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Child Health > Paediatric Respiratory Medicine - Inhaled FB, Obstruction, URTI, Whooping cough > Flashcards

Paediatric Respiratory Medicine - Inhaled FB, Obstruction, URTI, Whooping cough Flashcards

1
Q

What signs are associated with inhaled foreign body?

A

Unequal air entry
Asymmetrical chest movement
Wheeze

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2
Q

How would an effective cough be described?

A

Loud
Breath in before each cough
Responsive and alert
Verbal

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3
Q

How was a child with an ineffective cough sound?

A 
Quite/silent cough
Not breathing
LOC
Not able to vocalise
Cyanosed
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4
Q

When would inhalation of a foreign body be an emergency?

A

Complete obstruction

Button battery - even if partial obstruction

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5
Q

What can be seen on a CXR of an inhaled FB

A

Inspiratory and expiratory CXR (air can’t exit so affected lung is hyperlucent and overinflated with depressed hemidiaphragm)
Obvious FB
Lobar collapse

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6
Q

Where is a foreign body most likely to obstruct?

A

Right main bronchus

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7
Q

What is laryngomalacia?

A

Cartilage problem meaning larynx is soft and floppy so collapses on breathing

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8
Q

How do children with laryngomalacia present?

A

Noisy breathing and stridor which is worse when supine, feeding or agitated

GORD

Normal cry

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9
Q

When are children with laryngomalacia picked up?

A

Within first 6 weeks of life

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10
Q

Describe the appearance of laryngomalacia on laryngoscopy

A

Omega shaped epiglottis

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11
Q

How is laryngomalacia managed?

A

Spontaneously resolve by 18-24 months so monitor closely

Tracheostomy if resp distress

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12
Q

What are the complications of laryngomalacia?

A

Resp distress
Failure to thrive
Cyanosis

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13
Q

What is subglottic stenosis?

A

Malformed cricoid cartilage narrowing the subglottic airway

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14
Q

What are the categories of subglotic stenosis severity and how would each present?

A

Mild - may only be picked up if child needs intubating

Moderate - biphasic stridor, hoarse weak voice and resp distress during URTI in first few months of life

Severe - airway obstruction at birth

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15
Q

What are the management options for subglottic stenosis?

A

Not always needed but 2 surgical options

Laser ablation
Open reconstruction

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16
Q

How does the common cold present?

A

Colourless nasal discharge
“blocked nose”
Cough
Sneeze

Last 10 days

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17
Q

How is a cold managed?

A

Paracetamol and ibuprofen
Fluids
Honey and lemon

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18
Q

What causes the common cold?

A

Rhinovirus

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19
Q

What causes Pharyngitis/tonsillitis?

A

2/3 EBV

1/3 Group A Beta Haemolytic strep

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20
Q

How does pharyngitis/tonsillitis present?

A 
Sore throat - can refer to ear
Painful swallow
Tonsillar exudates
Headache
Abdo pain
Fever
Cervical lymphadenopathy
Red, enlarged tonsils
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21
Q

How are pharyngitis/tonsillitis managed?

A

Reassure self limiting

Delay abx for 3-5 days - phenoxymethylpenicilillin (depend on centor criteria)

22
Q

What are the complications of tonsillitis and pharyngitis?

A

Peritonsillar abscess
Otitis media
Rheumatic fever

23
Q

What are the differentials for tonsillitis and pharyngitis?

A

Cold
Hand foot and mouth disease
Glandular fever

24
Q

What is the Centor criteria?

A

Tonsillar exudate

Tender anterior cervical lymphadenopathy or lymphadenitis

Fever (over 38°C)

Absence of cough

Add one point if child under 15yo
Score <=1 then no antibiotics
Score >=3 then 60% chance bacterial

25
Q

What causes acute otitis media?

A

Virus - rhinovirus, RSV

Bacteria - 70%
H inleunzae, Strep pneumonia, Moraxella catarrhalis

26
Q

How does acute otitis media present?

A

Fever
Ear pain - tugging
Hearing loss

Red inflamed tympanic membrane with loss of light reflex

27
Q

How is otitis media treated?

