Paediatrics Flashcards
What is the other name for croup?
Laryngotracheobronchitis
In what population is croup common in
6m-3.y.o., more common in males
Give the four main symptoms of croup
Hoarse voice, barking cough, inspiratory stridor, increased RR
Describe four signs of croup
Intercostal recession, tracheal tug, chest wall recession, hypoxia, tachycardia
How do we treat croup?
Dexamethasone, nebulised adrenaline if moderate/severe
Give four differentials of croup
Anaphylaxis, epiglottitis, bacterial tracheitis, inhaled foreign body, congenital abnormality
What causes bronchiolitis?
Respiratory syncytial virus (RSV), usually
Describe the signs of bronchiolitis
Tracheal tug, increased RR, inspiratory crepitations, wheeze, abdominal breathing, intercostal recession, apnoea, grunting, cyanosis
Give risk factors for bronchiolitis
<6wks, premature, lower weight for gestation, immunodeficiency, congenital heart disease, neurological conditions
Give differentials for bronchiolitis
Acute asthma, viral induced wheeze, pneumonia, CHF, pertussis
What bacteria most commonly causes epiglottitis?
Haemophilus influenza type B
How can you distinguish between epiglottitis and croup?
Epiglottitis can present in a similar way to croup, but with a more rapid onset.
Describe the characteristic epiglottitis pt
Unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling
What is the tripod position?
Sat forward with a hand on each knee
Describe the investigations and findings for epiglottitis
Performing a lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”. This is a soft tissue shadow that looks like a thumb pressed into the trachea.
A five year old comes in acutely unwell. You suspect epiglottitis. What Ix are you going to perform.
None. If the patient is acutely unwell and epiglottitis is suspected then investigations should not be performed (risk of stress causing airway closure).
How is epiglottitis managed?
Don’t distress the pt. The most important thing is to alert the most senior paediatrician and anaesthetist available. They will secure the airway, and potentially give steroids and abx
Give a common complication of epiglottitis.
Epiglottic abscess.
Give a common cause of croup
Parainfluenza virus, RSV
What dose of dexamethasone do we give to croup pts?
Usually a single dose of 150 mcg/kg, which can be repeated if required after 12 hours. Prednisolone is sometimes used as an alternative where dexamethasone in not available (e.g. by GPs).
What are coryzal symptoms?
These are the typical symptoms of a viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.
Give nine signs of respiratory distress.
Raised RR, use of accessory muscles, intercostal recessions, subcostal recessions, nasal flaring, head bobbing, tracheal tugging, cyanosis, abnormal airway noises
What is wheezing?
A whistling sound caused by narrowed airways, typically heard during expiration
What causes grunting?
Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
What is stridor?
Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
What is palivizumab?
A monoclonal antibody that targets the respiratory syncytial virus. A monthly injection is given as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ex-premature and those with congenital heart disease. Passive protection.
What causes cystic fibrosis?
It is caused by a genetic mutation of the cystic fibrosis transmembrane conductance regulatory gene on chromosome 7.
What are the main consequences of CF?
Thick pancreatic and biliary secretions, low volume thick airway secretions, congenital bilateral absence of the vas deferens
Some cystic fibrosis pts suffer from thick pancreatic and biliary secretions. Why is this an issue?
It can cause blockage of the ducts, resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract
Some cystic fibrosis pts suffer from low volume thick airway secretions. Why is this an issue?
It can reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections
Explain why male cystic fibrosis sufferers may be infertile.
Patients generally have healthy sperm, but the sperm have no way of getting from the testes to the ejaculate due to lack the of the vas deferens, resulting in male infertility
Two parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?
The child doesn’t have the condition, so the answer is two in three
How do we screen for CF?
Newborn bloodspot test
What is meconium ileus?
Often the first sign of cystic fibrosis. The first stool that a baby passes is called meconium. This is usually black and should be passed within 24 hours of birth. In about 20% of babies with CF, the meconium is thick and sticky, causing it to get stuck and obstruct the bowel. This is called meconium ileus, and is practically pathognomonic for cystic fibrosis. This presents as not passing meconium within 24 hours, abdominal distention and vomiting.
If a pt isn’t diagnosed with CF as a baby, how may it present?
FTT, recurrent resp tract infections, pancreatitis
Give symptoms of CF
Chronic cough, thick sputum production, recurrent resp tract infections, steatorrhoea, abdo pain and bloating, salty sweat, FTT
Give signs of CF
Low weight/height on growth charts, nasal polyps, finger clubbing, crackles and wheezes on auscultation, abdominal distension
How do we diagnose CF?
Sweat test is the gold standard. Genetic testing for CFTR gene can be performed during pregnancy by amniocentesis or chorionic villous sampling, or as a blood test after birth.
What is the diagnostic chloride concentration in sweat for CF?
The diagnostic chloride concentration for cystic fibrosis is more than 60mmol/l.
Describe two key colonisers of the respiratory tract for pts with CF.
The key colonisers to remember for your exams are staph aureus and pseudomonas.
Patients with cystic fibrosis take long term prophylactic flucloxacillin to prevent staph aureus infection. Pseudomonas should be remembered as a particularly troublesome coloniser that is hard to treat and worsens the prognosis of patients with cystic fibrosis.
What is otitis media?
An infection in the middle ear. The middle ear is the space that sits between the tympanic membrane (ear drum) and the inner ear.
How does otitis media occur?
The bacteria enter from the back of the throat through the eustachian tube. Bacterial infection of the inner ear is often preceded by a viral upper respiratory tract infection.
How do we treat otitis media?
Try to avoid antibiotic use, it usually resolves on its own. Prescribe simple analgesia. If abx used, use amoxicillin first line or alternatives are erythromycin/clarithromycin.
A young pt comes to see you with otitis media. Their parent is very worried about them, and wants you to prescribe abx. It is not clinically indicated to do so, as the child rates the pain a 4/10. What will you do?
Inform them that complications (usually mastoiditis) are rare. Consider giving a delayed prescription for three days time if symptoms do not improve. Advise them to get in touch if the symptoms worsen.
Give complications of otitis media.
Otitis media with effusion Hearing loss (usually temporary) Perforated eardrum Recurrent infection Mastoiditis (rare) Abscess (rare)
