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Fire Through Finals > Paediatrics: Respiratory and infections > Flashcards

Paediatrics: Respiratory and infections Flashcards

1
Q

Paeds traffic light system

Colour

A
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2
Q

Paediatric traffic light system

Activity

A
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3
Q

Paediatric traffic light system

Respiratory including rate (Amber and Red)

A

Amber

6-12 months: >50

>12 months: > 40

Red

>60

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4
Q

Paediatric traffic light system

Circulation + hydration

A
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5
Q

Paediatric traffic light system

Other

A
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6
Q

Barking cough without prominent stridor and raised temperature describes what condition?

A

Croup

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7
Q

Barking cough with biphasic stridor. Week of stability then rapid deterioration

A

Bacterial tracheitis

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8
Q

Snoring stridor, non-prominent cough, raised temp and drooling.

A

Epiglottis

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9
Q

How do you manage a child with croup-like symptoms?

A

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

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10
Q

What circumstances would you admit someone with croup-like symptoms?

A

<6 months
Severe
Uncertainty about diagnosis

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11
Q

What causes bacterial tracheitis?

A

Staph aureus

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12
Q

How do you distinguish croup from whooping cough?

A

Croup: Barking cough
Whooping cough: Inspiratory whoop after cough.
–> Also vomiting and breathless spells

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13
Q

What gram negative coccobacillus is responsible for whooping cough?

A

B. pertussis

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14
Q

What is the treatment for whooping cough

A

If 21 days since the onset
Macrolide (<1yr: Clarithromycin, >1yr: erythromycin)
Co trimoxazole if macrolide not tolerated

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15
Q

Other than the patient, who else should receive antibiotics for whooping cough

A

Premature <32wks, non-immune/partially immune infants 32 wks
Pregnant women >=32 weeks
Those in a lot of contact with infants

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16
Q

What urgency should whooping cough be reported?

A

Urgent if acute phase
Routine if later diagnosis

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17
Q

How do you differentiate tonsillitis and quinsy?

A

Both have sore throat, fever, big red tonsils
Quinsy: + Can’t open mouth

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18
Q

How do tonsillitis and quinsy differ in their bacterial agents?

A

Tonsil: S. pneumoniae (G+ve streptococcus)
Quinsy: S. aureus (G+ve cocci, coag +ve), H.influenzae (G-ve coccobacilli)

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19
Q

When and how do you treat a bacterial tonsillitis

A

When: FEVERPain >4 or CENTOR >3
How:
1. Penicillin V
2. Clarithromycin

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20
Q

How do you treat quinsy?

A

Incision and drainage by ENT

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21
Q

What is the most common pathogen of pneumonia in children?

A

S. Pneumoniae (G+ve streptococcus)

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22
Q

How do you treat community acquired pneumonia?

A

Assess severity using CRB65/CURB65
Non severe: Amox PO 5 days (Clarithromyci alternative)
Severe: Co-amox IV then PO 7 days total

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23
Q

Dry cough, wheeze and crackles following on from coryzal symptoms in a 3-6 month old suggests what condition paeds resp infection?

A

Bronchiolitis (although pretty non-specific tbf)

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24
Q

What is the most common cause of bronchiolitis? How is it treated

A

RSV
Supportive: Humidified 02 (if <92%)
NG tube if can’t feed

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25
Q

How to differentiate viral induced wheeze and asthma? How does their management differ?

A

Lack of atopic history in VIW
Management does not differ

26
Q

Since they both present with recurrent chest infections, how can you clinically distinguish between cystic fibrosis and ciliary dyskinesia (Kartagener’s)?

A

CF: Salty sweat and GI problems (greasy stools, Hx meconium obstruction, failure to thrive)

CD: Situs inversus, recurrent sinusitis

27
Q

What is the aetiology of CF? What are the chances of being born with CF?

A

Defect in Cl- channel due to AR mutation of CFTR gene

1/2500

28
Q

How do you diagnose CF and CD?

A

CF: >60mmol/L on sweat test; antenatal/neonatal screening

CD: Bronchoscopy +biopsy

29
Q

What is the treatment for chest infections in CF/CD?

A

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

30
Q

What can be done to aid GI problems in CF?

A

High calorie diet, CREON tablets

31
Q

Aside from resp and GI, what other counselling points must be given for CF?

