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Phase 3a > Paediatrics- Respiratory > Flashcards

Paediatrics- Respiratory Flashcards

1
Q

What % of childhood infections are caused by viruses?

A

80-90%

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2
Q

What are the important viruses in childhood infections?

A 
RSV
Rhinoviruses
Parainfluenza
Influenza
Metapneumovirus
Adenovirus
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3
Q

What are the important bacterial pathogens in childhood infections?

A 
Strep pneumoniae 
Streptococci 
Haemophilus Influenzae  
Morazella Catarrhalis
Bordatella Pertussis
Mycoplasma Pneumoniae
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4
Q

What are the host and environmental factors that increase risk of respiratory infection?

A

1) Parental smoking (esp maternal)
2) Poor socioeconomic status (large family, overcrowded, damp housing)
3) Poor nutrition
4) Underlying lung disease (bronchopulmonary dysplasia)
5) Male gender
6) Haemodynamically significant congenital heart disease
7) Immunodeficiency

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5
Q

How are respiratory infections classified?

A

According to the level of the respiratory tract most involved:

URTI
Laryngeal/tracheal infection
Bronchitis
Bronchiolitis 
Pneumonia
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6
Q

What conditions does the term ‘URTI’ include?

A

1) Common cold (coryza)
2) Sore throat (pharyngitis, tonsillitis)
3) Acute otitis media
4) Sinusitis (uncommon)

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7
Q

What more serious problems can URTIs lead to?

A

1) Difficulty feeding due to blocked nose (obstruct breathing)
2) Febrile seizures
3) Acute exacerbations of asthma

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8
Q

What are the common causative organisms of a cold?

A

Rhinovirus, Coronavirus, RSV

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9
Q

What are the common causes of pharyngitis (sore throat)?

A

Rhinovirus, enterovirus, adenovirus (group A b-haemolytic strep in older kids)

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10
Q

What are the common causes of tonsillitis?

A

Group A b-haemolytic strep

EBV (infectious mononucleosis)

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11
Q

How can you distinguish viral from bacterial cause in tonsillitis?

A

Difficult to do

In bacterial there might be headache, abdo pain, white tonsillar exudate, and cervical lymphadenopathy

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12
Q

What antibiotics are given for laryngitis/tonsillitis?

A

Penicillin V or erythromycin for 10 days

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13
Q

Why do you avoid giving amoxicillin for tonsillitis?

A

May cause a widespread maculopapular rash if the tonsillitis is due to infectious mononucleosis

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14
Q

Along with tonsillitis, what might group A strep also cause?

A

Scarlett fever (sandpaper rash with flushed cheeks and peri-oral sparing)

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15
Q

What are common causative organisms of otitis media?

A

RSV, rhinovirus

Pneumococcus, H. Influenza, and moraxella

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16
Q

How does otitis media present?

A

1) Pain in the ear and fever
2) In acute OM, the tympanic membrane is bright red and bulging with loss of normal light reflection
3) Sometimes: acute perfusion of eardrum with pus visible in the external canal

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17
Q

What is the management of otitis media?

A

1) Manage pain with paracetamol or ibuprofen until inflammation has stopped
2) Most will resolve spontaneously
3) Antibiotics (amoxicillin) can reduce duration of pain but not prevent hearing loss

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18
Q

What can happen in recurrent ear infections, and how is it managed?

A

Otitis media with effusion (can cause conductive hearing loss- impact speech development)

Grommets (ventilation tubes) inserted for one year. If this does not work, then grommets reinserted with adjuvant adenoidectomy

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19
Q

What is the most common cause of upper airways obstruction (stridor)?

A

Viral laryngotracheobronchitis (Croup)

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20
Q

What are some rarer causes of upper airways obstruction?

A 
Epiglottitis
Bacterial tracheitis 
Inhalation of smoke and hot air
Trauma to throat
Laryngeal foreign body
Measles
Diphtheria
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21
Q

What are the causative organisms of croup?

A

Parainfluenza, rhinovirus, RSV, influenza

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22
Q

At what age does croup typically present?

A

From 6 months to 6 years

Peak incidence at 2 years

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23
Q

What is croup?

A

Laryngotracheobronchitis

There is mucosal inflammation and increased secretions in the airway, but oedema of the subglottic area is the dangerous part as it can critically narrow the trachea

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24
Q

How does croup present?

A

1) Fever and coryza, followed by:
2) Hoarseness (vocal cord inflammation)
3) Barking cough (tracheal oedema and collapse)
4) Harsh stridor + breathing difficulty
5) Symptoms often worse at night

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25
Q

How is croup managed?

