Paediatric Respiratory Flashcards
1
Q
What are URTIs characterised by?
A
Fever
2
Q
Presentation of URTIs
A
Fever
Runny nose
Sore throat
3
Q
Who is URTIs especially common in?
A
Children
4
Q
How much of URTIs are self limiting?
A
. 99%
5
Q
How many times a year can a child get rhinitis?
A
5 - 10 per year - VERY common
6
Q
When do children get rhinitis?
A
Week 35 of the year
Winter months
Stops generally when clocks go forward
7
Q
What causes rhinitis?
A
Rhinovirus
8
Q
What is rhinitis a prodrome to?
A
Other invasive illnesses
- pneumonia / bronchiolitis
- meningitis
- septicaemia
9
Q
How long does a cold normally last for?
A
11 days but can last longer
10
Q
Causation of otitis media
A
Primary viral infection
Secondary infection with pneumococcus / H flu
11
Q
Presentation of otitis media
A
Pain
Redness (erythema)
Bulging drum - pushed forward
Drum no longer transparent and shiney
12
Q
What is otitis media characterised by?
A
Pain
Redness
13
Q
How long does an ear ache usually last?
A
A week is common
14
Q
What can happen in otitis media?
A
Spontaneous rupture of drum
15
Q
Treatment of otitis media
A
Analgesia
Oxygen
Hydration
16
Q
What does NOT usually help in respiratory problems in childhood?
A
Antibiotics
17
Q
Is tonsillitis / pharyngitis common?
A
Yes
18
Q
Can you tell if tonsillitis / pharyngitis is bacterial or viral?
A
Cannot tell by looking at the throat
Throat swav
19
Q
How long does a normal sore throat last?
A
Usually 2 days
More than one day but less than a week
20
Q
Treatment of tonsillitis / pharyngitis
A
Nothing or
10 days penicillin
21
Q
What is NOT to be given in tonsillitis / pharyngitis?
A
Amoxycillin
22
Q
What causes croup / LTB?
A
Para flu I
23
Q
Presentation of croup / LTB
A
Stridor Coryza Hoarse voice "Barking" cough that sounds like a seal Well
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
25
Treatment of croup
Oral dexamethasone
26
How common is epiglottitis?
Rare as everyone is vaccinated against the causative organism
27
What is epiglottis caused by?
H influenzae type B
28
Presentation of epiglottitis
Toxic
Stridor
Drooling
Dehydration
29
Treatment of Epiglottitis
Intubation
| Antibiotics
30
Examples of some URTIs
```
Rhinitis
Tonsillitis / pharyngitis
Otitis media
Croup / LTB
Epiglottitis
```
31
Common agents causing LRTIs
```
Bacterial overgrowth
- strep pneumoniae
- h influenzar
- chlamydia pneumonia
Viral infection
- RSV
- parainfluenza III
- influenza A and B
- adenovirus
- Rhinovirus
```
32
Principles of management of LRTIs
OXYGENATION
HYDRATION
NUTRITION
33
LRTIs
Bronchitis
Bronchiolitis
Pertussis
34
How common is bronchitis?
VERY common
35
What age gets bronchitis?
6 months - 4 years
36
Presentation of bronchitis
Loose wet rattly cough
Post tussive vomit - "glut"
chest free of wheeze / crep
Child VERY well
37
Causative organisms of bronchitis
Haemophilus
| Pneumococcus
38
Cyclical pattern of the symptoms of bronchitis
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
39
Pathology of bronchitis
Disturbed mucociliary clearance
- RSV / adenovirus
Bacterial overgrowth is secondary
40
How long does the cough of bronchitis last for?
> 2 weeks
41
Red flags for bronchitis
```
age < 6 months and > 4 y /o
Static weight
Disrupts childs life
Associated SOB when not coughing
Acute admission
Other co morbidities (neuro/gastro)
```
42
Treatment of persistent bacterial bronchitis
DO NOT TREAT
| Reassure
43
Who does bronchiolitis affect?
