Child with breathing difficulties (respiratory conditions)

Question 1

What causes Bronchiolitis?

Answer 1

RSV (respiratory syncytial virus)

Question 2

What is the association between Bronchiolitis and viral wheeze?

Answer 2

Children who have had bronchiolitis as infants are more likely to have viral induced wheeze during childhood.

Question 3

What are the signs of Bronchiolitis in a child?

Answer 3

• Coryzal symptoms e.g. runny nose, sneezing, mucus in throat and watery eyes
• Poor feeding
• Mild fever (under 39)
• Apnoeas in infants
• Wheeze and crackles on auscultation

Question 4

How does Bronchiolitis present (course of illness)

Answer 4

1. Starts with coryza, seems like a cold (days 1-3)
2. Infant seems to get a bit better OR symptom get worse days 3-4 they can become chesty/respiratory distress
3. Patient will generally begin to get better by day 7-10 but can take 2-3 weeks for full recovery

Question 5

What are indications for admission to hospital with Bronchiolitis?

Answer 5

• Aged under 3 months or pre-existing condition e.g. prematurity
• Down’s syndrome
• Cystic fibrosis
• 50-75% of their normal milk intake
• Clinical dehydration
• Respiratory rate 70+
• Oxygen sats below 92%
• Moderate to severe respiratory distress e.g. head bobbing and recessions
• Apnoeas
• Parents not confident in their ability to manage at home

Question 6

When can supplementary oxygen be given to a child with Bronchiolitis? How are their sats and resp status measured?

Answer 6

if the oxygen saturations remain below 92%

Capillary blood gas to look for falling pH, pCO2 and pO2.

Question 7

What is the most common causative agent of Croup?

Answer 7

Parainfluenza virus

Question 8

What is croup and who does it most commonly affect?

Answer 8

An acute infective respiratory disease affecting young children.
Typically affects children aged 6 months - 6 years

Question 9

What causes the symptoms of croup?

Answer 9

Oedema of the larynx

Question 10

What are the common signs and symptoms of croup?

Answer 10

• Increasedwork of breathing
• Barkingcough, occurring in clusters of coughing episodes. Sounds like a dog/seal.
• Hoarse voice
• Stridor
• Low gradefever

Question 11

What is the mainstay of treatment for croup?

Answer 11

Oraldexamethasone.

This is usually a single dose of 150 mcg/kg, which can be repeated if required after 12 hours.

Question 12

If symptoms do not improve after initial dexamethasone, what is the management of patients with croup?

Answer 12

• Oxygen
• Nebulised budesonide
• Nubulised adrenaline
• Intubation and ventilation if required

Question 13

Which organism is most likely to cause epiglottitis?

Answer 13

Haemophilus influenza type B (HiB)

Question 14

What age does epiglottitis present in?

Answer 14

6-12 years of age

Question 15

Signs and symptoms of epiglottitis

Answer 15

• Tripoding
• Septic / unwell
• Stridor
• Muffled voice
• Sore throat
• Febrile
• Drooling

Question 16

What is the most important step in management of epiglottitis?

Answer 16

Not distressing the patient, as this could prompt closure of the airway.

If you see a child with suspected epiglottitis, leave them well alone and in their comfort zone.

Don’t examine them and don’t make them upset. The most important thing is to alert the mostsenior paediatricianandanaesthetistavailable.

Question 17

Why are most patients with epiglottitis admitted to ICU?

Answer 17

There is an ongoing risk of upper airway closure. They may need a tracheostomy.

Question 18

What medications may be given to patients with epiglottitis?

Answer 18

• Ceftriaxone (IV)
• Dexamethasone

Question 19

What is the most common cause of neonatal stridor?

Answer 19

Laryngomalacia

Question 20

What is the causative agent of Whooping cough?

Answer 20

Bordetella pertussis

Question 21

When should whooping cough be suspected?(diagnostic criteria)

Answer 21

• Cough lasting for more than 14 days without apparent cause AND 1 OF:

1. Paroxysmal cough
2. Inspiratory whoop
3. Post-tussive vomiting
4. Apnoea in infants

Question 22

What is the management of whooping cough?

Answer 22

• Clarithromycin or Azithromycin if the onset of the cough is within 21 days previous
• 48 hours after commencing antibiotics, child can go back to school
• Household contacts should be offered antibiotic prophylaxis

Question 23

What is the most common cause of Pneumonia in paediatrics?

Answer 23

Streptococcus pneumonia

Question 24

What is the severity of an asthma attack where Peak flow is > 50% of predicted?

Answer 24

Moderate

Question 25

What is the severity of an asthma attack where Peak flow is less than 50% of predicted?

Answer 25

Severe

Question 26

What is the severity of an asthma attack where the peak flow is <33% predicted?

Answer 26

Life threatening

Question 27

What is the most worrying sign in a child with asthma attack?

Answer 27

Silent chest

This is because the airways are so tight, it is not possible for the child to move enough air through the airways to create a wheeze. This is life threatening and is dangerous as can be interpreted as there is no wheeze, so the sign is missed.

Question 28

What should be monitored in hospital after an acute asthma attack?

Answer 28

Potassium levels as high dose salbutamol can cause potassium absorption from the blood to the cells

Question 29

Management of an asthma attack in a child

Answer 29

1. Supplementary oxygen (i.e. saturations less than 94%)
2. Bronchodilators
   
   1. salbutamol first line
   2. ipratropium bromide second line
   3. IV magnesium sulphate
   4. IV aminophylline
3. Prednisone and/or hydrocortisone to reduce airway inflammation (30mg PO for 3 days)

Question 30

When can a child be discharged from hospital post asthma attack?

Answer 30

Generally, discharge can be considered when the child is well on 6 puffs 4 hourly of salbutamol.

Question 31

Which abx is used for first line treatment of pneumonia?

Answer 31

Amoxicillin

Question 32

Which abx is added to the treatment regime if there is no response to Amoxicillin (for pneumonia)?

Answer 32

Macrolides e.g. azithromycin, clarithromycin

Question 33

In pneumonia with mycoplasma or chlamydia what is given

Answer 33

Macrolides e.g. azithromycin

Question 34

What abx is given for pneumonia associated with influenza?

Answer 34

co-amoxiclav