Paediatric Chronic Conditions

Question 1

What are 10 signs of increasing respiratory distress?

Answer 1

1. Tachypnoea
2. Tachycardia
3. Cyanosis
4. Cool peripheries
5. Nasal flaring
6. Tracheal tug
7. Recessions - intercostal, subcostal and substernal
8. Seesaw chest movement
9. Tripod position
10. Head bobbing

Question 2

Why does airflow obstruction or narrowing occur?

Answer 2

1. Smooth muscle hypertrophy and hyperplasia
2. Inflammatory cell infiltration
3. Oedema
4. Goblet cell and mucous gland hyperplasia
5. Mucous hypersecretion
6. Protein deposition including collagen
7. Epithelial desquamation

Question 3

What are other causes of wheezing in young children? [apart from asthma]

Answer 3

1. Transient infant wheezing
2. Maternal smoking
3. Cystic Fibrosis
4. Inhaled foreign bodies
5. Milk aspiration - cough during feeds
6. Associated with developmental delay [structural abnormalities]
7. Cardiac failures

Question 4

What are 7 clinical manifestations of Cystic Fibrosis?

Answer 4

1. Chronic suppurative lung disease
2. Sinusitis
3. Nasal polyps
4. Exocrine pancreatic insufficiency
5. Endocrine pancreatic insufficiency
6. Liver disease
7. Distal intestinal obstruction syndrome (DIOS)

Question 5

How can cystic fibrosis be diagnosed?

Answer 5

1. Newborn screening (DNA)
2. Sweat test
3. Pancreatic insufficiency
4. Family Hx
5. Clinical features

Question 6

What is the management of lung disease?

Answer 6

1. Chest physiotherapy & exercise
2. Antibiotic therapy
3. Mucolytics [pulmonzyme / hypertonic saline]
4. Lung transplant and gene therapy.

Question 7

What are the 2 primary issues related to GI disease in CF? Give an example for each

Answer 7

1. Exocrine pancreatic insufficiency [malabsorption / malnutrition]
2. Endocrine pancreatic deficiency [glucose intolerance / diabetes]

Question 8

What are some CF challenges in childhood?

Answer 8

1. Family adaptation and dynamics
2. Genetic counselling - future siblings
3. Compliance / adherence
4. Hospitalisations - missing school and friends
5. Medication administration
6. Self image and appearance
7. Relationships / sexuality / fertility
8. Coping with shortened life expectancy
9. QOL / lifestyle and responsibility / education / careers
10. Smoking / drug use and rebellion

Question 9

What are some causes of paediatric strokes?

Answer 9

1. Some types of heart disease or surgery
2. Abnormal or inflamed blood vessels in the brain
3. Blood clotting problems
4. Low blood count
5. Central venous catheters
6. Some types of cancers
7. Head injury
8. Dehydration
9. Prolonged low BP
10. Some viral infections
11. Other conditions such as sickle cells and thalassaemia

Question 10

How can paediatric strokes be diagnosed?

Answer 10

CT/MRI
Angiogram
Ultrasound
Echocardiogram
Blood tests
Clinical presentations and VS

Question 11

How can paediatric strokes be treated?

Answer 11

With anticoagulants and surgery.