Paediatrics: Respiratory and infections Flashcards
Paeds traffic light system
Colour
Paediatric traffic light system
Activity
Paediatric traffic light system
Respiratory including rate (Amber and Red)
Amber
6-12 months: >50
>12 months: > 40
Red
>60
Paediatric traffic light system
Circulation + hydration
Paediatric traffic light system
Other
Barking cough without prominent stridor and raised temperature describes what condition?
Croup
Barking cough with biphasic stridor. Week of stability then rapid deterioration
Bacterial tracheitis
Snoring stridor, non-prominent cough, raised temp and drooling.
Epiglottis
How do you manage a child with croup-like symptoms?
All
- Oral dexamethasone (0.15mg/kg)/oral prednisilone is alternative
Severe:
- Admit
- Can give IM dexamethasone or neb budenoside as alternatives to oral drugs
- Nebulised adrenaline 5ml 1:5000
What circumstances would you admit someone with croup-like symptoms?
<6 months
Severe
Uncertainty about diagnosis
What causes bacterial tracheitis?
Staph aureus
How do you distinguish croup from whooping cough?
Croup: Barking cough
Whooping cough: Inspiratory whoop after cough.
–> Also vomiting and breathless spells
What gram negative coccobacillus is responsible for whooping cough?
B. pertussis
What is the treatment for whooping cough
If 21 days since the onset
Macrolide (<1yr: Clarithromycin, >1yr: erythromycin)
Co trimoxazole if macrolide not tolerated
Other than the patient, who else should receive antibiotics for whooping cough
Premature <32wks, non-immune/partially immune infants 32 wks
Pregnant women >=32 weeks
Those in a lot of contact with infants
What urgency should whooping cough be reported?
Urgent if acute phase
Routine if later diagnosis
How do you differentiate tonsillitis and quinsy?
Both have sore throat, fever, big red tonsils
Quinsy: + Can’t open mouth
How do tonsillitis and quinsy differ in their bacterial agents?
Tonsil: S. pneumoniae (G+ve streptococcus)
Quinsy: S. aureus (G+ve cocci, coag +ve), H.influenzae (G-ve coccobacilli)
When and how do you treat a bacterial tonsillitis
When: FEVERPain >4 or CENTOR >3
How:
1. Penicillin V
2. Clarithromycin
How do you treat quinsy?
Incision and drainage by ENT
What is the most common pathogen of pneumonia in children?
S. Pneumoniae (G+ve streptococcus)
How do you treat community acquired pneumonia?
Assess severity using CRB65/CURB65
Non severe: Amox PO 5 days (Clarithromyci alternative)
Severe: Co-amox IV then PO 7 days total
Dry cough, wheeze and crackles following on from coryzal symptoms in a 3-6 month old suggests what condition paeds resp infection?
Bronchiolitis (although pretty non-specific tbf)
What is the most common cause of bronchiolitis? How is it treated
RSV
Supportive: Humidified 02 (if <92%)
NG tube if can’t feed
How to differentiate viral induced wheeze and asthma? How does their management differ?
Lack of atopic history in VIW
Management does not differ
Since they both present with recurrent chest infections, how can you clinically distinguish between cystic fibrosis and ciliary dyskinesia (Kartagener’s)?
CF: Salty sweat and GI problems (greasy stools, Hx meconium obstruction, failure to thrive)
CD: Situs inversus, recurrent sinusitis
What is the aetiology of CF? What are the chances of being born with CF?
Defect in Cl- channel due to AR mutation of CFTR gene
1/2500
How do you diagnose CF and CD?
CF: >60mmol/L on sweat test; antenatal/neonatal screening
CD: Bronchoscopy +biopsy
What is the treatment for chest infections in CF/CD?
Prophylactic
Oral flucloxacillin 3-6yrs old for staph aureus
Acute:
S. aureus: Treatment dose flucloxicillin
P. aeringuosa: ciprofloxacin, levofloxacin.
Chronic:
P. aeringuosa: Colistimethate –> aztreonam/tobramycin
What can be done to aid GI problems in CF?
High calorie diet, CREON tablets
Aside from resp and GI, what other counselling points must be given for CF?
Infertility
Reduced life expectancy (47yrs)
What are the red flags for neonatal sepsis?
Suspected sepsis in mother
Signs of Shock
Seizures
Resp distress > 4hrs after birth
Suspected sepsis in other baby if multiple
What are the risk factors for neonatal sepsis?
