Paeds - Respiratory conditions Flashcards
What is the most common cause of Bronchiolitis?
RSV (80%)
What is the epidemiology of bronchiolitis? (3)
90% are aged 1-9 months (rare after 1 year)
Winter epidemics
Half have recurrent episodes
What are the initial symptoms of bronchiolitis?
Initially get coryzal symptoms - including mild fever
What are the symptoms of bronchiolitis after the initial symptoms/prodrome?
1) Increasing SOB
2) Dry cough
3) Wheezing
4) Fine crackles on insp
5) Feeding difficulties
What are the investigations you would do for suspected bronchiolitis?
1) PCR of nasopharyngeal secretions - test for RSV
2) CXR - rule out pneumonia, might see hyperinflation due to small airway obstruction, air trapping and focal alectasis
3) Pulse oximetry
4) Blood gas - in severe disease
In bronchiolitis what might you see on CXR?
1) Hyperinflation - due to small airways obstruction, air trapping and focal alectasis
What are the reasons for referring someone with bronchiolitis to hospital? (NICE
- Immediate and consider)
1) 999 refferal
a) apnoea
b) severe respiratory distress/RR over 70 per minute
c) central cyanosis
d) persistent oxygen saturation
2) Consider
a) RR over 60 breaths per minute
b) difficulty with breastfeeding/inadequate oral fluid intake (50-75% of usual volume)
c) clinical dehydration
What is the management of bronchiolitis?
Largely supportive
1) Humidified oxygen if sats less than 92
2) NG feeding if child cannot take enough fluid/feed
3) suction to clear excessive upper airway secretions
What is the most common causative organism of croup?
Parainfluenza
crouP = Parainfluenza
What time of the year is croup most common?
Autumn
What ages is croup most common?
Peak incidence is 1-4 years
Child can get croup 6 months - 6 years
What is the long name for croup which describes where there is inflammation?
laryngo tracheo bronchitis
What precedes the classical croup symptoms?
Fever and coryzal symptoms
What are the classical symptoms of croup?
1) Barking cough
2) Harsh strydor
3) Hoarseness
Symptoms often start and are worse at night
In acute stridor with respirartory distress what should you not do?
Examine the throat
What is the management for croup regardless of severity?
Single dose of oral dexamethasone (250 micrograms/kg - BNF)
When should you admit someone with croup?
Al children with features of moderate/severe/impending respiratory failure
1) High resp rate (>60) or high fever or toxic appearance
2) Children with mild illness may have factors that warrant a lower threshold for admission
a) Chronic lung disease
b) Hameodynamically significant congenital heart disease
c) neuromuscular disorder
d) immunodeficiency
e) Age under 3 months
f) Inadequate fluid intake (50-75% normal volume or no wet nappy for 12h)
g) always consider carer abilities of parents - including distance to healthcare
What are the NICE catergories of croup and their features?
Mild – seal-like barking cough but no stridor or sternal/intercostal recession at rest.
Moderate – seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
Severe – seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
Impending respiratory failure – increasing upper airway obstruction, sternal/intercostal recession, asynchronous chest wall and abdominal movement, fatigue, pallor or cyanosis, decreased level of consciousness or tachycardia. The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires.
A respiratory rate of over 70 breaths/minute is also indicative of severe respiratory distress.
How do you safey net parents with a croup child who does nto need admission?
1) Symptoms usually resolve in 48h - give leaflet
2) Take to hospital if stridor can be heard continually, the skin between ribs is pulling in with each rest and/or the child is restless or agitated
3) Call ambulance if child very pale, blue or grey/unrepsonsive/lots of trouble breathing/drooling/trouble swallowing
4) check on child regularly through night
What is the potential treatment of a child who has been admitted to hospital with croup? (2)
1) High flow oxygen
2) Nebulised oxygen
(single dose oral dexamethasone if not already had)
What is the most common causative organism for Epiglotitis?
Haemophilus influenza type b
What age is most common to get epiglotitis?
Aged 1-6
Can get at any age
What is the presentation of a child with epiglottis? (5)
1) Acute onset with high fever
2) intensely painful throat stops child speaking or swallowing
3) Drooling
4) Soft inspiratory stridor
5) rapidly increasing respiratory difficulty over hour
6) Child is immobile
7) Minimal/absent cough
What is the management of a child with epiglotitis?
1) Urgent hospital admisson
2) NEED anaesthetist, ENT and paedatrician
3) Intubation under GA
4) blood culture and IV abx e.g. cefuroxime
5) Tube removed after 24h and abx given 3-5 days
6) Rifampicin offered to close household contacts
Children recover completely within 2-3 days
What are the most common causative organisms for newborn pneumonia?
1) Organisms from mother’s vagina - Listeria
2) Gram -ve enterococci - ecoli
What are the most common causative organisms for young children (<5yo) pneumonia?
