Paediatric Respiratory & ENT Flashcards
How is CF inherited?
Autosomal recessive
The gene affected by CF is the CFTR gene- this affects the movement of which ion across epithelial surfaces?
Chloride
In Northern Europe, 1 in every how many individuals are a carrier for CF?
1 in 25
Nasal polyps are a feature of which chronic lung condition seen in children?
CF
What gastrointestinal problem is seen in 20% of neonates with CF?
Meconium ileus
Children with CF can become deficient in which vitamins?
Fat soluble vitamins (ADEK)
What happens to the levels of sodium and chloride ions in the blood of individuals with CF?
Both low
When screening for CF, the serum concentration of what is measured?
Trypsinogen (will be raised in CF)
What is the gold standard investigation for CF?
Chloride sweat test
In CF patients, chronic infection with what organism is associated with a deterioration in lung function and a poorer prognosis?
Pseudomonas aeruginosa
What kind of diet is recommended for children with CF?
High calorie, high fat diet
Because of impaired pancreatic function, there is a risk that children with CF may develop what other chronic condition?
Diabetes mellitus
What fungal organism colonises up to 60% of CF patients?
Aspergillus fumigatus
What is the median lifespan of an individual with CF?
40 years
What medication is used to treat cystic fibrosis patients who are homozygous for the delta F508 mutation?
Lumacaftor/Ivacaftor
Most children with CF are on what prophylactic antibiotic?
Flucloxacillin
Which organism is responsible for > 90% of childhood URTIs?
Rhinovirus
How are viral URTIs treated in children?
Paracetamol and/or ibuprofen and adequate fluid intake
What can sometimes be the only sign of pneumonia in children?
Abdominal pain
The peak incidence of bronchiolitis is less than how old?
18 months
What organism is responsible for causing 80% of cases of bronchiolitis?
Respiratory syncytial virus (RSV)
What is the natural history of bronchiolitis infection?
Worsening of symptoms until days 5-7, followed by a gradual improvement and resolution by around day 10
A diagnosis of bronchiolitis is usually made clinically. However, the RSV virus can be detected on what investigation?
Nasopharyngeal aspirate
Which children with bronchiolitis are admitted to hospital?
If they are hypoxic or if they are unable to take half of their normal feeds
How is bronchiolitis managed?
Supportive care with oxygen therapy and feeding (possible NG)
What treatments may be indicated in babies with bronchiolitis who have worsening hypoxia, exhaustion or apnoea?
CPAP or mechanical ventilation
What organism is responsible for causing whooping cough?
Bordetella pertussis
How long does the cough associated with whooping cough usually last for?
> 3 months
How is whooping cough treated?
Supportive care only
Viral laryngotracheobronchitis is also known as what?
Croup
What is the most common cause for upper airway obstruction, manifesting as stridor with breathing difficulties?
Croup
A ‘barking cough’ is characteristically heard in what condition?
Croup
Croup is most common in children of what age?
6 months to 3 years
What is the most common causative organism of croup?
Parainfluenza virus
In young children, what should always be considered as a differential diagnosis for upper airway obstruction?
Inhaled foreign body
What is the most important aspect of managing a child with upper airway obstruction?
Don’t distress them
How are children with croup treated?
Oral dexamethasone (or nebulised budesonide)
What organism causes acute epiglottitis?
Haemophilus influenzae type B
Other than an inhaled foreign body, what are the two main causes of stridor in children?
Croup and acute epigottitis
How is acute epiglottitis treated?
IV ceftriaxone
If tonsillitis is bacterial, which bacteria is most likely to be the cause?
Group A strep
Tonsillectomy can be considered for children with how many episodes or more of tonsillitis yearly, that are severe enough for them to have to miss school?
6 episodes
What is the commonest cause of acute stridor in the neonatal period, up to several weeks of age?
Laryngomalacia
What is the clinical course of laryngomalacia?
Should resolve spontaneously by 12 months
What clinical condition causes the tympanic membrane to be red and bulging?
Acute otitis media
If a child with acute otitis media remains unwell beyond 48 hours, how should they be treated?
PO amoxicillin
What is the most significant complication of acute otitis media to be aware of?
Mastoiditis
In otitis media with effusion, there is a chronic effusion in the middle ear lasting for how long?
> 3 months
What type of hearing loss can be caused by otitis media with effusion?
Conductive
Otitis media with effusion usually resolves within how long?
4-6 months
What are the main risk factors for obstructive sleep apnoea in children?
Obesity, neuromuscular conditions and large adenoids
What is the first line investigation for obstructive sleep apnoea in children?
Overnight pulse oximetry
If results of overnight pulse oximetry are negative for sleep apnoea but symptoms persist, what investigation should be performed?
Overnight polysomnography
How should children with obstructive sleep apnoea as a result of large tonsils be treated?
Adenoidectomy
How should children with obstructive sleep apnoea without large tonsils be treated?
Overnight non-invasive ventilation
What is diagnosed when a child aged between a few months to three years presents with multiple episodes of wheeze associated with URTIs?
Transient early wheeze
In children who are too young to undergo lung function tests, how is asthma diagnosed?
On a trial of bronchodilators- asthma can be diagnosed if there is relief from symptoms
What investigation is used to diagnose asthma in older children?
Peak expiratory flow rate
In children aged under 5, if more therapy is needed for suspected asthma than a SABA alone, what should be started next?
Moderate dose ICS (8 week trial)
What is always an important differential to keep in mind for children presenting with acute difficulty breathing and wheeze, even in children with known asthma?
Anaphylaxis
In children with acute severe asthma, how should SABAs be given?
10 puffs either through a spacer or a nebuliser
Children with acute severe asthma can be discharged from hospital when they are stable for how long between taking their SABA inhaler?
4 hours
How often can SABA/ipratropium be given in acute severe asthma?
Up to every 20 minutes for 1 hour
How long should oral steroids be given for in a child with an acute asthma exacerbation?
3-5 days
Respiratory distress which occurs shortly after birth and appears to improve upon crying, is suggestive of what diagnosis?
Choanal atresia
