1: Resp - Croup, Viral Wheeze, Bronchiolitis, Pneumonia Flashcards
1
Q
What is croup also known as
A
Laryngotracheobronchitis
2
Q
What is croup
A
Acute upper airway obstruction caused by infection with parainfluenza virus
3
Q
What is the most common cause of paediatric upper airway obstruction
A
Croup
4
Q
What is the peak incidence of croup infection
A
6m - 3Y
5
Q
What age can croup occur up to
A
up to 6Y
6
Q
When is croup more common
A
Autumn and Winter
7
Q
What is the main cause of croup
A
Parainfluenza virus (95%)
8
Q
What type of virus is the parainfluenza virus
A
RNA virus
9
Q
What are two other viruses
A
RSV
Measles
10
Q
How long is the pro-drome for croup
A
1-2d
11
Q
What symptoms may be experienced in the pro-drome for croup
A
- Fever
- Rhinitis
12
Q
What is rhinitis
A
Nasal congestion and discharge
13
Q
How long dose the inflammation phase of croup last
A
2-7d
14
Q
When are symptoms of croup more common
A
Nocturnal
15
Q
What are the four symptoms of mild croup
A
- Occasional barking cough
- No audible stridor
- No intercostal recession
- Child still able to eat and play
16
Q
What are five symptoms of moderate croup
A
- Frequent barking cough
- Stridor at rest
- Intercostal recession at rest
- No agitation
- Placated child
17
Q
What are five symptoms of severe croup
A
- Frequent barking cough
- Inspiratory and expiratory stridor
- Sternal retraction
- Visible distress and agitation
- Tachycardia
18
Q
What is a main differentiating fever between mild and moderate croup
A
Mild: no stridor
Moderate: stridor
19
Q
Which children with croup need to be admitted
A
Moderate
Severe
20
Q
How is croup diagnosed
A
Clinical diagnosis
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.
22
Q
Where is mild croup managed
A
At home
23
Q
What is first line management of mild croup
A
Oral Dexamethasone
24
Q
What dose of oral dexamethasone is given for mild croup
A
0.15mg/Kg
25
How long does dexamethasone take to reduce airway swelling
6h
26
What advice should be given to parents in mild croup
Child should sleep upright to avoid airway obstruction
27
Where is moderate-severe croup managed
Hospital
28
How is moderate croup managed
- Humidified oxygen
- Oral dexamethasone or oral prednisolone
- Nebulised adrenaline
29
What dose of oral dexamethasone is given in moderate-severe croup
0.15mg/Kg
30
What dose of oral prednisolone is given in severe croup
2mg/Kg
31
If child does not respond to humidified air, oral dexamethasone and nebuliser adrenaline - what is done
Admit to ITU for intubation
32
How long will croup last
Few weeks
33
What are two complications of croup
- Respiratory failure
| - Bacterial tracheitis
34
When is bacterial tracheitis suspected
- Unresponsive to adrenaline and steroids
| - Sudden deterioration following viral illness
35
What causes 80% of respiratory infections
Ear, Sinus, Throat Infections (URTI)
36
What organisms typically cause the common cold
1. Rhinovirus
| Others: coronavirus, RSV
37
What commonly causes pharyngitis
Adenovirus
Enterovirus
Rhinovirus
38
What may cause pharyngitis in older children
Group A B-Haemolytic Streptococci
39
What typically causes tonsillitis
- Group A B-Haemolytic Streptococci
| - EBV
40
What is viral wheeze
In children to young to be diagnosed with asthma, may present with wheezing following viral infection
41
What percentage of children have viral wheeze before 18m
25%
42
How can pre-school wheeze be divided
1. Episodic viral wheeze
| 2. Multi trigger wheeze
43
What is episodic viral wheeze
Presence of wheezing when child has viral URTI with no symptoms in between
44
What is multi-trigger wheeze
Wheezing can be triggered by URTI and in-between by smoking, exercise and allergens
45
What is the most common organism causing viral wheeze to require consultation
RSV
46
What 4 other organisms may cause viral wheeze
Coronavirus
Adenovirus
Human metapneumovirus
Human bocavirus
47
What are two risk factors for viral wheeze
- Maternal smoking during pregnancy
| - Passive smoking
48
Explain association between viral wheeze and passive smoking
Passive smoking does not increase risk of disease but prolongs duration
49
How dose viral wheeze present
Expiratory wheeze
50
Explain investigations in viral wheeze
- If child is eating/playing/growing does not need investigation
- if prolonged symptoms consider sweat test to exclude CF
51
What advice would you give parents of a child with viral wheeze
- smoking cessation
52
What is first-line treatment for episodic viral wheeze
SABA
53
What is second-line treatment for episodic viral wheeze
LTRA or Intermittent corticosteroids
54
What is first line treatment for multiple trigger wheeze
Intermittent trial LTRA for 8W
55
If symptoms are severe enough for hospital admission what should be given
Oral prednisolone
56
