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Paediatrics > Paediatric resp > Flashcards

Paediatric resp Flashcards

1
Q

What should be considered when giving antibiotics to children?

A

Do benefits outweigh the harm?

Doesnt matter if viral or bacterial

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2
Q

What is the most common symptom of URTIs?

A

Fever

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3
Q

What are side effects of antibiotics in children?

A 
Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Multiresistance
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4
Q

What causes bacterial infection in resp tract?

A

Virus breaking membranes

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5
Q

What should you do for most children presenting with a resp infection if they are not at major risk?

A

Safety net

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6
Q

What is safety netting?

A

Telling parents to keep an eye on the child and report if deterioration

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7
Q

How long can ear ache last?

A

Usually resolved within a week, can take slightly longer

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8
Q

What can be given for otitis media?

A

Analgesia for pain
Antibiotics MIGHT make a difference after 24 hours
End point is the same either way

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9
Q

How is tonsillitis/pharyngitis diagnosed?

A

Throat swab

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10
Q

What should be given for tonsilitis or pharyngitis?

A

10 days penicillin or nothing
Analgesia
Fluids

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11
Q

What is croup also called?

A

Laryngotracheobronchitis

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12
Q

What are features of croup?

A

Caused by type I parainfluenza
Common
Generally well
Coryza++, stridor, hoarse voice, barking cough

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13
Q

How is croup treated?

A

Oral dexamethasone

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14
Q

What are features of epiglottitis?

A 
Caused by H.influenzae tybe B
Rare
Child is very unwell
Stridor, drooling, horrendously sore throat
High pulse low blood pressure
Temperature
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15
Q

How is epiglottitis treated?

A

Intubation and antibiotics

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16
Q

How long does croup typically last?

A

2 days

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17
Q

What are common bacteria causing LRTI?

A

Strep pneumoniae

Haemophilus influenzae

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18
Q

How is the patient assessed with a LRTI?

A

Oxygenation
Hydration
Nutrition

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19
Q

What are features of bronchitis?

A 
Very very common
Loose rattly cough
Post-tussive vomit - glut
Chest free of wheeze/creps
Child is very well
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20
Q

What causes bronchitis?

A

Haemophilus/pneumococcus

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21
Q

What is the mechanism of bacterial bronchitis?

A

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

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22
Q

What are red flags of bronchitis?

A 
Age <6months or >4 years
No relapse-remission
Static weight
Disrupt's childs life
Associated SOB when not coughing
Acute admission
Other co-morbidities
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23
Q

What should you do with bacterial bronchitis?

A

Make diagnosis
Reassure parent
Do not treat

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24
Q

Who is affected by bronchiolitis?

A

Infants

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25
Q

What usually causes bronchiolitis?

A

RSV
Paraflu III
HMPV

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26
Q

What are features of bronchiolitis?

A 
Nasal stuffiness
Tachypnoea
Poor feeding
Crackles 
May have wheeze
27
Q

What is the progression of bronchiolitis?

A

Inocculation and well for first 2 days
Get worse over next 3 days
Stabilise (no better or worse) for 2 days
Recovery

28
Q

What are features of the child that reduce uncertainty of bronchiolitis?

A

<12 months old
One off - NOT recurrent
Typical history

29
Q

How is bronchiolitis treated?

A

Maximal observation

Minimal intervention

30
Q

Should you give medication for bronchiolitis?

A

No

31
Q

What are general characteristics of LRTIs?

A 
48 hrs fever >38.5C
SOB
Cough, grunting
Wheeze makes bacterial unlikely
Reduced or bronchial breath sounds
Infective agents
32
Q

What are features of pneumonia in children?

A

Focal signs
Creps
High fever

33
Q

What is management of pnemonia?

A

NOTHING IF MILD SYMPTOMS
Oral amoxycillin first line
Oral macrolide second choice

34
Q

Should antibiotics be given orally or IV in LRTI?

A

Orally unless vomiting

35
Q

Is pertussis common?

A

Yes despite vaccination - reduces risk and severity

36
Q

What are characteristic features of pertussis?

A

Coughing fits out of the blue followed by whoop

Vomiting and colour change

37
Q

What is the main factor of knowing if a child has asthma?

A

No wheeze no asthma

38
Q

When should you give a trial of ICS?

A

If patient QoL is affected

39
Q

What are the key features of asthma?

A

Wheeze
Variability
Respond to treatment

40
Q

What is thought to cause asthma?

A 
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
41
Q

What is epidemiology of asthma?

A

About 10% of each age groups

42
Q

Does reduced spirometry diagnose asthma?

A

No but it is consisent

43
Q

How is asthma diagnosed?

A

Almost entirely through history and symptoms

44
Q

What can you ask a parent to determine if their child actually has wheeze?

A

Ask if it is a rattle or whistle

45
Q

What causes SOB at rest?

A

Airway obstruction

46
Q

What is a feature of SOB at rest?

A

Sucking in ribs with wheeze

47
Q

What are characteristics of asthmatic cough?

A

Dry
Nocturnal
Exertional

48
Q

What asthma treatment is used to assess for asthma?

A

2 months ICS

49
Q

What should be done if asthma responds to treatment to avoid false positives?

A

ICS holiday to see if symptoms return

50
Q

What are benefits of trial of treatment for asthma?

A

Helps diagnosis

Improve QoL and reduce risk of attack if symptoms respond

51
Q

Is an under 18 month old likely to have asthma?

A

No, more likely to be infection but can still be asthma

52
Q

What are differential diagnoses for asthma if onset is under 5 years old?

A 
Congenital problem
Cystic fibrosis
Primary ciliary dyskinesia
Bronchitis
Foreign body
53
Q

What are differential diagnoses if onset is over 5 years?

A

Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis

54
Q

What is the most important aspect of treatment of asthma?

A

Patient QoL

55
Q

What factors in QoL are important to work on?

A

Minimal symptoms
Minimal need for reliever medication
No attacks/exacerbations
No limitation of physical activity

56
Q

What is the SANE mnemonic for closed questions regarding asthma?

A

SABA/week - shouldn’t be more than 2
Absence from school or nursery
Nocturnal symptoms/week
Excertional symptoms/week

57
Q

What should you do if asthma is not well controlled?

A

If patient is not taking treatment or taking it wrong - don’t change treatment
If it is not asthma, stop treatment

58
Q

What are examples of add on medications for asthma?

A

LABA
Leukotriene receptor antagonists
Theophyllines

59
Q

What are the steps in asthma treatment?

A 
Regular preventer with very low dose ICS
Initial add-on preventer
Additional add-on therapies
High dose therapies
Continuous use of oral steroids
60
Q

What is the first regular preventer given?

A

Beta 2 agonist

61
Q

What should be given for the third step in asthma?

A

LABA with low dose ICS first option

62
Q

What should be done in severe asthma?

A

Question diagnosis - identify adherence

63
Q

What is the best type of delivery system for inhaler?

A

MDI/spacer
Dry powder device
Both give 20% medication to lungs

64
Q

What can be done to the child’s environment to improve symptoms?

A

Stop tobacco smoke exposure

Remove environmental triggers - cat/dog if allergic, etc

Paediatrics (25 decks)

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