset of symptoms
When the cough has been present for more than 2 weeks then patients can be tested for the anti pertussis immunoglobulin G. The anti pertussis immunoglobulin G can be tested in the oral fluid of children aged 5-16 or in blood of those aged over 16.
56
What is the management of pertussis?
1st line treatment in children over 1 month of age is with azithromycin.
2nd line treatment in children over 1 month of age is with trimethoprim/sulfamethoxazole
If under 6 months
57
What is a potential complication of whooping cough?
It has a really long duration- can be known as 100 day cough!
Apnoea is a rare but life-threatening acute complication of pertussis
Pneumonia either due to bordetella pertusssis or secondary to another organism
Seizure triggered by cerebral hypoxia which can develop during severe cough paroxysms
Otitis media is the most common complication in pertussis and is often seen in the following few weeks
58
What is chronic lung disease of prematurity also known as?
Bronchopulmonary dysplasia
59
What is chronic lung disease of prematurity?
It occurs in premature babies, typically those born before 28 weeks gestation. These babies suffer with respiratory distress syndrome and require oxygen therapy or intubation and ventilation at birth. Diagnosis is made based on chest X-ray changes and when the infant requires oxygen therapy after 36 weeks gestational age.
60
What are the features of chronic lung disease of prematurity?
```
Low O2 sats
Increased work of breathing
Poor feeding and weight gain
Crackles and wheezes on chest auscultation
Increased susceptibility to infection.
```
61
What measures can be taken to prevent chronic lung disease of prematurity?
Giving corticosteroids eg: betamethasone to mothers who show signs of premature labour at less than 36 weeks gestation, this helps to speed up the development of the fetal lungs before birth and reduce the risk of CLDP occurring.
Using CPAP rather than intubation and ventilation when possible
Using caffeine
Not over oxygenating with supplemental oxygen
62
What is the management of CLDP?
Formal sleep study to assess the oxygen sats during sleep supports the diagnosis and guides management.
Babies may be discharged from the neonatal unit on a low dose of oxygen to continue at home, they are followed up to slowly wean off oxygen over the first year of life.
Babies with CLDP require protection against resp syncytial virus to reduce the risk and severity of bronchiolitis, this involves monthly injections of a monoclonal antibody against the virus (called palivizumab) this is very expensive and therefore is reserved for babies meeting certain criteria.
63
What is cystic fibrosis?
Autosomal recessive genetic condition which affects the mucus glands. It is caused by a genetic mutation of the cystic fibrosis transmembrane conductance regulatory gene on chromosome 7.
64
What are the key consequences of the cystic fibrosis mutation?
Thick pancreatic and biliary secretions causing blockage of the ducts, resulting in a lack of digestive enzymes in the digestive tract
Low volume thick is way secretions which reduce airway clearance and lead to bacterial colonisation and infections.
Congenital bilateral absence of vas deferens (Male infertility)
65
How will cystic fibrosis present in terms of symptoms?
In a neonate it normally presents as- failure to thrive, meconium aspiration, rectal prolapse
In terms of respiratory features…
- chronic sinusitis
- nasal polyps
- cough, wheeze, haemoptysis
- recurrent, lower RTI
- bronchiectasis
- pneumothorax
- cor pulmonare
- resp failure
66
What are the signs of CF?
```
Low weight or height on growth charts
Nasal polyps
Finger clubbing
Crackles and wheezes on auscultation
Abdominal distension
```
67
What are the causes of clubbing in children?
```
Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
TB
IBD
Liver cirrhosis
```
68
How do you diagnose CF?
Newborn blood spot testing
Sweat test is gold standard for diagnosis
Genetic testing for CFTR gene can be performed during pregnancy by amniocentesis or chorionic villus sampling.
69
What chloride concentration in the sweat test is diagnostic of CF?
More than 60mmol/l
70
Patients with cystic fibrosis struggle to clear the secretions in their airways, what are examples of common colonisers in CF?
Two key ones to remember for exams= Staph aureus and pseudomonas
Others= E. coli, haemophilus influenza, klebsiella pneumoniae, burkodheria cepacia, pseudomonas aureginosa.
71
What is a particularly troublesome bacteria in CF you should remember?
Pseudomonas! Staph aureus can be treated with long term prophylactic flucloxacillin.
72
How can pseudomonas colonisation be treated?
Long term nebulised antibiotics ie: tobramycin. Oral ciprofloxacin can also be used.
73
What is the management of CF?
Chest physiotherapy
Exercise helps improve respiratory function and reserve and helps to clear sputum
A high calorie diet is required for malabsorption, increased resp effort, coughing, infections and physiotherapy
CREON tablets to digest fats in patients with pancreatic insufficiency
Treat chest infections when they occur
Bronchodilators (salbutamol- help treat bronchoconstriction)
Nebulised DNase (dornase Alfa)
Nebulised hypertonic saline
Vaccinations- pneumococcal, influenza, varicella
74
What is nebulised DNase (dornase alfa)?
An enzyme that can break down DNA material in respiratory secretions, making the secretions less viscous and easier to clear.
