Respiratory Paediatrics

Question 1

What are the side effects of antibiotics in children?

Answer 1

Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Multi resistance

Question 2

Rhinitis

Answer 2

Very common
5-10 per year 
Self-limiting
Blocked/runny nose
Prodrome to other illnesses - pneumonia, bronchiolitis, meningitis, septicaemia

Question 3

Otitis media

Answer 3

Common
Self-limiting
Typical duration - 1 week

Question 4

What kind of infection causes otitis media?

Answer 4

Primary - viral

Secondary - pneumococcus/H’flu

Question 5

What are the signs of otitis media?

Answer 5

Red ear
Painful
Discharge if perforation

Question 6

How is otitis media treated?

Answer 6

Analgesia for pain relief

Question 7

Tonsilitis/pharyngitis

Answer 7

Common
Bacterial or viral
Typical duration - 1 week
Throat swab - 2 days
Either nothing or 10 days penicillin (if strep)

Question 8

Croup

Answer 8

Common
Child is well
Typical duration - 3 days

Question 9

What causes croup?

Answer 9

Para flu’1

Question 10

What are the signs of croup?

Answer 10

Stridor
Hoarse voice
Barking cough

Question 11

How is croup treated?

Answer 11

Oral dexamethasone

Question 12

Epiglottitis

Answer 12

Medical emergency
Rare
Toxic

Question 13

What is the cause of epiglottitis?

Answer 13

H/influenzae type B

Question 14

What are the signs of epiglottitis?

Answer 14

Stridor
Drooling
Extremely painful

Question 15

How is epiglottitis treated?

Answer 15

Intubation

Antibiotics

Question 16

What are common agents in LRTIs?

Answer 16

Bacterial overgrowth - strep pneumoniae, haemophilus influenzae, moraxella catarrhalis, mycoplasma pneumoniae
Viral - RSV, para-influenza 2, influenza A and B, adenovirus, rhinovirus

Question 17

Bronchitis

Answer 17

Common
Mostly self-limiting
Relapsing remitting cycle - typically happens in Winter

Question 18

What causes bronchitis?

Answer 18

Haemophilus/pneumococcus

Question 19

What are the symptoms of bronchitis?

Answer 19

Loose rattly cough
Post-tussive vomit - ‘glut’, lots of mucous comes up
No wheeze or creps in the chest

Question 20

Bacterial bronchitis

Answer 20

Disturbed much-ciliary clearance
Lack of social inhibition
Bacterial overgrowth is secondary

Question 21

What are red flags in bronchitis?

Answer 21

Age - <6 months, >4 years
No relapsing-remitting pattern
Static weight
Disrupts child's life
Associated SOB
Acute admission
Other co-morbidities

Question 22

Bronchiolitis

Answer 22

LRTI of infants
Usually RSV - Christmas time
Typical duration - 16 days

Question 23

What are the symptoms of bronchiolitis?

Answer 23

Blocked nose
Tachypnoea, SOB
Poor feeding
Chest - crackles and wheeze

Question 24

How is bronchiolitis managed?

Answer 24

If the patient is in the stabilising phase then do nothing

If the child is getting worse give antibiotics

Question 25

What are the symptoms of LRTI/pneumonia?

Answer 25

``` Duration 48 hrs Fever - >38.5 SOB Cough Grunting Reduced or bronchial breathing ```

Question 26

When do you definitely call it pneumonia?

Answer 26

Signs are focal - ie in one area Creps High fever

Question 27

How is LRTI/pneumonia managed?

Answer 27

Nothing if symptoms are mild 1st - oral amoxycillin 2nd - oral macrolide

Question 28

Pertussis

Answer 28

``` Common Whooping cough Vaccination reduces risk and severity Coughing fits Vomiting and colour change ```

Question 29

What is always first line treatment in a child?

Answer 29

Oxygenation, hydration, nutrition

Question 30

What is the epidemiology of childhood asthma?

Answer 30

1 million UK children

Question 31

What are the causes of childhood asthma?

Answer 31

Genes - 30-80% Primary epithelial abnormality resulting in - eczema, asthma Host response environment Infection is important

Question 32

What are the symptoms of asthma?

Answer 32

Essential - wheeze, variability, responds to treatment Wheeze - check noise with parents SOB at rest Cough

Question 33

How is asthma investigated?

Answer 33

None normally needed | Could no - peak flow, spirometry, exhaled nitric oxide

Question 34

How is asthma treated?

Answer 34

With a spacer ALWAYS Watch and wait or trial ICS for 2 months SABA - salbutamol ICS - low dose Initial add on - LABA (children >5), LTRA (children <5) Additional add on's - increase dose of ICS

Question 35

Severe asthma

Answer 35

50% psychological issues 50% compliance issues Only minority have genuine severe disease

Question 36

How is control of asthma measured?

Answer 36

``` SANE Short acting beta agonist/week - if >2 then poor control Absence school/nursery Nocturnal symptoms/weel Exertional symptoms/weel ```

Question 37

What are the differences in child asthma compared with adults?

Answer 37

Max dose ICS 800 micro (<12) No oral B2 tablet LTRA first line preventer in <5s No LAMA

Question 38

What is the common age of bronchiolitis?

Answer 38

<12 months

Question 39

What are signs of respiratory distress?

Answer 39

``` Raised respiratory rate Use of accessory muscles of breathing (sternocleidomastoid, abdominal and intercostal muscles Intercostal and subcostal recessions) Nasal flaring Head bobbing Tracheal tugging Cyanosis (due to low oxygen saturation) Abnormal airway noises ```