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MK SR INDEX CASES CHILD HEALTH > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Aetiology of bronchiolitis

A
  • It is the commonest serious infection in infancy
  • Cause of the winter epidemic in UK
  • Age
  • Younger the age, more severe the disease
  • Can present as apnoea in babies under 4 months • Rare after the age of 1
  • Aetiology
  • RSV–80%
  • meta-pneumovirus, adenovirus and mycoplasma pneumoniae
  • Dual virus infection – more severe disease
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2
Q

What are the clinical features of bronchiolitis?

A
  • coryzal prodrome lasting 1 to 3 days, • followed by persistent sharp cough
  • Increased work of breathing
  • Hyperinflation of chest
  • Fine end inspiratory crackles • High pitched wheeze
  • Tachycardia
  • Cyanosis or pallor
  • Feeding difficulty • How to assess
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3
Q

How to assess severity of bronchiolitis

A

3 groups of factors
• Risk factors that predict severe disease • Ability to care at home
• Features that reflect severity

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4
Q

Features that reflect severity of bronchiolitis

A
  • Apnoea (observed or reported)
  • Hypoxia
  • Persisting severe respiratory distress
  • Inadequate oral intake (50-75% of usual volume, use clinical judgement)
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5
Q

Outline supportive management of bronchiolitis

A
  • Good hand hygiene
  • Good nursing care
  • Pulse oximetry and monitor for apnoea
  • Humidified Oxygen
  • Nasal prongs
  • Humidified high flow oxygen (AIRVO)
  • No medications
  • Feeds and fluids
  • Supplement feeds by nasogastric tube • Consider intravenous fluids
  • Severe patient
  • Assisted ventilation – CPAP or ventilation
  • Further tests such as Blood gas, Chest Xray
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6
Q

Prognosis of bronchiolitis

A
  • Most infants recover within 2 weeks
  • Upto half of infants may have recurrent episodes of cough and wheeze • Very, very rarely babies may develop bronchiolitis obliterans
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7
Q

Prevention of bronchiolitis

A

Prevention
• Monoclonal antibody to RSV
• Expensive and monthly injections

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8
Q

How to safely discharge a child with bronchiolitis ?

A
  • Key safety information (written)
  • how to recognise developing ‘red flag’ symptoms:
  • worsening work of breathing (for example grunting, nasal flaring, marked chest recession)
  • fluid intake is 50–75% of normal or no wet nappy for 12 hours
  • apnoea or cyanosis
  • exhaustion
  • that people should not smoke in the child’s home because it increases the risk of more severe symptoms in bronchiolitis
  • how to get immediate help from an appropriate professional if any red flag symptoms develop
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9
Q

6 month infant with cough and noisy breathing: Differential diagnosis

A
  • Pneumonia
  • Recurrent wheeze
  • Other possibilities
  • Recurrent aspiration
  • Cystic fibrosis
  • Foreign body
  • Pertussis
  • Beware of other illnesses
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10
Q

Half of all children wheeze at some point. What are the 3 patterns of wheezing?

A
  • Viral episodic wheeze

* Multiple trigger wheeze – likely to develop into asthma over time • Asthma

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11
Q

What are the characteristics of Virus episodic wheeze

A
  • Commonest type
  • Due to small airways – more likely to narrow and obstruct • Aberrant response to viruses
  • Episodic nature triggered by viral colds
  • They have reduced small airway diameter from birth
  • Risk factors
  • Maternal smoking during/after pregnancy
  • Prematurity
  • Family history of asthma or allergy – Not a risk factor
  • Commoner in males
  • Resolves by 5 years of age
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12
Q

What are the characteristics of Multiple trigger wheeze

A
  • Both preschool and school age children affected • Frequent wheeze triggered by many stimuli
  • Viruses, cold air, animal dander, exercise
  • In preschool children this label is useful • More likely to respond to steroid inhalers • More likely to develop asthma
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13
Q

What are the characteristics of Atopic asthma

A
  • Usually in school age children
  • Recurrent wheezy episodes
  • Symptoms in between - interval symptoms
  • Evidence of allergy to inhaled allergens • House dust mite, pollen, pets
  • Evidence of allergy
  • Positive SPT; raised IgE
  • Strongly associated with eczema, rhinoconjunctivitis, food allergy • Family history of atopic disease present
  • Small number have non-atopic asthma
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14
Q

Causes of recurrent / persistent wheezing in children

A 
Asthma 
• Chronic aspiration
• Recurrent anaphylaxis
• Cystic fibrosis
• Bronchopulmonary dysplasia (CLD of infancy) • Tracheo-bronchomalacia
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15
Q

Clinical features of asthma

A
  • Symptoms worse at night and early in the morning • Symptoms that have nonviral triggers
  • Exercise, pets, dust, cold air, emotions • Interval symptoms
  • Between acute exacerbations
  • Personal or family history of atopic disease • Positive response to therapy
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16
Q

How to asses Pattern and severity of asthma

A
  • Frequency of acute symptoms
  • GP visits, hospital admissions, oxygen therapy
  • What triggers asthma
  • Sport and general activities
  • How often is sleep affected
  • How severe are the interval symptoms
  • Frequency of bronchodilator use • How much school is missed
17
Q

signs on Examination of a child with asthma

A

chest usually normal
• Rarely hyperinflated chest, polyphonic wheeze, prolonged expiration • Harrison’s sulci
• Evidence of eczema, rhinitis • Check growth
• Presence of a wet cough or sputum production , clubbing or poor growth – other conditions suspected

18
Q

Investigations for asthma

A

• Diagnosed from history and examination
• Parental description of symptoms and response to treatment is
most important in diagnosis
• Tests
• Skin prick tests to diagnose atopy and aid avoidance measures • Chest X-ray may be considered
• Tests to explore severity
• Symptom diary
• Spirometry
• Peak expiratory flow rates (PEFR) diary
• Response to treatment helpful

19
Q

findings on spirometry in asthma

A
  • Forced expiratory volume in 1 sec (FEV1)
  • Blowing out as hard and as fast as possible
  • Measure of air flow through large airways to bronchioles
  • Response to bronchodilator • 12% improvement in FEV1
  • PEFR
  • Less sensitive to changes, but portable
  • Increased variability
  • Diurnal and day to day
20
Q

Inhaled corticosteroids (preventers) side effects

A
  • Side effects
  • No clinically significant side effects when used in low doses
  • Can cause a mild reduction in height velocity – catch up occurs in late childhood
  • Systemic side effects with high doses - impaired growth, adrenal suppression, affects bone metabolism
  • Most children require ‘very low dose inhaled steroids’
21
Q

Add-on therapy for asthma in children

A
  • Under 5 years of age
  • Oral leukotriene receptor antagonist – montelukast
  • Over 5 years of age
  • Long acting bronchodilator (LABA)
  • In addition – montelukast
  • Slow release oral theophylline • High incidence of side effects
  • Oral prednisolone (alternate days)
  • Anti-IgE therapy (injectable) - omalizumab • Antibiotics no value
  • Antihistamines, nasal steroids for rhinitis
22
Q

Definition of respiratory distress

A

• When the child is unable to obtain adequate oxygenation despite significant efforts to breathe
• The normal gas exchange is impaired and this leads to increased effort and reduced efficacy
• OR
state characterised by increase in rate and /or effort of breathing
• A subjective difficulty in breathing

23
Q

Features of respiratory distress

A
  • Dyspnoea
  • Tachypnoea
  • Chest wall retraction
  • Nasal flaring
  • Sternal recession and head bobbing
  • Other system manifestations • Cardiovascular
  • Central nervous system
24
Q

Causes in upper airway of stridor

A
  • Croup
  • Epiglottitis
  • Bacterial tracheitis
  • Foreign body inhalation
  • Trauma and thermal injury
25
Q

what is croup?

A
  • Acute laryngotracheobronchitis
  • Acute laryngeal and sub glottic stenosis • Causes – viruses
  • Age 6 months to 6 years
  • Peak incidence – second year
  • Perinatal history and intubation at birth
26
Q

Basic management of croup

A
  • Treatment at home
  • When to admit to hospital
  • Reduce anxiety by being calm and organised
  • Do not move the child from the mother
  • observe carefully for signs of hypoxia or exhaustion • Do not examine the throat with a spatula
27
Q

management of croup

A
  • Steroids beneficial
  • Dexamethasone and nebulised budesonide • Takes 90-120 minutes to work
  • If severe
  • Nebulised adrenaline
  • Watch for rebound of symptoms
  • If deteriorating call for urgent senior help • When to discharge
  • Safety netting advice
28
Q

Management of epiglottis

A
  • Life threatening emergency
  • Urgent admission
  • Senior Anaesthetist, Paediatrician and ENT surgeon summoned • Intubated
  • Blood culture and antibiotics
29
Q

How does Bacterial tracheitis present and what is the management?

A 
• Bacterial tracheitis
• Appears toxic
• Harsh stridor
• Copious thick secretion • Staph. aureus
Management
IV antibiotics

MK SR INDEX CASES CHILD HEALTH (24 decks)

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