75
How should you monitor CF patients?
Should be seen every 6 months
| Need screening for diabetes, osteoporosis, vit D deficiency (this is a fat soluble vitamin) and liver failure.
76
What are the complications of CF?
90% of patients develop pancreatic insufficiency
50% develop diabetes and require insulin treatment
30% develop liver disease
Most males are infertile due to no vas deferens
77
What is primary ciliary dyskinesia?
Autosomal recessive disorder which causes dysfunction of motile cells around the body, most notably the respiratory tract. It leads to a buildup of mucus in the lungs,providing a great site for infection which is not easily cleared.
78
What does primary ciliary dyskinesia present with?
Similar presentation to cystic fibrosis - frequent and chronic chest infections, poor growth and bronchiectasis.
Also affects cilia in the Fallopian tubes of women and the tails (flagella) of the sperm in men, leading to reduced or absent fertility.
79
What is another name for primary ciliary dyskinesia
Kartagners syndrome
80
What is the kartagners triad?
This describes three features of PCD...
. Paranasal sinusitis
. Bronchiectasis
. Situs inversus
81
What is situs inversus and what is its link with primary ciliary dyskinesia?
This is a condition where all the internal (visceral) organs are mirrored inside the body
25% of patients with situs inversus will have primary ciliary dyskinesia, 50% of patients with primary ciliary dyskinesia will have situs inversus
82
How do you diagnose PCD?
Recurrent respiratory tract infections
Take a careful HCL and H2 of consanguinity in the parents
Examination and imaging (CXR) can be used to diagnose the situs inversus
Semen analysis can be used to investigate male infertility
Key investigation= take a sample of the ciliated epithelium of the upper airway and examine the action of the cilia, sample can be obtained through nasal brushing or bronchoscopy.
83
What is the management of primary ciliary dyskinesia?
Similar to CF and bronchiectasis- daily physiotherapy, high calorie diet and ABx.
84
What are the two types of wheeze for children?
Transient early wheezing
Results from small airways being more likely to narrow and obstruct due to inflammation and aberrant immune responses to viral infection.
Persistent and recurrent wheezing
Frequent wheezing with many stimuli. Presence of IGE to common inhaling allergens (atopic asthma)
85
What are the causes of childhood wheeze?
```
Transient early wheezing
Atopic asthma (IgE mediated)
Non atopic asthma
Recurrent aspiration of feeds
Inhaled foreign body
Cystic fibrosis
Recurrent anaphylaxis in a child with food allergies
Congenital abnormalities of the lung or heart
```
86
What are the causes of recurrent or persistent childhood wheeze?
```
Viral episodic wheeze
Multiple trigger wheeze
Asthma
Recurrent anaphylaxis
Chronic aspiration
CF
Bronchopulmonary dysplasia
Bronchiolitis obliterates
Teacher bronchomalacia
```
87
What are the causes of recurrent or persistent childhood wheeze?
```
Viral episodic wheeze
Multiple trigger wheeze
Asthma
Recurrent anaphylaxis
Chronic aspiration
CF
Bronchopulmonary dysplasia
Bronchiolitis obliterates
Teacher bronchomalacia
```
88
What are key features associated with the child having asthma?
Symptoms worse at night and early morning
Symptoms which have non viral triggers
Interval symptoms (symptoms between acute exacerbation)
Personal or family history of atopic disease
Positive response to asthma therapy
89
What key questions should you ask in the diagnosis of asthma?
How frequent ar the symptoms
What triggers the symptoms?
How often is sleep disturbed by asthma?
How severe are the interval symptoms between exacerbations?
How much school has been missed due to the asthma?
90
What are the causes of acute breathlessness in the older child?
```
Asthma
Pneumonia/ LRTI
Foreign body
Anaphylaxis
Pneumothorax or pleural effusion
Metabolic acidosis (DKA, lactic acidosis, inborn error of metabolism)
Severe anaemia
Heart failure
Pannick attacks
```
91
What is the criteria for admission to hospital with asthma?
If after high dose bronchodilator therapy they have...
. Not responded adequately clinically (persistently breathless/tachypnoea)
. Becoming exhausted
. Have a marked reduction in their predicted pr usual best peak flow rate or FEV1 is less than 50%
Reduced oxygen sat (<92%)
92
What are the signs of life threatening asthma in an acute attack?
```
Silent chest, cyanosis
Poor resp effort
Exhaustion
Arrythmia
Hypotension
altered consciousness
Agitation, confusion
Peak flow <33%
O2 sats <92%
```
93
What are the causes of acute wheezing?
Asthma attack
Atypical pneumonia (mycoplasma, chlamydia, adenovirus)
Foreign body inhalation
Anaphylaxis
94
What are the principles of epiglottitis management?
Initially secure the airway- give high flow O2 through a non rebreather mask, if tolerated then give nebulised adrenaline which can afford temporary improvement.
Intubation is first line
IV ABx
IV steroids to reduce inflammation
IV maintenance fluids as the patient is NB!