What is the advantage of oral prednislone
Reduces duration symptoms 6-35m
57
What is the prognosis of viral wheeze
50% grow-out by pre-school
58
Explain association between viral wheeze and asthma
- Episodic viral wheeze dose not increase risk of asthma
| - Multi-trigger wheeze dose increase asthma risk
59
What is bronchiolitis
Acute inflammation of the bronchioles caused by RSV
60
Explain the epidemiology of bronchiolitis
Most common cause of serious lower respiratory tract infections in under ones
61
What age group dose bronchiolitis occur in
1-9m
62
What is the peak incidence of bronchiolitis
3-6m
63
Why dose bronchiolitis tend to not occur before 3m
Due to maternal IgG antibodies passed through the placenta
64
What time of year is bronchiolitis more common
Autumn and Winter
65
What organism causes bronchiolitis
RSV
66
How is RSV transmitted
Aerosol droplets
67
What are 4 risk factors for bronchiolitis
Pre-maturity
Congenital heart disease
Neuromuscular disorders
Immunodeficiency
68
Why are NMD risk factor for bronchiolitis
As individual is unable to clear their lungs
69
How will bronchiolitis present initially
Upper respiratory tract symptoms
70
What are upper respiratory tract symptoms
- Congestion
- Nasal discharge
- Low grade fever
- Dry cough
71
How will bronchiolitis present later on
- Signs of respiratory distress
| - Wheeze
72
What are signs of respiratory distress
- Cyanosis
- Nasal flaring
- Grunting
- Intercostal recessions
- Dyspneoa
- Tachypneoa
- Poor feeding (prioritises breathing)
73
In bronchiolitis what may be heard on auscultation
- Fine inspiratory crackles
74
What is a 1 year-old child with upper respiratory tract symptoms and then a wheeze likely to have
Bronchiolitis
75
How is RSV diagnosed
Clinical diagnosis
76
If severe what investigation may be ordered in bronchiolitis
CXR to exclude atelectasis or pneumothorax
77
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
78
When should a child be considered to be admitted to hospital
RR > 60
Difficultly breast-feeding
Clinical dehydration
79
How are infants with bronchiolitis typically managed
- Humidified oxygen
- NG tube
(May need CPAP if severe)
80
When is ribavirin used
If underlying chronic heart or lung condition
81
When is palivizumab indicated
Monoclonal antibody against RSV. Indicated for infants at risk from bronchiolitis - pre-mature, immunocompromised, underlying heart or lung condition.
82
What are two complications of bronchiolitis
- Pneumonia
| - Respiratory Failure
83
What is pneumonia
Infection of lower airway and lung parenchyma
84
What defines a neonate
Less than 28d
85
What type of organisms are more likely to cause pneumonia in neonates
Organisms that colonise the mothers genital tract
86
What 4 organisms commonly cause pneumonia in neonates
1. GBS
2. E.coli
3. Klebsiella
4. Staph. a
87
What 6 organisms likely cause pneumonia in children <5Y
1. RSV
2. Streptococcus pneumonia
3. Haemophillus influenza
4. Bordetella pertussis
5. Chalmydia tachomatis
6. S.aureus
88
What 3 organisms likely cause pneumonia in >5Y
S. pneumonia
M. pneumonia
Chlamydia pneumonia
89
What are two viral causes of pneumonia in children
RSV
| Parainfluenza virus
90
In children under 2-years what is more likely to cause pneumonia
Viral
91
In children 2-5y what is more common cause of pneumonia
Streptococcus pneumonia
92
In children over 5y what is a common cause of pneumonia
Mycoplasma pneumonia
93
How will pneumonia present in children
- Breathlessness
- Chest pain
- Fever
- Malaise
94
In which age group will a cough with sputum manifest
>7Y
95
What are signs of pneumonia
Respiratory distress:
| Grunting, SpO2 <92, Nasal flaring, IC recessions, Cyanosis, tachypnoea, poor feeding
96
If a child is going home with pneumonia, what investigations should be done
None
97
When should a child be admitted to hospital with pneumonia
SpO2 <92%
98
What investigations may be performed if admitted
Obs
CXR
Nasopharyngeal aspirate
99
If a child has saturations <92% how should they be managed
IV Fluids
Oxygen
Antibiotics
100
How should children <2Y be managed and why
No antibiotics, due to likely viral cause of pneumonia
101
What is the most likely cause in children 2-5y
S. Pneumonia
102
What antibiotics should be given in children 2-5y
Amoxicillin
103
What is second line antibiotic for childhood pneumonia
Macrolide
104
What is first-line antibiotic for children over 5
Amoxicillin
105
What is the most likely causative organism in children over 5
Mycoplasma Pneumonia
106
If a child is suspected to have pneumonia due to chlamydia or mycoplasma what should be offered
Macrolide
107
If a child has influenza and pneumonia what antibiotic is offered
Co-amoxiclav
108
If a child develops complications such as empyema, how should they be followed up
Chest x-ray in 4-6W