30-40% of all infants
44
Causative organisms of bronchiolitis
RSV mostly
Paraflu III
HMPV
45
Presentation of bronchiolitis
```
Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze
Wet cough
```
46
Natural history of bronchiolitis
Gets worse 2 - 5 days after the start of the cough
Stabilise after about a week of onset of symptoms
Recovery
47
Investigations of bronchiolitis
Clinical
- NPA
Oxygen sats show severity
48
Treatment of bronchiolitis
DO NOT USE MEDICATIONS
Dont send home if still getting worse
Maximal observation, minimal intervention
49
When can a child go home with a LRTI?
Once stabilising and if oxygen, hydration and nutrition are okay
50
Duration of bronchiolitis
50% have symptoms that last 2 weeks
51
Diagnostic criteria of bronchiolitis
< 12 months
One off (NOT recurrent)
Typical history
52
When are RSV cases more prominent?
Winter
53
Presentation of LRTI
```
48 hours
Fever > 38.5C
SOB
cough
grunting
reduced or bronchial breathing sounds
```
54
What does a wheezy chest indicate about the cause?
unlikely to be BACTERIAL
55
Only call a LRTI pneumonia if.....
Signs are focal i.e. in one area
Creps
High fever
56
Treatment for community acquired pneumonia
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
What is the only indication for IV antibiotics in LRTI?
Vomiting
58
Is pertussis common?
Yes
59
What does vaccination of pertussis do?
Reduces risk
| Reduces severity
60
Presentation of pertussis
coughing fits
whooping cough
vomiting
colour change
61
Do you treat otitis media with antibiotics?
NO
| unless age < 2 yrs and bilateral OM - use oral amoxycillin
62
Do you treat bronchiolitis with antibiotics?
NO
63
Do you treat tonsillitis with antibiotics?
Yes if you know it is a strep cause
64
Do you treat bronchitis with antibiotics?
NO
65
Do you treat LRTI / pneumonia with antibiotics?
```
No
unless
- 2 day fever
- cough
- focal signs i.e. one side
use amoxicillin
```
66
What does no wheeze indicate?
NO asthma
67
Presentation of asthma
```
Literally "panting"
Wheeze
Cough
- dry
- nocturnal
- exertional
SOB at rest
Atopy
```
68
Triggers of asthma
URTI
exercise
cold weather
Allergen
69
Causes of asthma
Genes
- heterogenous condition
Environment
70
When can asthma present?
```
Infant
childhood
adult
exertional
occupational
```
71
The multiple hits of asthma
```
Genes
Inherently abnormal lungs
Early onset atopy
Late (env) exposures
- Rhinovirus
- Exercise
- smoking
```
72
Key words of defining asthma
Wheeze
Variability
Responds to treatment
73
Investigations for asthma
THERE IS NONE in children
74
Criteria for diagnosis of asthma (ideally)
```
WHEEZE
- with and without URTI
SOB at rest
Parental asthma
Responds to treatment
```
75
Common associations of asthma
```
Atopy
FH
Eczema
Hay fever
Food allergies
```
76
Features of an asthmatic cough
Dry
Nocturnal
Exertional
77
First line treatment for suspicion of asthma
ICS for 2 months
78
To prevent false positive responses for asthma, what can be done?
Inhaler holidays
79
Differential diagnosis of asthma
```
Onset < 5
- congenital
- CF
- PCD
- bronchitis
- foreign body
onset > 5
- dysfunctional breathing
- vocal cord dysfunction
- habitual cough
- pertussis
```
80
Goals of asthma treatment
"minimal symptoms" during day and night
minimal need for reliver medication
No attacks (exacerbations)
no limitation of physical activity
81
SANE questions
Short acting beta agonist / week
Absence school / nursery
Nocturnal symptoms / week
Exertional symptoms / week
82
How Is control of asthma measured?