95
Why would you not want to try an examine the pharynx with a tongue depressor in a patient with epiglottitis?
These patients are at risk of reflex laryngospasm and subsequent acute airway obstruction.
96
Bacterial tracheitis is a differential diagnosis for croup, how can you distinguish between them?
Laryngoscopy
97
What can be used to grade the severity of croup?
Westley scoring system
98
What is the leading cause of hospital admission in children?
Bronchiolitis
99
What are the risk factors for severe disease of bronchiolitis?
```
Prematurity (born <37 weeks gestation)
Chronic lung disease of prematurity
Immunodeficiency
Congenital/acquired lung disease (cystic fibrosis)
Congenital cardiac disease
```
100
What investigations are done for bronchiolitis?
In all cases a nasopharyngeal aspirate for rapid RSV testing is taken.
101
When would you consider admitting a child with bronchiolitis
| ?
```
Apnoea
Feeding <50%
Sats < or equal to 94%
History of apnoea
Resp rate >70 breaths
```
102
How do you treat bronchiolitis?
Primary care: self limiting illness usually conservatively managed at home with adequate hydration and anti pyrexial medication
Secondary care: Oxygen and NG tube, nebulised hypertonic saline have shown good evidence to reduce hospital stay
103
What is a lower respiratory infection?
Infection below the level of the larynx, usually refers to bronchitis or pneumonia but bronchiolitis and croup are also LRTI. By definition the symptoms and signs of pneumonia without radiological changes= LRTI with radiological symptoms it’s pneumonia.
104
What are the causes of pneumonia in terms of typical, atypical bacteria and viral?
Typical- s pneumoniae, H influenzae, S aureus, K pneumoniae
Atypical- M pneumoniae, L pneumophila, C pneumoniae
Viral- influenza A, RSV, VZV
105
What are the risk factors for LRTI?
Exposure to infected children (transmission by direct inoculation or resp aerosol)
Preterm birth (underdevelopment of the lungs)
Cigarette smoke
106
What are the clinical features for LRTI in children?
In neonates, localising symptoms to the chest are rare and consequently, a LRTI should be considered in an unwell, febrile child.
Symptoms of an URTI commonly precede the illness
Child will be febrile and have other non spec symptoms
Cough is the most common symptom, commonly purulent however be aware this is often absent in younger children.
Signs:
Listen to chest for coarse crackles, wheeze, bronchia breath sounds or assymetrey of air entry.
Reduced chest expansion
Dull percussion note
Fever +/- tachypnoea +/- reduced spO2
107
What investigations would you do on a child with LRTI?
Investigations are mainly to identify the causal organism and therefore allow a targeted therapy.
Sputum culture may be taken however this is rarely positive
Bloods- raised WCC indicates infection and blood culture may be useful
CXR shows consolidation but does not reliably differentiate between vita and bacterial causes.
108
What are the differentials for LRTI?
```
Asthma
Bronchiolitis
Inhaled foreign body
Cardiac disease
GORD
```
109
How do you treat a LRTI?
Simple analgesics can be used as benefit
Definitive treatment is with ABx- usually PO amoxicillin for 3 days
Admit children with sats <92%, RR>70, high HR, high CRT or apnoea/grunting
110
Why should you not use aspirin in children?
Aspirin is associated with Reye syndrome! An acute non inflammatory encephalopathy and fatty degeneration of the liver.
DO NOT USE ASPIRIN IN UNDER 16s in the UK
111
What signs would you expect in an aspirated foreign body?
Fever, tachycardia, tachypnoea and low sats of O2
Signs of resp distress
On auscultation would have widespread fine Inspiratory crackles.
112
What would be the gold standard investigation for aspirated foreign body?
Bronchoscopy
113
What is the management of inhaled foreign body?
Bronchoscopy for the retrieval of the FB
If choking- paediatric basic life support
Prevention: avoidance of easily aspirated foods until the child is able to chew safely, feed sitting upright, avoid play whilst eating, keep small objects out of reach.
114
How do you treat choking in an infant?
Assess the severity of the choking...
If they have an effective cough then you should encourage coughing and check to see if they deteriorate to an ineffective cough.
If they have an ineffective cough and they are unconscious- open airway, do 5 breaths then start CPR
If they are conscious then 5 back blows and 5 thrusts (chest for infant and abdominal for child >1 year).
115
What is the pathophysiology behind whooping cough?on
Spread via. Respiratory droplets, bordatella pertussis is a highly contagious organism.
Infection spreads to bronchi and bronchioles where an exudate forms, this exudate can compromise the small airways, predisposing to Alectasis and pneumonia
116
What signs would you look for in asthma?
On inspection, look for eczema to us skin changes (particularly in the flexures), hyperinflation of the chest and if a long history look for Harrison’s sulcus.
Patients are often well between attacks and the remainder of the examination is therefore undemaekblw
117
What is Harrison’s sulcus?
A permanent horizontal groove inferior to the costal margin.
118
What are the two types of wheeze in children?
Episodic viral wheeze- only wheezes when there is a viral upper respiratory tract infection, child is symptom free between episodes
