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Paediatrics > 1: Resp - Croup, Viral Wheeze, Bronchiolitis, Pneumonia > Flashcards

1: Resp - Croup, Viral Wheeze, Bronchiolitis, Pneumonia Flashcards

1
Q

What is croup also known as

A

Laryngotracheobronchitis

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2
Q

What is croup

A

Acute upper airway obstruction caused by infection with parainfluenza virus

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3
Q

What is the most common cause of paediatric upper airway obstruction

A

Croup

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4
Q

What is the peak incidence of croup infection

A

6m - 3Y

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5
Q

What age can croup occur up to

A

up to 6Y

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6
Q

When is croup more common

A

Autumn and Winter

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7
Q

What is the main cause of croup

A

Parainfluenza virus (95%)

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8
Q

What type of virus is the parainfluenza virus

A

RNA virus

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9
Q

What are two other viruses

A

RSV

Measles

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10
Q

How long is the pro-drome for croup

A

1-2d

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11
Q

What symptoms may be experienced in the pro-drome for croup

A
  • Fever

- Rhinitis

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12
Q

What is rhinitis

A

Nasal congestion and discharge

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13
Q

How long dose the inflammation phase of croup last

A

2-7d

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14
Q

When are symptoms of croup more common

A

Nocturnal

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15
Q

What are the four symptoms of mild croup

A
  1. Occasional barking cough
  2. No audible stridor
  3. No intercostal recession
  4. Child still able to eat and play
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16
Q

What are five symptoms of moderate croup

A
  1. Frequent barking cough
  2. Stridor at rest
  3. Intercostal recession at rest
  4. No agitation
  5. Placated child
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17
Q

What are five symptoms of severe croup

A
  1. Frequent barking cough
  2. Inspiratory and expiratory stridor
  3. Sternal retraction
  4. Visible distress and agitation
  5. Tachycardia
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18
Q

What is a main differentiating fever between mild and moderate croup

A

Mild: no stridor
Moderate: stridor

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19
Q

Which children with croup need to be admitted

A

Moderate

Severe

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20
Q

How is croup diagnosed

A

Clinical diagnosis

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21
Q

What should never be done in suspected croup and why

A

Throat should never be examined with a tongue depressor as this can cause total airway obstruction.

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22
Q

Where is mild croup managed

A

At home

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23
Q

What is first line management of mild croup

A

Oral Dexamethasone

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24
Q

What dose of oral dexamethasone is given for mild croup

A

0.15mg/Kg

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25
Q

How long does dexamethasone take to reduce airway swelling

A

6h

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26
Q

What advice should be given to parents in mild croup

A

Child should sleep upright to avoid airway obstruction

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27
Q

Where is moderate-severe croup managed

A

Hospital

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28
Q

How is moderate croup managed

A
  • Humidified oxygen
  • Oral dexamethasone or oral prednisolone
  • Nebulised adrenaline
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29
Q

What dose of oral dexamethasone is given in moderate-severe croup

A

0.15mg/Kg

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30
Q

What dose of oral prednisolone is given in severe croup

A

2mg/Kg

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31
Q

If child does not respond to humidified air, oral dexamethasone and nebuliser adrenaline - what is done

A

Admit to ITU for intubation

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32
Q

How long will croup last

A

Few weeks

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33
Q

What are two complications of croup

A
  • Respiratory failure

- Bacterial tracheitis

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34
Q

When is bacterial tracheitis suspected

A
  • Unresponsive to adrenaline and steroids

- Sudden deterioration following viral illness

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35
Q

What causes 80% of respiratory infections

A

Ear, Sinus, Throat Infections (URTI)

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36
Q

What organisms typically cause the common cold

A
  1. Rhinovirus

Others: coronavirus, RSV

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37
Q

What commonly causes pharyngitis

A

Adenovirus
Enterovirus
Rhinovirus

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38
Q

What may cause pharyngitis in older children

A

Group A B-Haemolytic Streptococci

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39
Q

What typically causes tonsillitis

A
  • Group A B-Haemolytic Streptococci

- EBV

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40
Q

What is viral wheeze

A

In children to young to be diagnosed with asthma, may present with wheezing following viral infection

