Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a > Paediatric respiratory medicine > Flashcards

Paediatric respiratory medicine Flashcards

1
Q

Asthma treatment for under 5s?

A
  1. SABA
  2. SABA + ICS (8 week trial)
  3. SABA + ICS + LRTA (montelukast)
  4. Specialist referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Asthma treatment for 5-16 year olds?

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LRTA
  4. SABA + ICS + LABA
  5. SABA + low dose MART
  6. SABA + moderate dose MART
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute management of severe asthma attack

A 
O SHIT ME
Oxygen
Salbutamol NEB
Hydrocortisone IV / oral pred
Ipratropium bromide NEB
Theophylline IV
Magnesium sulphate IV
Escalate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The diagnosis of croup is mainly clinical. How would croup typically present?

A

Children 6 months - 3 years in autumn + spring.

Preceding coryzal symptoms, barking cough (nocturnal), hoarseness + stridor (worst when agitated).

Red flags - improving stridor, drowsiness, cyanosis - ?resp failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is croup managed?

If there is no improvement what might the diagnosis be?

A
  1. oral dexamethasone / pred
  2. ABC + O2 therapy
  3. NEB adrenaline if severe
  4. ITU + intubation if very severe

Consider bacterial tracheitis if no improvement (thick purulent exudate not cleared by coughing - need IV Abx) - STAPH AUREUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is spasmodic croup?

A

Child suddenly wakes in the night with significant stridor + resp distress but no runny nose or fever - likely allergic cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common causative organism of croup?

A

Parainfluenza virus I

other:

  • other parainfluenzas
  • SRV
  • Adenovirus
  • Influenza A + B = associated with severe disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bronchiolitis:

  • who does it affect?
  • What may make a case worse?
  • when?
  • what is the main causative organism?
A
  • children <2 years
  • winter
  • CHD
  • Respiratory syncytial virus = 80% of cases (other viruses less common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does bronchiolitis present?

A 
1-3 days of:
Persistent cough
AND
Tachypnoea / chest recession (or both)
AND
Wheeze / crackles on auscultation (or both)

may also have fever and poor feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you investigate suspected bronchiolitis?

A

SATS
viral throat swabs
only CXR or bloods only if worsening resp distress / rule out pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is bronchiolitis managed?

A

Mostly self limiting
Hospital monitoring / O2 / NG / CPAP if resp distress, persistent sats <92%, low fluid intake.

Ribavirin for prevention if severe lung/ heard disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the presentation of epiglottitis?

A

VERY ACUTE presentation:
Sore throat, DROOLING, muffled voice, fever, ear pain.

Signs:
Tachycardia, ant neck tenderness, ant EXTENDED NECK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the red flags for severe epiglottitis?

What must you remember when examining a child with suspected epiglottitis?

A

Dyspnoea, dysphagia, dysphonia.
Respiratory distress
STRIDO = SURGICAL EMERGENCY

*Do not upset patient, lie patient down or examine throat with spatula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the gold standard for diagnosing epiglottitis?

What is the main causative organism?

A

Gold standard = fibre-optic laryngoscopy
Other = lateral neck Xray, throat swab, blood cultures

Main causative organism = Haemophilus influenza B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat epiglottitis?

What are the complications of untreated epiglottitis?

A

Intubation under GA
IV Abx - cefotaxime
?Surgery

Complications:
Abscess
Meningitis
Sepsis
Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main pathogens for the common (coryzal) cold?

A

Rhinovirus
Coronavirus
RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is pharyngitis?

  • organism
  • treatment
A

Pharynx, soft palate, lymph nodes inflamed and tender.

Viral:
Cold viruses (25%)
Adenoviruses
EBV
Bacterial:
Group A beta-haemolytic streptococcus (older children)

Paracetamol / ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the main organisms associated with tonsilitis?

A

Mostly viral:
Rhinovirus, coronavirus, RSV, adenovirus, EBV (glandular fever)

Bacterial:
Group A beta-streptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the presentation of tonsillitis?

A

Pharyngitis also affecting tonsils AND constitutional disturbance = headache, abdo pain, exudate (bacterial)

20
Q

What is the CENTOR criteria for prescribing Abx to a child with tonsilitis?

A 
3+ of:
Tonsillar exudate
Tender anterior lymph nodes
Fever
Absence of a cough
21
Q

What are the complications of tonsillitis?

A
  1. Quinsy / peritonsillar abscess - dysphagia _ uvula deviation –> Abx + drainage
  2. Otitis media
  3. Sinusitis
22
Q

What is the management of tonsillitis?

A

Symptomatic relief

Penicillin / erythromycin if bacterial (CENTOR >3)

23
Q

How can you differentiate between otitis media and otitis externa?

A

Mucus = almost always middle ear as no mucus glands in external ear

24
Q

Describe the presentation of otitis media:

A

Sudden onset ear pain - may resolve if eardrum perforates
fever / unwell
irritability

25
Q

What are the possible complications of otitis media?

A
  1. Mastoiditis - destruction of air cells in mastoid bone / abscess –> ear protrusion + redness behind pinna
  2. Facial nerve palsy
  3. Meningitis
  4. Labrynthitis
  5. Intracranial abscess
26
Q

What are the common pathogens causing otitis media?

