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Year 3 > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

paeds resp: viral infections

A 
adenovirus
influenza A and B
parainfluenza I III
RSV
rhinovirus
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2
Q

paeds resp: bacterial infections

A 
o	Haemophilus influenzae
o	Moraxella catarrhalis
o	(mycoplasma)
o	(s. aureus)
o	Streptococci
	B haemolytic, S pyogenes
	Non haemolytic, S pneumoniae
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3
Q

rhinitis: how many a year

A

5-10

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4
Q

rhinitis: prodrome to what other conditions

A

pneumonia
bronchiolitis
meningitis
septicaemia

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5
Q

otitis media: cause

A

primary viral

secondary with pneumococcus/haemophilus influenzae

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6
Q

otitis media: to treat or not?

A
  • Severe uni or bilateral > 6 months, severe pain > 48hrs
  • Non-severe bilateral 6-23 months
  • ? non-severe in older children: “the clinician should either prescribe antibiotic therapy or offer observation with close follow up based on joint decision making with the parent(s)/caregiver”
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7
Q

treatment of tonsilitis

A

nothing or 10 days penicillin. Don’t give amoxycillin. 2-7 days.

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8
Q

croup: organism

A

parainfluenzae I

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9
Q

croup: features

A

coryza
stridor
hoarse voice
barking cough

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10
Q

croup: how long does it last

A

2-4 days

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11
Q

croup: treatment

A

oral dexamethasone

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12
Q

epiglottitis: organism

A

h influenzae B

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13
Q

epiglottitis: features

A

stridor

drooling

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14
Q

epiglottitis: treatment

A

intubation and antibiotics

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15
Q

tracheitis: is often described as?

A

croup which does not get better

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16
Q

tracheitis: features

A

fever and sick child

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17
Q

tracheitis: organism

A

staph or strep

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18
Q

tracheitis: treatment

A

augmentin

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19
Q

bronchitis: features

A

endobronchial infection causing a loose rattily cough with URTI. Post-tussive vomit – “glut”. The chest is free of wheeze and creps

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20
Q

bronchitis: organism

A

haemophilus

pneumococcus

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21
Q

bacterial bronchitis

A

Bacterial bronchitis results from disturbed mucociliary clearance. Minor airway malacia, RSV/adenovirus. There is a lack of social inhibition. Infection secondary.

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22
Q

bronchitis: how long do coughs laast for

A

7-25 days

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23
Q

bronchitis: natural history of bacterial

A
  • Following URTI
  • Lasts 4 weeks
  • 60-80% respond
  • First winter bad
  • Second winter better
  • Third winter fine
  • Pneumococcus/H flu
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24
Q

classifying persistent bacterial bronchitis

A
  1. Wet cough
  2. More than 1 month
  3. Remission with antibiotics
    With persistent bacterial bronchitis: make the diagnosis, reassure, do not treat.
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25
Q

bronchitis red flags

A
  • Age < 6 month, > 4 years
  • Static weight
  • Disrupts child’s life
  • Associated SOB (when not coughing)
  • Acute admission
  • Other co-morbidities (neuro/gastro)
26
Q

bronchiolitis: organisms

A

RSV

parainfluenzae III, HMPV

27
Q

bronchiolitis: features

A

nasal stuffiness, tachypnoea and poor feeding. Crackles +/- wheeze can be heard

28
Q

bronchiolitis: length

A

16 days

29
Q

bronchiolitis: management

A

maximal observation minimal intervention

30
Q

bronchiolitis: investiation

A

NPA

oxyggen sats

31
Q

medications proven NOT to work in bronchiolitis

A
  • Salbutamol
  • Ipratropium bromide
  • Adrenalin
  • Steroids
  • Antibiotics
  • Nebulised saline
32
Q

medications PROVEN to work in bronchiolitis

A

none

33
Q

LRTI: features

A
  • 48 hrs, fever (>38.5 C), SOB, cough, grunting
  • Wheeze makes bacterial cause unlikely
  • Reduced or bronchial breath sounds
34
Q

LRTI: organism

A

o Viruses in <35% (higher in younger)
o Bacteria pneumococcus, mycoplasma, chlamydia
o Mixed infection in <40%

35
Q

is a LRTI pneumonia?

A

Is it pneumonia or not? This question is totally academic but causes anxiety in parents. Call it pneumonia of signs are focal, there are creps and a high fever. Otherwise call it a LRTI. CXR should only confirm clinical findings.

