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Phase 3a conditions list flashcards > Paediatrics - respiratory + ENT > Flashcards

Paediatrics - respiratory + ENT Flashcards

1
Q

What respiratory conditions are important in children (9)?

A
  • Pneumonia
  • Croup
  • Asthma
  • Virally induced wheeze
  • Bronchiolitis
  • Cystic fibrosis
  • Acute epiglottitis
  • Whooping cough
  • Laryngomalacia
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2
Q

What age is a neonate?

A

A child under 28 days

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3
Q

What is an infant?

A

A child under 1 year

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4
Q

What is pneumonia?

A

Lower respiratory tract and lung parenchyma infection which leads to consolidation on X-ray

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5
Q

What are the signs/ symptoms of a child with pneumonia (6)?

A
  • Productive cough
  • Fever > 38.5
  • Lymphadenopathy
  • Tachycardia
  • Pain
  • Increased work of breathing
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6
Q

What are 3 chest signs of pneumonia?

A
  • Bronchial breath signs
  • Focal corse crackles
  • Dullness to percussion
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7
Q

What are 6 common bacterial causes of pneumonia?

A
  • S. pneumoniae = MC
  • Group A strep (strep pyogenes)
  • Group B strep (strep agalactiae)
  • Staph aureus
  • H. influenziae
  • Mycoplasma pneumoniae (atypical bacteria)
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8
Q

Which bacteria is most common in neonates to cause pneumonia?

A

Group B strep (can live in women’s genital tract)

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9
Q

What sign is indicative of staph aureus pneumonia on x ray?

A

Pneumatoceles - air filled cysts

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10
Q

What extrapulmonary sign may be seen in those with M. pneumoniae infection?

A

Erythema multiforme

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11
Q

What are the common viral causes of pneumonia (3)?

A
  • Respiratory syncytial virus (RSV) = MC
  • Parainfluenza virus
  • Influenza virus
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12
Q

What age and what time of year are viral pneumonia most common?

A

Young infants during winter

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13
Q

How is pneumonia in children investigated (3)?

A
  • Bloods
  • CXR
  • Sputum culture/ viral PCR
    In more severe cases blood cultures
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14
Q

How is pneumonia managed in children (3)?

A
  • Antibiotics (IV if absorption problem/ severe)
  • IV fluids
  • Oxygen (sats < 92%)
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15
Q

What antibiotics are typically used for pneumonia (2)?

A
  • Amoxicillin
  • Atypical = macrolide (azithro/erythro/clarithromycin)
    …however follow local guidelines
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16
Q

What are 2 complications of pneumonia?

A
  • Empyema
  • SEPSIS
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17
Q

What are 6 important conditions to rule out for children with recurrent LRTI ?

A
  • Cystic fibrosis
  • Reflux/ aspiration
  • Neurologic disease
  • Asthma
  • Immune deficiency
  • Primary ciliary dyskinesia (auto recessive)
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18
Q

What is croup?

A

Acute laryngotracheobronchitis - infection + oedema in the larynx

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19
Q

What age is typically affected by croup?

A

6 months to 3 years

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20
Q

What are four risk factors for croup other than age?

A
  • Preterm
  • Male
  • Underlying respiratory disease
  • Siblings at school
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21
Q

What are the common causes of croup (1 most common 3 others)?

A
  • Parainfluenza virus = MC
  • Adenovirus
  • RSV
  • Influenza virus
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22
Q

What organism used to commonly cause croup but has decreased in prevalence due to vaccination?

A

Diphtheria - causes inflammation of the mucous membranes

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23
Q

What is the presentation of those with croup (5)?

A
  • Barking cough occurring in clusters
  • Hoarse voice
  • Stridor
  • Increased work of breathing
  • Low fever
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24
Q

What criteria are used to assess the serverity of croup and what are some of the criteria (3)?

A

Westley score:
* Extent of stridor
* Difficulty of breathing
* Distressed child

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25
Q

How is croup investigated?

A

Mainly clinical, can do:
* FBC, U&E, CRP
* CXR (AP)

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26
Q

What sign is present on x-ray of those with croup?

A

Steeple sign

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27
Q

How can most cases of croup be managed (2)?

A
  • Single dose oral 0.15 mg/kg dexamethasone
  • Supportive management at home
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28
Q

How can more severe croup be managed?

