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Year 3 Paediatrics > 5. Respiratory Paediatrics > Flashcards

5. Respiratory Paediatrics Flashcards

1
Q

What divides the upper and the lower repsiratory tract?

A

The epiglottis

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2
Q

What commensal bacteria do we have in our lungs?

A

Pneumococcus
Haemophilia
Staphylococcus
Moraxelaa

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3
Q

What are the harmful side effects of antibiotics?

A 
Diarrhoea 
Allergic reaction
Oral thrush
Nappy rash
Multi resistance
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4
Q

What makes children feel better?

A

Time
Sugary fluid
Brufen

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5
Q

What are some poor prognostic signs used in safety netting children?

A

Increased breathing effort
Severe vomiting
Loss of shiny patch on tongue due to dehydration

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6
Q

What are the signs of otitis media?

A 
Erythema
Bulging drum
No light reflex 
Fever
Ear pain
Discharge 
3-7 days
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7
Q

What are the signs of an URTI?

A 
Runny nose
Sniffles
Malaise
Fever
Lasts 14-21 days
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8
Q

How do you treat Ottits media?

A

Analgesia works
Antibiotics work some times to slightly reduce but don’t do enough to justify treating the illness due to side effects
The end point is the same antibiotics or not

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9
Q

What is tonsillitis/pharyngitis

A 
Sore throat
Pus on throat 
Swinging fever, Scarlett rash
Lasts 3-7 days
Either EBV (glandular fever) or group A strep
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10
Q

What are the symptoms of croup?

What organism causes croup?

A 
Bark seal cough
Para flu 1
Common
Hoarse
Children are still very well
Lasts 2-4 days
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11
Q

How do you treat croup?

A

Oral dexamethasone

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12
Q

What is epiglottis?

A

Cause flu H. Influenzas type B (were vaccinated)
Rare
Stridor
Throat
Drooling as throat is so sore they can’t swallow
High BP, low pulse

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13
Q

How do you treat epiglottis?

A

Intubation and antibiotics

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14
Q

What do you do if you’re not sure if a child will get better or worse?

A

HR
BP
Systemic symptoms
Safety net

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15
Q

What bacteria cause respiratory diseases?

A

Pneumococcus, Haemophilus, Staphylococcus, Haemophilius

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16
Q

How do you manage an LRTI?

A

Diagnose
Assess the patient (oxygenation, hydration, nutrition (chronic))- FIRST!
Antibiotics don’t work straight away, grey area on how to treat

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17
Q

What is bronchitis?

What organsism cause it?

A 
Very very common esp in 2 years old
Loose rattly cough, lots of sputum (darth Vader cough)
Chest free of wheezes, crackles
Sample has haemophilus, pnumococcus 
Child well, parent worried
Lasts 7-21 days
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18
Q

Describe the pathophysiology of bronchitis?

A

Bronchitis paralyses cilia,
Cilia reactivates and clears sputum
2-3 weeks later happens again
Bronchitis paralyses cilia

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19
Q

What are the red flags for not bronchitis but something more serious?

A 
Age <6month, >4 years- most important
No relapse- remission- most important 
Static weight
Disrupt child’s life
Associates SOB
Acute admission
Other symptoms e.g. neuro/gastro
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20
Q

How do you treat bacterial bronchitis

A

Diagnose
Reassure parents
Don’t treat

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21
Q

Who gets bronchiolitis?

A

Every child born after 1 August with an older symptom

22
Q

What is bronchiolitis?

What are the symptoms

What causes it?

A 
LRTI
Affects 30-40% of all children
Usually RSV, paraflu III, HMPV
Nasal stuffiness, poor feeding, tachypnoea
Crackles +/- wheeze
Lasts 2-3 weeks
Affects children in 1 year
One off thing
23
Q

What is the timespan of bronchiolitis?

A

Gets worse for 2-3 days, becomes miserable
Stabilises 2 days
Recovers- gradually gets better

24
Q

How do you manage bronchiolitis?

A

Maximal observations

Minimal interventions

25
Q

What are the characteristics of a LRTI?

A

48 hours, fever (>38.5), SOB, cough, grunting
Wheeze males bacterial cause unlikely
Reduced or bronchial breath sounds (loud breath sounds)
Infective agents
Virus and commensal bacteria bacterium

26
Q

What indicates pneumonia?

