Paeds resp Flashcards
Give 4 symptoms of pneumonia ?
- Cough (wet and productive)
- High fever (>38.5)
- Lethargy
- Delirium
Give 5 signs of pneumonia
- Tachypnoea
- Tachycardia
- Increased work of breathing
- Hypoxia
- Hypotension
Give 3 investigations for pneumonia
- Sputum cultures and throat swabs for bacterial cultures and viral PCR
- Blood culture
- CXR : consolidation
Give 3 chest signs of pneumonia
- Bronchial breath sounds
- Focal coarse crackles
- Dullness to percussion
Causes of pneumonia by age
- Newborn : GBS or enterococci
- Infant + > 5 yrs : strp pneumonia or RSV
Give 3 viral causes of pneumonia
- RSV -> most common
- Parainfluenza virus
- Influenzavirus
What is the management for mild pneumonia ?
-Oral amoxicillin
- Add macrolide if no response (e.g. erythromycin)
- Co-amoxiclav in pneumonia associated with influenza
What is the management for severe pneumonia?
-Iv benzylpenicillin
Define croup
-Acute, infective, URTI causing oedema of the larynx
What age group does croup typically affect?
-6mnths to 2yrs
What is the most common cause of croup?
-Parainfluenzae
Give 5 symptoms of croup
- ‘Barking’ cough
- Stridor
- Low grade fever
- Hoarse voice
- Increased work of breathing
How is croup managed if more than supportive care is needed ?
- Oral dexamethasone (single dose of 0.15mg/kg)
Explain the different age groups affected by bronchiolitis, viral induced wheeze and asthma
- > Bronchiolitis : 6mns usually (less than <1 yr)
- > Viral induced wheeze : <3 years
- > Asthma : >3 years
What is the most common viral cause of bronchiolitis ?
-RSV -> respiratory syncytial virus
What can be given to high risk babies to protect against bronchiolitis
- Palivizumab -> monoclonal antibody targeting RSV.
- Given as a monthly IM injection
How does bronchiolitis present ?
- Wheeze and crackles
- Coryzal symptoms
- Tachypnoea
- Dyspnoea
- Dry cough
- Poor feeding
- Mild fever
- Apnoeas
- Signs of respiratory distress
Give 8 signs of respiratory distress
- Raised resp rate
- Use of accessory muscles : sternocleidomastoid, abdominal and intercostal muscles
- Nasal flaring
- Heading bobbing
- Tracheal tug
- Cyanosis
- Abnormal airway noises
what would suggest a diagnosis of pneumonia over bronchiolitis ?
- High fever (>39 degrees)
- Persistently focal crackles
What 6 factors would suggest admission to hospital for bronchiolitis ?
- Oxygen at 92% or below
- RR >70
- Moderate to severe resp distress
- 50-75% less of nomral milk intake
- Apnoea
- Clinical dehydration
How is bronchiolitis managed in hospital ?
Supportive
What is the stepwise approach to ventilation support in bronchiolitis ?
- High-flow humidified oxygen via tight nasal cannula
- Continuous positive airway pressure
- Intubation and ventilation
What 3 factors suggest viral induced wheeze over asthma?
<3 yrs
- No atopic history
- Only occurs following a viral infection
What is the presentation of a viral induced wheeze?
- Evidence of a viral illness (fever, cough and coryzal symptoms) before onset of :
- SOB
- Expiratory wheeze throughout the chest
- Signs of respiratory distress
What is cystic fibrosis ?
-Autosomal recessive condition affecting the mucus glands, most commonly caused by Delta-F508 mutation of CFTR gene on chromosome 7
what is the most common mutation in CF?
- Delta-F508 mutation of CFTR gene on chromosome 7
How is CF diagnosed ?
- Newborn bloodspot test
- Sweat test : gold standard
What is an early sign of CF
- Meconium ileus
Give 6 symptoms of CF
- Chronic cough
- Thick sputum production
- Recurrent resp tract infections
- Steatorrhoea
- Abdo pain and bloating
- Salty taste to child
- Failure to thrive
Give 5 signs of CF
- Low weight or height on growth charts
- Nasal polyps
- Finger clubbing
- Crackles and wheeze on auscultation
- Abdo distention
What is the gold standard test for CF?
- Sweat test
- Pilocarpine is applied to a patch on the skin, electrodes are placed either side and a small current passed between the electrodes.
- The sweat is absorbed and tested for chloride concentration
What chloride concentration is diagnostic for CF on a sweat test
> 60mmol/L
What are 2 common microbial colonisers in people with CF?
