Paeds Respiratory Diseases Flashcards
What is the most common chronic illness of childhood in the UK
Asthma
What does the bacteria causes whooping cough
Bordatella pertussis
What is the most common bacteria that causes pneumonia in school children
Mycoplasma pneumonia
What causes tonsillitis and how to treat
Viral (e.g EBV)
Group A strep
Use throat swab to distinguish between bacterial/viral
To treat bacterial tonsillitis use PenV to prevent rheumatic fever
When would a tonsillectomy be appropriate
Recurrent infections
If enlarged tonsils cause sleep apnoea
What is croup and how do you identify and treat it
• Inflammation of mucosa lining larynx, trachea and bronchi caused by parainfluenza virus
• Narrowing of subglottic area causes symptoms of croup
• Barking cough
• Inspiratory stridor
• Worse at night
• Peak age 2 years, most commonly 2-5 years
• Treatment depends on severity – PO dexamethasone, nebulised
adrenaline
How do you assess severity of croup
• Westley croup score
• Croup severity
• Mild < 2 • Moderate 3-7
• Severe 8-11
• Impending respiratory failure >12
• A child who has stridor but no signs of respiratory distress at rest, is fully alert has mild croup and can usually be discharged home with 2 doses of dexamethasone
• A child who has respiratory distress at rest and stridor falls into the
moderate category and should not be discharged home. They may require nebulized adrenaline
• Children with marked respiratory distress at rest who look unwell are likely to fit into the severe category and will require nebulized adrenaline in addition
to oral / inhaled steroids.
• Life threatening - intubation
What is acute epiglottitis and how do you identify and treat it
• Acute epiglottitis
• Uncommon
• Life-threatening
• H influenzae type B
• Intense swelling of epiglottis and surrounding tissues
• Unwell, intensly painful throat, drooling
• Stridor and respiratory distress (rapidly progressive)
• Septicaemia
• Most common 1 to 6 years
• HiB vaccine hugely reduced incidence
• Management
• Avoid examining throat, intubate, ventilate, ICU, IV antibiotics
What is whooping cough and how do you identify and treat it
• Bordetella pertussis
• Bronchitis
• Epidemics every 3-4 years
• Epidemic in 2012 – unclear why
• Coryzal
• Then Spasmodic cough
• Followed by inspiratory whoop
• Infants can become apnoeic – associated with sudden death (reduced since vaccine – including pregnant mothers since 2012 in response to epidemic)
• Erythromycin to reduce family spread
What is bronchiolitis and how do you identify it
• Most common potentially serious respiratory infection of
infancy
• 2-3% of all infants admitted each year
• October-Feb
• Rare after 1 year
• RSV pathogen in 75-80%
Clinical features
• Coryzal symptoms
• Dry cough initially then wet
• Increased work of breathing
• Fine inspiratory crackles, wheeze, pallor
• Feeding difficulties
What bacteria causes pneumonia in children and how to treat it
• Acute infection of lung parenchyma (alveoli)
Newborn
Genital tract of mother contain these bacteria which can cause pneumonia
• Group B strep
• EColi
Infancy
• RSV
• Strep Pneumoniae
• HiB
School age
• Mycoplasma Pneumoniae (atypical pneumonia)
• Clinical features
• Fever, cough, increased WOB
Treatment
• PO augmentin
• IV antibiotics – cephalosporin
• Macrolide added if mycoplasma suspected (e.g clarithromycin)
Management and symptomatic relief of asthma
Management
• Maintenance therapy (step-wise approach)
• Steroid inhaler (low dose/high dose)
• Montelukast
• long acting beta2 agonist inhalers (over 5’s)
Symptom relief
• Inhaled/nebulised bronchodilators
• Oral steroids
• Oxygen
• IV bronchodilators/steroids
What is viral induced wheeze
• Many pre-school children wheeze only in association with a viral illness
• Separate entity from atopic asthma
Management
• Salbutamol inhaler for relief of acute wheeze
• No evidence for use of steroids in prevention /management of simple viral induced wheeze
What is RDS and who does it affect
Preterm babies (unusual at term) Lack of surfactant
• Alveolar collapse and reduced gas exchange
• Tachypnoea, recession, grunting
Prevention
• Antenatal steroids if pre-term delivery likely
Treatment
• Surfactant (synthetic) via endotracheal tube
• Reduces mortality from RDS by 40%
• Non-invasive ventilation (preferred)
• Ventilation in more severe cases/extreme prematurity
• Try and minimise O2 requirements
What is Chronic lung disease in babies
• Requiring O2 beyond 28 days of birth
• Lung damage from artificial ventilation and oxygen toxicity
• CXR – widespread opacification and cystic changes
Management
• Home O2
• Steroids
• Diuretics (evidence lacking
