Paediatrics - Breathlessness in children

Question 1

signs of respiratory distress. increased work of breathing in a baby?

Answer 1

• nasal flaring
• head bobbing
• subcostal recession
• intercostal recession
• sternal recession

Question 2

signs of respiratory distress in older children?

Answer 2

• nasal flaring
• tracheal tug rather than head bobbing
• subcostal, intercostal and sternal recessions still seen
• tripod

Question 3

why does RSV affect adults and toddlers differently?

Answer 3

• RSV = severe cold in adults

- RSV in <2y/o –> bronchiolitis

Question 4

how much milk is recommended for non-weaned babies?

Answer 4

150ml/kg/day

Question 5

for bronchiolitis, what would be key factors determining need for admission?

Answer 5

a) oxygen <92%
b) feeding < 100ml/kg/day
c) significantly reduced wet nappies

Question 6

4 y/o
pc: fever of 37.9, 1 day hx coryza, intermittent erythematous blanching rash, increased RR, pulse, subcostal recession and nasal flaring.

can only say one or two words at a time.

auscultation: slight bilateral crepitations and no wheeze

likely diagnosis?

Answer 6

viral induced wheeze

- inflammation of the airways results in narrowing

Question 7

main differential diagnoses for child presenting with paroxysmal cough?

Answer 7

• bronchiolitis (viral respiratory infection)
• mycoplasma pneumonia
• bacterial pneumonia
• asthma
• tb

Question 8

management of whooping cough ?

Answer 8

if duration of cough is less than 21 days then macrolide antibiotic should be given

• clarithromycin for those under 1,

despite antibiotic treatment cough may last for 3 month

Question 9

8 y/o attends with wheezy episode, he is given 3 combined nebulisers, still remains tachypnoeic and has increased work of breathing.

what other medication should be given?

Answer 9

a) magnesium sulphate - smooth muscle relaxant, avoid if hypotensive
b) aminophylline - cardiac monitoring
c) IV salbutamol - cardiac monitoring
d) anaesthetics

Question 10

bronchiolitis most commonly caused by:

Answer 10

respiratory syncytial virus

Question 11

what does bronchiolitis lead to?

Answer 11

• virus causes inflammation of nasopharngeal epithelium and lower airways
• leads to increased mucus production, desquamation, mucosal swelling
• narrowing of airways, bronchiolar obstruction
• leads to pulmonary inflammation and atelectasis
• leads to respiratory ditress, difficulty feeding, bilateral crackles and wheeze

Question 12

treatment of bronchiolitis?

Answer 12

Supportive
- ensure adequate oxygenation

• adequate hydration
• NG for feeding

Question 13

give a name of a monoclonal antibody licensed for preventing serious lower reps tract disease caused by RSV in children at high risk of the disease?

Answer 13

Pavilizumab

Question 14

why is wheeze expiratory in older children?

Answer 14

• inflammation results in narrowing of airway
• worse on expiration
• due to intrathoracic pressure and lack of cartilage
• airways collapse on expiration
• give salbutamol (beta 2 agonist) to relax smooth muscle of airways

Question 15

why will salbutamol make no effect in younger children?

Answer 15

• lack beta 2 receptors

- giving baby salbutamol which just make them t.cardiac without improving breathing