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3A > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the other name for croup

A

acute laryngotracheobronchitis

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2
Q

Who is most commonly affected by croup

A

ages 6 months to 3 years
more common in boys

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3
Q

When is croup most common?

A

autumn/early winter

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4
Q

What pathogens can cause croup?

A

parainfluenza type 1 (most common) and type 2
adenovirus
influenza a and b
RSV

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5
Q

Describe the pathophysiology of croup

A
  1. virus initially infects the nasopharyngeal mucosa
  2. It spreads to the larynx and subglottic airways
  3. Inflammation of the larynx and subglottic airways leads to swelling and obsrtuction
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6
Q

Symptoms of croup

A

seal like barking cough
hoarse voice
fever
nasal congestion
stridor

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7
Q

Mild croup symptoms

A

-occasional barking cough
-no audible stridor
- no recession
-child can eat and drink normally

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8
Q

moderate croup symptoms

A

-frequent barking cough
- audible stridor at rest
- suprasternal recession
- no agitation

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9
Q

severe croup symptoms

A

-frequent barking cough
- prominent stridor
- marked sternal recession
- child agitated and distressed
- tachycardia

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10
Q

red flags of resp failure in croup

A

-drowsiness
-cyanosis
-laboured breathing
- lethargy
-tachycardia

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11
Q

Diagnosis of croup

A

usually clinical diagnosis
May x-ray to exclude foreign body

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12
Q

What X ray sign may be seen in croup

A

steeple sign (subglottic narrowing)

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13
Q

How is croup treated

A
  1. single dose oral dexamethasone (0.15 mg/kg) and antipyretics
  2. if no improvement= nebulised adrenaline

Can give O2 if required

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14
Q

What are 2 potential complications of croup

A

otitis media and superinfection leading to pneumonia

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15
Q

What is bronchiolitis

A

Viral infection of the bronchioles

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16
Q

Who is affected by bronchiolitis?

A
  • under 2’s
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17
Q

When is bronchiolitis most common?

A

winter and spring

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18
Q

Risk factors for bronchiolitis

A

-prematurity
-congenital heart disease
- chronic lung disease
- tobacco exposure
- pollutants
-older siblings in nursery/school

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19
Q

What is the most common cause of bronchiolitis?

A

RSV

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20
Q

What type of inflammation is predominate in bronchiolitis?

A

neutrophilic inflammation

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21
Q

Symptoms of bronchiolitis

A

Corzyal prodrome lasting 1-3 days then development of a persistent cough plus either:
- tachypnoea or chest recession (or both)
- wheeze or crackles (or both)

May also have:
- low grade fever
- poor feeding
- apnoea

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22
Q

Signs of respiratory distress in bronchiolitis

A
  • nasal flaring
  • tracheal tug
  • head bobbing
  • grunting
  • sub/intercostal recession
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23
Q

Bronchiolitis on examination

A
  • dry wheezy cough
  • cyanosis or pallor
  • hyperinflation of the chest
  • subcostal or intercostal recession
  • fine end inspiratory crackles and high-pitched wheezes.
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24
Q

Investigations for bronchiolitis

A
  • pulse oximetry
  • nasopharyngeal aspirate for RSV culture
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25
Q

When is hospital admission suggested in bronchiolitis

A

-apnoea
-persistent O2 <90
- inadequate fluid intake
-severe resp distress

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26
Q

Treatment of bronchiolitis

A

supportive management at home
Palvizumab vaccine for prophylaxis if suggested
hospital admission if severe (O2, fluids, CPAP)

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27
Q

When should Palvizumab be given for bronchiolitis

A
  • under 9 months if chronic lung disease of prematurity
  • under 2 years if severe immunodeficiency

given once monthly

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28
Q

Who is most commonly affected by acute epiglottitis?

A

children aged 1-6

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29
Q

What is the most common cause of acute epiglottitis?