A

Admit to hospital

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29
Q

What dose of dexamethasone should be used to treat croup?

A

0.15 mg/kg

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30
Q

What steps should be taken to treat very severe/ life threatening croup (5)?

A
  • Oral dexamethasone
  • Oxygen
  • Nebulised budesonide
  • Nebulised adrenaline
  • Intubation/ ventilation
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31
Q

What is important for children with croup to do?

A

Stay off school, wash hands, prevent spread

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32
Q

What are 2 complications of croup?

A
  • Otitis media
  • Dehydration due to reduced intake
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33
Q

What are causes of wheezing in children (3)?

A
  • Asthma
  • Virally induced wheeze
  • Persistent infantile wheeze
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34
Q

What is a bad sign of wheeze that may be heard on the chest (2)?

A
  • Focal wheeze = may be a focal airway obstruction - e.g. foreign object
  • Fixed inspiratory/ expiratory wheeze
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35
Q

What may be a cause of persistent infantile wheeze?

A

Smoking in the house

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36
Q

What causes a viral induced wheeze?

A

Swelling of the airways in response to a upper respiratory tract viral infection

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37
Q

What age is usually affected by virally induced wheeze?

A

Under 3s - they have smaller airways so any swelling of the airways significantly reduces flow of air

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38
Q

What would suggest a virally induced wheeze as opposed to asthma?

A
  • < 3 years old (resolve by 5 years)
  • No atopic history
  • Preceding viral infection
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39
Q

What is the presentation of a child with virally induced wheeze (3)?

A
  • Expiratory wheeze throughout chest
  • Viral infection for 1-2 days
  • SOB
  • Resp distress
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40
Q

How is virally induced wheeze managed (3)?

A
  1. SABA
  2. ICS (trial for 8 weeks)
  3. Consider LTRA
    refer
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41
Q

What is the most common chronic condition in children?

A

Asthma

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42
Q

What is asthma?

A

Reversible chronic inflammation of the airways leading to variable airway obstruction

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43
Q

What are some risk factors for the development of asthma (5)?

A
  • Low birth weight/ prematurity
  • Fam history
  • Smoking in the house
  • Viral bronchiolitis
  • Atopic conditions
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44
Q

What is the typical presentation of a child with asthma?

A
  • Dry cough
  • Bilateral wheeze
  • SOB
  • Episodic symptoms
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45
Q

What time of day is asthma worse?

A

At night + early morning

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46
Q

What conditions are associated with each other and make up the atopic triad?

A
  • Allergic rhinitis
  • Asthma
  • Atopic dermatitis
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47
Q

What are triggers for asthma (7)?

A
  • Pets
  • Cold air
  • Exercise
  • Smoke
  • Food allergens e.g. shellfish, eggs
  • Dust e.g. house dust mites
  • Mould
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48
Q

What age does asthma typically present in children?

A

After age 2-3

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49
Q

How is asthma diagnosed in under 5s?

A

Clinical diagnosis

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50
Q

How is asthma diagnosed in those over 5 (3)?

A
  • Spirometry with bronchodilator reversibility (required)
  • Peak flow diary
  • FeNO test if doubt
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51
Q

How are FEV1 and FVC affected in asthma?

A

FEV1 reduced, FVC usually normal
FEV1:FVC < 70% if poorly controlled

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52
Q

How much should FEV1 improve after a bronchodilator if a child has asthma?

A

More than 12%

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53
Q

What FeNO result would suggest asthma?

A

> 35 PPB is considered positive

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54
Q

What are the steps in the treatment of asthma in those over 5 years (7)?

A
  1. SABA
  2. ICS preventer
  3. LTRA
  4. Stop LTRA if hasn’t helped, add LABA
  5. Switch ICS and LABA to MART
  6. High dose ICS
  7. Refer - they may give muscarinic receptor antagonist/ theophylline
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55
Q

What is a MART inhaler?

A

Maintenance and reliever therapy - containing ICS and fast acting LABA

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56
Q

What is an example of a fast acting LABA?

A

Formoterol

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57
Q

What are the steps in the treatment of asthma in those under 5 years (4)?