A

1) If obstruction mild, manage at home but observe closely for signs of increasing severity
2) Inhalation of warm moist air
3) First-line therapy: oral dexamethasone, oral prednisolone, and nebulised steroids (budesonide) reduce the severity and duration of croup.
4) Severe obstruction: nebulised epinephrine with oxygen

26
Q

In a child with expected upper airways obstruction, what must you never do?

A

Examine the throat (might completely obstruct)

27
Q

What is bacterial tracheitis?

A

Pseudomembranous Croup

Similar to severe viral croup except the child has high fever, appears toxic, and has rapidly progressive airways obstruction with copious thick airway secretions.

Caused by Staph. Aureus

Treated with IV antibiotics, intubation, and ventilation

28
Q

What is acute epiglottitis?

A

Intense swelling of the epiglottis and surrounding tissues associated with septicaemia. High risk of respiratory obstruction

29
Q

What is the causative organism of acute epiglottitis?

A

H. Influenzae type B (HiB)

HiB vaccine has reduced incidence by 99%

30
Q

At what age does acute epiglottitis occur?

A

1-6 years old (but can affect any age)

31
Q

What is the presentation of acute epiglottitis?

A

1) Very acute
2) Intensely painful throat that prevents the child from speaking or swallowing. Saliva drools down chin.
3) Soft inspiratory stridor + increasingly difficult breathing over hours
4) Child sits immobile, upright with an open mouth to optimise the airway
5) Cough is minimal or absent

32
Q

How is acute epiglottitis investigated?

A

1) Do not lie child down or examine throat with spatula, or perform a lateral x-ray (all cause total airway obstruction
2) Otherwise clinical

33
Q

How is acute epiglottitis managed?

A

1) Intubate under general anaesthetic in case resp obstruction occurs (urgent tracheostomy if this can’t be done)
2) Once airway secure: blood cultures, IV antibiotics (cefuroxime)
3) Remove tube after 24 hours and antibiotics given for 3-5 days.
4) Due to H.Influenza infection, give rifampicin to family members (prophylaxis)

34
Q

What are the differences between croup and acute epiglottitis? Acute epiglottitis is in brackets

A

1) Croup: onset over days (over hours)
2) Croup: has preceding coryza
3) Croup: cough is severe + barking (absent or slight)
4) Croup: able to drink
5) Croup: looks unwell (toxic, very ill)
6) Croup: fever <38.5 (>38.5)
7) Croup: harsh, rasping stridor (soft, whispering)
8) Croup: hoarse voice/cry (muffled, reluctant to speak)

35
Q

Who is at a higher risk of developing severe bronchiolitis?

A

1) Premature infants who develop bronchopulmonary dysplasia
2) Children with underlying chronic disease (CF)
3) Children with congenital heart disease

36
Q

What are the causes of bronchiolitis?

A

RSV (80% of cases)

Enteroviruses, parainfluenza, rhinovirus, adenovirus, influenza, metapneumovirus

37
Q

What is the clinical presentation of bronchiolitis?

A

1) Coryzal symptoms precede a dry cough and increasing breathlessness
2) Feeding difficulty with increasing dyspnoea
3) Characteristic findings: dry wheezy cough, tachycardia, tachypnoea, subcostal and intercostal chest recession, hyperinflation of the chest, fine end-inspiratory crackles, high-pitched wheezes, cyanosis or pallor

38
Q

How is bronchiolitis investigated?

A

1) Pulse oximetry

2) CXR + ABG if respiratory failure suspected

39
Q

Bronchiolitis: when do you admit to hospital?

A

Apnoea, persistent sats of <90% on air, inadequate oral fluid intake, severe respiratory distress

40
Q

How is bronchiolitis managed?

A

Supportive

1) Oxygen
2) Fluids by NG/IV if necessary
3) CPAP if needed

41
Q

What can be given to high risk preterm infants in bronchiolitis?

A

Monoclonal antibody to RSV (palivizumab)

It reduces the number of hospital admissions

42
Q

What causes whooping cough?

A

Bordatella Pertussis

43
Q

What is the clinical presentation of whooping cough?

A

1) Starts with a week of coryzal symptoms
2) Then progresses to characteristic paroxysmal or spasmodic cough followed by a characteristic inspiratory whoop

Cough spasms often worse at night and may end in vomiting. During a paroxysmal event, the child goes red or blue in the face, and mucus flows from nose/mouth

Symptoms gradually regress, but may be present for months

44
Q

How is whooping cough investigated?

A

1) Peri-nasal swab culture or PCR

2) Characteristic marked lymphocytosis on blood count

45
Q

How is whooping cough managed?

