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Year 5 - Paediatrics > Paediatric RESP > Flashcards

Paediatric RESP Flashcards

1
Q

What is the proper medical name for croup?

A

Viral laryngotracheobronchitis

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2
Q

At what point of the year is croup most common?

A

Autumn

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3
Q

What age group is affected by croup?

A

6m to 6y, peak 2y

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4
Q

What is the main cause of croup?

A

Parainfluenza

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5
Q

Recall 3 differentials for croup

A

Laryngomalacia
Acute epiglottitis
Inhaled foreign body

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6
Q

Recall the signs and symptoms of croup

A

1st = coryzal Sx
2nd = barking cough (from vocal cord impairment) + stridor

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7
Q

What investigations should be done for croup?

A

Clinical diagnosis
DO NOT EXAMINE THROAT

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8
Q

How should croup be managed?

A

Westley score determines admission

Admit if RR>60, or complications

DEXAMETHOSONE TO ALL

For mild: discharge
For moderate: admit
For severe: admit and add nebulised adrenaline to dex
For impending respiratory failure: same as severe

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9
Q

What is the most likely complication of croup?

A

Secondary bacterial superinfection

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10
Q

What is the most common cause of acute epiglottitis?

A

Haemophilus influenza B (bacteria!!!!) hence is quite uncommon as vaccinated against

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11
Q

What are the signs and symptoms of acute epiglottitis?

A

Medical emergency
No cough as in croup
High-fever (‘toxic-looking’)
Stridor is soft inspiratory with high RR
“Hot potato” speech
Drooling as child cannot swallow
Immobile, upright + open mouth: ‘tripod sign’

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12
Q

How should acute epiglottitis be investigated and managed?

A

Do not lie child down or examine their throat (may precipitate a total obstruction)

  1. Immediately refer to ENT, paeds + anaesthetics –> transfer + secure airway
  2. Once airway is secured, blood culture, empirical Abx (cefuroxime) + dexamethosone
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13
Q

In what age range is bronchiolitis seen?

A

1-9 months
3-6 month peak

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14
Q

What is the most common cause of bronchiolitis?

A

RSV in 80%

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15
Q

What are the signs and symptoms of bronchiolitis?

A

1st = coryzal Sx which progress to
2nd = dry, wheezy cough, SOB, grunting

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16
Q

What are the examianation findings in bronchiolitis?

A

To distinguish from croup/ other ‘itis’
Auscultate: fine, bi-basal, end-inspiratory crackles

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17
Q

What investigations should be done in bronchiolitis?

A

Cinical dx but can do an NPA (nasopharyngeal aspirate) to confirm

If there is significant respiratory distress + fever, do a CXR to rule out pneumonia

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18
Q

What are the criteria for hospital admission in bronchiolitis?

A

Hospital admission:
If <2 months, lower threshold as they deteriorate quickly- apnoea/ cyanosis/ grunting
- Poor oral fluid intake
- SpO2 < 92% on normal room air
Supportive care: nasal O2, NG fluids/ feeds, CPAP if respiratory failure

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19
Q

Over how long is bronchiolitis self-limiting?

A

2 weeks

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20
Q

Describe the ‘spectrum’ of infant asthma

A

Bronchiolitis if <1y
Viral-induced wheeze (1-5y)
Asthma (>5)

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21
Q

Describe the wheeze in asthma

A

End-expiratory polyphonic

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22
Q

When are asthma symptoms worst?

A

Night/ early morning

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23
Q

What will be seen OE in childhood asthma?

A

Hyperinflated chest + accessory muscle use
Harrisson’s sulci - depressions at base of thorax where diaphragm has grown in muscular size

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24
Q

How should childhood asthma be diagnosed?

A

<5 years old = clinical dx
>5 years old = spirometry, bronchodilator, PEFR variability

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25
Q

Recall the PEFR range of moderate, severe, and life-threatening asthma

A

Moderate: 50-75%
Severe: 33-50%
Life-threatening: <33%

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26
Q

When should you admit a child with asthma?

A

When they are classified as severe or life-threatening?