36
Q

BTS Guidelines – Community Acquired Pneumonia: investigations

A

CXR and inflammatory markers NOT routine

37
Q

BTS Guidelines – Community Acquired Pneumonia: managment

A 
o	Nothing if symptoms are mild
o	(always offer to review if things get worse)
o	Oral amoxycillin first line
o	Oral macrolide second choice
o	Only for IV if vomiting
38
Q

Antibiotics and RTI (RACH Guidelines): bronchiolitis

A

not indicated

39
Q

Antibiotics and RTI (RACH Guidelines): croup

A

not indicated

40
Q

Antibiotics and RTI (RACH Guidelines): acute LRTI

A

o Often not indicated
o Children < 2 with mild presentation rarely require antibiotics and have had pneumococcal vaccine thus further reducing their need for antibiotics
o Amoxicillin should be first line

41
Q

Antibiotics and RTI (RACH Guidelines): otitis media

A

o Usually not indicated

o Consider amoxicillin if <2 and bilateral infection

42
Q

Antibiotics and RTI (RACH Guidelines): pharyngitis/tonsillitis

A

o Not usually indicated

o Consider penicillin

43
Q

pertusis

A

Pertussis is common, but vaccination reduces risk and severity. Coughing fits and vomiting and colour change. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment

44
Q

empyaema: what is it

A

Empyaema is a complication of pneumonia resulting in extension of infection into the pleural space.

45
Q

empyaema: treatment

A

antibiotics and drainage

maintain oxygenation, hydration and nutirion

46
Q

empyaema: prognosis

A

children good

47
Q

triggers for asthma

A

URTI, exercise, allergen, cold weather

48
Q

features of a cough in asthma

A

dry
nocturnal
exertional

49
Q

DDx for asthma

A 
•	?viral induced wheeze (=asthma)
•	Foreign body
•	Secretions causing noise
o	Cystic fibrosis
o	Immune deficiency
o	Ciliary dyskinesia
o	Aspiration, ? GOR
o	Tracheo-bronchomalacia
50
Q

management of asthma - goals

A 
The goals of treatment are:
•	Minimal symptoms during day and night
•	Minimal need for reliever medication
•	No attacks (exacerbations)
•	No limitation of physical activity
•	Normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best
51
Q

how to measure asthma controle

A 
SANE
o	Short acting beta agonist/week
o	Absence school/nursery
o	Nocturnal symptoms/week
o	Exertional symptoms/week
52
Q

classes of medications used in asthma

A 
•	Short acting beta agonists
•	Inhaled corticosteroids (ICS)
•	Add ons
o	Long acting beta agonist
o	Leukotriene receptor antagonists
o	Theophyllines
•	Oral steroids
53
Q

step up/down approach to management of asthma

A

• Start on low dose inhaled corticosteroid
o Severe may respond to minimal treatment
• Review after 2 months
o No routine test to monitor progress
o Stepping up easier than down

54
Q

management of childhood asthma: step 1

A

SABA

spacer/MDI or dry poweder

55
Q

management of childhood asthma: step 2

A

regular preventer

These should be added when using an inhaled B2 agonist three times a week or more. Symptomatic three times a week or more, or waking one night a week. Exacerbations of asthma in the last two years. Start with a very low dose of inhaled corticosteroids (or LTRA in the under 5s).

56
Q

management of childhood asthma: step 3

A
  • Add on LABA (BTS/SIGN)
  • Add on LTRA (NICE)
  • Increase ICS dose (GINA)
57
Q

use of a spacer

A

Shake inhaler between puffs and wash spacer monthly to reduce static. Each increases delivery by 100%

58
Q

nebulisers vs spacers

A

These are not indicated for day to day use. A spacer is quieter, quicker, valve mechanism, don’t break, portable and cheaper than a nebuliser.

59
Q

acute asthma management: 1st line

A

SABA via spacer

SABA via spacer + prednisolone

60
Q

acute asthma management: 2nd line

A

SABA via neb _ prednisolone

SABA + ipratropium via neb + prednisolone

61
Q

acute asthma management: 3rd line

A 
o	IV salbutamol
o	IV aminophylline
o	IV magnesium
o	IV hydrocortisone
o	Intubate and ventilate

Year 3 (164 decks)

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