A

1) Macrolide antibiotics (only decrease symptoms if started during the catarrhal phase)
2) Vaccination (macrolide prophylaxis)
3) Revaccination of mother during pregnancy will reduce risk of infant getting it in early life)

46
Q

What are the common causative organisms of pneumonia at different age groups?

A

Newborn: Group B strep, gram negative enterococci and bacilli

Infants/Young children: RSV, S.pneumonia, H.Influenza, Bordatella pertussis, Chlamydia Trachomatis, S.Aureus

Children over 5: Mycoplasma pneumoniae, S. Pneumoniae, Chlamydia Pneumoniae

47
Q

What are the common symptoms of pneumonia?

A

Fever, cough, rapid breathing

Usually preceded by a URTI

Other symptoms: lethargy, poor feeding

48
Q

What are the common signs of pneumonia?

A

Nasal flaring, chest indrawing, tachypnoea, raised resp rate, end-inspiratory coarse crackles

49
Q

How is pneumonia investigated?

A

Sats may be decreased

CXR confirms diagnosis.

Nasopharyngeal aspirate may identify viral cause (younger children)

50
Q

How is pneumonia managed?

A

Admit if sats <92%, recurrent apnoea, grunting, and/pr an inability to maintain feeds

General supportive care (fluids, analgesia, oxygen)

Antibiotics:
 Newborns require broad-spectrum IV antibiotics.
 Older infants- oral amoxicillin. Co-amoxiclav for more severe cases.
 Over 5- amoxicillin or macrolide like erythromycin.

51
Q

What can cause a recurrent or persistent cough?

A

1) Recurrent resp infections (most common)
2) Post-specific resp infections (pertussis, RSV, mycoplasma)
3) Asthma
4) Suppurative lung diseases (e.g CF, ciliary dyskinesia, immune deficiency)
5) Recurrent aspiration (reflux)
6) Persistent endobronchial infection
7) Inhaled foreign body
8) Cigarette smoking
9) TB
10) Habit cough
11) Airway anomalies

52
Q

What are the three patterns of wheezing?

A

1) Viral episodic wheezing
2) Multiple trigger wheeze (more likely to develop into asthma over time)
3) Asthma

53
Q

What is viral episodic wheezing?

A

A result of small airways being more likely to narrow and obstruct because of inflammation and immune responses to viral infection

54
Q

What are the risk factors of viral episodic wheezing?

A

Maternal smoking during/after pregnancy

Prematurity

(small airways diameter)

55
Q

What are the key features that increase probability of symptoms being asthma?

A

1) Symptoms worse at night and in the early morning
2) Symptoms that have non-viral triggers (dust, cold air, exercise, pets)
3) Interval symptoms (symptoms between acute exacerbations)
4) Personal or family history of an atopic disease
5) Positive response to asthma therapy (improves after bronchodilator use)

56
Q

When should asthma be suspected in a child?

A

When they have more than one episode of wheezing, particularly with interval symptoms

57
Q

What is seen on examination of asthma between acute attacks?

A

Hyperinflation of the chest

Generalised polyphonic expiratory wheeze with a prolonged expiratory phase

Harrison’s sulci (if onset in early childhood)

58
Q

How is asthma investigated in children?

A

1) In young children, mainly history + exam alone (as may struggle to do investigations)
2) Skin prick for common allergens
3) CXR (only to exclude other causes)
4) If uncertain/need to measure severity (children over 5 can use them): peak flow or spirometry

59
Q

What conditions can cause a wheeze in children?

A

1) Bronchiolitis
2) Pneumonia
3) Transient early wheezing
4) Non-atopic wheeze (viral LRTI)
5) Atopic asthma
6) Cardiac failure
7) Inhaled foreign body/aspiration of foods
8) Cystic fibrosis

60
Q

What is the general pathway regarding the pathophysiology of asthma?

A

1) Genetic predisposition + Atopy + Environmental triggers (some combination of these)
2) Bronchial inflammation (excessive mucus production + cell infiltration)
3) Bronchial hyperresponsiveness
4) Airway narrowing
5) Symptoms (wheeze, cough, breathlessness, chest tightness)

61
Q

What are the general steps in asthma management?

A

1) SABA (salbutamol/terbutaline)
2) Add ICS (beclometasone) /LTRA (if under 5- montelukast)
3) Add LTRA under 5, over 5 add LABA (Salmeterol)
4) Increase ICS dose (5-12 years), or add LRTA/Theophylline if not already
5) Long-term oral steroids

62
Q

When on steroids for asthma, what must be monitored?

A

Weight and height

Phase 3a (7 decks)

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