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Phase 3a medicine > Paediatrics - Respiratory > Flashcards

Paediatrics - Respiratory Flashcards

1
Q

Most common cause of Bronchiolitis

A

Respiratory Syncytial Virus (RSV)

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2
Q

Bronchiolitis usually affects children under what age? (+/- a year)

A

Under 1 year old (most common at 6 months)

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3
Q

Name 2 symptoms of Bronchiolitis

A

Diagnose bronchiolitis if the baby or child has a coryzal prodrome lasting 1 to 3 days, followed by:

  • persistent cough and
  • either tachypnoea or chest recession (or both) and
  • either wheeze or crackles on chest auscultation (or both
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4
Q

Name both investigations for Bronchiolitis

A

Pulse oximetry and Viral throat swab

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5
Q

Name 4 signs of respiratory distress

A

Use of accessory muscles; recessions (inter/subcostal); Nasal flaring; Head bobbing; tracheal tugging

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6
Q

A 4-month-old with 3 days of coryza symptoms, cough and SOB, wheeze and crackles on auscultation(walks into a bar)… Give a diagnosis, 3 options for ventilatory support AND name a drug used to prevent this Dx in high risk babies

A

a.) Bronchiolitis b.) High-flow humidified oxygen; Continuous positive airflow pressure (cpap); Intubation and ventilation c.) Palivizumab

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7
Q

Name an antibiotic used for strep. pneumoniae

A

Amoxicillin, Benzylpenicillin

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8
Q

Name an upper respiratory infection

A

Rhinitis; Otitis media; Pharyngitis; Tonsilitis; Laryngitis

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9
Q

Name 2 lower respiratory infections

A

Bronchitis; Croup; Epiglottis; Tracheitis; Bronchiolitis; Pneumonia

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10
Q

3 main causes of Pneumonia

A

1 - Pneumococcal (Strep P) 2 - Haemophilus Influenzae 3 - Staph Aureus / Klebsiella Pneumoniae

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11
Q

What is wheeze?

A

expiratory polyphonic noise

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12
Q

Name 3 conditions which cause wheeze

A

Asthma / viruses / preterm / / CF / CLDN chronic lung disease in newborn) / Tracheo-bronchomalacia / Ciliary dyskinesia / GORD / Chronic aspiration / Immune deficiency / Bacterial bronchitis

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13
Q

Acute Asthma management

A

Oxygen if needed > Beta agonist (inhaled salbutamol pen) > Inhaled Prednisolone 1mg/kg > IV Salbutamol/Aminophylline/LABA

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14
Q

What virus causes croup?

A

Parainfluenza

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15
Q

What is the most appropriate way to confirm a diagnosis of pertussis?

A

Nasal swab

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16
Q

What should you add if asthma is not being controlled by a SABA + paediatric low-dose ICS in a child aged 5-16 years

A

add a leukotriene receptor antagonist (montelukast)

17
Q

What is the most likely virus to cause croup?

A

Parainfluenza virus

18
Q

First line antibiotic for Strep throat?

A

phenoxymethylpenicillin

19
Q

What are the most common symptoms of Epiglottitis?

A

Sore throat.
Odynophagia (painful swallowing).
Inability to swallow secretions (drooling in children).
Muffled voice - ‘hot potato’ voice.
Fever
(Other: High temperature, Tachycardia, Anterior neck tenderness over the hyoid bone, Ear pain, Cervical lymphadenopathy)

20
Q

Investigations of Epiglottitis

A
  • Fibre-optic laryngoscopy remains the ‘gold standard’
  • Lateral neck X-ray (if laryngoscopy not possible)
  • Throat swabs
  • Blood cultures
21
Q

Name a complication of Epiglottitis

A 
Abscess formation: 25% in one series
Meningitis.
Sepsis.
Pneumothorax.
Pneumo-mediastinitis
22
Q

What are the 5 criteria of the fever pain score?

A

Fever lasting 24h, Pus on tonsils, Attend rapidly (3 or less days), Inflamed tonsils, No cough or coryza

23
Q

What antibiotic is first-line for Whooping Cough?

A

Macrolide antibiotics are first-line:

  • Clarithromycin for babies aged less than 1 month.
  • Azithromycin or clarithromycin for children aged 1 month or older and for non-pregnant adults.
  • Erythromycin for pregnant women.

Co-trimoxazole is advised (off-licence) where macrolides are contra-indicated or not tolerated.

24
Q

Diagnostic criteria for Whooping Cough

A

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:

  • Paroxysmal cough.
  • Inspiratory whoop.
  • Post-tussive vomiting.
  • Undiagnosed apnoeic attacks in young infants.
25
Q

When are kids immunised against Whooping Cough?

A

infants are routinely immunised at 2, 3, 4 months and 3-5 years. Newborn infants are particularly vulnerable, which is why the vaccination campaign for pregnant women was introduced (Women who are between 16-32 weeks pregnant will be offered the vaccine)

26
Q

An oxygen saturation of what number is life threatening?

A

<92%

27
Q

A child with whooping cough should be excluded from school for how long following commencement of antibiotics?

A

48 hours

28
Q

immediate management of croup in a 9-month-old baby

A
  • CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
  • prednisolone is an alternative if dexamethasone is not available

Emergency treatment

  • high-flow oxygen
  • nebulised adrenaline
29
Q

What is first line in children suspected of Mycoplasma pneumonia?

A

Erythromycin

Otherwise, amoxicillin is first line

30
Q

Acute epiglottitis is caused by what organism?

A

Haemophilus influenzae type B

31
Q

Management for Surfactant Deficient Lung Disease?

A
  • prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
  • oxygen
  • assisted ventilation
  • exogenous surfactant given via endotracheal tube
32
Q

Emergency treatment of Croup?

A

Emergency treatment

  • high-flow oxygen
  • nebulised adrenaline

(management: single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity)

33
Q

A low-grade fever is typical in bronchiolitis, what other diagnosis should be considered in a 9-month old with a temperature over 39C?

A

Pneumonia

34
Q

What is the most common cause of stridor?

A

Larnygomalacia

35
Q

O2 Sats and Peak flow percentages in a severe asthma attack?

A

Severe or life threatening O2 sats = <92%
Severe peak flow = 33-50%
(Life threatening = <33%)

36
Q

What characteristic sign is shown on x-ray of Epiglottitis?

A

‘Thumbprint’ sign - a soft tissue shadow that looks like a thumb pressed into the trachea. This is caused by the oedematous and swollen epiglottis

Phase 3a medicine (24 decks)

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