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Paeds > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

What are URTIs characterised by?

A

Fever

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2
Q

Presentation of URTIs

A

Fever
Runny nose
Sore throat

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3
Q

Who is URTIs especially common in?

A

Children

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4
Q

How much of URTIs are self limiting?

A

. 99%

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5
Q

How many times a year can a child get rhinitis?

A

5 - 10 per year - VERY common

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6
Q

When do children get rhinitis?

A

Week 35 of the year
Winter months
Stops generally when clocks go forward

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7
Q

What causes rhinitis?

A

Rhinovirus

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8
Q

What is rhinitis a prodrome to?

A

Other invasive illnesses

  • pneumonia / bronchiolitis
  • meningitis
  • septicaemia
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9
Q

How long does a cold normally last for?

A

11 days but can last longer

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10
Q

Causation of otitis media

A

Primary viral infection

Secondary infection with pneumococcus / H flu

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11
Q

Presentation of otitis media

A

Pain
Redness (erythema)
Bulging drum - pushed forward
Drum no longer transparent and shiney

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12
Q

What is otitis media characterised by?

A

Pain

Redness

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13
Q

How long does an ear ache usually last?

A

A week is common

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14
Q

What can happen in otitis media?

A

Spontaneous rupture of drum

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15
Q

Treatment of otitis media

A

Analgesia
Oxygen
Hydration

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16
Q

What does NOT usually help in respiratory problems in childhood?

A

Antibiotics

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17
Q

Is tonsillitis / pharyngitis common?

A

Yes

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18
Q

Can you tell if tonsillitis / pharyngitis is bacterial or viral?

A

Cannot tell by looking at the throat

Throat swav

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19
Q

How long does a normal sore throat last?

A

Usually 2 days

More than one day but less than a week

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20
Q

Treatment of tonsillitis / pharyngitis

A

Nothing or

10 days penicillin

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21
Q

What is NOT to be given in tonsillitis / pharyngitis?

A

Amoxycillin

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22
Q

What causes croup / LTB?

A

Para flu I

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23
Q

Presentation of croup / LTB

A 
Stridor
Coryza 
Hoarse voice
"Barking" cough that sounds like a seal
Well
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24
Q

When does croup occur?

A

Comes on about 10 pm and wakes up coughing
Parents terrified
Alright in a few hours
Repeats next day

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25
Q

Treatment of croup

A

Oral dexamethasone

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26
Q

How common is epiglottitis?

A

Rare as everyone is vaccinated against the causative organism

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27
Q

What is epiglottis caused by?

A

H influenzae type B

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28
Q

Presentation of epiglottitis

A

Toxic
Stridor
Drooling
Dehydration

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29
Q

Treatment of Epiglottitis

A

Intubation

Antibiotics

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30
Q

Examples of some URTIs

A 
Rhinitis 
Tonsillitis / pharyngitis 
Otitis media 
Croup / LTB 
Epiglottitis
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31
Q

Common agents causing LRTIs

A 
Bacterial overgrowth 
- strep pneumoniae
- h influenzar
- chlamydia pneumonia 
Viral infection 
- RSV
- parainfluenza III
- influenza A and B 
- adenovirus 
- Rhinovirus
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32
Q

Principles of management of LRTIs

A

OXYGENATION
HYDRATION
NUTRITION

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33
Q

LRTIs

A

Bronchitis
Bronchiolitis
Pertussis

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34
Q

How common is bronchitis?

A

VERY common

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35
Q

What age gets bronchitis?

A

6 months - 4 years

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36
Q

Presentation of bronchitis

A

Loose wet rattly cough
Post tussive vomit - “glut”
chest free of wheeze / crep
Child VERY well

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37
Q

Causative organisms of bronchitis

A

Haemophilus

Pneumococcus

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38
Q

Cyclical pattern of the symptoms of bronchitis

A

Symptoms last the whole of winter
nursery etc and children get loads of viruses
Switches off mucociliary escalator
- the only way to clear the secretions is to cough - so symptoms of cough and rattle
Takes two weeks to resolve
Then get another virus - and this carries on the cycle

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39
Q

Pathology of bronchitis

A

Disturbed mucociliary clearance
- RSV / adenovirus
Bacterial overgrowth is secondary

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40
Q

How long does the cough of bronchitis last for?

A

> 2 weeks

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41
Q

Red flags for bronchitis

A 
age < 6 months and > 4 y /o 
Static weight
Disrupts childs life
Associated SOB when not coughing 
Acute admission 
Other co morbidities (neuro/gastro)
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42
Q

Treatment of persistent bacterial bronchitis

A

DO NOT TREAT

Reassure

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43
Q

Who does bronchiolitis affect?

