Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a self > Paeds ughhh > Flashcards

Paeds ughhh Flashcards

1
Q

What is Bronchiolitis and what is its epidemiology?

A

Inflammation and infection of the bronchioles caused by RSV.
Commonest serious respiratory infection in infancy
 Rare after the age of 1 y/o
 RSV is the cause in 80% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What examination signs might you find in a brochiolitic baby?

A

O/E hyperinflated lungs with a prominent sternum and downwardly displaced Liver, fine-inspiratory crackles, high-pitched wheeze heard louder on expiration and subcostal recession

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the presentation of Bronchiolitis?

A
  • Coryzal sx (runny nose, sneezing etc)
    *SIGNS OF RESPIRATORY DISTRESS (LEARN THESE)
    *Dyspnoea
    *Tachypnoea
    *Poor feeding
    *mild fever
    *Wheeze + crackles on ausc
    *Sometimes apnoea episodes(child stops breathing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of respiratory distress? (most imp thing!!!!!!!!!!!)

A

*Raised respiratory rate
*Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
*Intercostal and subcostal recessions
*Nasal flaring
*Head bobbing
*Tracheal tugging
*Cyanosis (due to low oxygen saturation)
*Abnormal airway noises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why might you need to admit a broncho baby?

A

Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis
50 – 75% or less of their normal intake of milk
Clinical dehydration
Respiratory rate above 70
Oxygen saturations below 92%
Moderate to severe respiratory distress, such as deep recessions or head bobbing
Apnoeas
Parents not confident in their ability to manage at home or difficulty accessing medical help from home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Mx of bronchiolitis?

A

 Supportive e.g. Humidified O2 via nasal cannulae, Fluids if needed, nasal suction
 Assisted ventilation e.g. nasal cannulae or CPAP may be needed
 Most infants recover within 2 weeks, some have a recurrent cough and wheeze
 To reduce the risk in pre-term infants, Palivizumab is given monthly IM
*Adequete food intake via NG, orally or IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can you give to at risk babies to prevent bronchiolitis?

A

To reduce the risk in pre-term infants, Palivizumab is given monthly IM.

*Palivizumab is a monoclonal antibody that targets the respiratory syncytial virus. A monthly injection is given as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ex-premature and those with congenital heart disease.
It is not a true vaccine as it does not stimulate the infant’s immune system. It provides passive protection by circulating the body until the virus is encountered, as which point it works as an antibody against the virus, activating the immune system to fight the virus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the paeds causes of Bacterial Pneumonia in different age groups?

A

Streptococcus pneumonia is most common
Group A strep (e.g. Streptococcus pyogenes)
*Group B strep occurs in pre-vaccinated infants, often contracted during birth as it often colonises the vagina.
Staphylococcus aureus.
H.influenzae - prevaccinated or unvaccinated children
Mycoplasma pneumonia, an atypical bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Viral causes of paeds pneumonia?

A

Respiratory syncytial virus (RSV) is the most common viral cause
Parainfluenza virus
Influenza virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ix for bacterial pneumonia?

A

*A chest xray is the investigation of choice for diagnosing pneumonia. It is not routinely required.
* Sputum cultures + throat swabs and viral PCR to establish organism and guide tx
*Ptx with sepsis -> Blood cultures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx of paeds pneumonia?

A

Newborns- co-amoxiclav
<5yo- amoxicillin + co-amox
>5yo- amox or erythromycin

Amoxicillin is often used first line. Adding a macrolide (erythromycin, clarithromycin or azithromycin) will cover atypical pneumonia. Macrolides can be used as monotherapy in patients with a penicillin allergy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of pneumonia in children?

A

Px with fever, respiratory distress, poor feeding, lethargy
 Chest, abdo or neck pain indicates pleural irritation and a bacterial cause
 Biggest clinical sign of Pneumonia is increased RR

*Bronchial breath sounds. These are harsh breath sounds that are equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
*Focal coarse crackles caused by air passing through sputum similar to using a straw to blow into a drink.
*Dullness to percussion due to lung tissue collapse and/or consolidation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you know briefly about the main things - Bronchectasis?