1) RSV
2) Strep. Pneumonia
3) H.influenza
4) Borfella Pertussis
5. Chlamydia pneumonia
Staph aureus = UNcommon but serious
What are the most common causative organisms for children (>5yo) pneumonia?
1) Strep pneumoniae
2) Chlamydia pneumonia
3) Mycoplasma pnuemonaia
When are viral causes and bacterial causes the most common cause of pneumonia in children?
Viruses = younger children
Bacteria = older children
What chronic condition massively increases the risk of pneumonia?
Cystic Firbrosis
Obviously there are others
What can commonly precede pneumonia? (3)
1) Bronchiolitis
2) Viral ifeciton
3) Whooping cough
What is the causative organism of whooping cough?
Bordella pertussis (gram -ve)
incubation period 7-14 days
Describe the progression of whooping cough?
1) 2-3 days of coryza
2) Coughing bouts and inspiratory ‘whoop’ - lasts ip to 14 weeks
Symptoms can last 10-14 weeks and tend to be more severe in infants
What are potential complications of the repeated bouts of coughing in whooping cough?
1) subconjunctival haemorrgaes
2) anoxia - leading to syncope and seizures
What happens to the lymphocytes in whooping cough?
Lymphocytosis - increase number of lymphocytes
When should you admit someone with whooping cough?
Infants and young children suffering severe spasms of cough or cyanotic attacks should be admitted to hospital and isolated from other children.
What is the treatment of whooping cough?
Oral macrolide IF onset of cough is within previous 21 days (this only reduces spread NOT cause of illness)
What if any school exclusion should be implemented for someone with whooping cough?
2 days after commencing abx
OR
21 days from onset of symptoms
What must you do in addition to treating the bordella pertusis?
Report the disease - it is a notifiable disease
How do you diagnose Bordella pertusis?
Per nasal swab or PCR/serology
What does Pass Medicine say about whooping cough and pregancy?
Women between 20 and 32 weeks preganant will be offered the vaccine
What is the most common causative organsisms for pharyngitis? (examples of viral and bacterial causes)
1) Viruses - adenoviruses, enteroviruses and rhinoviruses
2) Bacteria - Group A Beta haemolytic strep (strep pyogenes)
What are the most common organism causes of tonsilitis?
1) Strep pyogenes
2) EBV
3) Viruses - RSV, rhinovirus, adenovirus
What are the 2 scoring systems for bacterial vs viral tonsilitis?
CENTOR Fever Absent cough Cervical lymphadenopathy Exudate >3 is bacterial, <1 viral
FEVER PAIN Fever Purulent tonsils Attends rapidly Inflamed tonsils No cough A score of 2 or 3 = 34 to 40% actually strep A score of 4 or 5 = 62 to 65% actually strep
What are the potential complications of tonsilitis? (2)
1) Peritonsilar abcess (quinsy)
2) Rheumatic fever 1-2 weeks later
What does the surface of the toniss look like in EBV?
More membranous in appearance to bacterial tonsilits
What symptomatic relief can you give for tonsilitis?
1) paracetamol
2) Cold drinks
3) Local anaesthetic throat spray
What antibiotic should be used to treat tonsilitis?
Phenoxymethylpenicillin (PV)
Not amoxicilling as it can cause a widespread maculopapular rash if the tonsilitis is due to EBV
What are the most common causative organisms for otitis media? (give bacterial and viral answers)
1) Viral - RSV, rhinovirus
2) Bacterial - Strep pneumoniae. H influenzae and moxarella catarrhalis
At what age is acute otitis media most common?
6-12 months of age
What are some of the (rare) serioud complications of otitis media?
1) Mastoiditis
2) meningitis
3) lateral sinus thrombosis
4) cerebral abscess
5) Problems with learning development (as effectively deaf)
When and what antibiotic should be given for otitis media?
Amoxicillin - if child very unwell or if symptoms persist for >4 days
What organism causes TB?
Mycobacterium tuberculosis
What are the symptoms of TB? (4)
Non specific features
1) prolonged fever
2) malaise
3) anorexia
4) weight loss
What investigations should be done to diagnose TB? (2)
1) Mantoux test
2) CXR
3) Gastric washings on three consecutive mornings are required to visualise or culture acid-fast bacilli originating from the lung in kids
4) Tested for HIV also
What is the management of TB?
Triple or quadruple therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) is the recommended initial combination.
ALSO notifiable disease
In children what is the most common cause of pneumonia?
Strep pneumoniae
What organism causes pneumonia in HIV patients?
Pneumocystitis jirovecci
What are the features of mycoplasma pneumonia?
FLu like symptoms claccialy precede a dry cough - complications include haemolytic ananemia and erythema multiforme
What organism causes bronchiectasis flare ups?
Haemophilus influenza
