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

Question 1

What signs are associated with inhaled foreign body?

Answer 1

Unequal air entry
Asymmetrical chest movement
Wheeze

Question 2

How would an effective cough be described?

Answer 2

Loud
Breath in before each cough
Responsive and alert
Verbal

Question 3

How was a child with an ineffective cough sound?

Answer 3

Quite/silent cough
Not breathing
LOC
Not able to vocalise
Cyanosed

Question 4

When would inhalation of a foreign body be an emergency?

Answer 4

Complete obstruction

Button battery - even if partial obstruction

Question 5

What can be seen on a CXR of an inhaled FB

Answer 5

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

Question 6

Where is a foreign body most likely to obstruct?

Answer 6

Right main bronchus

Question 7

What is laryngomalacia?

Answer 7

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

Question 8

How do children with laryngomalacia present?

Answer 8

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

GORD

Normal cry

Question 9

When are children with laryngomalacia picked up?

Answer 9

Within first 6 weeks of life

Question 10

Describe the appearance of laryngomalacia on laryngoscopy

Answer 10

Omega shaped epiglottis

Question 11

How is laryngomalacia managed?

Answer 11

Spontaneously resolve by 18-24 months so monitor closely

Tracheostomy if resp distress

Question 12

What are the complications of laryngomalacia?

Answer 12

Resp distress
Failure to thrive
Cyanosis

Question 13

What is subglottic stenosis?

Answer 13

Malformed cricoid cartilage narrowing the subglottic airway

Question 14

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

Answer 14

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

Question 15

What are the management options for subglottic stenosis?

Answer 15

Not always needed but 2 surgical options

Laser ablation
Open reconstruction

Question 16

How does the common cold present?

Answer 16

Colourless nasal discharge
“blocked nose”
Cough
Sneeze

Last 10 days

Question 17

How is a cold managed?

Answer 17

Paracetamol and ibuprofen
Fluids
Honey and lemon

Question 18

What causes the common cold?

Answer 18

Rhinovirus

Question 19

What causes Pharyngitis/tonsillitis?

Answer 19

2/3 EBV

1/3 Group A Beta Haemolytic strep

Question 20

How does pharyngitis/tonsillitis present?

Answer 20

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

Question 21

How are pharyngitis/tonsillitis managed?

Answer 21

Reassure self limiting

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

Question 22

What are the complications of tonsillitis and pharyngitis?

Answer 22

Peritonsillar abscess
Otitis media
Rheumatic fever

Question 23

What are the differentials for tonsillitis and pharyngitis?

Answer 23

Cold
Hand foot and mouth disease
Glandular fever

Question 24

What is the Centor criteria?

Answer 24

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

Question 25

What causes acute otitis media?

Answer 25

Virus - rhinovirus, RSV Bacteria - 70% H inleunzae, Strep pneumonia, Moraxella catarrhalis

Question 26

How does acute otitis media present?

Answer 26

Fever Ear pain - tugging Hearing loss Red inflamed tympanic membrane with loss of light reflex

Question 27

How is otitis media treated?

Answer 27

80% self resolve 5 days amor if systemically unwell or not improving after 4 days

Question 28

What complications are associated with otitis media?

Answer 28

TM perforation Mastoiditis Facial nerve palsy Meningitis

Question 29

Why is otitis media common in children?

Answer 29

Short flat eustachian tube

Question 30

What causes acute sinusitis?

Answer 30

Most bacterial: H Influenzae Strep pneumoniae Moraxella Catarrhalis

Question 31

How does acute sinusitis present?

Answer 31

Non-resolving cold Pain, swelling and tenderness over zygomatic/cheek region Hyponasal speech Mouth breathing

Question 32

How long does sinusitis normally last?

Answer 32

17 days

Question 33

How is sinusitis managed?

Answer 33

Symptom relief - fluid, analgesia, rest 7 days amoxicillin if severe or not resolving after 5 dats

Question 34

Before what age is sinusitis not usually present?

Answer 34

10yo - sinuses don't develop properly

Question 35

What symptoms can adenoid hypertrophy present with?

Answer 35

Noisy rattly nose breathing If nose breathing difficult --> mouth breathe Runny nose Snore at night Glue ear - Eustachian tube blocked

Question 36

What is the normal life cycle in adenoid hypertrophy?

Answer 36

Grow from birth Largest at 3yo Regress and atrophy at 7/8

Question 37

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

Answer 37

Bordetella Pertussis - gram negative bacilli Also known as pertussis

Question 38

How prevalent is the whooping cough?

Answer 38

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

Question 39

What vaccine is available for whooping cough?

Answer 39

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

Question 40

How long is the incubation period for whooping cough?

Answer 40

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

Question 41

What is the pathophysiology of pertussis?

Answer 41

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

Question 42

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

Answer 42

Catarrhal phase - 1-2 weeks | Paroxysmal phase - 2-8 weeks

Question 43

What happens in the catarrhal phase of pertussis?

Answer 43

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

Question 44

What happens in the paroxysmal phase of pertussis?

Answer 44

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

Question 45

What can the coughing phase cause?

Answer 45

Epistaxis | Subconjunctival haemorrhage

Question 46

How is whooping cough investigated and diagnosed?

Answer 46

Nasopharyngeal swap or aspirate - PCR If cough >2 weeks - anti-pertussis toxin IgG serology recommended Marked lymphocytosis is characteristic Diagnose by ruling out differentials

Question 47

What are the differential diagnoses for whooping cough?

Answer 47

``` Bronchiolitis Mycoplasma pneumonia Bacterial pneumonia Asthma TB ```

Question 48

Which children with whooping cough are admitted to hospital?

Answer 48

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

Question 49

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

Answer 49

Doesn't alter course of infection - reduce infectivity <1month - clarithromycin >1month - azithromycin or clarithromycin Co-trimoxazole 2nd line if macrocodes CI

Question 50

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

Answer 50

NOTIFIABLE DISEASE - report to local health protection team Tell parents the cough can take unto 3 months to resolve

Question 51

What complications are associated with whooping cough?

Answer 51

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