A
  1. SABA
  2. Low dose ICS 8 week trial if symptoms reoccur within 4 weeks, restart ICS
  3. LTRA
  4. Refer
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58
Q

How often should a spacer be cleaned?

A

Once a month with warm soapy water, do not scrub, air dry

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59
Q

What are the criteria for a mild/ moderate asthma attack (2)?

A
  • PEFR > 50% predicted
  • Normal speech
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60
Q

What are the criteria for a severe asthma attack (5)?

A
  • 33 < PEFR < 50%
  • Sats < 92%
  • Resp rate > 30 (over 5’s)/ >40 (under 5’s)
  • Can’t talk/ feed
  • HR > 125 or 140 (over/ under 5’s)
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61
Q

What are the criteria of a life threatening asthma attack (5)?

A
  • PEFR < 33%
  • Sats < 92%
  • Altered conciseness/ confusion
  • Cyanosis
  • Silent chest (not enough air flow to make a wheeze sound)
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62
Q

How is a moderate - life threatening asthma attack treated (6)?

A
  • O2
  • Nebulised salbutamol
  • Ipratropium bromide (nebulised)
  • Oral prednisolone / IV hydrocortisone
  • IV MgSO4/ aminophylline/ salbutamol
  • Escalate - intubate + intensive care
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63
Q

How long should oral steroids be given for after an asthma exacerbation?

A

At least 3 days

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64
Q

What is important to monitor during an asthma attack if IV salbutamol is given?

A

Potassium levels as can cause hypokalaemia

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65
Q

How long should a child be off oxygen for before being discharged after an asthma attack?

A

12-24 hours

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66
Q

What is bronchiolitis?

A

Viral inflammation/ infection of the bronchioles (small airways)

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67
Q

What is the most common cause of bronchiolitis?

A

Respiratory syncytial virus (RSV)

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68
Q

What age are affected by bronchiolitis?

A

Under 2 years, most commonly under 6 months

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69
Q

What time of year is bronchiolitis most common?

A

Winter

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70
Q

Why are adults not affected by bronchiolitis?

A

They have much wider airways so are not affected as much by build up of mucous and inflammation

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71
Q

What are some risk factors for bronchiolitis (6)?

A
  • Breastfed < 2 months
  • Smoke exposure
  • Older siblings attending school
  • Chronic lung disease of prematurity
  • CHD
  • Immunodeficient
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72
Q

What is the presentation of a child with bronchiolitis (6)?

A
  • Coryzal symptoms (typical of viral URTI)
  • Signs of respiratory distress
  • Dyspnoea/ tachypnoea
  • Apnoea
  • Mild fever < 39
  • Wheeze/ crackles on auscultation
73
Q

What are coryzal symptoms (4)?

A
  • Snotty nose
  • Sneezing
  • Mucous in throat
  • Watery eyes
74
Q

What are the signs of respiratory distress (8)?

A
  • Tachypnoea
  • Accessory muscle use
  • Intercostal + subcostal recession
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging
  • Cyanosis
  • Abnormal airway noises
75
Q

What are three abnormal airway noises?

A
  • Wheezing
  • Grunting
  • Stridor
76
Q

What is a wheeze?

A

Whistling sound causes by narrow airways usually during expiration

77
Q

What is grunting noise?

A

Exhaling with the glottis partially closed to increase end respiratory pressure

78
Q

What is stridor?

A

High pitched inspiratory noise caused by obstruction of upper airway

79
Q

What is the corse of infection of RSV causing bronchiolitis?

A

9 days of symptoms, worst around d 5

80
Q

What investigations may be done in those with bronchiolitis (3)?

A
  • Nasopharyngeal aspirate for RSV culture
  • Bloods or CXR if more unwell
81
Q

What would indicate a need for admission in children with bronchiolitis (7)?

A
  • < 3 months
  • Another condition e.g. prematurity, CF, downs
  • Significantly reduced feeding
  • Clinically dehydrated
  • RR > 70
  • Sats < 92%
  • Apnoeas
82
Q

How is bronchiolitis managed (4)?

A
  • O2
  • Fluids
  • CPAP
  • Secretion suctioning
    no evidence for bronchodilation, steroids or Abx
83
Q

What medication can be used to directly treat bronchiolitis?

A

Ribavirin (antiviral)

84
Q

What investigation can be helpful in severe respiratory distress?

