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Dan 4th year > Paeds - Respiratory conditions > Flashcards

Paeds - Respiratory conditions Flashcards

1
Q

What is the most common cause of Bronchiolitis?

A

RSV (80%)

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2
Q

What is the epidemiology of bronchiolitis? (3)

A

90% are aged 1-9 months (rare after 1 year)

Winter epidemics

Half have recurrent episodes

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3
Q

What are the initial symptoms of bronchiolitis?

A

Initially get coryzal symptoms - including mild fever

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4
Q

What are the symptoms of bronchiolitis after the initial symptoms/prodrome?

A

1) Increasing SOB
2) Dry cough
3) Wheezing
4) Fine crackles on insp
5) Feeding difficulties

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5
Q

What are the investigations you would do for suspected bronchiolitis?

A

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

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6
Q

In bronchiolitis what might you see on CXR?

A

1) Hyperinflation - due to small airways obstruction, air trapping and focal alectasis

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7
Q

What are the reasons for referring someone with bronchiolitis to hospital? (NICE
- Immediate and consider)

A

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

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8
Q

What is the management of bronchiolitis?

A

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

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9
Q

What is the most common causative organism of croup?

A

Parainfluenza

crouP = Parainfluenza

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10
Q

What time of the year is croup most common?

A

Autumn

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11
Q

What ages is croup most common?

A

Peak incidence is 1-4 years

Child can get croup 6 months - 6 years

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12
Q

What is the long name for croup which describes where there is inflammation?

A

laryngo tracheo bronchitis

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13
Q

What precedes the classical croup symptoms?

A

Fever and coryzal symptoms

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14
Q

What are the classical symptoms of croup?

A

1) Barking cough
2) Harsh strydor
3) Hoarseness

Symptoms often start and are worse at night

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15
Q

In acute stridor with respirartory distress what should you not do?

A

Examine the throat

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16
Q

What is the management for croup regardless of severity?

A

Single dose of oral dexamethasone (250 micrograms/kg - BNF)

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17
Q

When should you admit someone with croup?

A

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

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18
Q

What are the NICE catergories of croup and their features?

A

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.

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19
Q

How do you safey net parents with a croup child who does nto need admission?

A

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

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20
Q

What is the potential treatment of a child who has been admitted to hospital with croup? (2)

A

1) High flow oxygen
2) Nebulised oxygen

(single dose oral dexamethasone if not already had)

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21
Q

What is the most common causative organism for Epiglotitis?

A

Haemophilus influenza type b

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22
Q

What age is most common to get epiglotitis?

A

Aged 1-6

Can get at any age

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23
Q

What is the presentation of a child with epiglottis? (5)

A

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

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24
Q

What is the management of a child with epiglotitis?

A

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

25
Q

What are the most common causative organisms for newborn pneumonia?

A

1) Organisms from mother’s vagina - Listeria

2) Gram -ve enterococci - ecoli

26
Q

What are the most common causative organisms for young children (<5yo) pneumonia?

A

1) RSV
2) Strep. Pneumonia
3) H.influenza
4) Borfella Pertussis
5. Chlamydia pneumonia

Staph aureus = UNcommon but serious

27
Q

What are the most common causative organisms for children (>5yo) pneumonia?

A

1) Strep pneumoniae
2) Chlamydia pneumonia
3) Mycoplasma pnuemonaia

28
Q

When are viral causes and bacterial causes the most common cause of pneumonia in children?

A

Viruses = younger children

Bacteria = older children

29
Q

What chronic condition massively increases the risk of pneumonia?

A

Cystic Firbrosis

Obviously there are others

30
Q

What can commonly precede pneumonia? (3)

A

1) Bronchiolitis
2) Viral ifeciton
3) Whooping cough

31
Q

What is the causative organism of whooping cough?

A

Bordella pertussis (gram -ve)

incubation period 7-14 days

32
Q

Describe the progression of whooping cough?

A

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

33
Q

What are potential complications of the repeated bouts of coughing in whooping cough?

A

1) subconjunctival haemorrgaes

2) anoxia - leading to syncope and seizures

34
Q

What happens to the lymphocytes in whooping cough?

A

Lymphocytosis - increase number of lymphocytes

35
Q

When should you admit someone with whooping cough?

A

Infants and young children suffering severe spasms of cough or cyanotic attacks should be admitted to hospital and isolated from other children.

36
Q

What is the treatment of whooping cough?

A

Oral macrolide IF onset of cough is within previous 21 days (this only reduces spread NOT cause of illness)

37
Q

What if any school exclusion should be implemented for someone with whooping cough?

A

2 days after commencing abx
OR
21 days from onset of symptoms

38
Q

What must you do in addition to treating the bordella pertusis?

A

Report the disease - it is a notifiable disease

39
Q

How do you diagnose Bordella pertusis?

A

Per nasal swab or PCR/serology

40
Q

What does Pass Medicine say about whooping cough and pregancy?

A

Women between 20 and 32 weeks preganant will be offered the vaccine

41
Q

What is the most common causative organsisms for pharyngitis? (examples of viral and bacterial causes)

A

1) Viruses - adenoviruses, enteroviruses and rhinoviruses

2) Bacteria - Group A Beta haemolytic strep (strep pyogenes)

42
Q

What are the most common organism causes of tonsilitis?

A

1) Strep pyogenes
2) EBV
3) Viruses - RSV, rhinovirus, adenovirus

43
Q

What are the 2 scoring systems for bacterial vs viral tonsilitis?

A 
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
44
Q

What are the potential complications of tonsilitis? (2)

A

1) Peritonsilar abcess (quinsy)

2) Rheumatic fever 1-2 weeks later

45
Q

What does the surface of the toniss look like in EBV?

A

More membranous in appearance to bacterial tonsilits

46
Q

What symptomatic relief can you give for tonsilitis?

A

1) paracetamol
2) Cold drinks
3) Local anaesthetic throat spray

47
Q

What antibiotic should be used to treat tonsilitis?

A

Phenoxymethylpenicillin (PV)

Not amoxicilling as it can cause a widespread maculopapular rash if the tonsilitis is due to EBV

48
Q

What are the most common causative organisms for otitis media? (give bacterial and viral answers)

A

1) Viral - RSV, rhinovirus

2) Bacterial - Strep pneumoniae. H influenzae and moxarella catarrhalis

49
Q

At what age is acute otitis media most common?

A

6-12 months of age

50
Q

What are some of the (rare) serioud complications of otitis media?

A

1) Mastoiditis
2) meningitis
3) lateral sinus thrombosis
4) cerebral abscess
5) Problems with learning development (as effectively deaf)

51
Q

When and what antibiotic should be given for otitis media?

A

Amoxicillin - if child very unwell or if symptoms persist for >4 days

52
Q

What organism causes TB?

A

Mycobacterium tuberculosis

53
Q

What are the symptoms of TB? (4)

A

Non specific features

1) prolonged fever
2) malaise
3) anorexia
4) weight loss

54
Q

What investigations should be done to diagnose TB? (2)

A

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

55
Q

What is the management of TB?

A

Triple or quadruple therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) is the recommended initial combination.

ALSO notifiable disease

56
Q

In children what is the most common cause of pneumonia?

A

Strep pneumoniae

57
Q

What organism causes pneumonia in HIV patients?

A

Pneumocystitis jirovecci

58
Q

What are the features of mycoplasma pneumonia?

A

FLu like symptoms claccialy precede a dry cough - complications include haemolytic ananemia and erythema multiforme

59
Q

What organism causes bronchiectasis flare ups?

A

Haemophilus influenza

Dan 4th year (8 decks)

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