A

Permanent dilatation of the bronchi globally or restricted to 1 lobe (focal)
 Px with recurrent chest infections, productive cough (in adults there’s lots of sputum
production, children swallow it so not seen as much), haemoptysis
 Best investigation = High-res CT chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the characteristic imaging sign in bronchiectassis?

A

Signet ring sign - when looking at the bronchus and pulmonary artery, the bronchus > artery whereas they should be the same size or vessel > bronchus.

Can also get tram lines or honeycombing of dlated thickened bronchial walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes of bronchiectasis?

A

*CF
*Primary ciliary dyskinesia
*immunodeficiency: HIV, malignancy etc
*Chronic aspiration
*TB
*Foreign body (if focal and only one sided)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Primary ciliary dyskinesia?

A

Primary ciliary dyskinesia (PCD) is also known as Kartagner’s syndrome. It is an autosomal recessive condition affecting the cilia of various cells in the body. It is more common in populations where there is consanguinity.
PCD causes dysfunction of the motile cilia around the body, most notably in the respiratory tract. This leads to a buildup of mucus in the lungs, providing a great site for infection that is not easily cleared.
It also affects the cilia in the fallopian tubes of women and the tails (flagella) of the sperm in men, leading to reduced or absent fertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Kartagners triad?

A

Kartagner’s triad describes the three key features of PCD. Not all patients will have all three features. These are:

Paranasal sinusitis
Bronchiectasis
Situs Inversus - where all the internal (visceral) organs are mirrored inside the body. Therefore the heart is on the right, the stomach is on the right and the liver is on the left. Dextrocardia is when only the heart is reversed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the tx and mx of primary ciliary dyskinesia?

A

Mx with daily physiotherapy to clear secretions, prompt tx of infections with abx and ENT
follow-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Examination findings of CF?

A

O/E persistent loose cough with purulent sputum, hyperinflation of the chest, coarse
crepitations and/or inspiratory wheeze. With established disease there’s clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CF investigations?

A

 Sweat test - there’s abnormally high levels of Cl (60-125 mmol/L in comparison with 10-40 mmol/L in normal children)
 Testing faecal elastase - if it’s low = pancreatic insufficiency
 Testing for gene abnormalities
*Heel Prick test, days 5-9 in new borns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pathophysio of CF?

A

*Thick pancreatic and biliary secretions that cause blockage of the ducts, resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract
*Low volume thick airway secretions that reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections
*Congenital bilateral absence of the vas deferens in males. Patients generally have healthy sperm, but the sperm have no way of getting from the testes to the ejaculate, resulting in male infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What genes are affected in CF?

A

cystic fibrosis transmembrane conductance regulatory gene on chromosome 7.

23
Q

What are the px that you can get?

A

 Causes meconium ileus in 20% of infants because meconium is so thick - px with vomiting, abdo distension
and failure to pass meconium. Tx with enemas and surgery
 Causes recurrent chest infections, pancreatic enzyme deficiency, malabsorption and infertility
 Pancreatic insufficiency can px with steatorrhea, failure to thrive
 In a young child it can px with bronchiectasis, rectal prolapse, nasal polyp or sinusitis
 In an adolescent it can px with ABPA, DM, cirrhosis and portal hypertension, pneumothorax or sterility

24
Q

What colonisers do you need to be worried about in CF?

A

The key colonisers to remember for your exams are staph aureus and pseudomonas. Patients with cystic fibrosis take long term prophylactic flucloxacillin to prevent staph aureus infection. Pseudomonas should be remembered as a particularly troublesome coloniser that is hard to treat and worsens the prognosis of patients with cystic fibrosis.

25
Q

What is the mx of CF?

A

*2x daily physio
*treat infection with vigorous 14 day abx regime
* Anti-pseudomonal abx - flucloxacillin daily
*Oral pancreatic enzyme with meals
*High calorie diet (150%)

26
Q

Croup. What is it and what is it caused by?

A

Croup is an acute infective respiratory disease affecting young children. It typically affects children aged 6 months to 2 years, however they can be older. It is an upper respiratory tract infection causing oedema in the larynx. The classic cause of croup that you need to spot in your exams, is parainfluenza virus. It usually improves in less than 48 hours and responds well to treatment is steroids, particularly dexamethasone.

