Paediatric 2 Flashcards
Symptoms of obstructive sleep apnoea
COgnitive deficits, behavioural abnormalities, impulsivity, hyperactivity, bed wetting, poor growth: usually thin
IS sleep study essential for sleep apnoea diagnosis
NO. sometimes history is enough. Otherwise healthy child is not necessary
MOst comprehensive type of sleep study
Polysomnogrophy: measures HR, sats, Co2, EEG, airflow sensors, chest/abdo sensors
obstructive sleep apnoea treatment
Conservative if low clinical concern
Adenotonsillectomy in persistent OSA
ANasal steroid spray (mild OSA)
Airway craniofacial surgery depending on pathology
Chronic lymphadenopathy in children worrying? Treatment
NO they are very common. Be worried if there is a history of malignancy, if it is >2cm, it is supraclavicular and if they are getting bigger or are fixed/hard (lymphoma)
CXR, FBC. if abnormal then biopsy
Give abx and review in 2 weeks and biopsy if getting bigger
What is non-tuberculous mycobacteria
Occurs in a well child with violet skin colour over cold abscess, usually submandibular area. Abx or nil as settles spontaneously over 1-2 years. Often conservative management is better
Normal reactive lymph nodes
Size <1cm, fluctuates in size, worse with URTI. Clear source of infection e.g. scalp disease or tonsillitis, jugulodigastic area, well child, no other nodes or B symptoms. Offer reassurance and conservative management/monitoring
Treatment of thyroglossal duct cysts and branchial cysts
Need excision
Do you need to excise pre auricular sinus
Only if symptomatic
Complications of DNSI
Airway compromise
Rupture: pneumonia, empyema, lung abscess
Mediastinitis
Menierre’s syndrome: IJV thrombosis
Carotid artery erosion
Treatment of DNSI
Airway protection: observation/intubation/trache
IV abx
Surgical drainage/aspiration
What is Ludwig’s angina
Floor of mouth swelling
How to examine airway in children
Ask about breathing, blue episodes, feeding, weight gain (red book), voice, prematurity/intubation (risk factor for subglottic stenosis), skin, haemangioma (symptoms in child that get worse), PMH
Look for accessory muscle used, head bobbing, sniffing position, drooling, intercostal/subcostal/suprasternal recession
Bad signs: quiet child, no crying, marked recession, mottled, increasing tachycardia
Commonest causes of stridor
LAryngomalacia (floppiness of larynx which causes squeaky inspiratory sound)
BIlateral vocal cord palsy at birth
Unilateral vocal cord palsy after cardiac surgery
Acquired subglottic problems with formation of cysts and occur in children who have been intubated because of prematurity
Commonest causes of paediatric stridor in a newborn
M=Vocal cord motion impairment
Commonest cause of paediatric stridor in weeks old child
Laryngomalacia /haemangioma
Commonest causes of paediatric stridor in a months old
Recurrent respiratory papillomatosis
Commonest causes of paediatric stridor in intubated NNU/PICU child
Subglottic stenosis
Common causes of paediatric stridor in years old
Croup, epiglottitis, foreign body
What to do if someone presents with a vocal cord motion impairment (unilateral vs bilateral)
Unilateral is usually iatrogenic
SO is bilateral. But needs a posterior fossa brain scan to rule out malformations in the brain leading to damage to vagus nerve. Half need trashy. 2/3 will recover at least partially
Factfile of laryngomalavia. treatment?
Flexiscope. See a epiglottis that is folded. Inspiratory stridor worse with feed, prone position, agitation
If they are otherwise well and ti is not bad, then nothing really needs to be done. IF bad, can have supraglottoplasty
Factfule of haemangioma
Management?
Rapid growth during first few months of life then convolution over next 2-3 years. There is a biphasic stridor (inspiratory and extrinsic).
MAnagement: Propranolol
Recurrent respiratory papillomatosis warts factfile and treatment
HPV causes warts. Acquired from vertical transmission (still occurs with C section). Risk factors: first child, vaginal delivery, young mother
Presentation: husky voice and eventually airway obstruction
Treatment: repeated debulking
Factfile of acquired subglottic stenosis
happens in children who are extubated (taken off intubation). Present with stridor when intubated. Wait until there is no infection, minimal respiratory support and normal O2 requirements and give them dexamethasone before reinserting tube.