A

If you want to terrify the parents
Signs are focal
Crepitations
High fever

27
Q

What should you not do in LRTI?

A

White cell count

Chest x-ray

28
Q

How do you manage LRTI with antibiotics?

A

No symptoms are mild
Oral amoxicillin first line
Oral macrolides second choice
Only for IV if vomiting

29
Q

What is pertussis?

A 
Whooping cough
Common 
Vaccine reduces risk and severity, still going to get it
Coughing fits leads to
Vomiting and colour change
30
Q

When DO you give antibiotics in respiratory peadiatrics?

What agents are given

A

Otitis media if under two years and bilateral otitis media- oral amoxicillin
Tonsillitis if you know it’s strep- penicillin
LRTI/pneumonia- 2 days, fever focal sign, oral amoxicillin

31
Q

What did bob Marley have to say about asthma?

A

NO WHEEZE NO ASTHMA

32
Q

What decided whether you treat for asthma?

A

Quality of life affected- treat (not parents QoL, patients QoL)

Quality of life not affected- watch and wait

33
Q

What are the characteristics of asthma?

A

Not a diagnosis of exclusion

Wheeze
Variability
Responds to treatment

34
Q

What causes asthma?

What specific genes are associated with asthma?

A

Genes a moderate contributor (load the gun)
ADAM33, ORMDL3
Intact with environment (pull the trigger)
Epigenitcs
allergy (probably doesn’t cause asthma, allergy and asthma development happen in parallel)

35
Q

What are the different classes of asthma that makes up asthma syndrome?

A 
Infant asthma
Childhood onset
Adult onset
Excertional asthma
Occupational asthma
36
Q

What are the diagnostic tests for asthma

A 
There are no tests you idiot 
Peak flow sucks 
Allergy tests irrelevant
Spirometery lacks specificity 
Nitric oxide- unproven
37
Q

What is the NICE guidelines for investigating asthma?

A

First need clinical suspicion in child between 5 and 16

Spirometery
BDR (bronchodilator reversibility)
Exhaled nitric oxide
Peak flow (not very good)

38
Q

What is a great sign of a respiratory problem

A

Shortness of breath at rest (30% of lung function)

Breathing with tummy muscles

39
Q

How does cough diagnose asthma?

A

Dry cough, just after sleep, comes with exercise

40
Q

What are the asthma signs?

A

Wheeze
SOB at rest
Parental asthma
Responds to treatment

41
Q

What are the negative aspects Of asthma treatment?

A

Cost
Hassle
0.5-1cm loss in height
Oral thrush

42
Q

What are the benefits of asthma treatment?

A

Helps diagnosis
If symptoms respond
Improves QoL
Reduces risk of attack

43
Q

What are the differentials of asthma in children under 5?

A 
Congenital 
Cystic Fibrosis
Primary ciliary dyskinesia
Bronchitis
Foreign body
44
Q

What are the differentials of asthma over 5?

A

Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis

45
Q

How do yiu measure asthma control?

A 
SANE
Short acting beta agonist/ week? >2 poorly controlled
Absence of school nursery
Nocturnal symptoms/ week
Exceptional symptoms/ week
46
Q

What are the goals of asthma treatment?

A

Minimal symptoms day and night
Minimal need for reliever treatment
No attacks
No limitation of physical activity

47
Q

What do you do if someone’s asthma is well controlled?

A

Leave as is?

Reduce treatment and hope it goes away

48
Q

What do you do if someone’s asthma isn’t well controlled?

A

Ask these key questions: Not talking treatment
Not taking treatment correctly
Not asthma

if so increase treatment

49
Q

How do you start asthma treatment?

A

Step up, step down process.

Started on low dose ICS

50
Q

What are the classes of asthma medications?

A 
Short acting beta agonist
Inhaled corticosteroids
Long acting beta agonist
Leukotriene receptor antagonists
Theophyllines
Oral steroids
51
Q

What is different in paediatric vs adulthood hood asthma?

A 
Max dose ICS 800mcgs
No oral B2 tablet
LTRA first line in under 5's
No LAMA's
Only biological
52
Q

What do you do in a child on a brown inhaler who is still poorly controlled?

A

Long acting beta agonists- slightly better than
Increased inhaled corticosteroids and
Leukotriene beta agonists

Keep an open mind though!

Year 3 Paediatrics (42 decks)

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