A

Capillary blood gas

85
Q

What would a capillary blood gas show if there is poor ventilation (2)?

A
  • Rising pCO2 - airways can’t clear CO2
  • Falling pH - due to high CO2
    type 2 resp failure
86
Q

What ‘vaccine’ can be used to prevent bronchiolitis in those at higher risk due to, for example prematurity or immunodeficiency?

A

Palvizumab
not a true vaccine as it is just a monoclonal antibody against RSV

87
Q

What is a complication of those with bronchiolitis?

A

Bronchiolitis obliterans

88
Q

What organism most commonly causes bronchiolitis obliterans?

A

Adenovirus

89
Q

What is cystic fibrosis?

A

Autosomal recessive genetic condition affecting mucous glands

90
Q

What gene and chromosome are affected by cystic fibrosis?

A

CFTR (cystic fibrosis transmembrane conductance regulator gene) on chromosome 7

91
Q

What cellular channel is particularly affected in CF?

A

Chloride channels

92
Q

What are the three main areas affected/ consequences in the body of those with CF?

A
  • Thick pancreatic and biliary secretions resulting in blockage of the ducts
  • Low volume thick airway secretions
  • Bilateral absence of vas deferens = infertility
93
Q

What are the signs/ symptoms of CF (6)?

A
  • Chronic cough
  • Thick sputum
  • Loose greasy stools
  • Low weight/ height
  • Finger clubbing
  • Crackles/ wheeze
94
Q

What may children with CF present with during early childhood (3)?

A
  • Failure to thrive
  • Meconium ileus
  • Recurrent LRTI
95
Q

What are the signs/ symptoms of meconium ileus?

A
  • Not passing meconium within 24 hours
  • Abdo distension
  • Vomiting
96
Q

What are causes of clubbing in children (7)?

A
  • Hereditary clubbing
  • Cyanotic heart disease
  • Infective endocarditis
  • CF
  • TB
  • IBD
  • Liver cirrhosis
97
Q

How is CF diagnosed (3)?

A
  • At birth with the newborn bloodspot test
  • Sweat test = gold standard
  • Genetic testing (before birth - amniocentesis/ chorionic villous sampling)
98
Q

What organisms commonly infect those with CF?

A
  • Staph aureus
  • H. influenziae
  • Pseudomonas aeruginosa
99
Q

What antibiotic is used to treat p. aeruginosa (2)?

A
  • Nebulised tobramycin
  • Oral ciprofloxacin
100
Q

What antibiotic is sometimes taken long term by those with CF to prevent staph aureus infection?

A

Flucloxacillin

101
Q

How is CF managed (7)?

A
  • Physio
  • Pancreatic enzyme replacement (CREON tablets for lipase)
  • Vaccinations
  • Bronchodilators
  • Mucolytics
  • High calorie, high fat diet
  • Fertility treatments
102
Q

What are some examples of mucoactive agents used for CF (3)?

A
  • DNase
  • Lumacaftor
  • Hypertonic saline
103
Q

What other more extreme way can CF be treated?

A

Transplants - liver and lungs

104
Q

What conditions are those with CF at risk of developing (6)?

A
  • Liver failure
  • Diabetes
  • Pancreatic insufficiency
  • Vitamin D deficiency
  • Osteoporosis
  • Bowel Ca
105
Q

What is the most common cause of epiglottitis?

A

H. influenzae type B

106
Q

What has helped decrease the prevalence of epiglottitis?

A

Vaccination programme

107
Q

What are the signs/ symptoms of epiglottitis (7)?

A
  • Sore throat
  • Stridor
  • Drooling
  • Tripod position - sat forward, hands on knees
  • Tongue out
  • Difficulty swallowing
  • Fever
108
Q

How is epiglottitis diagnosed (2)?

A
  • Lateral X-ray = thumb sign
  • Experiences anaesthetist visualise epilottitis (diagnostic)
    DO NOT EXAMINE AIRWAY OTHERWISE
109
Q

How is epiglottitis treated (3)?

A
  • Secure airway - intubation/ cricothyroidostomy
  • IV Abx (e.g. ceftriaxone)
  • Nebulised adrenaline
110
Q

What is a complication of epiglottitis?

