Paediatrics - Respiratory Flashcards
Most common cause of Bronchiolitis
Respiratory Syncytial Virus (RSV)
Bronchiolitis usually affects children under what age? (+/- a year)
Under 1 year old (most common at 6 months)
Name 2 symptoms of Bronchiolitis
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
Name both investigations for Bronchiolitis
Pulse oximetry and Viral throat swab
Name 4 signs of respiratory distress
Use of accessory muscles; recessions (inter/subcostal); Nasal flaring; Head bobbing; tracheal tugging
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.) Bronchiolitis b.) High-flow humidified oxygen; Continuous positive airflow pressure (cpap); Intubation and ventilation c.) Palivizumab
Name an antibiotic used for strep. pneumoniae
Amoxicillin, Benzylpenicillin
Name an upper respiratory infection
Rhinitis; Otitis media; Pharyngitis; Tonsilitis; Laryngitis
Name 2 lower respiratory infections
Bronchitis; Croup; Epiglottis; Tracheitis; Bronchiolitis; Pneumonia
3 main causes of Pneumonia
1 - Pneumococcal (Strep P) 2 - Haemophilus Influenzae 3 - Staph Aureus / Klebsiella Pneumoniae
What is wheeze?
expiratory polyphonic noise
Name 3 conditions which cause wheeze
Asthma / viruses / preterm / / CF / CLDN chronic lung disease in newborn) / Tracheo-bronchomalacia / Ciliary dyskinesia / GORD / Chronic aspiration / Immune deficiency / Bacterial bronchitis
Acute Asthma management
Oxygen if needed > Beta agonist (inhaled salbutamol pen) > Inhaled Prednisolone 1mg/kg > IV Salbutamol/Aminophylline/LABA
What virus causes croup?
Parainfluenza
What is the most appropriate way to confirm a diagnosis of pertussis?
Nasal swab
What should you add if asthma is not being controlled by a SABA + paediatric low-dose ICS in a child aged 5-16 years
add a leukotriene receptor antagonist (montelukast)
What is the most likely virus to cause croup?
Parainfluenza virus
First line antibiotic for Strep throat?
phenoxymethylpenicillin
What are the most common symptoms of Epiglottitis?
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)
Investigations of Epiglottitis
- Fibre-optic laryngoscopy remains the ‘gold standard’
- Lateral neck X-ray (if laryngoscopy not possible)
- Throat swabs
- Blood cultures
Name a complication of Epiglottitis
Abscess formation: 25% in one series Meningitis. Sepsis. Pneumothorax. Pneumo-mediastinitis
What are the 5 criteria of the fever pain score?
Fever lasting 24h, Pus on tonsils, Attend rapidly (3 or less days), Inflamed tonsils, No cough or coryza
What antibiotic is first-line for Whooping Cough?
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.
Diagnostic criteria for Whooping Cough
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.