A

80% self resolve

5 days amor if systemically unwell or not improving after 4 days

28
Q

What complications are associated with otitis media?

A

TM perforation
Mastoiditis
Facial nerve palsy
Meningitis

29
Q

Why is otitis media common in children?

A

Short flat eustachian tube

30
Q

What causes acute sinusitis?

A

Most bacterial:

H Influenzae
Strep pneumoniae
Moraxella Catarrhalis

31
Q

How does acute sinusitis present?

A

Non-resolving cold

Pain, swelling and tenderness over zygomatic/cheek region

Hyponasal speech

Mouth breathing

32
Q

How long does sinusitis normally last?

A

17 days

33
Q

How is sinusitis managed?

A

Symptom relief - fluid, analgesia, rest

7 days amoxicillin if severe or not resolving after 5 dats

34
Q

Before what age is sinusitis not usually present?

A

10yo - sinuses don’t develop properly

35
Q

What symptoms can adenoid hypertrophy present with?

A

Noisy rattly nose breathing

If nose breathing difficult –> mouth breathe

Runny nose

Snore at night

Glue ear - Eustachian tube blocked

36
Q

What is the normal life cycle in adenoid hypertrophy?

A

Grow from birth

Largest at 3yo

Regress and atrophy at 7/8

37
Q

What is Whooping cough normally caused by (with classification)? What is its other name?

A

Bordetella Pertussis - gram negative bacilli

Also known as pertussis

38
Q

How prevalent is the whooping cough?

A

Was very prevalent but cases have dropped dramatically since the vaccine was introduced

39
Q

What vaccine is available for whooping cough?

A

DTP

Given at 2,3 and 4 months of age. Booster at 3 years 4 months.

Temporary vaccination for pregnant women to confer passive immunity until DTP

40
Q

How long is the incubation period for whooping cough?

A

7-20 days - off school for 3 weeks after onset of symptoms

41
Q

What is the pathophysiology of pertussis?

A

Bacteria paralyse cilia and promote inflammation leading to impaired clearance of resp secretions

42
Q

What are the phases of whooping cough and how long do each last?

A

Catarrhal phase - 1-2 weeks

Paroxysmal phase - 2-8 weeks

43
Q

What happens in the catarrhal phase of pertussis?

A 
Symptoms of mild Resp infection:
Rhinitis
Conjunctivitis
Irritable
Sore throat
Low grade fever
Dry cough
44
Q

What happens in the paroxysmal phase of pertussis?

A

Severe episodes of dry hacking cough where child chokes, gasps, flails arms and legs, goes red, eyes water and can vomit - more common at night

Coughing phase followed by classic whoop

45
Q

What can the coughing phase cause?

A

Epistaxis

Subconjunctival haemorrhage

46
Q

How is whooping cough investigated and diagnosed?

A

Nasopharyngeal swap or aspirate - PCR
If cough >2 weeks - anti-pertussis toxin IgG serology recommended

Marked lymphocytosis is characteristic

Diagnose by ruling out differentials

47
Q

What are the differential diagnoses for whooping cough?

A 
Bronchiolitis
Mycoplasma pneumonia
Bacterial pneumonia
Asthma
TB
48
Q

Which children with whooping cough are admitted to hospital?

A

<6months and acutely unwell
Breathing difficulty significant
Feeding difficulty
Complications

49
Q

What is the purpose of antibiotics in whooping cough management and which antibiotics are used?

A

Doesn’t alter course of infection - reduce infectivity

<1month - clarithromycin
>1month - azithromycin or clarithromycin

Co-trimoxazole 2nd line if macrocodes CI

50
Q

What do you have to do if a child has whooping cough?

A

NOTIFIABLE DISEASE - report to local health protection team

Tell parents the cough can take unto 3 months to resolve

51
Q

What complications are associated with whooping cough?

A 
Pneumonia - unto 20% of infants
Seizures
Encephalopathy
Apnoea
Raised intra-abdominal pressure can cause hernia/prolapse

Child Health (30 decks)

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