Paediatrics Flashcards
1
Q
Croup epidemiology
A
- Children aged 6months-3years
- Peak incidence at 2 years
2
Q
Croup pathophysiology
A
Mucosal inflammation between nose and trachea, barking cough caused by impaired movement of vocal cords
3
Q
Croup causative organisms
A
- Parainfluenza viras (most common)
- Respiratory Syncytial virus
- Adenovirus
- Rhinovirus
- Enteroviruses
- Measles
4
Q
Croup risk factors
A
- Male
- Autumn + spring
- C/C variant of the CD14 C-159T gene lowers risk
5
Q
Croup signs in history
A
- 1-4 day history of non-specific cough, fever, hourseness
- Worse at night
- Red flag - drowsiness, lethargy
6
Q
Croup signs on examination
A
- Stridor
- chest sounds normal or decreased
- In resp distress - trachypnoea, intercostal recession
- Red flag - cyanosis, lethargy, laboured breathing, tachycardia
7
Q
Westey croup score items
A
- SaO2 <92% - 0=none, 4= when agitated, 5= at rest
- Stridor - 0=none, 1= when agitated, 2= at rest
- Retractions - 0=none, 1= mild, 2= moderate, 3= severe
- Air entry - 0= normal, 1= reduced, 2= markedly reduced
- Consciousness - 0= normal, 5= reduced
8
Q
Croup differentials
A
- Epiglottitis
- Inhaled foreign body
- Inhaled noxious substance
- Acute anaphylaxis
- Bacterial tracheitis
- Diphtheria
9
Q
Croup investigations
A
- Diagnosis normally clincal
- Bloods- FBC, CRP, U&Es
- CXR - identify foreign bodies
10
Q
Croup management
A
- At home - paracetamol or ibuprofen, fluids
- Consider admission - PMH severe airway obstruction, <6 months age, immunocompromised, poor response to treatment, inadequate fluid intake
- Immediate hospital admission - moderate/severe croup, impending resp failure, suspected serious differential
11
Q
Croup medical treatment
A
- Single dose of oral dexamethasone or oral prednisolone
- Nebulised adrenaline for temporary relief of symptoms
12
Q
Croup complications
A
- Lymphadenitis
- Otitis media
- Dehydration
- Rare: bacterial superinfection causing pneumonia
- Extremely rare: pulmonary oedema, pneumothorax
13
Q
Asthma exacerbation management
A
- Oxygen - high flow to maintain sats 94-98%
- Bronchodilators - Inhaled SABA (via nebuliser if severe)
- Ipatropium bromide - if poor response to SABA
- Corticosteroids - 3 days of oral prednisolone
- Intravenous salbutamol - if no response to inhaled bronchodilators (monitor for salbutamol toxicity)
- Magnesium sulphate - considered
14
Q
Asthma epidemiology
A
- Most common chronic condition in children
- 1 in 11 children in UK affected
15
Q
Asthma risk factors
A
- Genetic
- Environmental - low birth weight, parental smoking, prematurity
- Other - viral bronchiolitis in early life, atopic dermatitis
16
Q
Asthma precipitating factors
A
- Cold air and exercise
- Atmospheric pollution
- NSAIDs
- Beta-blockers
- Exposure to allergens
17
Q
Asthma wheezing criteria
A
- Infrequent episodic wheezing - discrete episodes lasting a few days
- Frequent episodic wheeze - occur more frequently (2-6 weekly)
- Persistent wheezing - wheeze and cough most days and may have disturbed nights
18
Q
Asthma history questions
A
- age of onset
- Frequency of symptoms
- severity of symptoms
- Previous treatments tried
- Any hospital attendances
- Presence of food allergies
- Triggers for symptoms
- Disease history (viral infections, eczema, hay fever)
- Family history of atopy
19
Q
Asthma examination points
A
- Finger clubbing (to eliminate)
- chest shape - hyperinflated suggests poorly controlled asthma
- Chest symmetry
- Breaths ounds
- Presence of crepitations
- Presence of wheeze
- Examination of throat - infectious causes?