A

Epiglottic abscess

111
Q

What is whooping cough and what causes it?

A

Upper respiratory tract infection caused by bordetella pertussis

112
Q

What does the characteristic whooping cough sound like?

A

Loud inspiratory whoop

113
Q

How is whooping cough diagnosed (2)?

A
  • Nasal swab + PCR/ culture
  • If > 2 weeks test for anti-pertussis toxin immunoglobulin G in oral fluid/ blood
114
Q

How is whooping cough treated?

A

Macrolides < 21 days of cough onset
azithromycin; erythromycin (pregnant); clarithromycin (under 1 month)

115
Q

What is important to do if a patient tests positive for bordetella pertussis?

A

Inform public health England as it is a notifiable disease

116
Q

What is a complication of whooping cough?

A

Bronchiectasis

117
Q

What is primary ciliary dyskinesia (kartagners syndrome)?

A

Autosomal recessive condition affecting motile cilia around the body

118
Q

What is included in kartagners triad (presentation of those with PCD)?

A
  • Situs inversus - organs on opposite side of body
  • Bronchiectasis
  • Paranasal sinusitis
119
Q

How is PCD diagnosed?

A

Sample of ciliated epithelium of the upper airway is analysed

120
Q

How does PCD present?

A

Similar to CF due to mucous/ excretions not being expelled effectively

121
Q

How is PCD managed?

A

Similar to CF

122
Q

What is laryngomalacia?

A

The larynx is structured in such a way it causes a partial upper airway obstruction, resulting in stridor

123
Q

What is otitis media?

A

Infection of the middle ear

124
Q

Where/ what is the middle ear?

A

The space between the tympanic membrane and inner ear

125
Q

How does infection enter the middle ear?

A

Pathogens enter though the eustachian tube

126
Q

What infection often precedes otitis media?

A

Viral upper respiratory tract infection

127
Q

What is the most common cause of otitis media?

A

Steptococcus pneumoniae

128
Q

Other than S. pneumoniae, what other bacteria sometimes cause otitis media (2)?

A
  • H. influenziae
  • Staph aureus
129
Q

What are the signs/ symptoms of otitis media (3)?

A
  • Ear pain
  • Hearing loss
  • Upper resp infection Sx
    balance problems and vertigo usually only if inner ear affected (labyrinthitis)
130
Q

What can discharge from the ear mean (2)?

A
  • Perforated eardrum
  • Outer ear infection
131
Q

What would be seen on otoscopy of those with otitis media?

A

Bulging, red, inflamed tympanic membrane

132
Q

How is otitis media generally treated?

A

Analgesics

133
Q

Should antibiotics be prescribed for otitis media?

A

Generally not. Most cases get better within 3 days without antibiotics.

134
Q

When should antibiotics be used to treat otitis media (2)?

A
  • Systemically unwell
  • Symptoms not improving after 3 days
135
Q

What antibiotic is first line for otitis media?

A

Amoxicillin
Co-amoxiclav/ ceftriaxone usually second line

136
Q

When should a child with otitis media be referred to hospital (2)?

A
  • 3 months or younger fever > 38
  • 3-6 months with a fever > 39
137
Q

What are some complications of otitis media (6)?

A
  • Mastoiditis
  • Perforated eardrum
  • Hearing loss
  • Recurrent infection
  • Effusion
  • Abscess
138
Q

What is glue ear?

A

Otitis media with effusion - middle ear becomes full of fluid due to blockage in Eustachian tube

139
Q

How is glue ear usually treated and how long does it typically last?

A

Usually resolves with conservative treatment within 3 months

140
Q

What is a treatment that can be offered if glue ear persists beyond 3 months?

A

Grommets

141
Q

Where should children be referred if glue ear is suspected?

A

Audiometry - establish diagnosis and extent of hearing loss

142
Q

What is the most common cause of otitis externa?

A

Staph aureus

143
Q

What activity commonly causes otitis externa?

A

Swimming pool

144
Q

How is otitis externa treated?

A

Flucloxacillin drops + steroid drops

145
Q

How does mastoiditis present (3)?

A
  • Otalgia (ear pain)
  • Swollen, tender mastoid
  • Systemically unwell
146
Q

How is mastoiditis managed?

A

IV Abx in hospital

147
Q

What is pharyngitis?