A

human influenzae virus type b (Hib)

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30
Q

Describe the pathophysiology of acute epiglottitis

A

Inflammation leading to oedema of the airways, increasing airway resistance and narrowing of the supraglottic aperture

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31
Q

How does acute epiglottitis present

A

-very acute onset
- very ill, toxic looking child
- high fever
- drooling saliva
- can’t speak or swallow
- soft whispering stridor
- tripoding position (upright with open mouth)

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32
Q

What should you not do to a child with suspected acute epiglottitis

A

EXAMINE

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33
Q

What sign would be seen on an x ray of acute epiglottitis

A

Thumb sign and epiglottic swelling

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34
Q

How is acute epiglottitis treated?

A

Secure airway- direct rigid laryngoscopy and intubation in theatre
IV antibiotics (cefotaxime, ceftriaxone)
Corticosteroids
adrenaline nebuliser

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35
Q

What is the most common cause of pneumonia in young infants?

A

Viruses

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36
Q

Causes of pneumonia in neonates

A

organisms from the mother’s genital tract
E.coli
Klebsiella
staph aureus
group b strep

37
Q

causes of pneumonia in infants

A

respiratory viruses (mainly RSV)
bacteria (strep pneumoniae, chlamydia tracheomatis)

38
Q

Causes of pneumonia in school age children

A

staph aureus
group a strep
mycoplasma bacteria
strep pneumonia

39
Q

4 ways in which bacteria can spread to the lungs to cause pneumonia

A
  1. inhalation
  2. aspiration of oropharyngeal secretions in the trachea
  3. haematogenous spread from localised infections
  4. direct extension from adjacent foci
40
Q

How does pneumonia present?

A

-preceding upper respiratory tract infection
- fever
- shortness of breath
- lethargy
- poor feeding
- signs of respiratory distress
- cyanosis
- wheeze and hyperinflation

41
Q

How would pneumonia present of examination

A

-tachypnoea
-nasal flaring
-chest indrawing
-end-inspiratory crackles

42
Q

how is pneumonia diagnosed?

A

-mainly clinical diagnosis
-X ray not routinely used but may be done if hypoxic, in significant respiratory distress or if considering pleural effusion
-bloods
-microbiology

43
Q

How is pneumonia treated?

A

oral antibiotics (amoxicillin/ co-amoxiclav)
O2
IV fluids

44
Q

What signs indicate that pneumonia should be treated in the hospital?

A

-hypoxaemia (<92)
-severe resp distress
-dehydration
-toxic appearance
-underlying condition
-indication of complications

45
Q

What two types of virally induced wheeze are there?

A

-episodic viral wheeze
- multi-trigger viral wheeze

46
Q

Explain what episodic viral wheeze is

A

wheezing that occurs at distinct periods associated with upper respiratory tract infections.
Asymptomatic between periods

47
Q

Explain multi-trigger wheeze

A

Same distinct exacerbations as episodic plus symptoms inbetween periods (potentially in response to allergens, emotions, activity etc)

48
Q

What is used to the predict whether virally induced wheeze will develop into asthma

A

the asthma predictive index (API)

49
Q

Explain how the asthma predictive index works

A

For children under the age of 3 who have had 4 or more episodes of wheeze in the past year.
Determines likelihood of developing asthma based on fulfilling one major or two minor criteria

50
Q

major criteria for the API

A

parent with asthma
diagnosis of eczema
sensitivities to air allergens (RAST or skin prick test)

51
Q

minor criteria of API

A
  • food allergens
  • more than 4% blood eosinophils
  • wheezing apart from colds
52
Q

What is a wheeze

A

A high pitched musical sounds on expiration

53
Q

Differentials for virally induced wheeze

A

Asthma, bronchiolitis, inhaled foreign body, CF, GORD

54
Q

Long term management of viral induced wheeze

A

Give salbutamol during exacerbations and if multi-trigger then consider inhaled corticosteroid

55
Q

acute management of viral induced wheeze

A

O2
salbutamol
consider inhaled ipatropium bromide if severe
consider oral steroids if no improvement after 8-12 hours

56
Q

RF for asthma

A

genetic predisposition, atopy, environmental triggers (URTI, smoking, pollutants, cold air, exercise)

