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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
What differential diagnosis should you consider for bronchiolitis?
``` Pneumonia Croup CF Heart failure Bronchitis ```
26
What lab tests would you request if you suspect bronchiolitis?
Nasopharyngeal aspirate Blood and urine culture FBC ABG - if systemically unwell
27
What imaging would you request for bronchiolitis and what would it show?
CXR ``` Hyperinflation Focal atelectasis Air trapping Flat diaphragm Peribronchial cuffing ```
28
What features would make you refer a child to hospital urgently if they had bronchiolitis?
``` Apnoea Child look seriously unwell Severe resp distress Central cyanosis Sats <92 ```
29
What features would make you consider general hospital admission if a child had bronchiolitis?
Resp Rate >60 Inadequate fluid - 50-75% of usual Clinically dehydrated
30
How is most bronchiolitis managed?
Supportive measures - fluid, nutrition, temp control Generally self limiting
31
What may make a child high risk of having severe bronchiolitis?
Premature Chronic lung disease Congenital heart disease Immunodeficient
32
How are high risk patients managed?
Prophylactic palivizumab
33
How is bronchiolitis managed in hospital?
``` Oxygen - high flow nasal cannula NG tube - feed CPAP if impending respiratory failure Ribavirin - high risk patients Possible upper airway suction ```
34
When would you discharge a child following admission for bronchiolitis?
Clinically stable Adequate oral fluids Maintain sats >92 for 4 hours +
35
What are the complications associated with bronchiolitis?
``` Hypoxia Dehydration Fatigue Resp failure Persistent cough/wheeze Bronchiolitis obliterans ```
36
What is the prognosis for bronchiolitis?
Usually last 7-10 days If hospitalised, children can take unto 6 weeks to clear cough
37
What are the types of viral wheeze?
Episodic | Multiple trigger
38
What causes episodic viral wheeze?
Viral URTI
39
What causes multiple trigger wheeze?
Viral URTI and triggers such as smoke, allergens and exercise
40
What is the difference in prognosis of multiple trigger and episodic wheeze?
Multiple trigger wheeze is associated with an increased risk of developing asthma
41
How is a viral wheeze managed?
SABA via spacer to aim for sats of 94-98 10 puffs, 30s apart Repeat after 15 mins
42
What organisms can cause croup?
Most common - parainfluenza Can be RSV, adeno, rhino and enter virus
43
What does the viral infection lead to in croup?
Subglottal inflammation and oedema causing impaired vocal cord movement
44
At what age are children affected by croup?
6 month - 3 years Peak at 2 years
45
What are the differential diagnoses for croup?
Epiglottitis FB inhalation Anaphylaxis Quinsy
46
What are the risk factors for croup?
Male | Autumn or spring season
47
How would a child with croup present?
Few day history of coryza and fever Characteristic barking cough Stridor Symptoms worse at night Decreased chest sounds? Poss resp distress?
48
How is the severity of croup categorised?
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
How do you diagnose croup? What investigations would you order
Clinical diagnosis normally FBC, CRP, U&E CXR Pulse oximetry
50
What should you not do if you suspect a child has croup?
Examine their throat - precipitate complete obstruction
51
How is mild croup managed?
At home with supportive measures - generally spontaneously resolve
52
What would cause you to consider admitting a child with croup to hospital?
``` History of severe airway obstruction <6months old Immunocompromised Poor fluid Poor response to initial treatment Uncertain diagnosis Significant parental anxiety ```
53
How is croup treated?
Paracetamol/ibuprofen - fever and pain Single dose oral dexamethasone - (0.15mg/kg) O2 and nebuliser adrenaline if severe
54
What is the scoring system for croup called?
Westley scoring system
55
What causes epiglottitis and why is it rare?
Haemophilus Influenza type B Rare due to Hib vaccine
56
When do children get epiglottitis?
Between 2-6yo
57
How does epiglottitis present?
Symptoms develop over few hours Sore throat - esp. swallowing Drooling Hot potato voice Fever
58
What investigations would you do for epiglottitis?
Fibre optic laryngoscopy Lateral neck xray - thumbprint DONT EXAMINE THROAT - PRECIPITATE COMPLETE OBSTRUCTION
59
How is epiglottitis managed?
IV or oral antibiotics - senior paediatrician, ENT surgeon and anaesthetist should be present Intubation
60
How does croup differ from epiglottitis?
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

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