Paeds: Respiratory medicine

Question 1

Harrison’s sulcus. Indicates?

Answer 1

Asthma

Question 2

Most common causative agent of bacterial pneumonia in the child?

Answer 2

Streptococcus pneumoniae

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Other common causes would be Mycoplasma pneumonia or Chlamydia pneumoniae.

Although RSV is a common cause of respiratory symptoms in children, bronchiolitis usually affects children before the age of 2.

Haemophilus influenza and Bordetella pertussis are less likely causative agents in children who are immunised and not immunocompromised.

Legionella pneumophila can cause significant pneumonia it is unlikely to be found in a child of this age.

Question 3

Key points of pneumonia management in children?

Answer 3

Amoxicillin is first-line for all children with pneumonia

Macrolides may be added if there is no response to first line therapy

Macrolides should be used if mycoplasma or chlamydia is suspected

In pneumonia associated with influenza, co-amoxiclav is recommended

Question 4

Most common cause of stridor in infants?

Answer 4

Laryngomalacia

Question 5

Child aged < 5 years with asthma not controlled by a SABA + paediatric low-dose ICS. Next step in management?

Answer 5

dd a leukotriene receptor antagonist (LTRA)

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SABA: Short Acting Beta Antagonists

ICS: Inhaled Corticosteroids

Children aged 5-16 with asthma are now managed in a very similar way to adults

Question 6

Features:

• Coryzal symptoms (including mild fever) precede:
• Dry cough
• Increasing breathlessness
• Wheezing, fine inspiratory crackles (not always present)
• Feeding difficulties associated with increasing dyspnoea (Often the reason for hospital admission)

Most likely diagnosis?

Answer 6

Bronchiolitis

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NB: Croup, epiglottis, viral induced wheeze. They could be similar presentations.

Question 7

A 9-month-old boy presents to the paediatric emergency department with a fever and dry cough for 2 days. He was born 2 weeks premature and has no other significant past medical history. His temperature is 38.6ºC, heart rate is 110 beats per minute and respiratory rate is 45 breaths per minute. On examination, you find tachypnoea, a wheeze on auscultation and nasal flaring. No rash is noted and no abnormalities have been noted upon ear and throat examination.

Normal values of vital signs for children under 1 year are below:
Heart rate 110-160 beats per minute
Respiratory rate 30-40 breaths per minute
Systolic blood pressure 70-90 mmHg
Rectal temperature 36.6°C–37.5°C

What treatment would be recommended for this patient?

Answer 7

Supportive measures, such as maintaining oxygenation and hydration

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This is most likely bronchiolitis as the child was born prematurely, has a low-grade fever and a wheeze on auscultation