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27
Q

How should paediatric asthma be managed in a hospital setting?

A
  1. Burst step
    - 3 x salbutamol nebs, or up to 10 inhales on a pump
    - 2 x ipratropium bromide nebs (SE of too much = shivering, vomiting)
    - Involve seniors if burst therapy has failed to work
  2. IV Bolus step = give one of the following: MgSO4, salbutamol, aminophylline
  3. Infusion step
    - IV salbutamol/ aminophylline
  4. Panic step
    - Intubate + ventillate
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28
Q

Recall 4 contraindications of beta-agonists/ salbutamol

A

Beta-blockers
NSAIDs
Adenosine
ACE inhibitors

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29
Q

Recall outpatient management of asthma in children over 5

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + low dose ICS MART
  6. SABA + mod dose ICS MART / mod ICS + LABA
    • increase ICS to paediatric high dose / Theophylline
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30
Q

What is the most common cause of rhinitis?

A

Rhinovirus

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31
Q

What is rhinitis more commonly known as?

A

Common cold

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32
Q

What is the general recovery time for rhinitis?

A

2 weeks

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33
Q

What are the possible complications of rhinitis?

A

Otitis media
Acute sinusitis

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34
Q

What is sinusitis?

A

Infection of the maxillary sinuses from viral URTIs
May lead to a secondary bacterial infection

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35
Q

How should sinusitis be managed?

A

If Sx last <10 days
- no Abx, advise them that virus will take 2-3w to resolve, simple analgesia

If Sx last >10 days, high dose nasal CS for 14 days
- this may improve Sx but is unlikely to reduce duration of illness
- Give back up prescription of Abx

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36
Q

When should a pt be admitted to hospital for sinusitis?

A

Severe systemic infection

Intraorbital/ periorbital problems (eg periorbital cellulitis, diplopia)

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37
Q

Why are children particularly vulnerable to otitis media?

A

Eustacian tubes are short, horizontal + function poorly

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38
Q

What are the 3 most common causative organisms in otitis media?

A

H influenza
S. pneumoniae
RSV

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39
Q

What investigations should be done in otitis media?

A

Temperature
Otoscopy

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40
Q

What would be seen on otoscopy in otitis media?

A

Bright red bulging tympanic membranes
Loss of normal light reaction
Perforation
Pus

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41
Q

Recall 3 indications for admission in acute otitis media

A

Severe systemic infection
Complications (eg meningitis, mastoiditis, facial nerve palsy)
Children <3 months with a temperature >38

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42
Q

When should abx be given in otitis media?

A

Delayed prescription if not better after 3 days or if it gets suddenly worse

Immediate Abx prescription if systemically unwell, age <2 yo

If there is a perforation: oral amoxicillin + review in 6w to ensure healing

43
Q

What is another name for otitis media with effusion?

A

Glue ear

44
Q

What are the signs and symptoms of otitis media?

A

Asymptomatic apartfrom possible reduced hearing
Can interfere with normal speech development

45
Q

What does otoscopy show in otitis media with effusion?

A

Eardrum is dull + retracted, often with a fluid level visible

46
Q

How should otitis media with effusion be investigated?

A

Tympanometry
Audiometry

47
Q

When should a referral be made to ENT in otitis media with effusion?

A

If persistent past 6-12 weeks

48
Q

What is the most common complication of chronic otitis media?

A

Mastoiditis (chronic OM –? Honeycomb structure behind ear inflamed –> discharge + swelling behind ear)

49
Q

What is another name for acute diffuse otitis externa?

A

Swimmer’s ear

50
Q

What is the cause of chronic otitis externa?

A

Fungal cause

51
Q

What is necrotising otitis externa?

A

Life-threatening extension into mastoid + temporal bones

52
Q

What demographic of folks are most likely to get necrotising otitis externa?

A

The elderly

53
Q

How should otitis externa be investigated?

A

If indicated: swabs + culture

54
Q

How should otitis externa be managed?