A

Inflammation of the pharynx +/- tonsils

148
Q

What are the most common causes of pharyngitis (2)?

A
  • EBV
  • S. pyogenes
149
Q

What criteria can be used to determine weather antibiotics should be given for pharyngitis?

A

Fever pain score
Abx if 4 or more; consider if 2-3

150
Q

What are the criteria in fever pain score (5)?

A
  • Fever > 38
  • Purulent exudate (on tonsils)
  • Absence of cough
  • Symptoms onset < 3 days
  • Severe tonsil inflammation
151
Q

What can happen if penicillin is given for EBV?

A

Widespread maculopapular rash

152
Q

What is important to advice people with EBV not to do?

A

Avoid contact sports for at least 4 weeks due to risk of spleen rupture

153
Q

How is pharyngitis investigated (2)?

A
  • Pharyngeal swab (viral PCR, MC&S)
  • Monospot test (for EBV)
154
Q

How is pharyngitis treated?

A

Phenoxymethylpenicillin (pen V) if fever score indicates bacterial

155
Q

What is a complication of pharyngitis?

A

Quinsy (peritonsillar abscess) - IV Abx + surgical drainage

156
Q

What are the three broad ways a child might have hearing loss?

A
  • Congenital
  • Perinatal
  • Acquired after birth
157
Q

What does congenital mean?

A

Present from birth

158
Q

What are some congenital causes of hearing loss (3)?

A
  • Maternal infection
  • Genetic deafness (autosomal dom or recess)
  • Associated syndromes e.g. Down’s
159
Q

What maternal infections most commonly cause congenital deafness (2)?

A
  • Rubella
  • Cytomegalovirus
160
Q

What are some perinatal causes of hearing loss (2)?

A
  • Hypoxia during/ after birth
  • Prematurity
161
Q

What are some causes of hearing loss after birth (4)?

A
  • Jaundice
  • Meningitis
  • Otitis media
  • Chemo
162
Q

How might hearing loss be picked up early on in childhood?

A

Newborn hearing screening programme - tests all neonates, looking for response to sounds

163
Q

What is recorded on an audiogram?

A
  • Left ear
  • Right ear
  • Bone conduction
  • Air conduction
164
Q

What are the 3 types of hearing loss?

A
  • Sensorineural
  • Mixed
  • Conductive
165
Q

What is the difference between sensorineural and conductive hearing loss?

A
  • Sensorineural = nerve damaged so bone and air conduction decrease by similar amounts
  • Conductive = problem conducting through ear so bone conduction normal and air decreased
166
Q

What is mixed hearing loss?

A

Sensorineural and conductive element - air and bone conduction decrease, but air decreases more than bone

167
Q

What professionals would be involved in a child with hearing loss (3)?

A
  • Speech and language therapy
  • Educational psychology
  • ENT specialist
168
Q

What is the medical term for a nose bleed?

A

Epistaxis

169
Q

What is the most common area to be affected by epistaxis?

A

Littles area (area most affected by little finger) - at the front of the nose

170
Q

What may a child who has swallowed blood during epistaxis present with?

A

Vomiting blood

171
Q

What should a child be advised to do if they have a nose bleed (3)?

A
  • Tilt head forward
  • Squeeze soft parts of nose
  • Spit any blood instead of swallowing
172
Q

When should a child go to hospital with epistaxis (2)?

A
  • Continues for more than 15 minutes
  • Very severe/ from both nostrils
173
Q

What is tongue tied known as?

A

Ankyloglossia

174
Q

What does tongue tied usually present as?

A

Difficulty feeding/ attaching to nipple

175
Q

What three cysts are most commonly found in the area around the neck?

A
  • Cystic hygroma
  • Thyroglossal cyst
  • Branchial cyst
176
Q

Where is a cystic hygroma?

A

Posterior triangle of neck

177
Q

Where is a thyroglossal cyst?

A

Midline of the neck

178
Q

Where is a branchial cyst?

A

Anterior border of sternocleidomastoid

179
Q

What are do these 3 neck cysts typically present?

A
  • Cystic hygroma = present from birth
  • Thyroglossal cyst = age 2
  • Branchial cyst = after age 10

Phase 3a conditions list flashcards (29 decks)

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