Paediatric Respiratory Flashcards
What is your DDx for wheezing in a child?
- Intraluminal airway obstruction
- inhaled foreign object
- blood, mucus, pus
- food/milk in GORD or TOF - Intrinsic change in lower airway dimension
- asthma
- bronchiolitis and other viral LRTIs
- bronchiolitis obliterans
- bronchitis
- bronchiectasis
- CF and PCDs
- bronchomalacia - Extrinsic lower airway compression
- lung parenchyma: pneumonia, pulmonary oedema (CHD, HF), bronchogenic cyst
- lymphadenopathy
- chest wall deformity e.g. scoliosis
- vascular e.g. enlarged LA, pulmonary artery vascular ring
Name common organisms causing typical and atypical CAP.
Typical pneumonias often caused by viruses: - influenza A - RSV But can also be caused by bacteria: - Streptococcus pneumoniae (most common) - Haemophilus influenzae - Staphylococcus aureus - Klebsiella pneumoniae
Atypical CAP can be cause by:
- Mycoplasma pneumoniae
- Legionella pneumophila
- Chlamydophila pneumoniae
Which clinical features suggest whether a CAP is viral or bacterial?
Viral:
- temp <38.5
- wheeze present
- rhinorrhoea present
Bacterial:
- temp >38.5
- wheeze absent
- rhinorrhoea absent
Which Ix would you request for a child admitted with suspected severe or atypical CAP?
- bloods
- FBC, CRP, U+Es
- blood culture
- mycoplasma serology - urine
- test for Legionella + Pneumococcal antigen - NPA for RSV + influenza
- CXR
what are the indications for IV Abx in children with CAP?
- severe CAP
- complicated CAP e.g. effusion
- unable to tolerate oral Abx e.g. vomiting
What Abx would you prescribe for non-severe CAP? For severe/complicated CAP? For suspected aspiration pneumonia?
Non-severe CAP: 5 days PO AMOXICILLIN (clarithryomycin if penicllin allergy)
Severe/complicated CAP: IV CO-AMOXICLAV + CLARITHROMYCIN (cefuroxime + clarithromycin if penicillin allergy). r/v and switch to PO. Total of 4 weeks.
Aspiration pneumonia: PO/IV CO-AMOXICLAV
Name the common causative agents of bronchiolitis.
- RSV (80%)
- influenza A + B
- parainfluenza
- adenovirus
- rhinovirus
Name possible risk factors for development of bronchiolitis
- age 3-6 mths
- older siblings
- nursery attendance
- passive smoking
- winter months (oct-march)
Describe the classical signs and symptoms of bronchiolitis.
Symptoms
- 1-3 days coryzal symptoms
- cough
- poor feeding
- fever (usually <39)
Signs
- widespread wheeze + crackles on auscultation
- apnoea
Which investigations would you request for a baby presenting with suspected bronchiolitis?
- NPA for RSV + influenza
- CXR, bloods + blood gases only if deterioration/diagnostic uncertainty
A baby with bronchiolitis is admitted to hospital in respiratory distress. How would you manage them?
- O2 if sPO2 <92%
- vapotherm (high-flow nasal cannula O2)
- CPAP if impending resp. failure
- NG feeding or IV fluids where necessary
How can babies at high risk of bronchiolitis be protected?
Prophylactic PALIVIZUMAB IM injections once per month during season.
For children with:
- BPD due to prematurity or chronic lung disease
- CHD
- SCID
Suggest possible risk factors for asthma in children.
- Atopy e.g. atopic eczema, hay fever, food allergy esp. to eggs
- FHx of asthma or atopy
- Parental smoking
- PMH of prematurity, mechanical ventilation, bronchiolitis requiring hospitalisation
Describe the key clinical features of asthma.
Recurrent and frequent:
- wheeze (polyphonic)
- cough, esp. nocturnal
- SOB/chest tightness
Features:
- Sx are worse at night and in early morning
- Sx have non-viral triggers e.g. exercise, pets, cold, emotion (as well as viral)
- personal or FHx of an atopic disease
- positive response to asthma therapy
What features might you see on examination of a child with long-standing asthma?
- chest hyperinflation
- generalised polyphonic expiratory wheeze
- Harrison’s sulci (depressions at base of thorax associated with muscular insertion of diaphragm)
