1: Resp - Croup, Viral Wheeze, Bronchiolitis, Pneumonia Flashcards
What is croup also known as
Laryngotracheobronchitis
What is croup
Acute upper airway obstruction caused by infection with parainfluenza virus
What is the most common cause of paediatric upper airway obstruction
Croup
What is the peak incidence of croup infection
6m - 3Y
What age can croup occur up to
up to 6Y
When is croup more common
Autumn and Winter
What is the main cause of croup
Parainfluenza virus (95%)
What type of virus is the parainfluenza virus
RNA virus
What are two other viruses
RSV
Measles
How long is the pro-drome for croup
1-2d
What symptoms may be experienced in the pro-drome for croup
- Fever
- Rhinitis
What is rhinitis
Nasal congestion and discharge
How long dose the inflammation phase of croup last
2-7d
When are symptoms of croup more common
Nocturnal
What are the four symptoms of mild croup
- Occasional barking cough
- No audible stridor
- No intercostal recession
- Child still able to eat and play
What are five symptoms of moderate croup
- Frequent barking cough
- Stridor at rest
- Intercostal recession at rest
- No agitation
- Placated child
What are five symptoms of severe croup
- Frequent barking cough
- Inspiratory and expiratory stridor
- Sternal retraction
- Visible distress and agitation
- Tachycardia
What is a main differentiating fever between mild and moderate croup
Mild: no stridor
Moderate: stridor
Which children with croup need to be admitted
Moderate
Severe
How is croup diagnosed
Clinical diagnosis
What should never be done in suspected croup and why
Throat should never be examined with a tongue depressor as this can cause total airway obstruction.
Where is mild croup managed
At home
What is first line management of mild croup
Oral Dexamethasone
What dose of oral dexamethasone is given for mild croup
0.15mg/Kg
How long does dexamethasone take to reduce airway swelling
6h
What advice should be given to parents in mild croup
Child should sleep upright to avoid airway obstruction
Where is moderate-severe croup managed
Hospital
How is moderate croup managed
- Humidified oxygen
- Oral dexamethasone or oral prednisolone
- Nebulised adrenaline
What dose of oral dexamethasone is given in moderate-severe croup
0.15mg/Kg
What dose of oral prednisolone is given in severe croup
2mg/Kg
If child does not respond to humidified air, oral dexamethasone and nebuliser adrenaline - what is done
Admit to ITU for intubation
How long will croup last
Few weeks
What are two complications of croup
- Respiratory failure
- Bacterial tracheitis
When is bacterial tracheitis suspected
- Unresponsive to adrenaline and steroids
- Sudden deterioration following viral illness
What causes 80% of respiratory infections
Ear, Sinus, Throat Infections (URTI)
What organisms typically cause the common cold
- Rhinovirus
Others: coronavirus, RSV
What commonly causes pharyngitis
Adenovirus
Enterovirus
Rhinovirus
What may cause pharyngitis in older children
Group A B-Haemolytic Streptococci
What typically causes tonsillitis
- Group A B-Haemolytic Streptococci
- EBV
What is viral wheeze
In children to young to be diagnosed with asthma, may present with wheezing following viral infection
What percentage of children have viral wheeze before 18m
25%
How can pre-school wheeze be divided
- Episodic viral wheeze
2. Multi trigger wheeze
What is episodic viral wheeze
Presence of wheezing when child has viral URTI with no symptoms in between
What is multi-trigger wheeze
Wheezing can be triggered by URTI and in-between by smoking, exercise and allergens
What is the most common organism causing viral wheeze to require consultation
RSV
What 4 other organisms may cause viral wheeze
Coronavirus
Adenovirus
Human metapneumovirus
Human bocavirus
What are two risk factors for viral wheeze
- Maternal smoking during pregnancy
- Passive smoking
Explain association between viral wheeze and passive smoking
Passive smoking does not increase risk of disease but prolongs duration
How dose viral wheeze present
Expiratory wheeze
Explain investigations in viral wheeze
- If child is eating/playing/growing does not need investigation
- if prolonged symptoms consider sweat test to exclude CF
What advice would you give parents of a child with viral wheeze
- smoking cessation
What is first-line treatment for episodic viral wheeze
SABA
What is second-line treatment for episodic viral wheeze
LTRA or Intermittent corticosteroids
What is first line treatment for multiple trigger wheeze
Intermittent trial LTRA for 8W
If symptoms are severe enough for hospital admission what should be given
Oral prednisolone
What is the advantage of oral prednislone
Reduces duration symptoms 6-35m