A

30-40% of all infants

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44
Q

Causative organisms of bronchiolitis

A

RSV mostly
Paraflu III
HMPV

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45
Q

Presentation of bronchiolitis

A 
Nasal stuffiness 
Tachypnoea
Poor feeding
Crackles +/- wheeze 
Wet cough
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46
Q

Natural history of bronchiolitis

A

Gets worse 2 - 5 days after the start of the cough
Stabilise after about a week of onset of symptoms
Recovery

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47
Q

Investigations of bronchiolitis

A

Clinical
- NPA
Oxygen sats show severity

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48
Q

Treatment of bronchiolitis

A

DO NOT USE MEDICATIONS
Dont send home if still getting worse
Maximal observation, minimal intervention

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49
Q

When can a child go home with a LRTI?

A

Once stabilising and if oxygen, hydration and nutrition are okay

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50
Q

Duration of bronchiolitis

A

50% have symptoms that last 2 weeks

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51
Q

Diagnostic criteria of bronchiolitis

A

< 12 months
One off (NOT recurrent)
Typical history

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52
Q

When are RSV cases more prominent?

A

Winter

53
Q

Presentation of LRTI

A 
48 hours
Fever > 38.5C
SOB
cough 
grunting 
reduced or bronchial breathing sounds
54
Q

What does a wheezy chest indicate about the cause?

A

unlikely to be BACTERIAL

55
Q

Only call a LRTI pneumonia if…..

A

Signs are focal i.e. in one area
Creps
High fever

56
Q

Treatment for community acquired pneumonia

A

NOTHING if symptoms are milk
- hydration, oxygenation and nutrition = okay
Always offer review if symptoms get worse
Oral amoxicillin first line
Oral macrolide second line

57
Q

What is the only indication for IV antibiotics in LRTI?

A

Vomiting

58
Q

Is pertussis common?

A

Yes

59
Q

What does vaccination of pertussis do?

A

Reduces risk

Reduces severity

60
Q

Presentation of pertussis

A

coughing fits
whooping cough
vomiting
colour change

61
Q

Do you treat otitis media with antibiotics?

A

NO

unless age < 2 yrs and bilateral OM - use oral amoxycillin

62
Q

Do you treat bronchiolitis with antibiotics?

A

NO

63
Q

Do you treat tonsillitis with antibiotics?

A

Yes if you know it is a strep cause

64
Q

Do you treat bronchitis with antibiotics?

A

NO

65
Q

Do you treat LRTI / pneumonia with antibiotics?

A 
No 
unless 
- 2 day fever
- cough 
- focal signs i.e. one side
use amoxicillin
66
Q

What does no wheeze indicate?

A

NO asthma

67
Q

Presentation of asthma

A 
Literally "panting"
Wheeze 
Cough 
- dry
- nocturnal 
- exertional 
SOB at rest 
Atopy
68
Q

Triggers of asthma

A

URTI
exercise
cold weather
Allergen

69
Q

Causes of asthma

A

Genes
- heterogenous condition
Environment

70
Q

When can asthma present?

A 
Infant
childhood
adult
exertional 
occupational
71
Q

The multiple hits of asthma

A 
Genes
Inherently abnormal lungs
Early onset atopy 
Late (env) exposures
- Rhinovirus 
- Exercise
- smoking
72
Q

Key words of defining asthma

A

Wheeze
Variability
Responds to treatment

73
Q

Investigations for asthma

A

THERE IS NONE in children

74
Q

Criteria for diagnosis of asthma (ideally)

A 
WHEEZE
- with and without URTI
SOB at rest
Parental asthma 
Responds to treatment
75
Q

Common associations of asthma

A 
Atopy 
FH 
Eczema 
Hay fever
Food allergies
76
Q

Features of an asthmatic cough

A

Dry
Nocturnal
Exertional

77
Q

First line treatment for suspicion of asthma

A

ICS for 2 months

78
Q

To prevent false positive responses for asthma, what can be done?

A

Inhaler holidays

79
Q

Differential diagnosis of asthma

A 
Onset < 5
- congenital 
- CF
- PCD
- bronchitis
- foreign body 
onset > 5
- dysfunctional breathing
- vocal cord dysfunction 
- habitual cough 
- pertussis
80
Q

Goals of asthma treatment

A

“minimal symptoms” during day and night
minimal need for reliver medication
No attacks (exacerbations)
no limitation of physical activity

81
Q

SANE questions

A

Short acting beta agonist / week
Absence school / nursery
Nocturnal symptoms / week
Exertional symptoms / week

82
Q

How Is control of asthma measured?