27
Q

Px of someone with croup?

A

Px with coryzal sx and fever initially for 12-48 hrs, then developing a barking cough, stridor and hoarseness
Sx worse at night

28
Q

How do you know if croup is moderate? or requires admission?

A

o Mild = just barking cough, no recession or stridor at rest
o Moderate = barking cough, stridor and intercostal recession at rest
o Severe = barking cough, stridor, intercostal recession, agitation, lethargy

29
Q

Mx of croup?

A

 Stat dose of Dexamethasone 0.15mg/kg PO
 If too unwell, 2mg nebulised Budesonide or IM Dexamethasone 0.6mg/kg are alternatives
 If there’s airway compromise - O2 and nebulised Adrenaline

30
Q

In what sect of the population should you be suspicious of epiglottitis?

A

You need to be extra cautious and have high suspicion in children that have not had vaccines. It can present in a similar way to croup, but with a more rapid onset. In you exams keep a lookout for an unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling and suspect epiglottitis.

31
Q

What is acute epiglottitis caused by? What is epi?

A

 Emergency
 Caused by Hib
 Most common in children aged 1-6 y/o
UNVACCINATED!!!!!

32
Q

What are the presenting signs of epiglottitis?

A

Very acute onset in comparison with Croup, px with high pyrexia (>38.5), toxic-looking child with an
extremely painful throat stopping them from speaking or swallowing
 O/E child sits upright, immobile, with an open mouth to optimise airway. Can see drooling and signs of
respiratory distress - Stridor, tripoding

33
Q

What investigation would you do in acute epiglottitis?

A

DO NOT DO ANYTHING!
THIS WILL ONLY AGITATE THE CHILD AND MAKE EVERYTHING WORSE and cause airway obstruction. REFER ON!!!!!!!!

For SBA’s: thumbprint sign on lateral neck xray

34
Q

What is mx of acute epi?

A

*Secure airway and urgent ITU referral - intubation or trache

 After air way is secured do blood cultures and tx with IV Abx e.g. Cefuroxime for 3-5 days
 Prophylactic Rifampicin offered to household contacts (same as all serious H influenzae infections)

35
Q

What causes tonsilitis?

A

Most common cause is viral (EBV).
Bacterial most common is Group A strep (streprococcus pyogenes - most common) then Strep pneumon in 2nd place

Other:
H.influenzae
Staph aureus

36
Q

What is a typical tonsillitis presentation?

A

A typical presentation is a child with a fever, sore throat and painful swallowing. Children aged 5 to 10 are most often affected, with another peak between ages 15 and 20.

Tonsillitis can present with non-specific symptoms, particularly in younger children. They may present with only a fever, poor oral intake, headache, vomiting or even abdominal pain.

Examination of the throat will reveal red, inflamed and enlarged tonsils, with or without exudates.

37
Q

What different scores are there for tonsilits?

A
  • Centor - Estimate likelihood of bacterial tonsillitis. score of 3 or more give abx
  • FeverPAIN- alternative to above: features of a bacterial one
38
Q

What is the FeverPAIN criteria?

A

Tonsillitis
The FeverPAIN score is an alternative to the Centor criteria. A score of 2 – 3 gives a 34 – 40% probability and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:

Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza

39
Q

What is the centor criteria?

A

The Centor criteria can be used to estimate the probability that tonsillitis is due to a bacteria infection, and will benefit from antibiotics.

A score of 3 or more gives a 40 – 60 % probability of bacterial tonsillitis, and it is appropriate to offer antibiotics. A point is given if each of the following features are present:

Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

40
Q

When should you prescribe abx in tonsillitis?

A

Consider prescribing antibiotics if the Centor score is ≥ 3 or the FeverPAIN score is ≥ 4

41
Q

What is the mx of bacterial tonsillitis?

A

Penicillin V (also called phenoxymethylpenicillin) for a 10 day course is typically first line. The trouble with penicillin V is it tastes bad, so young children requiring syrups are often reluctant to take it.
*alternative: Clarithromycin

42
Q

What is Quinsy?

