W06 - PAEDS: Resp

Question 1

Dx pathway for asthma in children

Answer 1

Spirometry
BDR (12%+ improvement in FEV1.)
FeNO(>40ppb is considered positive, or 35ppb if there is normal/obstructive spirometry without reversibility)
Peak flow

ASTHMA TX, then inhlaer holiday to see if matches

+ wheeze
* cough-predominant asthma
+ SOB@rest, FHx

• <18mos most likely infection

Question 2

Tx for Asthma in Children

Answer 2

ICS for 2mos

low-dose, inhaler holiday, review 2mos

(1)
low dose ICS
- LTRA <5yo

(2)
+LABA 5yr+

(3)
increase ICS dose
?LTRA = monteleukast

(4)
ICS
+ SR theophylline

(5)
Steroid tablet

Question 3

Acute Asthma mgmt

Answer 3

(1) - spacers starters
SABA
SABA + pred oral

(2) mains with nebs
SABA nep + pred
SABA + ipra neb + pred

(3)
IV SALBUTAMOL
IV AMINOPHYLLINE
IV Mg neb
IV hydrocortisone
Intubate and ventilate

*1hr review

Question 4

Tracheitis

Answer 4

• complicated croup: fever, sick child
  staph or strep

> co-amox. / augmentin

Question 5

Bronchitis

Answer 5

very very common
ratty cough, post-tussive vomit

haemophilus/pneumococcus
self-limit, gets better every winter

> reassure

Question 6

Bronchiolitis

Answer 6

LRTI in very young <12mos
RSV, paraflu III, HMPV
nasal stuffi, tachypnoea, poor feeding

crackles +/- wheeze

> reassure and observe, NPA O2 sats

Question 7

LRTI

Answer 7

48 hrs, fever (>38.5oC), SOB, cough, grunting
Wheeze makes bacterial cause unlikely
Reduced or bronchial breath sounds

Question 8

Community Acquired Pneumonia

Answer 8

> conservaive if symptoms are milkd

> oral amox.
2. oral macrolife

> IV if vomitting

!empyema: expansion into pleural space thus chest pain and very unwell
> IV abx and drainage