Paediatrics

Question 1

Risk factors for Bronchiolitis

Answer 1

Gestation age less than 37 weeks
Chronological age less than 10weeks
Chronic lung disease
Congenital heart disease 
Indigenous

Question 2

Bronchiolitis

Answer 2

Inflammation of the bronchioles usually caused Abby acute viral illness - most common RSV.
Most common lower respiratory illness in children <2yrs
Inflammation of epithelial cells of small airways leads to mucus production, inflammation, cellular necrosis. Can lead to airway obstruction and result in wheezing.
Infants who develop bronch, have a hx of mild upper respiratory tract infection, symptoms of rhinorrhea, cough, fever and decreased appetite.

Question 3

Bronchiolitis characteristics

Answer 3

Irritating cough
Use of accessory muscles with intercostal and subcostal retractions
Wheezing
Eventually - grunting, nasal flaring, cyanosis, hypoxia and respiratory failure can occur
Fever can be present

Question 4

Assessment findings and diagnosis of bronchiolitis

Answer 4

Acute upper respiratory illness followed by onset of respiratory distress and one or more of
Cough
Tachypnoea 
Retractions 
Widespread crackles or wheeze

Question 5

Investigations and management of bronchiolitis

Answer 5

No investigations required

Supportive care only - ensure adequate oxygenation and fluid intake

Question 6

Croup

Answer 6

Swelling of the larynx, trachea and lge bronchi due to infiltrate of WBC. Swelling results in partial airway obstruction which can result in increased WOB and the characteristic turbulent, noisy, airflow (stridor).
Obstruction- greatest at subglottic area which is the infants narrowest part of respiratory tract

Question 7

Croup # 2

Answer 7

Upper airway obstruction - prevalent in infants 3months up to 6 years
Parainfluenza virus typical cause

Question 8

Clincal manifestations of croup

Answer 8

Proceed after an upper respiratory tract infection
Followed by a barking cough causing various degrees of respiratory distress
Worse at night
Dyspnoea
Nasal flaring
Substernal and intercostal retractions

Question 9

Management of croup

Answer 9

Do not upset or agitate child
Minimal handling
Keep child with carer
Mild/moderate: Dexamethasone 0.15mg/kg PO or prednisone 1mg/kg
Severe: nebulised adrenaline 0.5/kg and dexamethasone 0.6mg/kg (max 12mg) IV, IM, oral
If persists repeat adrenaline and refer to senior

Question 10

Pertussis

Answer 10

Highly contagious bacterial infection
Characterised by paroxysmal cough
Significant cause of morbidity and mortality in children <2yrs

Question 11

Epiglottitis

Answer 11

Cause: hot fluids, direct injury to throat and various other bacteria including streptococcus pneumoniae, strep A,B,C
Life threatening- can block airway

Question 12

Clinical manifestations of Epiglottitis

Answer 12

Difficulty breathing, swallowing, drooling, inspiratory stridor, muffled voice.
Pts won’t have a cough
Radiology can be used to diagnose

Question 13

Treatment of Epiglottitis

Answer 13

Protect airway - will be a difficult airway
Consider Neb adrenaline
Antibiotics

Question 14

Anaphylaxis clinical manifestations

Answer 14

Persistent cough
Wheeze
Tongue swelling 
Stridor
Horse voice
Sensation Of throat swelling or tightness 
Dysphasia

Question 15

Treatment of anaphylaxis

Answer 15

IM into lateral thigh of adrenaline 10mcg/kg - repeat after 5 minutes
Should be considered if swelling of the face or tongue, wheeze and urticarial rash

Question 16

Foreign Body of the larynx or main bronchus

Answer 16

Suspect if there is a sudden, catastrophic event
Child my be coughing, choking, possibly vomiting. A complete obstruction child can rapidly deteriorate to unconsciousness and arrest

Question 17

Partial obstruction

Answer 17

Keep child comfortable, arrange for removal in theatre

Question 18

Management of complete obstruction

Answer 18

Open airway and directly visualise move and try to remove FB with magill forceps
Initiate 5 rescue breaths
Place child in prone with head down give 5 blows between scapula
Turn child over and give 5 thrusts to chest (same as cpr)
Recheck mouth for FB
Continue
Attempt positive pressure ventilation to remove FB
Surgical airway maybe required

Question 19

Lower than main bronchus

Answer 19

Suspect in 6mths to 4yrs
Symptoms vary from asymptomatic to persistent wheeze, cough, fever or dyspnoea which are otherwise unexplained.
Clinical manifestations: asymmetrical chest wall movement, tracheal deviation, wheeze and decreased breath sounds
Management: place child in a comfortable position, arrange for removal in operating theatre or bronchoscopy

Question 20

Fluid replacement therapy ORAL

Answer 20

Oral: 10ml/kg/hr of rehydration solution
Can offer diluted apple juice 1:1 if refusing ORS
If breast fed - continue - bit more Ofen

Question 21

In Shocked paeds

Answer 21

10-20ml/kg n/saline stat

Question 22

Kidneys

Answer 22

High urine output 1-2ml/kg/hr

Neonates and infants are unable to concentrate their urine

Question 23

Glucose metabolism

Answer 23

Hypoglycaemia common in unwell/stressed neonates/infants
Children has an increased metabolic rate and there for increased glucose needs
Infants have small glycogen stores

Question 24

Factors increasing susceptibility to respiratory illnesses in children

Answer 24

Age
Pre-existing medical conditions
Iiving conditions

Question 25

Croup

Answer 25

Typically caused by Parainfluenza virus

Question 26

Croup

Answer 26

Mild: barking cough without inspiratory stridor
Moderate: increased respiratory effort and resting stridor - still alert and active
Severe: persistent stridor, cyanosed, child is restless or apathetic, tracheal tug and intercostal recession.
A single dose of dexamthasone is required in all case of croup. Moderate requires Dex plus nebulised adrenaline. Severe May require o2

Question 27

Oral rehydration

Answer 27

Identify any methods to help the child drink
Continue breastfeeding
Encourage oral rehydration salts (gastrolyte)
Do not give lemonade, or sports drinks
Cease any feed fortifications eg additional scoops of formula
Encourage normal diet once rehydrated

Question 28

NGT rehydration

Answer 28

Effective for moderate dehydration.

Most children will stop vomiting once NGT feed commences

Question 29

2/3 maintenance

Answer 29

Appropriate for most unwell children requiring hydration support

Question 30

Full maintenance fluid replacement

Answer 30

May be appropriate for children who are not drinking adequately.

Question 31

Assessment of hydration

Answer 31

Conscious state
HR
RR
bP
Skin colour
Extremities
Peripheral pulses
Eyes and Fontanal
Mucus membranes 
Skin tugur 
Central cap refill