GBS colonisation/sepsis in previous pregnancy
Maternal sepsis, chorioamnionitis >38 degrees
<37 weeks
Premature rupture of membranes
Prolonged rupture of membrane
For neonatal sepsis when do you
Observe
Start Antibiotics
1 risk factor/feature = observe
>=2 factors/features = start abx
What Abx do you give in neonatal sepsis?
Penicillin + Aminoglycoside
eg benpen + gent
How do you provide further management in neonatal sepsis?
24hr CRP
36hrs Blood cultures
Consider stopping abx if well/results normal
What constitutes the APGAR score?
Appearance
Pulse
Grimace
Activity
Respiration
Get up to 2 points for each
APGAR appearance score
2: Pink
1: Blue extremeties
0: Blue
APGAR pulse score
2: >100
1: <100
0: Absent
APGAR Grimace score
2: Cries/sneezes/coughs
1: Grimace
0: Nothing
APGAR Activity Score
2: Active
1: Flexed arms and legs
0: Floppy
APGAR Respiratory Effort
2: Strong/Crying
1: Slow/Irregular
0: Absent
APGAR
Good
Moderate
Low
7-10
4-6
0-3
What is the most common organism for late onset (>72hrs) neonatal sepsis?
Coag negative staph eg Staph Epidermidis
Outline Neonatal resuscitation
Birth
Dry baby and APGAR
Gasping/no breath: Airway + 5 breaths
No chest movement: Repeat airway + breaths
Reassess chest + HR, repeat above if needed
If HR < 60 now: Compressions 3:1
Reassess + consider direct access drugs
Male delivered via C-section displays raised RR and intercostal recession. His mother is diabetic. What is his likely condition?
Surfactant deficient lung disease/ARDS
How do you manage ARDS?
Antenatal steroids to prevent
Oxygen
Assisted ventilation
What is seen in transient tachypnoea of the newborn and how do you manage it?
Hyperinflation of the lungs + fluid in horizontal fissure
Observation + supplementary oxygen
Which congenital infection causes:
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
Cytomegalovirus
Which congenital infection causes:
Itchy rash on head/trunk that spreads
Macular –> Papular –> Vesicular
Fever
Chickenpox
What congenital infection causes
Skin scarring
Eye defects
limb hypoplasia
Microcephaly
Learning disabilities
Fetal varciella syndrome
Mother unsure if immune to chickenpox, what do?
Check maternal blood for antibodies
If a woman is VZ antibody -ve, what is the plan if they are…
19 weeks
27 weeks
under 20 weeks: VZIG ASAP up to 10 days post-exposure
Over 20 weeks: VZIG/antivirals between 7-14 days post-exposure
How do you manage a pregnant woman who has chickenpox rash after 20 weeks?
Oral aciclovir within 24 hours exposure
What childhood infection causes
Fever
Rash behind ears then all over: maculopapular –> blotchy
White spots in mouth
Measles
Which childhood infection causes
Pink rash on face that spreads to body, stops between day 3-5
Lymph nodes behind ears and back of head
Rubella
How do you confirm and treat measles?
IgM antibodies
Supportive unless IC/pregnant
Which childhood infection causes
Sudden high fever
Subsequent truncal rash that spreads to extremeties
Affects 6-36 month olds
Roseola infantum
HHV 6
What childhood infection causes
Viral symptoms
Slapped cheek 3 days later
Itchy rash on trunk and limbs
Parovirus B19
Also called erythema infectiosum and Fifth’s disease
What infection causes strawberry tongue and tonsilitis? How do you treat it?
Scarlet fever (GAS)
Oral penicillin/aminoglycoside 10 days
What is the school exclusion for the following?
Scarlet fever
Whooping cough
Measles
Rubella
Chickenpox
Impetigo
Mumps
Scabies
Influenza
Diarrhoea & vomiting
Scarlet fever: 24 hours after abx therapy
Whooping: 2 days after abx start/21 days from onset
Measles: 4 days from rash onset
Rubella: 5 days from rash
Chickenpox: 5 days after rash onset/crusted over
Impetigo: 5 days rash onset/crusted over
Mumps: 5 days from gland onset
Scabies: Until treated
Influenza: Until recovery
Diarrhoea + Vomiting: 48 hours after recovery
Which congential infections cause sensorineural deafness?
Rubella
Cytomegalovirus
