paediatric respiratory Flashcards
What is otitis media
Common self limiting painful ear - infection of the middle ear
What does the ear look like on otoscopy in otitis media
Erythema and a buldging ear drum
When is amoxycillin given for otitis media in children
Child less than 2 with bilateral otitis media or if they are systemically un well
What should not be given for treatment of tonsillitis
Amoxycillin
What is Croup
Laryngotracheobronchitis
What is the presentation of croup
- Initial runny nose and cold symptoms
- Then in the morning presents with croup - barking cough
What is the treatment of croup
Dexamethasone
What is tracheitis
Inflammation of trachea - presents with croup which does not get better
What is the treatment of tracheitis
Antibiotics
What is the presentation of bronchitis
- 1- 4 years old
- Loose rattly cough with URTI
- Post-tussive vomit
- No wheeze or crepitations
- Child appears very well
What is the presentation of bronchiolitis
- Day 1 cough
- then gets worse for few days
- Starts to stabilise and recover
- Nasal stuffiness
- tachypnoea
- poor feeding
- crackles with or without wheeze
- low grade fever
What is used to investigate bronchiolitis
NPA - nasopharyngeal airway
O2 sats
What does wheeze make more unlikely in the diagnosis
Less likely to be bacterial
What is the presentation of pneumonia
- Focal signs
- Crepitations
- High fever
What is the NICE guidelines for a child less than 2 with a respiratory tract infection
- Oxygenation, hydration and nutrition
- Do not need antibiotics
What is the difference between bronchiolitis compared to asthma and viral wheeze
- Bronchiolitis is in <12 monhs old
- Bronchiolitis is not chronic or recurrent
What is the treatment for tracheitis
Augmentin
Which antibiotic for pneumonia or LRTI
oral amoxycillin
What is the treatment for empyema
IV antibiotics
What is the presentation of asthma
- Chronic
- Wheeze
- Cough
- Shortness of breath
- Multiple triggers such as cold
- reversible
- Diurnal variation
What are the 3 key points required for asthma
- Cough, wheeze and difficulty breathing
- Variability
- Responds to steroids
What is the guideline for investigations of asthma in children between 5 and 16
- FeNO >35ppb
- Bronchodilator reversability with spirometry
- Peak flow variability
- Skin prick test or total IgE blood eosinophils
What is the presentation of a habitual cough
- 6-11 years old
- Dry cough
- loud
- single
- throat clearing
- Strong FH of asthma
- Absent when sleeping or watching TV
What is the presentation of laryngomalacia
- Variable nose
- Infant appears well
What pneumonic is used to measure control of childhood asthma
SANE:
S- short acting beta agonist/week
A - abscence from school
N - nocturnal symptoms/week
E - Exertional symptoms/week
What are the adverse effects of ICS
- Height suppression
- Oral candidiasis
What is the treatment plan when starting ICS
low does ICS 2x a day(bd)
What has to be done when taking long acting beta agonists (LABA)
- need to take with ICS
- Needs to be used as a fixed dose inhaler
Describe the management of asthma in children aged 5-11
- Low dose ICS bd + SABA
- MART
- Add LRTA
- Add LABA
- Increase ICS dose
What is the treatment for asthma in under 5s
- ICS
- LTRA
- LABA licensed for over 3s
What is the treatment for mild acute asthma attack
SABA via spacer + prednisolone
What is the treatment for moderate acute asthma
SABA via nebuliser plus prednisolone
What is the treatment of severe acute asthma
- IV salbutamol
- IV aminophylline
- IV magnesium nebuliser
- IV hydrocortison
- intubate and ventilate