- Staph aureus : long term prophylactic flucloxacillin taken
- Psuedomonas aeruginosa : treated with nebulised tobramycin
What is epiglottitis ?
-Inflammation and swelling of the epiglottis caused by infection
What is the cause of epiglottitis ?
-Haemophilus influenzae type B
Give 5 presenting symptoms of epiglottitis
Rapid onset :
- High fever
- Sore throat
- Drooling
- Difficulty or painful swallowing
- Muffled voice
Give 4 signs of epiglottitis
- Tripod position
- Scared and quiet child
- Septic and unwell appearance
- Soft, whispering stridor
How is epiglottitis diagnosed?
- Lateral X-ray of the neck -> ‘thumb’ or ‘thumbprint’ sign
- However if child is acutely unwell, don’t waste time with Ix
How is epiglottitis managed ?
1) Don’t examine throat
2) Call ENT and anaestehtics
3) Intubate and IV 3rd gen cephalosporin (cefuroxime)
What is a complication of epiglottitis ?
-Epiglottic abscess
What is whopping cough and what causes it ?
- URTI
- Bordetella pertussis (gram neg)
How does whooping cough present ?
- 1 wk Preceding coryza
- 3- 6 wks severe paroxysmal coughing fits with large inspiratory whoop.
- Possible apnoea presentation
How is pertussis diagnosed ?
- Nasal swab with PCR testing or bacterial culture within 2 to 3 wks of symptoms
- If cough present for >2 wks : anti-pertussis toxin immunoglobulin G on oral fluid aged 5-16 and blood if >17
How is whooping cough managed ?
- <6 mnths. = admit
- Oral macrolide if within 21 days of cough (erythromycin)
- Household prophylaxis
- School exlusion : 48 hrs after starting Abx
What is a key complication of whooping cough ?
-Bronchiectasis
How does a moderate acute exaccerbation of asthma present ?
- Peak flow >50% predicated
- Normal speech
How does a severe asthma exacerbation present ?
- Peak flow <50% predicated
- Saturations <92%
- Unable to complete sentances in one breath
- Signs of resp distress
- Resp rate : >40 in 1-5 or >30 in over 5’s
- HR : >140 in 1-5 yrs or >125 in over 5’s.
How does a life threatening asthma exacerbation present ? (8)
- Peak flow <33%
- Saturations <92%
- Exhaustion and poor resp effort
- Hypotension
- Silent chest
- Cyanosis
- Altered consciousness / confusion
What are the stepwise medications used in viral induced wheeze / acute asthma
- Oxygen (if <94%)
- Bronchodilators
- Steroids
- Antibiotics
What is the discharge plan in acute asthma?
-Can be discharged once on 6 puffs 4 hrly of salbutamol
What is determined as mild croup
- Occasional barking cough
- No audible stridor at rest
- No or mild suprasternal or intercostal recession
- Child is happy and prepared to eat, drink and play
What is defined as moderate croup
- Frequent barking cough
- Easily audible stridor at rest
- Suprasternal and sternal wall retraction at rest
- No or little distress and agitation
- Child can be placated and is interest in its surroundings
What is defined as severe croup
- Frequent barking cough
- Prominent inspiratory stridor
- Marked sternal wall retractions
- Significant distress and agitation, or lethargy or restlessness
- Tachycardia and hypoxaemia
When is a child admitted with croup
- Moderate or severe
- <6 mnths
- Known upper airway abnormalities
- Uncertainty about diagnosis
what can be seen on bloods in whooping cough
Marked lymphocytosis
How is asthma diagnosed in >5
-> Peak flow (2/3 times daily for 2 wks)
-> Spirometry with reversibility
-> FeNO can support
What would be seen on spirometry with asthma
- FEV1/FVC : <70%
- Reversibility : Improvement of 12% or more
what is a common finding in CF in a male
Bilateral absence of vas deferens
Give the stepwise management of croup
- Oral dex
- Oxygen
- Nebulised budenoside
- Nebulised adrenaline
- Intubation and ventilation
What is the step up of bronchodilators
- Inhaled or nebulised salbutamol
- Inhaled or nebulised ipratropium bromide
- IV mag sulph
- IV aminophylline
How is a mild asthma attack managed ?
- Salbutamol inhalers via spacer
How is a moderate to severe asthma attack managed ?
- Salbutamol via spacer
- Nebulised salbutamol / ipratropium bromide
- Oral pred
- IV hydrocortisone
- IV mag sulph
- IV salbutamol
- IV aminophylline
