Paediatric resp Flashcards by Pete McEwan

What should be considered when giving antibiotics to children?

Do benefits outweigh the harm?

Doesnt matter if viral or bacterial

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What is the most common symptom of URTIs?

Fever

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What are side effects of antibiotics in children?

Diarrhoea
Oral thrush
Nappy rash
Allergic reaction
Multiresistance

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What causes bacterial infection in resp tract?

Virus breaking membranes

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

Safety net

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What is safety netting?

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

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How long can ear ache last?

Usually resolved within a week, can take slightly longer

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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

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How is tonsillitis/pharyngitis diagnosed?

Throat swab

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What should be given for tonsilitis or pharyngitis?

10 days penicillin or nothing
Analgesia
Fluids

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What is croup also called?

Laryngotracheobronchitis

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What are features of croup?

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

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How is croup treated?

Oral dexamethasone

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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

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How is epiglottitis treated?

Intubation and antibiotics

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How long does croup typically last?

2 days

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What are common bacteria causing LRTI?

Strep pneumoniae

Haemophilus influenzae

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How is the patient assessed with a LRTI?

Oxygenation
Hydration
Nutrition

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What are features of bronchitis?

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

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What causes bronchitis?

Haemophilus/pneumococcus

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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

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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

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What should you do with bacterial bronchitis?

Make diagnosis
Reassure parent
Do not treat

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Who is affected by bronchiolitis?

Infants

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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?

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