A

Topical acetic acid (only effective for 1 week)
If indicated: topical Abx (neomycin/ clioquinol)
Wicking + removal of debris

55
Q

Recall 2 indications for abx use in otitis externa?

A

Cellulitis
Cervical lymphadenopathy

56
Q

What is tonsilitis?

A

Form of pharyngitis with inflammation of the tonsils + purulent exudate

57
Q

What is the most common cause of bacterial tonsilitis?

A

Group A beta-haemolytic streptococcus

58
Q

What score determines likelihood of bacterial over viral aetiology of tonsilitis? Recall it as well as the consequences of each score

A

Centor score:
+1: exudate
+1: tender anterior cervical LNs
+1: Temp >38
+1: Cough absent
+1: age 3-14
“CETTA”
1 = no abx
2/3 = rapid strep test
4/5 = rapid strep test + Abx

59
Q

When should a referral for laryngoscopy be made in tonsilitis?

A

If persistent (>3w) and change in voice

60
Q

When should you admit for tonsilitis/ pharyngitis/ laryngitis?

A

Difficulty breathing
Peri-tonsillar abscess (quinsy) or cellulitis
Suspected rare cause (eg kawasaki/ diptheria)

61
Q

How would diptheria appear OE of the throat?

A

‘web’/ pseudomembrane at back of throat

62
Q

If bacterial tonsilitis is confirmed using rapid strep test, how should it be treated?

A

Phenoxymethylpenicillin 10 days QDS

63
Q

What tx should be avoided in tonsilitis?

A

Amoxicillin in case it’s EBV because then you would get a maculpapular rash

64
Q

For how long should school be avoided in tonsilitis?

A

Unti 24 hours after abx have been started (in case of scarlet fever)

65
Q

What should you advise for self-tx for tonsilitis if no abx indicated?

A

Paracetamol
Lozenges
Saltwater
Difflam (anaesthetic spray)

66
Q

What is the connection between tonsilitis and scarlet fever?

A

GAS (s pyogenes) infection can progress from tonsilitis to scarlet fever

67
Q

What are the signs and symptoms of scarlet fever?

A

Rash and erythroderma
Neck + chest –> trunk + legs
Characteristic sandpaper texture
Pastia’s lines (rash prominent in skin creases)
Strawberry tongue (starts as white, then desquamates)
May progress to rheumatic fever with a week’s latency

68
Q

How should scarlet fever be managed?

A

Phenoxymethylpenicillin 10 days QDS

69
Q

Upon which chromosome is the cAMP-dependent Cl channel defect in cystic fibrosis?

A

Chromosome 7

70
Q

What is the incidence of cystic fibrosis in terms of number of live births?

A

1 in 25, 000

71
Q

Recall some of the most important signs and symptoms of cystic fibrosis in children?

A

Meconium ileus
Recurring chest infections
Clubbing of fingers

72
Q

When is cystic fibrosis screened for in children?

A

At birth: heel prick test

73
Q

If cystic fibrosis screening is positive, what further tests can be done?

A

Immunoreactive trypsinogen
Sweat test (abnormally high NaCl)
Genetic tests

74
Q

Recall the timeline of routine reviews in cystic fibrosis?

A

Weekly in 1st month
Every 4w in 1st year
Every 6-8w when 1-5y
Every 2-3m when 5-12yo
Then every 3-6m

75
Q

What is the main method of monitoring for cystic fibrosis?

A

Spirometry

76
Q

How frequent should physiotherapy be done for respiratory symptoms in CF?

A

twice a day

77
Q

Recall the protocol for mucolytic therapy in cystic fibrosis

A

1st line = rhDNase
2nd line = rhDNase + hypertonic saline
Orkambi (lumcaftor + ivacaftor) may be effective in treating CF caused by the FGO8 mutation

78
Q

How should recurrent infection be managed in cystic fibrosis?

A

Prophylactic abx: usually flucloxacillin + azithromycin
Rescue packs given for prompt IV Abx

79
Q

How should cystic fibrosis patients be nutritionally managed?

A

High calorie + high fat diet (150% of normal) + fat-soluble vitamins
Pancreatic enzyme replacemet with every meal –> CREON

80
Q

How can liver problems in cystic fibrosis be managed?

