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Paediatrics > LRTI > Flashcards

LRTI Flashcards

1
Q

How do you manage LRTI

A

Make Dx
Assess patient - oxygenation, hydration, nutrition
Decide whether to treat

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2
Q

What is LRTI

A 
>48 hours 
Fever >38.5
SOB
Cough
Grunting 
Reduced or bronchial breath sounds
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3
Q

What makes bacterial cause of LRTI unlikely

A

Wheeze

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4
Q

What are common agents in LRTI

A 
H influenza 
Pneumococcus
Mycoplasma
Chlamydia 
S.Aureus
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5
Q

When do you call it pneumonia

A 
Signs are focal
Crepitations
Consolidation on CXR in adults 
High fever / cough  / SOB etc
Otherwise = LRTI but can call it this as pneumonia causes anxiety
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6
Q

What is 1st line treatment in acute LRTI and when do you treat

A 
Amoxicillin 
Macrolide 2nd line
Look for scarlet fever rash 
IV only if vomiting  
Treat if oxygenation, nutrition and hydration is okay
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7
Q

How do you diagnose LRTI

What is not routine

A

HISTORY
CXR and inflammatory markers NOT routine
Only do CXR / bloods if suspect empyema / sepsis

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8
Q

What are signs of respiratory distress

A 
Increased RR >70
Increased HR >160 
Grunting
Nasal flaring
Recession - sternal, intercostal, subcostal
Use of accessory muscles - SCM, abdominal and intercostal 
Cyanosis
Sweating
Tracheal tug
Head bobing
Wheeze
Stridor 
As get exhausted - go into type 2 resp failure and develop cyanosis
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9
Q

What is bronchitis

A

Self limiting infection of bronchi

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10
Q

What age group is bronchitis common in

A

2-3 years

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11
Q

What does bronchitis present with

A

Loose rattly cough - can continue for week
Post vomit / glut
May have cold like symptoms, wheeze, sore throat
Chest free of creps / crackles

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12
Q

What causes bronchitis

A

RSV - common in winter
Adenovirus
Switch of mucociliary clearance so repeated infection
Bacteria can also cause on top

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13
Q

How do you Rx bronchitis

A

Supportive

Full septic screen / LP if <3 months + fever

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14
Q

What are red flag symptoms (suggest bronchiectasis)

A 
<6 months or >5
Worry in babies especially <1 months as should have mother IgG -full septic screen / LP if fever
FTT
Disrupt QOL
SOB at rest
Co-morbidities
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15
Q

What is bronchiolitis

A

LRTI of infants common in <1 year
Most common 3-9 months as <3 months should be protected
Can occur up to 2 years particularly if pre-mature / chronic resp disease
33% get bronchiolitis
3% admitted

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16
Q

What causes bronchiolitis

A

RSV most common (RNA) virus
Paraflu III
Often FH of URTI

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17
Q

When is bronchiolitis common

A

Winter months

Never recurrent like viral wheeze

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18
Q

What are the symptoms of bronchiolitis

A 
Coryza prodrome - discharge / snuffly
Persistent cough - can last week 
Signs of resp distress
Dyspnoea 
Tachypnoea
Chest recession
Wheeze/ crackles in chest due to small airways filled with mucous 
\+- fever (30%)
Poor feeding due to SOB 
Increased respiratory effort - refer to 2 care
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19
Q

How may an infant <6 week present

A

Apnoea only

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20
Q

When do you admit to 2 care

A 
<3 months 
Pre-mature /
Pre-existing lung disease 
Apnoea
Persistent low sats
Inadequate oral intake
Dehydration 
Lethargy
Persistent resp distress
CYanosis 
Social issues
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21
Q

Who are at risk of more severe

A 
Chronic lung - CF
Congenital heart
<3 months
Premature
Bronchpulmonary dysplasia 
Immunedeficient
Neuromuscular - may not see respiratory signs 
Parenteral smoke
22
Q

What is the typical history of bronchiolitis

A

Getting worse 5 days
Worse 3-5
Stabilise and recovery over 2 weeks
Think is oxygen, hydration, nutrition okay?