A

S. pneumonia
H. influenza
Moraxella catarrhalis
other streps and staphs

27
Q

How would you manage otitis media in a child who was systemically well?

A

Pain relief
watch + wait
(60% resolve in 24 hours)
Grommet insertion if recurrent

28
Q

How would you manage otitis media in a child who was systemically unwell / immunocompromised / symptoms not resolved within 4 days

A

Amoxicillin or erythromycin

Delay 2 days if <3 months or <2 years with bilateral OM

29
Q

What is OM with effusion / glue ear / serous otitis media?

A

Fluid in middle ear without acute inflammation - Main cause of hearing loss in children.
Usually self limiting but may need grommets or hearing aids.

30
Q

How would you differentiate viral and bacterial sinusitis?

A

Viral <10 days = self limiting

Bacterial >10 days / worsening after 5 days = amoxicillin / doxycycline

31
Q

Whooping cough / pertussis:

  1. how is it spread?
  2. Is it a notifiable disease?
  3. What is a common co-infection?
  4. What class of bacteria is bordatella pertussis?
A
  1. droplet
  2. yes
  3. RSV (bronchiolitis)
  4. Gram negative coccobacillus
32
Q

Describe the clinical presentation of whooping cough

A 
CATARRHAL PHASE
- malaise
- conjunctivitis, nasal discharge
- sore throat
- mild fever
PAROXYSMAL COUGHING PHASE
- dry hacking coughing followed by 'whoop'
- worse at night / brought on by feeds
- choking, flailing, eyes bulging, red face during coughing with apnoea / cyanosis after
- post-cough vomiting
33
Q

How would you diagnose whooping cough?

A

PCR via nasal swab
bloods - marked lymphocytosis
serology - anti-pertussis IgG

NOTIFIABLE DISEASE

34
Q

How is whooping cough treated?

A
  • Hospital admission if <6 months or resp difficulties
  • ventilation or ECMO
  • Abx reduce period of infectivity:
    Macrolides (azithromycin..)
35
Q

What is the most common type of pneumonia in younger and older children (bacterial / viral)?

A

Younger children = viruses

Older children = bacteria

36
Q

What are the most common causative organisms of pneumonia in:

1) Newborns
2) Infants + young children

A

1) Newborns
- Group B streptococcus (maternal)
- gram negative enterococci

2) Infants / young children
- Streptococcus pneumoniae (gram positive diplococci)
- Haemophilus influenza B
- Staph aureus (rare but serious)

37
Q

Name 3 atypical causes of pneumonia in children or infants

A
  1. Mycoplasma pneumoniae
  2. Chlamydia pneumoniae
  3. Mycobacterium tuberculosis
38
Q

What are the signs of respiratory distress in children?

A 
Tachypnoea
Grunting
Intercostal recession
Cyanosis
Use of accessory muscles
Nasal flaring
39
Q

Management of pneumonia in children?

A

Supportive Tx
First line abx = Amoxicillin

If child unwell after period of improvement –> CXR to check for empyema

40
Q

What are the 2 main types of wheezing in children?

A
  1. Transient early wheezing / viral-induced wheeze (RSV // resolves by 5 yrs)
  2. Persistent + recurrent wheezing (IgE + wheeze to common allergens/ stimuli, atopy, FHx)
41
Q

What is primary ciliary dyskinesia?
Diagnosis?
Management?

A

congenital abnoormality in cilia –> impaired mucous clearance, causing recurrent URTI + LRTI.

Dx = lab inspection of cilia
Mx = daily chest physio + proactive Tx of infections
42
Q

What is the genetic abnormality responsible for Cystic fibrosis?

A

Mutations to CFTR gene on chromosome 7, which codes for a chloride channel.

The most common mutation is a deletion at position 508.

43
Q

What are the main respiratory symptoms of CF?

A 
Recurrent LRTI
Sinusitis
Nasal polyps
Bronchiectasis
Spontaneous pneumothorax

Late:

  • breathlessness
  • haemoptysis
  • resp failure + cor pulmonale
44
Q

What are the main GI symptoms of CF?

A

Steatorrhoea (pancreatic dysfunction)
10% - meconium ileus (due to high viscosity of meconium)
Cholesterol gallstones
Malnutrition - failure to thrive

45
Q

What are the sexual and endocrine symptoms of CF?

A

Delayed puberty
Male infertility (no vas def)
Secondary amenorrhoea
Diabetes

46
Q

How is cystic fibrosis diagnosed?

A
  1. Heel prick test (high trypsinogen, CFTR mutations)
  2. Sweat test - >60mmol/L Na supports diagnosis (false positives common in newborns)
  3. genetic testing
  4. Clinical history
47
Q

How is cystic fibrosis managed?

A
  1. Education, lifestyle, physio
  2. Abx (s. aureus, strep. pneumonias, eventually - psuedomonas aeruginosa)
  3. Symptomatic relief - B2-agonists and ICS
  4. Airway clearance - inhaled rhDNAse, inhaled hypertonic saline, amiloride, acetylcysteine
  5. Pancreas - enzyme replacement, Creon
  6. GI - omeprazole helps absorption
  7. Lung transplant if FEV1 <30% expected

Phase 3a (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions