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Paeds Written - RESP Flashcards

1
Q

MILD CROUP Features

A

Occasional barking cough
No stridor
No sternal/intercostal recessions at rest
Happy child - eats, drinks, plays

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2
Q

Factors that may impact decision to admit child with Croup?

A

Moderate (or above) illness severity

Mild illness but other concern:

  • age <3 months
  • chronic lung disease
  • congenital heart disease
  • neuromuscular disorder
  • immunodeficiency
  • poor fluid intake/wet nappies
  • long distance to healthcare
  • concerns re: parents coping
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3
Q

Signs of impending respiratory failure in croup

A 
Asynchronous chest wall movements
Fatigue
Pallor/cyanosis
RR > 70
Tachycardia
Decreased consciousness
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4
Q

Most important Tx for croup

A

Single dose oral dexamethasone 0.15mg/kg

  • can be repeated after 12 hours
  • prednisolone is alternative
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5
Q

Croup Signs & Sx

A 
Wheeze
Dry cough
Coryzal Sx
Poor feeding
dyspnoea
?resp distress

O/E: fine, bi-basal, end expiratory crackles

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6
Q

Factors that may require hospital admission in child with bronchiolitis?

A

Resp distress

  • head bobbing
  • tracheal tug
  • acc muscle use
  • nasal flaring
  • high RR, cyanosis

Poor fluid intake
Grunting
Apnoea
Sp <90-92% on room air

+ lower threshold if <2 months OR existing disease

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7
Q

What bronchiolitis-causing agent requires PICU care?

A

Human meta-pneumovirus

Rare though

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8
Q

Acute asthma / VIW management pathway

A

1a. O2 + Burst therapy
- Salbutamol nebs / MDI with spacer
- + ipratropium bromide

1b. + 1 x oral prednisolone (give early as takes 4-6 hrs)

INVOLVE SENIOR after burst therapy not working

  1. IV bolus of: Mag Sulph, Salbutamol, Aminophylline (monitor ECG - can cause arrhythmia)
  2. IV infusion (same as above)
  3. Intubation + ventilation
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9
Q

Requirements for discharge in acute asthma/VIW

A

Stable on 4 hourly SABA (salbutamol)
peak flow 75% of best/predicted
Sats >94%

Attend follow up with GP within 2 days

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10
Q

Chronic asthma stepwise Tx (in 5-16 yo)

A
  1. SABA
  2. if not controlled (or presents with Sx 3x/week +) –> SABA + low dose ICS
  3. SABA + low dose ICS + LRTA
  4. SABA + low dose ICS + LABA (stop LRTA if no benefit - unlike in adults)
  5. SABA + MART (incl low dose ICS)
  6. SABA + mod dose MART (or separate mod dose ICS + LABA)
  7. SABA + 1 of:
    - high dose ICS (separate or part of MART)
    - trial of theophylline
    - asthma specialist advice!
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11
Q

Chronic asthma stepwise Tx in under 5s

A
  1. SABA
  2. IF Sx not controlled or new Dx with Sx 3x/week + –> SABA + 8 week trial mod dose ICS
  3. Review + if consistent with asthma (ie. Sx resolved then recurred within 4 weeks) –> SABA + low dose ICS
  4. SABA + low dose ICS + LTRA
  5. Seek specialist help + stop LTRA
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12
Q

Epiglottitis Tx

A

Contact on call Paeds / ENT / Anaesthetist for urgent review + admission

IV dexamethasone

Blood cultures + empirical Abs - cefuroxime

+ Rifampicin for close household contacts

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13
Q

Nutritional support in CF

A

High calorie + high fat diet

Fat soluble vitamins (ADEK)

Pancreatic enzyme replacement - Pancreatin, CREON?

Overnight gastrostomy tube if diet insufficient

Regular glucose monitoring for possible DM

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14
Q

Mucolytics used in CF

A

1st line = rhDNase (or inhaled mannitol dry powder if too young)

2nd line = rhDNase + nebulised hypertonic saline

Lumacaftor / Ivacaftor (Orkambi)

  • for delta F508 mutation patients
  • Lumacaftor increases CFTR protein transported to surface
  • Ivacaftor potentiates CFTR at surface –> increased opening
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15
Q

Acute otitis media Abx

A

1st line = amoxicillin 5 days

If penicillin allergic: erythromycin, clarithromycin

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16
Q

Indications for immediate Abx in acute otitis media

A

Immediate script if <2 years old or systemically unwell

OR acute otitis media with perforation (also review within 6 weeks to ensure healing)

17
Q

Otoscopy findings in acute otitis media

A

bright red bulging tympanic membranes
loss of normal light reaction
perforation
pus

18
Q

Otoscopy findings in glue ear (otitis media with effusion)

A

eardrum is dull and retracted

often a fluid level visible

19
Q

Modified CENTOR criteria for bacterial pharyngitis

A 
o	Exudate/swelling on tonsils			
o	Tender/swollen anterior cervical lymph nodes	
o	Temperature >38C				
o	Cough absent 					
o	Age 3-14yo (-1 if age ≥45yo)			
1 = 5-10% chance GAS, no ABx
2 = 11-17% chance GAS, rapid strep test
3 = 28-35% chance GAS, rapid strep test
4 = 51-53% chance GAS, ABx + strep test
5 = 51-53% chance GAS, ABx + strep test

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