A

Infertility

Reduced life expectancy (47yrs)

32
Q

What are the red flags for neonatal sepsis?

A

Suspected sepsis in mother
Signs of Shock
Seizures
Resp distress > 4hrs after birth
Suspected sepsis in other baby if multiple

33
Q

What are the risk factors for neonatal sepsis?

A

GBS colonisation/sepsis in previous pregnancy
Maternal sepsis, chorioamnionitis >38 degrees
<37 weeks
Premature rupture of membranes
Prolonged rupture of membrane

34
Q

For neonatal sepsis when do you
Observe
Start Antibiotics

A

1 risk factor/feature = observe
>=2 factors/features = start abx

35
Q

What Abx do you give in neonatal sepsis?

A

Penicillin + Aminoglycoside
eg benpen + gent

36
Q

How do you provide further management in neonatal sepsis?

A

24hr CRP
36hrs Blood cultures
Consider stopping abx if well/results normal

37
Q

What constitutes the APGAR score?

A

Appearance
Pulse
Grimace
Activity
Respiration
Get up to 2 points for each

38
Q

APGAR appearance score

A

2: Pink
1: Blue extremeties
0: Blue

39
Q

APGAR pulse score

A

2: >100
1: <100
0: Absent

40
Q

APGAR Grimace score

A

2: Cries/sneezes/coughs
1: Grimace
0: Nothing

41
Q

APGAR Activity Score

A

2: Active
1: Flexed arms and legs
0: Floppy

42
Q

APGAR Respiratory Effort

A

2: Strong/Crying
1: Slow/Irregular
0: Absent

43
Q

APGAR
Good
Moderate
Low

A

7-10
4-6
0-3

44
Q

What is the most common organism for late onset (>72hrs) neonatal sepsis?

A

Coag negative staph eg Staph Epidermidis

45
Q

Outline Neonatal resuscitation

A

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

46
Q

Male delivered via C-section displays raised RR and intercostal recession. His mother is diabetic. What is his likely condition?

A

Surfactant deficient lung disease/ARDS

47
Q

How do you manage ARDS?

A

Antenatal steroids to prevent

Oxygen

Assisted ventilation

48
Q

What is seen in transient tachypnoea of the newborn and how do you manage it?

A

Hyperinflation of the lungs + fluid in horizontal fissure

Observation + supplementary oxygen

49
Q

Which congenital infection causes:

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

A

Cytomegalovirus

51
Q

Which congenital infection causes:

Itchy rash on head/trunk that spreads

Macular –> Papular –> Vesicular

Fever

A

Chickenpox

52
Q

What congenital infection causes

Skin scarring

Eye defects

limb hypoplasia

Microcephaly

Learning disabilities

A

Fetal varciella syndrome

53
Q

Mother unsure if immune to chickenpox, what do?

A

Check maternal blood for antibodies

54
Q

If a woman is VZ antibody -ve, what is the plan if they are…

19 weeks

27 weeks

A

under 20 weeks: VZIG ASAP up to 10 days post-exposure

Over 20 weeks: VZIG/antivirals between 7-14 days post-exposure

55
Q

How do you manage a pregnant woman who has chickenpox rash after 20 weeks?

A

Oral aciclovir within 24 hours exposure

56
Q

What childhood infection causes

Fever

Rash behind ears then all over: maculopapular –> blotchy

White spots in mouth

A

Measles

57
Q

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

A

Rubella

58
Q

How do you confirm and treat measles?

A

IgM antibodies

Supportive unless IC/pregnant

59
Q

Which childhood infection causes

Sudden high fever

Subsequent truncal rash that spreads to extremeties

Affects 6-36 month olds

A

Roseola infantum

HHV 6

61
Q

What childhood infection causes

Viral symptoms

Slapped cheek 3 days later

Itchy rash on trunk and limbs

A

Parovirus B19

Also called erythema infectiosum and Fifth’s disease

63
Q

What infection causes strawberry tongue and tonsilitis? How do you treat it?

A

Scarlet fever (GAS)

Oral penicillin/aminoglycoside 10 days

64
Q

What is the school exclusion for the following?

Scarlet fever

Whooping cough

Measles

Rubella

Chickenpox

Impetigo

Mumps

Scabies

Influenza

Diarrhoea & vomiting

A

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

65
Q

Which congential infections cause sensorineural deafness?

A

Rubella

Cytomegalovirus

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