20
Q
Asthma investigations
A
- Usually diagnosed on clinical
- Spirometry - obstructive pattern if poorly controlled. Reversal to normal after bronchodilators suggests asthma
- Peak expiratory flow rate
- Exercise testing
- Skin prick testing
- Chest X-ray
21
Q
Asthma management children <= 5
A
- step 1 - intermittent short course of low dose inhaled corticosteroids
- step 2 - daily low dose ICS
- step 3 - double low dose ICS
- step 4 - continue ICS and refer to resp
22
Q
Asthma management children 6-11 years
A
- step 1 - low dose inhaled corticosteroids whenever SABA is needed
- step 2 - daily low dose ICS + as required SABA
- step 3 - low dose ICS-LABA or medium dose ICS
- step 4 - medium dose ICS-LABA or low dose ICS-formoterol, refer to resp
- step 5 - high dose ICS-LABA, refer to resp
23
Q
Asthma management children >12 years
A
- Step 1 - as required low dose ICS-formoterol
- step 2 - as required low dose ICS-formoterol
- step 3 - low dose maintenance ICS-formoterol plus as required low dose ICS-formoterol
- step 4 - medium dose maintenance ICS-formoterol plus as required low dose ICS-formoterol
- step 5 - add on LAMA to step 4, refer to resp
24
Q
Asthma management points
A
- Aerosol inhaler should be used with spacer
- Always ask the question of compliance
- LABAs should be prescribed with corticosteroids
- All children with asthma should have a written asthma plan
- Inhaler technique should be reviewed by asthma/practice nurse
25
Q
Asthma exacerbation severity
A
- Mild - SaO2 >92% in air, vocalising without difficulty, mild chest wall recession and moderate trachypnoea
- Moderate - SaO2<92%, breathless, moderate chest wall recession
- Severe - SaO2<92%, PEFR 33-50%, cannot complete sentences in one breath
- Life-threatening - SaO2 <92%, PEFR <33%, silent chest, poor respiratory effort, cyanosis, hypotension, exhaustion, confusion
26
Q
Bronchiolitis epidemiology
A
- Usually children under 2
- Mainly during winter and spring
- 2% require admission
27
Q
Bronchiolitis pathophysiology
A
- Proliferation of goblet cells causing excess mucus production
- IgE-mediated type 1 allergic reaction causing inflammation
- Bronchiolar constriction
- Infiltration of lymphocytes causing submucosal oedema
- Infiltration of cytokines and chemokines
- Causes hyperinflation, increased airway resistance, lung collapse and ventilation-perfusion mismatch
28
Q
Bronchiolitis risk factors
A
- Being breast fed for less than 2 months
- Smoke exposure
- Having siblings attend nursery
- Chronic lung disease due to prematurity
29
Q
Bronchiolitis history
A
- Typically increasing symptoms over 2-5 days usually:
- low-grade fever
- Nasal congestion
- Rhinorrhoea
- Cough
- Feeding difficulty
30
Q
Bronchiolitis examination signs
A
- Tachypnoea
- Grunting
- Nasal flaring
- Intercostal, subcostal or supraclavicular recessions
- Inspiratory crackles
- Expiratory wheeze
- Hyperinlated chest
- Cyanosis or pallor
31
Q
Bronchiolitis differentials
A
- Pneumonia
- Croup
- Cystic fibrosis
- Heart failure
- Bronchitis
32
Q
Brochiolitis investigations
A
- Pulse oximetry
- Nasopharyngeal aspirate or throat swab
- Blood and urine culture if child is pyrexic
- FBC
- ABG if severely unwell
- CXR (only if diagnositic uncertainty) - hyperinflation, focal atelectasis, air trapping, flattened diaphragm, peribronchial cuffing
33
Q
Bronchiolitis management
A
- Mostly managed at home - fluids, nutrition and temp control
- Urgent hospital admission - apnoea, child looks seriously unwell, severe resp distress, central cyanosis, oxygen sats <92%
- Consider hosp referral - resp rate >60, inadequate fluids, clinical dehydration
- In hosp - give oxygen, fluids. Consider CPAP, upper airway suctioning
34
Q
Bronchiolitis complications
A
- hypoxia
- Dehydration
- Fatigue
- Resp failure
- Persistent cough or wheeze
- Bronchiolitis obliterans - airways permanently damaged
35
Q
Bronchiolitis prognosis
A
- Self-limiting infectious process
- Lasts 7-10 days
- Children requiring hospital cough for up to 6 weeks
36
Q
Cystic fibrosis epidemiology
A
- 1 in 25 are carriers of CF gene
- 1 in 2500 live births have CF
37
Q
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