A

Ursodeoxycholic acid to help bile flow

81
Q

What is laryngomalacia?

A

Congenital abnormality of larynx predisposing to supraglottic collapse during inspiration

82
Q

What are the signs and symptoms of laryngomalacia?

A

At 2-6w they go all noisy with their breathing (nb: not present at birth:
GORD +/- feeding difficulties, cough + choking
Normal cry

83
Q

How should laryngomalacia be managed?

A

Self-resolves within 18-24m so conservatively manage
If airway compromise/ feeding disrupted sufficiently to prevent normal growth –> endoscopic supraglottoplasty

84
Q

What is a breath holding attack?

A

When child cries vigorously for <15s + then becomes silent

85
Q

How should breath holding attack be managed?

A

Resolve spontaneously

86
Q

What will be heard on auscultation in pneumonia?

A

Consolidation + coarse crackles

87
Q

How should TB be investigated if there is exposure?

A

Manteaux test: if -ve excludes TB
If +ve –> IGRA test
If -ve –> prophylaxis (isoniazid)
If +ve –> tx

88
Q

Recall the treatment of TB pneumonia

A

RIPE;
Rifampicin 6m
Isoniazid 6m
Pyrazinamide 2m
Ethanbutol 2m

89
Q

How can pneumonia and bronchiolitis be differentiated clinically?

A

Bronchiolitis = fine crackles on auscultation,
Pneumonia = coarse crackles

90
Q

How should pneumonia be managed?

A
  1. Note severity using obs + examination
  2. Decide on whether they need admitting or not
  3. Abx (can’t distinguish viral + bacterial so just do it) - mild CAP = amoxicillin, 2nd line (severe CAP) = co-amoxiclav + macrolides
91
Q

How should you decide whether a child with pneumonia needs to be admitted?

A

SpO2 < 92% on air
RR>60
Child <3m
OE: grunting, cyanosis, chest recession marked
Low consciousness
T>38

92
Q

What is the gram status of pertussis?

A

-ve

93
Q

What are the signs and symptoms of pertussis?

A

1w coryzal Sx followed by continuous coughing followed by inspiratory whoop + vomiting

In infants it is apnoea rather than a whoop

94
Q

What investigations should be done in pertussis?

A

Culture + PCR per nasal swab

95
Q

How should pertussis be managed?

A

Notify HPU
Decide whether to admit
<1m: clarithromycin
1+months: azithromycin

96
Q

How do you decide whether to admit in whooping cough?

A

If <6m or acutely unwell

97
Q

What is the other name for paediatric chronic lung disease?

A

Bronchopulmonary dysplasia

98
Q

What would the CXR show in chronic lung disease?

A

Widespread opacification

99
Q

How should chronic lung disease be managed?

A

If severe: artificial ventilation/CPAP/ low-flow nasal cannula
Short course low-dose CS

100
Q

What is the pathophysiology of bronchiolitis?

A

Causes both upper and lower airway disease due to inflammation of bronchioles, causing the wheeze and crackles also seen

101
Q

What reasons related to bronchiolitis may cause a child to need admission?

A

Bronchiolitis causing difficulty breathing (especially in younger children who do not use nose to breathe yet)

Difficulty feeding
- Hydration status should be assessed
- Are they taking less than 50% of their feeds?

Apnoeas - may require respiratory support or HDU/ICU care

102
Q

What are some risk factors for severe bronchiolitis?

A

Chronic lung disease
Congenital heart disease
Less than 3 months old
Premature (especially before 28w)
Neuromuscular disorder
Immunodeficiency

103
Q

What would the in-hospital management of bronchiolitis involve?

A

Respiratory support if sats < 90%

NG tube with oral feeds, IV only if not tolerating

104
Q

Why is a CXR advised against in suspected bronchiolitis?

A

The x-ray changes with bronchiolitis are similar to bacterial pneumonia so should not be used to differentiate or whether to give antibiotics

Year 5 - Paediatrics (15 decks)

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