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Child Health > Paediatric Respiratory Medicine - URTI and LRTI's > Flashcards

Paediatric Respiratory Medicine - URTI and LRTI's Flashcards

1
Q

What is pneumonia?

A

Inflammation of the lung parenchyma with consolidation of alveoli

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2
Q

What is more likely to cause pneumonia is pre-schoolers? How is this different for older children?

A

Viruses > Bacteria

Vice versa for older children

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3
Q

What are the common causative organisms for pneumonia?

A

Bacteria - Strep Pneumoniae, Mycoplasma

Virus - RSV, Influenzae

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4
Q

What symptoms would a child with pneumonia present with?

A 
History of URTI
Fever
Cough
Breathlessness
Post-tussive vomiting
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5
Q

What signs would a child with pneumonia present with?

A

Tachypnoea

Consolidation signs - dull to percuss, decreased breath sounds, bronchial breathing

Grunting

Crackles

Recession

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6
Q

What can be seen on examination of a child with pneumonia?

A

Sats <95%
Fever >38.5
Signs of respiratory distress

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7
Q

What investigations would you request if you suspect pneumonia?

A

For community - not necessary

FBC, CRP, Culture - blood and sputum
Nasopharyngeal aspirate
CXR

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8
Q

What would suggest bacterial pneumonia?

A

Polymorphonuclear leucocytosis
Lobar consolidation
Pleural effusion

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9
Q

How is pneumonia managed?

A

Normally at home - depend on severe signs

Amoxicillin - 1st line for 1-2 weeks
Cefaclor if pen allerfic
Erythromycin for mycoplasma

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10
Q

What parental advice is given for management of pneumonia?

A

Alternate paracetamol and ibuprofen
Continue breast feeding
Encourage fluids
Safety net

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11
Q

What complications can arise from pneumonia?

A

Empyema
Sepsis
Abscess
Pleural effusion

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12
Q

How can neonates present with pneumonia?

A

Poor feed
Irritable
Grunting

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13
Q

By what mechanism may neonates get pneumonia?

A

Aspiration of micro-organisms at delivery

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14
Q

What picture would neonatal pneumonia lead to?

A

Respiratory Distress Syndrome picture

Destruction of tissue leading to inhibition of surfactant production

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15
Q

What is bronchiolitis?

A

Viral infection of the bronchioles

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16
Q

What causes bronchiolitis?

A

Normally caused by RSV

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17
Q

What does Respiratory Syncytial Virus do in the upper airway?

A

It first affects the nasopharyngeal epithelium and then spreads to the lower airway causing

Increased mucus production
Desquamation
Bronchiolar obstruction

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18
Q

What age does bronchiolitis affect children?

A

3-6 months is most common

All under age of 2

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19
Q

What are the risk factors for getting bronchiolitis?

A

Breast fed < 2months
Smoke exposure
Siblings at school/nursery
Chronic lung disease due to prematurity

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20
Q

What symptoms do children with bronchiolitis present with?

A

1-3 days coryzal symptoms - Nasal congestion, Rhinorrhoea etc.

Dry cough
Low grade fever
Feeding difficulty

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21
Q

What signs would you see on examination in a child with bronchiolitis?

A 
Tachypnoea
Grunting
Nasal flaring
Recession
Wheeze and fine crackles!
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22
Q

What symptoms may very young children with bronchiolitis present with?

A

Poor feed

Apnoea

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23
Q

If a child presented with coryzal symptoms, tachypnoea, flaring, recessions and a wheeze but no crackles, what diagnosis would you consider?

A

Viral induced wheeze

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24
Q

If a child presented with coryzal symptoms, tachypnoea, flaring, recessions, wheeze, crackles and a temperature over 39, what diagnosis would you consider?

A

Pneumonia

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25
Q

What differential diagnosis should you consider for bronchiolitis?

A 
Pneumonia
Croup
CF
Heart failure
Bronchitis
26
Q

What lab tests would you request if you suspect bronchiolitis?

A

Nasopharyngeal aspirate
Blood and urine culture
FBC
ABG - if systemically unwell

27
Q

What imaging would you request for bronchiolitis and what would it show?

A

CXR

Hyperinflation
Focal atelectasis
Air trapping
Flat diaphragm
Peribronchial cuffing
28
Q

What features would make you refer a child to hospital urgently if they had bronchiolitis?

A 
Apnoea
Child look seriously unwell
Severe resp distress
Central cyanosis
Sats <92
29
Q

What features would make you consider general hospital admission if a child had bronchiolitis?

