Paeds: Resp

Question 1

What are most childhood respiratory infections caused by? Name some examples

Answer 1

80-90% caused by viruses. Respiratory syncytial virus (RSV), parainfluenza & influenza, metapneumovirus and adenovirus

Question 2

In terms of the other large category of infection causers, name some examples

Answer 2

Strep pneumoniae, other strep, bordetalla petussis, haemophilus influenzae, mycoplasma pneumoniae

Question 3

We know that respiratory infections are just classified by what level of the respiratory tract is most involved but can you name the five levels

Answer 3

1. Upper respiratory
2. Tracheal/laryngeal
3. Bronchitis
4. Bronchiolitis
5. Pneumonia

Question 4

URTI: What often is the cause of these symptoms

Answer 4

Rhinoviruses or potentially RSV

Question 5

What usually causes a sore throat in younger and older children?

Answer 5

Younger is usually a virus. Older children, group A strep is a common pathogen

Question 6

Explain the diagnosis of tonsillitis

Answer 6

A serious form of pharyngitis, with a severe inflammation of the tonsils and sometimes pus.

Question 7

why are young children more prone to acute otitis media

Answer 7

Because they have some short tubes, horizontal and function poorly that are more prone to infection

Question 8

What must we examine with a case of OM where the child has a fever

Answer 8

Their (ear drum) tympanic membrane as occasionally the ear drum may have perforated

Question 9

What may a few OM cases lead to? Resulting in what needing to be put in?

Answer 9

OM with effusion. Presents only with conductive hearing loss essentially and is the most common cause of conductive hearing loss in young children.

The child will have grommets fitted to reduce the effusion

Question 10

How do we manage a child with OM

Answer 10

Basic pain analgesic

Usually will self resolve but can be useful to write a prescription for antibiotics that the parents can use if the child doesn’t recover in 2-3 days.

Question 11

Explain what sinusitis is and how we manage it

Answer 11

An infection of the sinuses, usually only the maxillary sinuses (as the frontal sinuses don’t develop until late childhood) and so give antibiotics and analgesia.

Question 12

Why are laryngeal and tracheal infections so dangerous?

Answer 12

As they can cause severe sudden narrowing of the airway

Question 13

How would a laryngeal/tracheal infection usually present:

Answer 13

With a stridor, barking cough, difficulty breathing (and possibly hoarse voice)

Question 14

Explain the best ways to assess the severity of upper airways obstruction (2):

Answer 14

By degree of stridor and chest recession, at rest, crying or coughing

Question 15

Explain the basic managmenet of acute upper airways obstruction. Including what to examine and what not to examinew, observe and administer

Answer 15

Look for signs of hypoxia, don’t exmanie the throat, potenitlaly administer epinephrine

Question 16

Describe the typical child that may have laryngotracheobronchitis

Answer 16

a 2 year old (can be 6m-6yr) with preceding coryza now with stridor and croupy cough

Question 17

Explain the pathogen cause of croup and how that causes such symptoms

Answer 17

(crouP) Parainfluenzea **viruses are the commonest

Typically viral in origin, possibly RSV and so causes odema of the subglottic airway and mucosal inflammation

Question 18

Explain how we manage a this child that comes into hospital with laryngotracheobronchitis:

Answer 18

First is steroid therapy: oral dexamethasone, prednsiolone or nebusilised budesonide Need to give adrenaline neublised if serious

Question 19

This condition is rare but dangerous. Explain how it differs to the child with croup and how the causation and thus management are different

Answer 19

Usually cihld will have high fever and appear toxic

Question 20

A life threatening condition like we saw on the medical drama ‘Bodies’. Caused by ?? . Explain how this usually presents in comparison to croup (as it is of course important to be able to tell the difference)

Answer 20

H. Influenzae (bacterial) which we now vaccinate against

Often intensely painful throat, whilst looking toxic and feverish - minimal cough in contrast to croup

Question 21

Pertussis is a bacteria that causes epidemics frequently of this highly contagious infection. Explain how a child will present

Answer 21

With fever and the classic inspiratory whooping cough attacks that are often occuring at night, usually has preceeding coryzal symptoms

Question 22

Also explain what should be done not only with managing the patient

Answer 22

Need to give erthromycin prohpylactic to close contacts and ensure infants are vaccincated

Question 23

What is the most common causing agent of bronchiolitis and what age of child is most commonly affected:

Answer 23

RSV - first year of life

Question 24

Explain the characteristic findings of a child suffering with bronchiolitis

Answer 24

Difficulty to breath

• Dry cough, sharp
• Chest recession
• tacyponea & tacycardia
• fine end-inspiratory crackles
• High pitched wheeze on expiration

