Paediatric respiratory Flashcards
1
Q
Define rhinitis
A
- Irritation of the lining of the nose
- Very common
- Winter months
- Self-limiting
- Can be prodrome to pneumonia, bronchiolitis, meningitis and septicaemia
2
Q
Define otitis media
A
- Common self-limiting infection of the middl ear
- Caused by primary URTI
- Spontaneous rupture of ear drugs
- Bulging red ear drugs
- Don’t need antibiotics
- May require analgesia
3
Q
Define tonsillitis/ pharyngitis
A
- Can be viral or bacterial
- Do throat swab
- Nothing or 10 days penicillin
4
Q
Define croup
A
- Commonly parainfluenza 1
- Lasts 1-3 days
- Laryngotracheobronchitis
- Presents with stridor, hoarse voice and barking cough
- Treat with oral dexamethasone
5
Q
Define epiglottitis
A
- Influenzae type B
- Rare
- Toxic
- Causes stridor and drooling
- May require intubation and antibiotics
- AIR RAIDS
- Airways closed
- Increased pulse
- Restlessness
- Retraction
- Anxious
- Inspiratory stridor
- Drooling
*
6
Q
Define tracheitis
A
- Swollen tracheal wall, narrowed lumen, luminal debris
- Croup that doesn’t get better
- Fever, sick cold
- Staph or strep infection
- Treat with augment → combo of amoxicillin and clavulanate
7
Q
Define bronchitis
A
- Endobrochial infection
- Loose rattly cough with URTI
- Post-tussive vomit
- Chest free of wheeze and crepe
- Haemophilus/ pneumococcus
- Self-limiting
- Reassure and don’t not treat
8
Q
Cause of bacterial bronchitis
A
- Disturbed mucociliary clearance → minor airway malaria and RSV/ adenovirus
- Lack of social inhibitor
- Infections secondary
9
Q
Respiratory tract infection red flags
A
- Age less than 6 months or more than 4 year s
- Static weight
- Disruption to child’s life
- Associated SOB
- Acute nature
- Other comorbidities
10
Q
Define bronchiolitis
A
- LRTI of infants
- Usually RSV
- Nasal stuffiness, tachypnoea, poor feeding
- Crackles and wheeze
- Less than 12 months
- One off
11
Q
Management of bronchiolitis
A
- Maximal observation and minimal intervention
- NG aspiration
- Do not need CXR, blood and culture
- Medication also not required
12
Q
Criteria for bronchiolitis
A
- Fever for 48 hours and above 38.5
- SOB, cough, grunting
- Wheeze
- Reduced or bronchial breath sounds
13
Q
Define pneumonia
A
- Inflammation of the lungs/ interstitium causing infiltrate and consolidation
- Typically → fever, cough, dyspnoea, chest pain
14
Q
Red flags of pneumonia
A
- Focal signs
- Crepitus
- High fever
15
Q
Management of pneumonia
A
- Nothing if mild
- Oral amoxicillin if bacterial Oral macrolide second choice
- IV if vomitting
16
Q
Empyema
A
- Pus in lungs
- Complication of pneumonia
- Infection in pleural space
- Chest pain and realllllly unwell
- Antibiotics with drainage
17
Q
Define pertussis
A
- Whooping cough
- Highly contagious
- Caused by bordetella pertussis
- Controllable, violent coughing, difficulty breathing
- Causes vomitting
- Reduced by vaccination
18
Q
Treat or not to treat
A
- Bronchiolitis → don’t
- Bronchitis → don’t
- Empymea → yes, IV antibiotics
- Croup → don;t
- Acute LRTI → not always, sometimes amoxicillin
- Otitis media - don’t
- Pharyngitis/ tonsillitis → not always, sometimes penicillin
19
Q
Definition of Asthma
A
- Syndrome of increased tracheobronchial responsiveness to stimuli
- Triad: paroxysmal dyspnoea, wheeze and cough
- Mild to severe
- Causes obstruction
20
Q
Clinical features of asthma
A
- Panting
- Chronic
- Wheeze, cough, SOB
- Multiple triggers → exercise, pollen, URTI, cold weather
- Variable/ reversible
- Responds to medication
- History of eczema, hay fever, atopy
21
Q
Differences from adult asthma
A
- More commonly in boys
- More severe
22
Q
Triggers of asthma
A
- URTI
- Exercise
- Allergen
- Cold air
- Emotions
- Menstruation
23
Q
Criteria for asthma
A
- Wheeze
- SOB at rest
- Familial asthma
- Responds to treatment
24
Q
Differentials for asthma
A
- Viral induced wheeze
- Foreign boy
- Cystic fibrosis
- Immune deficiency
- Ciliary dyskinesia
- Aspiration → GORD
- Tracheobronchomalacia
25
Difference between asthma and viral induced wheeze
* Not really separate → different shades of same colour
* VIW
* Presents before age of 3
* No history of atopy
* Viral infection
* Mx same as asthma
26
Goals in asthma management
* Minimise symtoms
* Minimal need for reliever medications
* No attacks
* No limitation to physical activity
* FEV1:FVC \>80%
27
How to measure control of asthma
* SANE
* Short acting beta agonist/ week
* Absence from school/ nursery
* Nocturnal symptoms/ weeks
* Exerction symptoms/ week
28
Management pathway for asthma
* Short-acting beta agonist
* Low does ICS
* Long-acting beta agonist
* Leuktotriene receptor antagonists
* Theophyllines
* Oral steroids
29
Classes of medications in asthma
* SABA
30
Adverse effects of ICS
* Height suppression
* Oral candidiasis
* Adrenocortical suppression
31
Other management of asthma
* Stop smoke exposure
* Remove environmental triggers → cats, dogs, mite
32
Management acute asthma exacerbation
* Mild disease
* SABA via spacer
* Saba via spacer and prednisolone
* Moderate disease
* SABA via nebuliser + prednisolone
* SABA + ipratropium + prednisolone
* Severe
* IV salbutamol
* IV aminophylinne
* IV magnesium nebuliser
* IV hydrocortisone
* Intubate and ventile
33
What to look out for in acute asthma attack
* Increased respiratory rate
* Work of breathing
* Increased heart rate
* Reduce oxygen saturations
* Ability to complete sentences
* Air entry