A

SANE

83
Q

Treatment of asthma

A
  1. start on low dose ICS
  2. review after 2 months
    step up step down approach
  3. regular preventer if needed
    - very low dose ICS or LTRA (< 5s)
  4. initial add on preventer
    - add on LTRA or Increase ICS dose or add on LABA (different guidelines say different things)
84
Q

Classes of asthma medications

A 
Short acting beta agonists ICS
Long acting beta agonists*
Leukotriene receptor antagonists *
Theophyllines* 
Oral steroids
  • = add ons
85
Q

Children differences in management of asthma compared to adults

A 
Max dose ICS 800 microg (<12 y/o)
No oral B2 tablet
LTRA first line preventer < 5s
No LAMAs
Only two biologicals
86
Q

Criteria for gaining a regular preventer

A 
Diagnostic test
B2 agonists > 2 days a week 
Symptomatic 3x a week or more
Waking one night a week 
Exacerbations of asthma in last 2 years (grey area)
87
Q

Adverse effects of ICS

A

Height suppression 0.5-1cm

Oral candidiasis

88
Q

What do you have to use a LABA with?

A

ICS

89
Q

What can LTRAs come as for reluctant toddlers?

A

Granules

90
Q

What do you do if on high dose ICS or regular oral steroids?

A

Refer

91
Q

Two types of delivery systems of asthma medications

A

MDI / spacer

Dry powder spacer

92
Q

Lung deposition of asthma medication with and without spacer

A 
Without = < 5%
With = < 20%
93
Q

What must you do when using a spacer?

A

Shake inhaler in between puffs

Wash it monthly to reduce static

94
Q

Which age group cannot use dry powder devices?

A

< 8s

but licensed for < 5s

95
Q

Extra / other management of asthma

A

Stop tobacco smoke exposure
Remove environmental triggers
- cat, dogs

96
Q

What do air ionisers do to a cough?

A

INCREASE the cough and so make the situation worse

97
Q

What is chronic maintenance treatment for asthma?

A

Inhaled steroids

98
Q

What is acute treatment for asthma?

A

Oral steriods

99
Q

3 signs of a chest infection in children

A

Fever

Focal crepitations on auscultation

100
Q

Why can a cough with sputum present with large amounts of vomiting?

A

The swallowing of the mucus

101
Q

Presentation of increased work of breathing in a baby

A 
Nasal flaring
Poor feeding
Accessory muscles 
- subcostal / intercostal recession 
Tracheal tug
Head bobbing
102
Q

Causes of a 18 month old body with a cough

A 
Common 
- Asthma 
- Bronchitis
Serious / rarer causes 
- CF
- Bronchiectasis
- Foreign body 
- Immune deficiencies
- Congenital airway problems
103
Q

Features of cough in bronchitis

A

RATTLE

Productive

104
Q

What type of noise does wheezing produce?

A

Whistling

105
Q

What does a wet cough indicate?

A

Infection

106
Q

What type of cough does pertussis give?

A

DRY cough

Parotisms - fits of them

107
Q

Sometimes when children cough they vomit. Is this normal?

A

Yes

108
Q

Why are babies sick sometimes slimey when they have a cough?

A

Mixed with saliva

109
Q

Pathology of a viral infection on the lungs

A

Disrupts normal epithelium

Commensals become invasive infection and cause a bacterial infection

110
Q

Is the bacteria for whooping cough a commensal?

A

No

111
Q

How many people with the vaccine for whooping cough still get it?

A

1 in 500

112
Q

Is whooping cough common?

A

Yes, very

113
Q

Presentation of whooping cough

A

Prodromal symptoms
- coryzal symptoms
Cough and vomit > 2 weeks
Coughing fits then a big breath in

114
Q

Treatment of whooping cough

A

Azithromycin

115
Q

What does the Ax treatment in whooping cough no treat?

A

The actual cough

116
Q

What is a wheeze due to a problem in?

A

Small airways

117
Q

What are crackles due to a problem in?

A

Alveoli

118
Q

What are transmitted sounds?

A

When listen to the childs mouth and see if it is the same sound

119
Q

What do you not do in croup?

A

Look at airway

120
Q

When do you admit croup?

A

< 6 months
Abnormal airway
Severe

121
Q

Treatment of croup

A

Dexamethasone

Adrenaline if severe

122
Q

Investigation for pertussis

A

Nasal swab

123
Q

What examination is contraindicated in croup and why?

A

Throat exam

Risk of airway obstruction

124
Q

What is palivizumab and what is it used for?

A

Monoclonal antibody to prevent RSV in children who are at risk of severe disease

125
Q

Who is at risk of developing severe RSV?

A

Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants

126
Q

Is whooping cough a notifiable disease?

A

Yes

127
Q

What is the commonest cause of stridor in children?

A

Laryngomalacia

128
Q

Treatment of viral induced wheeze

A
  1. Short acting bronchodilator therapy

2. Oral Montelukast or inhaled corticosteroids if didn’t help

129
Q

Should a child with whooping cough be excluded from school?

A

Yes - for 48 hours after commencement of antibiotics

Paeds (28 decks)

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