Paediatric resp Flashcards
What should be considered when giving antibiotics to children?
Do benefits outweigh the harm?
Doesnt matter if viral or bacterial
What is the most common symptom of URTIs?
Fever
What are side effects of antibiotics in children?
Diarrhoea Oral thrush Nappy rash Allergic reaction Multiresistance
What causes bacterial infection in resp tract?
Virus breaking membranes
What should you do for most children presenting with a resp infection if they are not at major risk?
Safety net
What is safety netting?
Telling parents to keep an eye on the child and report if deterioration
How long can ear ache last?
Usually resolved within a week, can take slightly longer
What can be given for otitis media?
Analgesia for pain
Antibiotics MIGHT make a difference after 24 hours
End point is the same either way
How is tonsillitis/pharyngitis diagnosed?
Throat swab
What should be given for tonsilitis or pharyngitis?
10 days penicillin or nothing
Analgesia
Fluids
What is croup also called?
Laryngotracheobronchitis
What are features of croup?
Caused by type I parainfluenza
Common
Generally well
Coryza++, stridor, hoarse voice, barking cough
How is croup treated?
Oral dexamethasone
What are features of epiglottitis?
Caused by H.influenzae tybe B Rare Child is very unwell Stridor, drooling, horrendously sore throat High pulse low blood pressure Temperature
How is epiglottitis treated?
Intubation and antibiotics
How long does croup typically last?
2 days
What are common bacteria causing LRTI?
Strep pneumoniae
Haemophilus influenzae
How is the patient assessed with a LRTI?
Oxygenation
Hydration
Nutrition
What are features of bronchitis?
Very very common Loose rattly cough Post-tussive vomit - glut Chest free of wheeze/creps Child is very well
What causes bronchitis?
Haemophilus/pneumococcus
What is the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance caused by adenovirus leading to secondary bacterial overgrowth, child nearly gets better then get a new viral infection which starts the cycle again
What are red flags of bronchitis?
Age <6months or >4 years No relapse-remission Static weight Disrupt's childs life Associated SOB when not coughing Acute admission Other co-morbidities
What should you do with bacterial bronchitis?
Make diagnosis
Reassure parent
Do not treat
Who is affected by bronchiolitis?
Infants
What usually causes bronchiolitis?
RSV
Paraflu III
HMPV
What are features of bronchiolitis?
Nasal stuffiness Tachypnoea Poor feeding Crackles May have wheeze
What is the progression of bronchiolitis?
Inocculation and well for first 2 days
Get worse over next 3 days
Stabilise (no better or worse) for 2 days
Recovery
What are features of the child that reduce uncertainty of bronchiolitis?
<12 months old
One off - NOT recurrent
Typical history
How is bronchiolitis treated?
Maximal observation
Minimal intervention
Should you give medication for bronchiolitis?
No
What are general characteristics of LRTIs?
48 hrs fever >38.5C SOB Cough, grunting Wheeze makes bacterial unlikely Reduced or bronchial breath sounds Infective agents
What are features of pneumonia in children?
Focal signs
Creps
High fever
What is management of pnemonia?
NOTHING IF MILD SYMPTOMS
Oral amoxycillin first line
Oral macrolide second choice
Should antibiotics be given orally or IV in LRTI?
Orally unless vomiting
Is pertussis common?
Yes despite vaccination - reduces risk and severity
What are characteristic features of pertussis?
Coughing fits out of the blue followed by whoop
Vomiting and colour change
What is the main factor of knowing if a child has asthma?
No wheeze no asthma
When should you give a trial of ICS?
If patient QoL is affected
What are the key features of asthma?
Wheeze
Variability
Respond to treatment
What is thought to cause asthma?
Host response to environment Infection has a role Physiology abnormal before symptoms It is a syndrome Genes Epigenetics Loss of integrity of airway allowing allergy to EXACERBATE asthma
What is epidemiology of asthma?
About 10% of each age groups
Does reduced spirometry diagnose asthma?
No but it is consisent
How is asthma diagnosed?
Almost entirely through history and symptoms
What can you ask a parent to determine if their child actually has wheeze?
Ask if it is a rattle or whistle
What causes SOB at rest?
Airway obstruction
What is a feature of SOB at rest?
Sucking in ribs with wheeze
What are characteristics of asthmatic cough?
Dry
Nocturnal
Exertional
What asthma treatment is used to assess for asthma?
2 months ICS
What should be done if asthma responds to treatment to avoid false positives?
ICS holiday to see if symptoms return
What are benefits of trial of treatment for asthma?
Helps diagnosis
Improve QoL and reduce risk of attack if symptoms respond
Is an under 18 month old likely to have asthma?
No, more likely to be infection but can still be asthma
What are differential diagnoses for asthma if onset is under 5 years old?
Congenital problem Cystic fibrosis Primary ciliary dyskinesia Bronchitis Foreign body
What are differential diagnoses if onset is over 5 years?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
What is the most important aspect of treatment of asthma?
Patient QoL
What factors in QoL are important to work on?
Minimal symptoms
Minimal need for reliever medication
No attacks/exacerbations
No limitation of physical activity
What is the SANE mnemonic for closed questions regarding asthma?
SABA/week - shouldn’t be more than 2
Absence from school or nursery
Nocturnal symptoms/week
Excertional symptoms/week
What should you do if asthma is not well controlled?
If patient is not taking treatment or taking it wrong - don’t change treatment
If it is not asthma, stop treatment
What are examples of add on medications for asthma?
LABA
Leukotriene receptor antagonists
Theophyllines
What are the steps in asthma treatment?
Regular preventer with very low dose ICS Initial add-on preventer Additional add-on therapies High dose therapies Continuous use of oral steroids
What is the first regular preventer given?
Beta 2 agonist
What should be given for the third step in asthma?
LABA with low dose ICS first option
What should be done in severe asthma?
Question diagnosis - identify adherence
What is the best type of delivery system for inhaler?
MDI/spacer
Dry powder device
Both give 20% medication to lungs
What can be done to the child’s environment to improve symptoms?
Stop tobacco smoke exposure
Remove environmental triggers - cat/dog if allergic, etc