Question 25

Explain the hospital management for a child suffering with bronch

Answer 25

Supportive therapy, humidified O2 or if worse ventilation/CPAP

Question 26

Explain what can be done to prevent bronchiolitis

Answer 26

For preterm infants at risk: monoclonal antibody vaccination

Question 27

Explain the commonest presenting symptoms of a pneumona

Answer 27

Fever and dysponea - best sign is resp rate

Pleural irritation may cause neck pain, abdominal pain or chest pain

Chest signs are often absent in younf children

Question 28

What is asthma in the young child

Answer 28

So asthma is commonly an atopic disease although can be hard to diagnose in the under 5s. Because of the narrow airways, under 3s can easily develop a wheeze due to a viral infection and so can be categorised as a transient wheeze. If the patient has more recurrent wheeze then a diagnosis of asthma is more likely. So asthma is more likely to be diagnosed in an older patient

Question 29

Allergy basis behind asthma

Answer 29

Ashtma may be atopic - meaning that it is related to a an IgE mediated reaction to common allergens or just non-atopic. Thus like in the allergies chapter we could do a skin-prick tesk. It can be recommended to stay away from common allergens but this is doesn’t sort the issue alone.

Question 30

PAthophysiology

Answer 30

The pathophysiology is that there is a hypersensitivity in the bronchi and inflammation causing narrowing of the airways. Asthma is excaerbated at night, cold weather and by exercise.

Question 31

How do we make a diagnosis of asthma; what is the classic diagnostic marker of asthma?

Answer 31

Often the history and examination of an asthma excaerbation (tachyponea/cardia, chest reccession, low sats) is enough to diagnose although some investigations might include measuring the improvement to therapy. By measuring their peak flow before using a reliver (beta-agonist (salbutamol)) and then measuring any improvement.

Question 32

Management of asthma in children

Answer 32

Salbutamol (salbluetamol) works by activating the sympathetic nervous system, espsecially the beta 2 receptors in the bronchi - to help them to dialate.

We use a stepwise process for asthma medication which is relatively simple in the over 5s.

• Of course it starts with using a salbutamol reliver as and when
• Then introducing a preventer (inhaled corticosteroids) to calm the immune system, such as inhaled becamethasone
• Next we might want to add a long-acting beta agonist (LABA) that provides some extra sympathetic prevention
  
  • LABA should be used with steroid
• Increase ICS to max dose, then refer upwards

Question 33

In the under 5 that might be struggling with wheeze

Answer 33

we can use the ipratropium bromide (anticholinergic dialtor) that helps. Add on therapy would be monteleukast (a leukotriene inhibitor)

Question 34

Features of life-threatening asthma

Answer 34

92 33 CHEST (92 sats; 33 peak flow; Cyanosis, hypotensive, excaerbation, silent chest,T?)

Silent chest

Sats below 92% (adults have to have low sats for it to be life-threatening, whereas can be severe in children)

Peak flow below 33% or predicted (33%-50% is severe)

Question 35

What are some causes of bronchiectasis

Answer 35

Generalised could be because of cystic fibrosis, or ciliary dyskinesia, where the cilia don’t move normally.

It may be single lobed due to a previous lobar pneuomina or lung abnormality

Question 36

How is bronchiectasis best investigated?

Answer 36

CT Scan

Question 37

Explain what CF is

Answer 37

Cystic fibrosis is a genetic AR condition where there is a disorder in a protein causing the production thick, problematic mucus. This mucus then shortens life due to the numerous recurrent infections that the person will suffer.

Question 38

When is the condition usually presenting

Answer 38

Usually presents with a baby having a THICK meconium causing an illeus. They never pass their first stool and so this requires surgery.
The condition is usually diagnosed in childhood, presenting with recurrent infections and possibly serious illness. They will present with excess mucus production and potentially a lot of penumonia

Question 39

How would we confirm the diagnosis

Answer 39

Investigations aside from treating the respiratroy infection would be mucus sampling and genetic testing to diagnose the disease. Guthrie test
Since it is a sodium/chloride pump protein problem, we can do a sweat test that indicates a likelihood of CF
part of the heel prick sample of blood

Question 40

In a new born baby what is the specific marker we are checking in screening for cystic fibrosis

Answer 40

Immunoreactive trypsinogen (trypsinogen plays a role as a protease right)

Question 41

How is the digestive system affected in CF?

Answer 41

The prancreatic ducts are blocked by the thick mucus so the enzymes can’t be released to breakdown fats

Question 42

What can be done to manage CF

Answer 42

• Antibiotics for treating or controlling infections
• Medicines to help clear the mucus
• exogenous pancreatic enzyme
• Physiotherapy (starting in babies )
• Bronchodilators and steroids possibly

Question 43

Other parts of health affected by CF

Answer 43

CF also affects bone health, fertility and liver ducts

Question 44

Howcome boys are infertile whom have CF

Answer 44

Usually absent vas deferens