SANE
83
Treatment of asthma
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
Classes of asthma medications
```
Short acting beta agonists ICS
Long acting beta agonists*
Leukotriene receptor antagonists *
Theophyllines*
Oral steroids
```
* = add ons
85
Children differences in management of asthma compared to adults
```
Max dose ICS 800 microg (<12 y/o)
No oral B2 tablet
LTRA first line preventer < 5s
No LAMAs
Only two biologicals
```
86
Criteria for gaining a regular preventer
```
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
Adverse effects of ICS
Height suppression 0.5-1cm
| Oral candidiasis
88
What do you have to use a LABA with?
ICS
89
What can LTRAs come as for reluctant toddlers?
Granules
90
What do you do if on high dose ICS or regular oral steroids?
Refer
91
Two types of delivery systems of asthma medications
MDI / spacer
| Dry powder spacer
92
Lung deposition of asthma medication with and without spacer
```
Without = < 5%
With = < 20%
```
93
What must you do when using a spacer?
Shake inhaler in between puffs
| Wash it monthly to reduce static
94
Which age group cannot use dry powder devices?
< 8s
| but licensed for < 5s
95
Extra / other management of asthma
Stop tobacco smoke exposure
Remove environmental triggers
- cat, dogs
96
What do air ionisers do to a cough?
INCREASE the cough and so make the situation worse
97
What is chronic maintenance treatment for asthma?
Inhaled steroids
98
What is acute treatment for asthma?
Oral steriods
99
3 signs of a chest infection in children
Fever
| Focal crepitations on auscultation
100
Why can a cough with sputum present with large amounts of vomiting?
The swallowing of the mucus
101
Presentation of increased work of breathing in a baby
```
Nasal flaring
Poor feeding
Accessory muscles
- subcostal / intercostal recession
Tracheal tug
Head bobbing
```
102
Causes of a 18 month old body with a cough
```
Common
- Asthma
- Bronchitis
Serious / rarer causes
- CF
- Bronchiectasis
- Foreign body
- Immune deficiencies
- Congenital airway problems
```
103
Features of cough in bronchitis
RATTLE
| Productive
104
What type of noise does wheezing produce?
Whistling
105
What does a wet cough indicate?
Infection
106
What type of cough does pertussis give?
DRY cough
| Parotisms - fits of them
107
Sometimes when children cough they vomit. Is this normal?
Yes
108
Why are babies sick sometimes slimey when they have a cough?
Mixed with saliva
109
Pathology of a viral infection on the lungs
Disrupts normal epithelium
| Commensals become invasive infection and cause a bacterial infection
110
Is the bacteria for whooping cough a commensal?
No
111
How many people with the vaccine for whooping cough still get it?
1 in 500
112
Is whooping cough common?
Yes, very
113
Presentation of whooping cough
Prodromal symptoms
- coryzal symptoms
Cough and vomit > 2 weeks
Coughing fits then a big breath in
114
Treatment of whooping cough
Azithromycin
115
What does the Ax treatment in whooping cough no treat?
The actual cough
116
What is a wheeze due to a problem in?
Small airways
117
What are crackles due to a problem in?
Alveoli
118
What are transmitted sounds?
When listen to the childs mouth and see if it is the same sound
119
What do you not do in croup?
Look at airway
120
When do you admit croup?
< 6 months
Abnormal airway
Severe
121
Treatment of croup
Dexamethasone
| Adrenaline if severe
122
Investigation for pertussis
Nasal swab
123
What examination is contraindicated in croup and why?
Throat exam
| Risk of airway obstruction
124
What is palivizumab and what is it used for?
Monoclonal antibody to prevent RSV in children who are at risk of severe disease
125
Who is at risk of developing severe RSV?
Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants
126
Is whooping cough a notifiable disease?
Yes
127
What is the commonest cause of stridor in children?
Laryngomalacia
128
Treatment of viral induced wheeze
1. Short acting bronchodilator therapy
| 2. Oral Montelukast or inhaled corticosteroids if didn't help
129
Should a child with whooping cough be excluded from school?
Yes - for 48 hours after commencement of antibiotics
