Common Paediatric Presentations

Question 1

what is the commonest chronic condition in children? (affects 1 in 11)

Answer 1

asthma

Question 2

how is asthma characterised?

Answer 2

reversible and paroxysmal constriction of teh airways

airway occlusion by inflammatory exudate and late airway remodelling

Question 3

which cytokien is toxic to epithelial cells in asthma?

Answer 3

leukotriene C4

Question 4

is preschool wheeze common?

Answer 4

yes- half of children will have had wheeze however 60% will outgrow this

Question 5

Investigations for asthma?

Answer 5

PEFR

spirometry

exercise testing

Exhaled Nitric Oxide

CXR

Question 6

if doubt of asthma what test should be done to exclude other conditions?

Answer 6

oesophageal pH study to exclude GORD

chloride sweat test to exclude CF

HRCT to exclude bronchiectasis

Question 7

why is exhaled nitric oxide (ENO) useful in asthma?

Answer 7

NO produced in bronchial epithelial cells and is increased in those with Th2 driven inflammation so is icnreased in asthma

Question 8

treatment steps for asthma?

Answer 8

1. SABA (salbutamol)
2. Add on ICS (beclometasone)
3. Add on LABA (salmeterol), inc ICS, Montelukast
4. inc ICS
5. Oral steroids and refer to resp paeds

Question 9

what are the criteria for mild, severe and life threatening asthma?

Answer 9

Mild, SpO2 >92%, Normal PEFR

Severe, SpO2 <92%, PEFR 33-50% predicted

Life threatening, SpO2 <92%, PEFR <33% predicted

Question 10

hospital management of acute asthma exacerbation?

Answer 10

1. ABG
2. Oxgyen 100% rebreather
3. 5mg Salbutamol and 0.5mg ipatropium bromide nebulised
4. Hydrocortisone 100mg IV or Prednisolone 50mg orally
5. CXR to exclude pneumothorax

Question 11

If life threatening asthma what can be given?

Answer 11

magnesium sulphate IV

Question 12

what must patients PEFR be to be discharged folllwing acuta asthma exacerbation?

Answer 12

PEFR >75% predicted

oral corticosteroids should be continued until no symptoms