57
Q

Symptoms of asthma

A

wheeze
dry cough
breathlessness
chest tightness

58
Q

What 3 physical sign may be present in long term asthma

A

hyperinflation of the chest
generalised polyphonic expiratory wheeze
Harrison’s sulci - depression at base of thorax associated with the muscular insetions of the diaphragm

59
Q

How is asthma diagnosed

A

spirometry showing obstructive pattern (bronchodilator reversible)
Peak expiratory flow rate

60
Q

Results of spirometry in asthma

A

FEV1 reduced
FVC normal
FEV1/FVC <70%

61
Q

what can long term steroid use in asthma lead to

A

adrenal suppression

62
Q

Explain the 6 steps of asthma management

A
  1. SABA (salbutamol)
  2. add ICS (beclomethasone)
  3. add LTRA (montelukast)
  4. swap LTRA to LABA (salmeterol)
  5. Stop LABA and use ICS + mart regimine
  6. LABA+ ICS + MART
63
Q

Explain the emergency management of an asthma attack

A
  • O2- high flow, non-rebreathing mask
  • nebulised salbutamol
  • nebulised ipatropium bromide
    -oral prednisolone
  • IV magnesium sulphate, IV salbutamol, IV aminophylline
64
Q

Indications asthma is life threatening

A
  • SpO2 <92%
  • PEF <33%
  • silent chest
  • poor resp effort
    -cyanosis
  • exhaustion
  • hypotension
  • confusion
65
Q

Indications asthma is acute and severe

A

SpO2 <92
PEF 33-50%
can’t speak in complete sentences
RR >40 (age 2-5) or >30 (>5)
HR >140 (2-5) or >125 (>5)

66
Q
A
67
Q

Definitive test for biliary atresia

A

Cholangiography

68
Q

What is the definitive diagnosis of hirschsprung disease

A

Rectal suction biopsy

69
Q

What are the Fraser guidelines?

A

A set of guidelines that can be applied when giving advice about contraception and sexual health in under 16s

70
Q

Rash associated with juvenile idiopathic arthritis

A

Salmon pink rash

71
Q

What medication is given to prevent ductus arteriosus from closing in transposition of the great arteries

A

Alprostadil

72
Q

Presentation of rickets

A

Bow legs, Harrison sulci and constipation

73
Q

Management of a small ventricular septal defect

A

Monitor and reassure

74
Q

Common x ray findings in rickets

A

Bowed femur and widened epiphyseal plates

75
Q

Presentation of Kawasaki disease

A

Fever for more than 5 days
Conjunctivitis
Erythema
Edema of hands and feet
Peeling
Cervical lymphadenopathy

76
Q

What antibiotic should be avoided in long qt syndrome

A

Macrolides such as clarithromycin

77
Q

Common cause of resp tract infections in cystic fibrosis

A

Pseudomonas aeruginosa

78
Q

What are brushfield spots a symptom of?

A

Trisomy 21

79
Q

What is congenital adrenal hyperplasia a deficiency of?

A

21- hydroxylase

80
Q

What is another trinucleotide repeat disorder other than huntingtions?

A

myotonic dystrophy

81
Q

First step of paediatric life support if no sign of breathing

A

5 rescue breaths (before checking pulses)

82
Q

How does congenital CMV present

A

microcephaly, petechial rash, seizures, low birth weight and hearing loss

83
Q

Is Perthes disease more common in men or women?

A

5 times more common in men

84
Q

What is Perthes sidease

A

idiopathic avascular necrosis of the femoral head in children

85
Q

How does Perthes disease typically present

A

irritable hip, limp and reduced range of motion despite no trauma or systemic symptoms

86
Q

Difference in presentation between transient synovitis and Perthes disease

A

transient synovitis typically has proceeding infection and self-resolved within 7-10 days.
Perthes disease is much longer (2-3 years)

87
Q

What respiratory rate is a red flag at any age according to NICE traffic lights

A

> 60

88
Q

side effect of methyphenidate

A

stunted growth

89
Q
A

3A (33 decks)

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