Passmedicine Questions Flashcards
What is bronchiolitis?
A condition characterised by bronchiolar inflammation
What is the most common pathogen causing bronchiolitis?
RSV
What is the most common LRTI in <1 year olds?
Bronchiolitis
What are the less common causes of bronchiolitis?
Mycoplasma, adenoviruses
NB there may be a secondary bacterial infection
When does bronchiolitis become more serious?
If the child has bronchopulmonary dysplasia (e.g. premature), congenital heart disease or CF
What are the features of bronchiolitis?
Coryzal + mild fever precede:
- Cough
- Increasing SoB
- Wheezing, fine inspiratory crackles
- Feeding difficulties assoc. w. dyspnoea
When does NICE recommend immediate referral for a child with bronchiolitis?
If they have any of the following:
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- central cyanosis
- persistent oxygen saturation of less than 92% when breathing air
When should clinicians consider a referral to hospital in bronchiolitis?
RR >60
Difficulty breastfeeding/inadequate oral fluid intake
Clinical dehydration
What investigations can you do for bronchiolitis?
Immunofluorescence of nasopharyngeal secretions may show RSV
How do you manage bronchiolitis?
Humidified O2 if sats <92%
NG feeding if cannot take fluid/feed by mouth
Suction sometimes used for excessive upper airway secretions
What kind of vaccine is the rotavirus?
Oral, live attenuated
How is the rotavirus vaccine given?
Orally
2 doses - one at 2 months and the second at 3 months
After what age can the rotavirus vaccine not be given after?
1st dose cannot be given after 14 weeks + 6 days
2nd dose cannot be given after 23 weeks + 6 days
Due to theoretical risk of intussception
At what age is a child presumed to be capable of consent?
16
Below the age of 16 how can a child consent?
If they are deemed capable of understanding what is involved in the decision
Can a child who is competent to consent and has refused treatment be overridden?
A parent/the court my be able to authorise investigations/treatment that are in the child’s best interests
What is Fraser’s competency?
Patients under the age of 16 can receive contraceptive advice if the young person:
- understands the professional’s advice
- cannot be persuaded to inform their parents
- is likely to begin, continue having sex with or without contraceptive
- unless they receive contraception, their mental and/or physical health are likely to suffer
- their best interests require them to receive contraceptive advice with or without parental consent
Who is croup mostly seen in ?
Infants and toddlers
What are the features of croup?
Barking cough
Stridor (due to laryngeal oedema and secretions)
What is causes croup?
Parainfluenza virus
What signs will you see in early shock?
Normal BP, tachycardia, tachypnoea, pale or mottled extremities, reduced urine output
What signs will you see in late shock?
Hypotension, bradycardia, Kussmaul breathing, blue peripheries, absent urine output
In early compensated shock how is the BP maintained?
By an increased HR and RR, redistribution of blood from venous reserve volume + diversion of BF from non-essential tissues
What is the most common cause of GE in children in the UK?
Rotavirus