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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
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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
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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
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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

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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

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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.

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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
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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)
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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

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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

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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

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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

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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

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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

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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
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16
Q

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

A

Rhinovirus
Coronavirus
RSV

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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

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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

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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
What are the possible complications of otitis media?
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
What are the common pathogens causing otitis media?
S. pneumonia H. influenza Moraxella catarrhalis other streps and staphs
27
How would you manage otitis media in a child who was systemically well?
Pain relief watch + wait (60% resolve in 24 hours) Grommet insertion if recurrent
28
How would you manage otitis media in a child who was systemically unwell / immunocompromised / symptoms not resolved within 4 days
Amoxicillin or erythromycin Delay 2 days if <3 months or <2 years with bilateral OM
29
What is OM with effusion / glue ear / serous otitis media?
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
How would you differentiate viral and bacterial sinusitis?
Viral <10 days = self limiting Bacterial >10 days / worsening after 5 days = amoxicillin / doxycycline
31
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?
1. droplet 2. yes 3. RSV (bronchiolitis) 4. Gram negative coccobacillus
32
Describe the clinical presentation of whooping cough
``` 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
How would you diagnose whooping cough?
PCR via nasal swab bloods - marked lymphocytosis serology - anti-pertussis IgG *NOTIFIABLE DISEASE*
34
How is whooping cough treated?
- Hospital admission if <6 months or resp difficulties - ventilation or ECMO - Abx reduce period of infectivity: Macrolides (azithromycin..)
35
What is the most common type of pneumonia in younger and older children (bacterial / viral)?
Younger children = viruses Older children = bacteria
36
What are the most common causative organisms of pneumonia in: 1) Newborns 2) Infants + young children
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
Name 3 atypical causes of pneumonia in children or infants
1. Mycoplasma pneumoniae 2. Chlamydia pneumoniae 3. Mycobacterium tuberculosis
38
What are the signs of respiratory distress in children?
``` Tachypnoea Grunting Intercostal recession Cyanosis Use of accessory muscles Nasal flaring ```
39
Management of pneumonia in children?
Supportive Tx First line abx = Amoxicillin If child unwell after period of improvement --> CXR to check for empyema
40
What are the 2 main types of wheezing in children?
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
What is primary ciliary dyskinesia? Diagnosis? Management?
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
What is the genetic abnormality responsible for Cystic fibrosis?
Mutations to CFTR gene on chromosome 7, which codes for a chloride channel. The most common mutation is a deletion at position 508.
43
What are the main respiratory symptoms of CF?
``` Recurrent LRTI Sinusitis Nasal polyps Bronchiectasis Spontaneous pneumothorax ``` Late: - breathlessness - haemoptysis - resp failure + cor pulmonale
44
What are the main GI symptoms of CF?
Steatorrhoea (pancreatic dysfunction) 10% - meconium ileus (due to high viscosity of meconium) Cholesterol gallstones Malnutrition - failure to thrive
45
What are the sexual and endocrine symptoms of CF?
Delayed puberty Male infertility (no vas def) Secondary amenorrhoea Diabetes
46
How is cystic fibrosis diagnosed?
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
How is cystic fibrosis managed?
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)

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