23
Q

How do you Dx bronchiolitis

A

NPA
02 sats show severity
No routine blood / gas / CXR

24
Q

When would you do blood / gas / CXR / sputum culture

A

ABG if looks very unwell to see C02 levels / or if on ventilation
If focal signs to exclude pneumonia / pneumothorax

25
Q

How do you treat bronchiolitis

A 
Max observation, minimal intervention
If sats >92% and feeding >50% = safety net
Admit 
Isolation and PPE 
02 if sats <92% (humidified) 
Fluids
May need NG tube if not feeding 
Rarely CPAP 
Intubation if resp failure 
Consider suction if significant secretion

Bronchodilators do not work as b2 receptors immature in <2

26
Q

If you send home what do you safety net with

A

If increased respiratory effort
Decreased fluid intake
Exhausted
Dry nappy

27
Q

When do you discharge

A

Adequate oral intak

Sats okay for 4 hours

28
Q

When would you consider pneumonia

A

Bronchiolitis
If high fever
Persistent focal signs - crackles, decreased breath sound, bronchial breathing
Older child

29
Q

What is important to remember with pneumonia

A

Look for rash of scarlet fever

30
Q

When would you consider viral induced wheeze

A 
Persistent wheeze
No crackles
Recurrent episodic wheeze
Don't fit LRTI 
Prev HX
31
Q

What causes viral induced wheeze

A

RSV = common
Passiv smoke worsens
Rare in

32
Q

How do you treat viral induced wheeze

A 
Mild = none
SABA (10 puffs MDI) or anti-cholinergic
Inhaled steroid - bexamethasone / LTRA
Oral pred if admitted
Send home with SABA and reduce amount
33
Q

What do you do for recurrent viral induced wheeze

A

Give a preventer - ICS / LTRA

34
Q

Is it asthma

A

Could be
Rare in <5
Have to wait and see as no test

35
Q

Who gets RSV monoclonal Ab

A

Immunocompromised
Repet bronchiolitis
Premature
Lung or heart abnormality

36
Q

What causes Whooping cough

A

Bordetella pertussis - gram -ve
Inc 10-14 days
Routinely immunised - no life long protection
Particuly vulnerable as newborn so pregnant women immunised

37
Q

What are the symptoms of whooping cough

A

Whooping cough - inspiratory whoop episodes during coughing fit
Followed by fainting / vomit after
Mild respiratory prodrome 2-3 days prior
Central cyanosis
Apnoea - can present with this rather than cough
Petechia from cough / subconjunctival haemorrhage
Marked lymphocytosis
Chest clear

38
Q

What are complications of whooping cough

A 
Pneumothorax
Bronchiectasis 
Anoxic seizure 
Pneumonia
Encepahlopathy - seizure
39
Q

How do you Dx whooping cough

A

Nasal swab - culture / PCR if symptoms <2 weeks

Serology of blood if >2

40
Q

How do you Rx whooping cough

A

Oral macrolide if within 21 days for 3 weeks
Ax prophylaxis to household contacts
Exclude from school 48 hours after Ax or if <21 days from symptom onset
Vaccine to newborn and pregnant women

41
Q

When do you admit

A

<6 months
Apnoea
Complications
Resp difficulty

42
Q

Do you report to public health

A

Yes

43
Q

CF

A

See respiratory

44
Q

How does chronic lung disease present

A

Hyper-inflated lung
Surgical emphysema
Pectus carnatum (out)
Pectus excavatum (in)

45
Q

If patients presenting with recurrent LRTI what should you think

A

Underlying lung condition e.g. CF

Underlying immune

46
Q

What should you asses for

A 
Reflux
Aspiration
Neurological disease
Heart disease
Asthma
CF
Primary ciliary diskinesia
Immune deficiency
47
Q

What tests

A 
FBC for WBC 
CXR for structural 
Serum Ig to look for low levels 
Sweat test
HIV
48
Q

Causes of clubbing in children

A 
CF
Bronchiectasis
Cyanotic heart disease
IE
TB
IBD
Liver cirrhosis
49
Q

What is primary ciliary dyskinesia

A

AR condition
Affects cilia of tracts
Also known as Kartamenger

50
Q

What is the triad

A

Sinusitis
Bronchiectasis - build up of mucous, chronic infection
Infertiltiy - affects epithelium of Fallopian tube
Situs inverts - all organs on different side not just the heart

51
Q

How do you Dx

A

FH
Examination
CXR to show situs invertus
Sample of ciliated epithelium for analysis

52
Q

How do you Rx

A

Similar to CF and bronchiectasis
Physio
High calorie diet
Ax

Paediatrics (35 decks)

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