What is the prognosis of viral wheeze
50% grow-out by pre-school
Explain association between viral wheeze and asthma
- Episodic viral wheeze dose not increase risk of asthma
- Multi-trigger wheeze dose increase asthma risk
What is bronchiolitis
Acute inflammation of the bronchioles caused by RSV
Explain the epidemiology of bronchiolitis
Most common cause of serious lower respiratory tract infections in under ones
What age group dose bronchiolitis occur in
1-9m
What is the peak incidence of bronchiolitis
3-6m
Why dose bronchiolitis tend to not occur before 3m
Due to maternal IgG antibodies passed through the placenta
What time of year is bronchiolitis more common
Autumn and Winter
What organism causes bronchiolitis
RSV
How is RSV transmitted
Aerosol droplets
What are 4 risk factors for bronchiolitis
Pre-maturity
Congenital heart disease
Neuromuscular disorders
Immunodeficiency
Why are NMD risk factor for bronchiolitis
As individual is unable to clear their lungs
How will bronchiolitis present initially
Upper respiratory tract symptoms
What are upper respiratory tract symptoms
- Congestion
- Nasal discharge
- Low grade fever
- Dry cough
How will bronchiolitis present later on
- Signs of respiratory distress
- Wheeze
What are signs of respiratory distress
- Cyanosis
- Nasal flaring
- Grunting
- Intercostal recessions
- Dyspneoa
- Tachypneoa
- Poor feeding (prioritises breathing)
In bronchiolitis what may be heard on auscultation
- Fine inspiratory crackles
What is a 1 year-old child with upper respiratory tract symptoms and then a wheeze likely to have
Bronchiolitis
How is RSV diagnosed
Clinical diagnosis
If severe what investigation may be ordered in bronchiolitis
CXR to exclude atelectasis or pneumothorax
When should a child with bronchiolitis be immediately referred to hospital
- Apneoa
- Looks unwell to HCP
Resp distress:
- Cyanosis
- SpO2 <92%
- IC recessions
- RR >70
When should a child be considered to be admitted to hospital
RR > 60
Difficultly breast-feeding
Clinical dehydration
How are infants with bronchiolitis typically managed
- Humidified oxygen
- NG tube
(May need CPAP if severe)
When is ribavirin used
If underlying chronic heart or lung condition
When is palivizumab indicated
Monoclonal antibody against RSV. Indicated for infants at risk from bronchiolitis - pre-mature, immunocompromised, underlying heart or lung condition.
What are two complications of bronchiolitis
- Pneumonia
- Respiratory Failure
What is pneumonia
Infection of lower airway and lung parenchyma
What defines a neonate
Less than 28d
What type of organisms are more likely to cause pneumonia in neonates
Organisms that colonise the mothers genital tract
What 4 organisms commonly cause pneumonia in neonates
- GBS
- E.coli
- Klebsiella
- Staph. a
What 6 organisms likely cause pneumonia in children <5Y
- RSV
- Streptococcus pneumonia
- Haemophillus influenza
- Bordetella pertussis
- Chalmydia tachomatis
- S.aureus
What 3 organisms likely cause pneumonia in >5Y
S. pneumonia
M. pneumonia
Chlamydia pneumonia
What are two viral causes of pneumonia in children
RSV
Parainfluenza virus
In children under 2-years what is more likely to cause pneumonia
Viral
In children 2-5y what is more common cause of pneumonia
Streptococcus pneumonia
In children over 5y what is a common cause of pneumonia
Mycoplasma pneumonia
How will pneumonia present in children
- Breathlessness
- Chest pain
- Fever
- Malaise
In which age group will a cough with sputum manifest
> 7Y
What are signs of pneumonia
Respiratory distress:
Grunting, SpO2 <92, Nasal flaring, IC recessions, Cyanosis, tachypnoea, poor feeding
If a child is going home with pneumonia, what investigations should be done
None
When should a child be admitted to hospital with pneumonia
SpO2 <92%
What investigations may be performed if admitted
Obs
CXR
Nasopharyngeal aspirate
If a child has saturations <92% how should they be managed
IV Fluids
Oxygen
Antibiotics
How should children <2Y be managed and why
No antibiotics, due to likely viral cause of pneumonia
What is the most likely cause in children 2-5y
S. Pneumonia
What antibiotics should be given in children 2-5y
Amoxicillin
What is second line antibiotic for childhood pneumonia
Macrolide
What is first-line antibiotic for children over 5
Amoxicillin
What is the most likely causative organism in children over 5
Mycoplasma Pneumonia
If a child is suspected to have pneumonia due to chlamydia or mycoplasma what should be offered
Macrolide
If a child has influenza and pneumonia what antibiotic is offered
Co-amoxiclav
If a child develops complications such as empyema, how should they be followed up
Chest x-ray in 4-6W