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41
Q

What percentage of children have viral wheeze before 18m

A

25%

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42
Q

How can pre-school wheeze be divided

A
  1. Episodic viral wheeze

2. Multi trigger wheeze

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43
Q

What is episodic viral wheeze

A

Presence of wheezing when child has viral URTI with no symptoms in between

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44
Q

What is multi-trigger wheeze

A

Wheezing can be triggered by URTI and in-between by smoking, exercise and allergens

45
Q

What is the most common organism causing viral wheeze to require consultation

A

RSV

46
Q

What 4 other organisms may cause viral wheeze

A

Coronavirus
Adenovirus
Human metapneumovirus
Human bocavirus

47
Q

What are two risk factors for viral wheeze

A
  • Maternal smoking during pregnancy

- Passive smoking

48
Q

Explain association between viral wheeze and passive smoking

A

Passive smoking does not increase risk of disease but prolongs duration

49
Q

How dose viral wheeze present

A

Expiratory wheeze

50
Q

Explain investigations in viral wheeze

A
  • If child is eating/playing/growing does not need investigation
  • if prolonged symptoms consider sweat test to exclude CF
51
Q

What advice would you give parents of a child with viral wheeze

A
  • smoking cessation
52
Q

What is first-line treatment for episodic viral wheeze

A

SABA

53
Q

What is second-line treatment for episodic viral wheeze

A

LTRA or Intermittent corticosteroids

54
Q

What is first line treatment for multiple trigger wheeze

A

Intermittent trial LTRA for 8W

55
Q

If symptoms are severe enough for hospital admission what should be given

A

Oral prednisolone

56
Q

What is the advantage of oral prednislone

A

Reduces duration symptoms 6-35m

57
Q

What is the prognosis of viral wheeze

A

50% grow-out by pre-school

58
Q

Explain association between viral wheeze and asthma

A
  • Episodic viral wheeze dose not increase risk of asthma

- Multi-trigger wheeze dose increase asthma risk

59
Q

What is bronchiolitis

A

Acute inflammation of the bronchioles caused by RSV

60
Q

Explain the epidemiology of bronchiolitis

A

Most common cause of serious lower respiratory tract infections in under ones

61
Q

What age group dose bronchiolitis occur in

A

1-9m

62
Q

What is the peak incidence of bronchiolitis

A

3-6m

63
Q

Why dose bronchiolitis tend to not occur before 3m

A

Due to maternal IgG antibodies passed through the placenta

64
Q

What time of year is bronchiolitis more common

A

Autumn and Winter

65
Q

What organism causes bronchiolitis

A

RSV

66
Q

How is RSV transmitted

A

Aerosol droplets

67
Q

What are 4 risk factors for bronchiolitis

A

Pre-maturity
Congenital heart disease
Neuromuscular disorders
Immunodeficiency

68
Q

Why are NMD risk factor for bronchiolitis

A

As individual is unable to clear their lungs

69
Q

How will bronchiolitis present initially

A

Upper respiratory tract symptoms

70
Q

What are upper respiratory tract symptoms

A
  • Congestion
  • Nasal discharge
  • Low grade fever
  • Dry cough
71
Q

How will bronchiolitis present later on

A
  • Signs of respiratory distress

- Wheeze

72
Q

What are signs of respiratory distress

A
  • Cyanosis
  • Nasal flaring
  • Grunting
  • Intercostal recessions
  • Dyspneoa
  • Tachypneoa
  • Poor feeding (prioritises breathing)
73
Q

In bronchiolitis what may be heard on auscultation

A
  • Fine inspiratory crackles
74
Q

What is a 1 year-old child with upper respiratory tract symptoms and then a wheeze likely to have

A

Bronchiolitis

75
Q

How is RSV diagnosed

A

Clinical diagnosis

76
Q

If severe what investigation may be ordered in bronchiolitis

A

CXR to exclude atelectasis or pneumothorax

77
Q

When should a child with bronchiolitis be immediately referred to hospital

A
  • Apneoa
  • Looks unwell to HCP

Resp distress:

  • Cyanosis
  • SpO2 <92%
  • IC recessions
  • RR >70
78
Q

When should a child be considered to be admitted to hospital

A

RR > 60
Difficultly breast-feeding
Clinical dehydration

79
Q

How are infants with bronchiolitis typically managed

A
  • Humidified oxygen
  • NG tube

(May need CPAP if severe)

80
Q

When is ribavirin used

A

If underlying chronic heart or lung condition

81
Q

When is palivizumab indicated

A

Monoclonal antibody against RSV. Indicated for infants at risk from bronchiolitis - pre-mature, immunocompromised, underlying heart or lung condition.

82
Q

What are two complications of bronchiolitis

A
  • Pneumonia

- Respiratory Failure

83
Q

What is pneumonia

A

Infection of lower airway and lung parenchyma

84
Q

What defines a neonate

A

Less than 28d

85
Q

What type of organisms are more likely to cause pneumonia in neonates

A

Organisms that colonise the mothers genital tract

86
Q

What 4 organisms commonly cause pneumonia in neonates

A
  1. GBS
  2. E.coli
  3. Klebsiella
  4. Staph. a
87
Q

What 6 organisms likely cause pneumonia in children <5Y

A
  1. RSV
  2. Streptococcus pneumonia
  3. Haemophillus influenza
  4. Bordetella pertussis
  5. Chalmydia tachomatis
  6. S.aureus
88
Q

What 3 organisms likely cause pneumonia in >5Y

A

S. pneumonia
M. pneumonia
Chlamydia pneumonia

89
Q

What are two viral causes of pneumonia in children

A

RSV

Parainfluenza virus

90
Q

In children under 2-years what is more likely to cause pneumonia

A

Viral

91
Q

In children 2-5y what is more common cause of pneumonia

A

Streptococcus pneumonia

92
Q

In children over 5y what is a common cause of pneumonia

A

Mycoplasma pneumonia

93
Q

How will pneumonia present in children

A
  • Breathlessness
  • Chest pain
  • Fever
  • Malaise
94
Q

In which age group will a cough with sputum manifest

A

> 7Y

95
Q

What are signs of pneumonia

A

Respiratory distress:

Grunting, SpO2 <92, Nasal flaring, IC recessions, Cyanosis, tachypnoea, poor feeding

96
Q

If a child is going home with pneumonia, what investigations should be done

A

None

97
Q

When should a child be admitted to hospital with pneumonia

A

SpO2 <92%

98
Q

What investigations may be performed if admitted

A

Obs
CXR
Nasopharyngeal aspirate

99
Q

If a child has saturations <92% how should they be managed

A

IV Fluids
Oxygen
Antibiotics

100
Q

How should children <2Y be managed and why

A

No antibiotics, due to likely viral cause of pneumonia

101
Q

What is the most likely cause in children 2-5y

A

S. Pneumonia

102
Q

What antibiotics should be given in children 2-5y

A

Amoxicillin

103
Q

What is second line antibiotic for childhood pneumonia

A

Macrolide

104
Q

What is first-line antibiotic for children over 5

A

Amoxicillin

105
Q

What is the most likely causative organism in children over 5

A

Mycoplasma Pneumonia

106
Q

If a child is suspected to have pneumonia due to chlamydia or mycoplasma what should be offered

A

Macrolide

107
Q

If a child has influenza and pneumonia what antibiotic is offered

A

Co-amoxiclav

108
Q

If a child develops complications such as empyema, how should they be followed up

A

Chest x-ray in 4-6W

Paediatrics (61 decks)

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