A

Resp Rate >60
Inadequate fluid - 50-75% of usual
Clinically dehydrated

30
Q

How is most bronchiolitis managed?

A

Supportive measures - fluid, nutrition, temp control

Generally self limiting

31
Q

What may make a child high risk of having severe bronchiolitis?

A

Premature
Chronic lung disease
Congenital heart disease
Immunodeficient

32
Q

How are high risk patients managed?

A

Prophylactic palivizumab

33
Q

How is bronchiolitis managed in hospital?

A 
Oxygen - high flow nasal cannula
NG tube - feed
CPAP if impending respiratory failure
Ribavirin - high risk patients
Possible upper airway suction
34
Q

When would you discharge a child following admission for bronchiolitis?

A

Clinically stable
Adequate oral fluids
Maintain sats >92 for 4 hours +

35
Q

What are the complications associated with bronchiolitis?

A 
Hypoxia
Dehydration
Fatigue
Resp failure
Persistent cough/wheeze
Bronchiolitis obliterans
36
Q

What is the prognosis for bronchiolitis?

A

Usually last 7-10 days

If hospitalised, children can take unto 6 weeks to clear cough

37
Q

What are the types of viral wheeze?

A

Episodic

Multiple trigger

38
Q

What causes episodic viral wheeze?

A

Viral URTI

39
Q

What causes multiple trigger wheeze?

A

Viral URTI and triggers such as smoke, allergens and exercise

40
Q

What is the difference in prognosis of multiple trigger and episodic wheeze?

A

Multiple trigger wheeze is associated with an increased risk of developing asthma

41
Q

How is a viral wheeze managed?

A

SABA via spacer to aim for sats of 94-98

10 puffs, 30s apart
Repeat after 15 mins

42
Q

What organisms can cause croup?

A

Most common - parainfluenza

Can be RSV, adeno, rhino and enter virus

43
Q

What does the viral infection lead to in croup?

A

Subglottal inflammation and oedema causing impaired vocal cord movement

44
Q

At what age are children affected by croup?

A

6 month - 3 years

Peak at 2 years

45
Q

What are the differential diagnoses for croup?

A

Epiglottitis
FB inhalation
Anaphylaxis
Quinsy

46
Q

What are the risk factors for croup?

A

Male

Autumn or spring season

47
Q

How would a child with croup present?

A

Few day history of coryza and fever
Characteristic barking cough
Stridor
Symptoms worse at night

Decreased chest sounds?
Poss resp distress?

48
Q

How is the severity of croup categorised?

A

Mild - occasional bark, no stridor or recession, child happy

Moderate - frequent barking cough, stridor at rest, recessions, child not distressed

Severe - as above but resp. failure signs

49
Q

How do you diagnose croup? What investigations would you order

A

Clinical diagnosis normally

FBC, CRP, U&E
CXR
Pulse oximetry

50
Q

What should you not do if you suspect a child has croup?

A

Examine their throat - precipitate complete obstruction

51
Q

How is mild croup managed?

A

At home with supportive measures - generally spontaneously resolve

52
Q

What would cause you to consider admitting a child with croup to hospital?

A 
History of severe airway obstruction
<6months old
Immunocompromised
Poor fluid
Poor response to initial treatment
Uncertain diagnosis
Significant parental anxiety
53
Q

How is croup treated?

A

Paracetamol/ibuprofen - fever and pain

Single dose oral dexamethasone - (0.15mg/kg)
O2 and nebuliser adrenaline if severe

54
Q

What is the scoring system for croup called?

A

Westley scoring system

55
Q

What causes epiglottitis and why is it rare?

A

Haemophilus Influenza type B

Rare due to Hib vaccine

56
Q

When do children get epiglottitis?

A

Between 2-6yo

57
Q

How does epiglottitis present?

A

Symptoms develop over few hours

Sore throat - esp. swallowing
Drooling
Hot potato voice
Fever

58
Q

What investigations would you do for epiglottitis?

A

Fibre optic laryngoscopy
Lateral neck xray - thumbprint

DONT EXAMINE THROAT - PRECIPITATE COMPLETE OBSTRUCTION

59
Q

How is epiglottitis managed?

A

IV or oral antibiotics - senior paediatrician, ENT surgeon and anaesthetist should be present

Intubation

60
Q

How does croup differ from epiglottitis?

A

Time - croup is over days, epiglottitis over hours

Croup has prior coryza

Epiglottitis children look toxic and unwell

Barking cough in croup

Fever much higher in epiglottitis

Epiglottitis - children can’t speak or swallow

Child Health (30 decks)

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