A

Peritonsillar abscess (aka Quinsy), is a serious complication of Tonsillitis that’s usually unilateral

43
Q

What are the px sx of quinsy?

A

Px with severe pharyngitis, otalgia, dysphagia, trismus, “hot potato” voice, uvular deviation
 Halitosis, and a ‘toxic appearance’ e.g. irritability, fever, anxiety, inconsolable, poor eye contact, may be seen

44
Q

What organisms cause Quinsy?

A

Same as tonsillitis basically:
The most common organism is streptococcus pyogenes (group A strep), but it is also commonly caused by staphylococcus aureus and haemophilus influenzae.

45
Q

How would you dx and tx Quinsy?

A

Needle aspiration to dx
ENT team for incision and drainage of the abscess under general anaesthetic.
. A broad spectrum antibiotic such as co-amoxiclav would be an appropriate choice

46
Q

What is otitis media and what is it caused by?

A

Otitis media is the name given to an infection in the middle ear. The middle ear is the space that sits between the tympanic membrane (ear drum) and the inner ear. The bacteria enter from the back of the throat through the eustachian tube. A bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection.
The most common bacterial causes of otitis media, as well as other ENT infections such as rhino-sinusitis and tonsillitis is streptococcus pneumoniae.

47
Q

What is the presentation of otitis media?

A

ear pain, reduced hearing in the affected ear and general symptoms of upper airway infection such as fever, cough, coryzal symptoms, sore throat and feeling generally unwell.

When the infection affects the vestibular system it can cause balance issues and vertigo. When the tympanic membrane has perforated there may be discharge from the ear.

O/E:there’s a swollen, red bulging TM with loss of light reflection

48
Q

Mx of otitis media?

A

most cases of otitis media will resolve within 3 days without antibiotics, but it can last for up to a week. Complications (mainly mastoiditis) are rare. Simple analgesia for pain and fever.
Abx of choice: amoxicillin - 5 days
Consider prescribing antibiotics at the initial presentation in patients who have significant co-morbidities, are systemically unwell or are immunocompromised. Children less than 2 years with bilateral otitis media and children with otorrhoea (discharge) are more likely to benefit from antibiotics.

Consider a delayed prescription that can be collected and used after 3 days if symptoms have not improved or have worsened at any time. This can be useful with patients that are very keen on antibiotics or where you suspect they might get worse.

49
Q

What is glue ear?

A

Glue ear is also known as otitis media with effusion. The middle ear becomes full of fluid, causing a loss of hearing in that ear.

The Eustachian tube connects the middle ear to the back of the throat. It helps drain secretions from the middle ear. When it becomes blocked, this causes middle ear secretions (fluid) to build up in the middle ear space.

50
Q

Presentation of glue ear?

A

px with hearing loss, without pain or fever
 Most common cause of hearing impairment in children (mostly aged 2-5 y/o)
 Usually seen in winter, following an episode of AOM in over 50% of cases

51
Q

Mx of glue ear?

A

Referral for audiometry to help establish the diagnosis and extent of hearing loss. Glue ear is usually treated conservatively, and resolves without treatment within 3 months. Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets (Grommets are tiny tubes inserted into the tympanic membrane by an ENT surgeon. This allows fluid from the middle ear to drain through the tympanic membrane to the ear canal. )

52
Q

What are the sx of foreign body inhalation?

A
  • Coughing
  • Gagging
  • Choking
  • Inspiratory stridor
    *Drooling
    CXR -> Shows obstruction mist of the time
53
Q

What is Laryngomalacia? When would you suspect and how would you tx?

A

Congenital abnormality of laryngeal cartilages and is the most common cause of noisy breathing in children.
Suspect in a child who is well with noisy breathing and inspiratory stridor.
Laryngoscopy or brnchoscopy to duagnose
Tx - resolves on its own usually in about 2 years after sx develop few weeks after birth so keep an eye out, If putting on weight or issues feeding or breathing Nasopharyngolaryngoscopy

54
Q

What is a neonate?

A

4 weeks old

3a self (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions