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Paediatrics - Buzz Words > Resp > Flashcards

Resp Flashcards

1
Q
  • I cause breathlessness, tight chest, Wheeze
  • I cause Dinural symptoms
  • I cause response to allergens, asprin and beta blockers
  • I cause Atopy
  • When I am chronic i cause severe Harrison’s sulcus - Funnel chest

What am I?.

A
  • Asthma
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2
Q

How am I Investigated?

A
  • Spirometry with a bronchodiolator reversibilty
  • FeNo - Detects imflammation in the lungs
  • Peak flow
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3
Q

How am I managed in Children >17?

A
  1. SABA (Salbutamol)
  2. Add ICS (Beclomethasone Dipropionate)
  3. Add LTRA (Montelukast)
  4. Add LABA (Salmeterol) + ICS (+/- LTRA)
  5. Swich to MART Therapy Combination which has low dose ICS
  6. Either continue MART with Moderate ICS or change to Fix ICS + LABA with SABA therapy
  7. Specialist supervison with High dose ICS
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4
Q

Management in children Under 5

A
  1. 8 Week trial of Paediatric moderate ICS (If uncontroleld with SABA & Causign symptoms)
  2. If symptoms resolved then restarted - 4 week trial ICS again
  3. Uncontrolled asthma is Low dose ICS and LTRA
  4. Specialist
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5
Q

I typically affect children under 3
They get signs of fever & Coryzal Symptoms.
-They eventually get Wheezy

What am I?

A

Viral Induced Wheeze

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6
Q

How am I Treated?

A

Treated like an acute asthma attack.

  • Moderate: Nebulised Beta 2 agonist, Nebulised Ipratropium (LABA), Steroids: Oral Prednisolone or IV hydrocortisone

Severe: O2 If less than 94 to maintain 94-98, Aminophylline, IV salbutamol

Life threataning: IV Magnesium sulphate, Admission to ICU, Intubation

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7
Q

How do you grade Asthma Severity?

A

Moderate: PEFR: 50 - 75% Predicted

Severe: PEFR: 33-50%, >25 RR, HR >110, Unable to complete sentences

Life Threatening: PEFR: <33%, O2 <92%, Becoming tired, No Wheeze (Silent chest), Haemodynamically unstable

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8
Q

I cause Bronchiolar inflammation
Caused by RSV
I affect 1-9 months with 3-6 being my target months
I provide Coryzal Symptoms, Dry cough, Wheezing, Feeding difficulties and sometimes fine crackels.

WHAT AM I?

A

BRONCHOLITIS

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9
Q

How do you find out what I am?

A

Immunofluoresence of Nasopharyngeal RSV Positive

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10
Q

What is the requirement for sending me to emergency (Bronchiolitis)

A
  1. Resp rate over 60
  2. Apnoea
  3. Child looks unwell, Central cyanosis
  4. Chest recession
  5. O2 less than 92%
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11
Q

Bronchiolitis management

A
  1. If child is not in critical condition, It is self limiting condition, analgesia, Paracetamol (Calpol) fluids. Check nightly for fever/distress
  2. Humidified oxygen Head box for children with less than <92
  3. Nasogastric feed if child cannot take fluids
  4. Suction for excess secretions.
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12
Q

I cause the following:

  • Stridor
  • Barking cough worse at night
  • Seal like cough
  • Fever
  • Coryzal symptoms

WHAT AM I?

A

CROUP

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13
Q

What Virus am I caused by?

A
  • PARAINFLUENZA
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14
Q

How do you categorise Croup for medical emergencies?

A
  1. Mild - No Barking, Stridor, or signs of Intercostal recession, Child is happy to eat and drink.
  2. Moderate - Frequent Bark cough, Audible stridor, chest retraction at rest, not in agitation or stress, Child can be alert and interested in sounds
  3. Severe - Frequent bark cough, Prominent chest recession, significant distress, lethargic and restless (Hypoxemia), Tachycardic.

(Moderate and Severe require hospital admission, less than 6 months or with other conditions)

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15
Q

How do you identify Croup?

A
  • Chest X ray - Subglottic narrowing - Steeple line, Narrow Larynx
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16
Q

How do you manage Croup?

A
  1. Oral dexamethasone 0.15mg/kg single dose. Prednisolone alternative.
  2. Emergency: High flow oxygen, nebulised Adrenaline
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17
Q

I cause the following:

  • Fever
  • Resp rate of 60 breaths per min
  • Increased work of breathing.
  • Crackles in chest
  • Cyanosis
  • Grunting and chest drawing
A
  • Pneumonia
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18
Q

How do you manage me (pneumonia)?

A
  1. Emergency situation: Supplementary O2 if less than 92%
  2. Amoxicillin
  3. Macrolides if chlamydia or mycoplasma suspected (cold like pneumonia symptoms)
  4. Influenza pneumonia : Co amoxiclav
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19
Q

Which pathogen is most associated with Child Pneumonia?

A

S.pneumoniae - common bacterial agent

RSV (Respiratory Syncytial Virus)

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20
Q

I cause the following:

  • Dull percussion
  • Reduced tactile fremitus
  • Asymmetrical chest expansion
  • Diminished or delayed expansion
  • Usually caused during or after a chest infection like pneumonia

WHAT AM I?

A

PLEURAL EFFUSION

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21
Q

How do you know what I am (Pleural Effusion)

A
  1. CRX
  2. Ultrasound - Identify where successful aspiration - Most common investigation
  3. Ct investigate underlying cause
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22
Q

How do you Investigate me? (Pleural effusion)

A
  1. 21G needle & 50ml Syringe (Sent for protein, PH, LDH)
  2. Light criteria:
    Exudate have protein level more >30g/L.
    Transudate have protein level of <30g/L

If protein is between 25 - 35g/L Use light criteria to determine EXUDATE:

  • PFP/ SP >0.5
  • PFP/Serum LDH >0.6
  • Pleural fluid is 2 thirds upper limit normal serum LDH
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23
Q

Which other conditions cause me (Pleural Effusion)

A
  • Rheumatoid arthritis, Tuberculosis(Low glucose)
  • Pancreatitis (Raised amylase)
  • Pulmonary embolism, Tuberculosis (Blood staining)
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24
Q

How do you manage me (Pleural Effusion)

A
  1. Aspiration
  2. Pleurodesis (Medical talc)
  3. Pleural catheter (to drain)
  4. Opioids - relieve dyspnoea
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25
Q

I cause the following:

  • I cause very fast symptoms
  • High temperature
  • I make your patient very unwell
  • Stridor
  • Excessive drooling of saliva
  • I cause a tripod position - leaning forward and extended neck

WHAT AM I?

A

ACUTE EPIGLOTTITIS

26
Q

What pathogen am I caused by? (Acute epiglottitis)

A
  • Haemophilius Influenzae type B (Bacterial)
27
Q

What signs do I show in my investigations (Acute Epiglottitis)?

A
  • Thumb sign of the epiglottis - CXR
28
Q

How do you manage me (Acute Epiglottitis)?

A
  1. Senior management (anesthesiologist) for endotracheal intubation
  2. Do not examine, can cause worsening
  3. Oxygen and IV antibiotics
29
Q

I cause the following:

  • Sudden Onset stridor
  • Fever
  • Respiratory distress
  • Follows after viral like infection where they are recovering then become worse.

WHAT AM I?

A
  • BACTERIAL TRACHEITIS
30
Q

What am I caused by? (Bacterial Tracheitis)

A

S.aureus

31
Q

How am I Managed? (Bacterial tracheitis)

A
  • Supportive measure
  • O2 or intubation
  • IV antibiotics - Flucloxacillin
32
Q

I cause the following:

  • 2 - 3 days of coryzal symptoms
  • Coughing bouts worse at night and after feeding leading to vomiting
  • Episodes of apnea (Breath holding)
  • ## Persistent coughing (Whooping sound)
A

PERTUSSIS (WHOOPING COUGH)

33
Q

What pathogen am I caused by? (Pertussis)

A

BORDETELLA PERTUSSIS

34
Q

How am I diagnosed (Pertussis)

A
  • Nasal swab

- PCR and Serology

35
Q

How do you manage me?

A
  1. Notifiable disease
  2. Clarithromycin (Oral Macrolide)
  3. 21 days to eradicate organism and school exclusion 48 hours using antibiotic treatment
  4. Antibiotic prophylaxis for the family members
36
Q

I cause the following:

  • Auto Recessive genetic disorder
  • I increase viscosity of lung and pancreas secretions
  • CFTR defect is what causes this condition which regulates cAMP sodium channel
  • Newborns experience meconium ileus (Thicker)
  • Recurrent chest infections
  • Malabsorption - Steatorrhoea
  • Stunted growth

WHAT AM I?

A

CYSTIC FIBROSIS

37
Q

How am I Investigated?

A
  • Newborn pin prick heel test
  • Sweat chloride test - Abnormally high chloride
  • Normal value <40 mEql, CF: >60 mEql

Patient may experience false positive test due to skin oedema hypoalbuminaemia/ hypoproteinaemia

Some causes: Malnutrition, G6PD, Glycogen storage disease

38
Q

How am I managed? (Cystic fibrosis)

A
  1. Lung physiotherapy twice daily, including breathing exercises. Postural drainage (Laying head down or legs up)
  2. High calorie and fat diet, slightly additional salt intake
  3. Minimise contact to reduce Burkholderia cepacia
  4. Vitamin supplication, Pancreatic enzyme supplements with meals
  5. Lung transplant if recurrent infection is present.
39
Q

I cause the following:

  • Usually due to a a chest disease or trauma
  • I cause sudden symptoms
  • Dyspnoea, Pleuritic chest pain, Sweating, Tachypnoea, Tachycardia.
A

PNEUMOTHORAX

40
Q

How am I managed? (Pneumothorax)

A
  • If rim air is more than >2 cm and patient is short of breath, insert chest drain
  • Inserted 2nd intercostal space, midclavicular line
41
Q

I cause the following:

  • I usually develop soon after birth
  • Usually noticed with first active viral infection
  • Stridor on inspiration only with high pitched sound.
  • Symptoms are more prominent in feeding or laying back
  • I show severe symptoms in 8-12 months

WHAT AM I?

A

LARYNGOMALACIA (FLOPPY LARYNX SYNDROME)

42
Q

How am I managed? (Laryngomalacia)

A
  • Tracheostomy
  • Excision of redundant mucosa
  • Laser division of the aryepiglottic folds.
43
Q

I cause the following:

  • Symptoms starts or are triggered by allergens
  • I cause severe life threatening hypersensitivity symptoms
  • Swelling of the tongue, throat, Respiratory wheeze, Hypotension, tachycardia
A

ANAPHYLAXIS

44
Q

How am I managed. (Anaphylaxis)

A

> 6 months : 100 - 150 mg

6 months - 6 years: 150mg

6-12 years: 300mg

adult and child >12: 500mg

Repeated every 5 mins IM injection anterolateral aspect of the thigh. Till reaction calms down

45
Q

I cause the following:

  • Sore throat
  • Dysphagia
  • Malaise (discomfort)
  • Pharyngeal mucosa reddened

WHAT AM I?

A

ACUTE PHARYNGITIS

46
Q

How am I managed? (Acute Pharyngitis)

A
  1. Analgesia Paracetamol & Nsaids

2. Usually resolves in 7 -14 days (Antibiotics not recommended)

47
Q

I cause the following:

  • Swelling with white exudate in the back of the throat
  • I cause fever, sore throat, tender cervical chain lymphadenopathy.

WHAT AM I?

A

ACUTE TONSILLITIS

48
Q

How do you assess me if I need to be treated with Antibiotics?

A

FeverPAIN SCORE - Score of 4/5 likely antibiotic treatment

49
Q

How do you manage me? (Acute Tonsillitis)

A

First line >18: Phenoxymethylpenicillin 500mg 4 times a day or 1000mg 2 times a day - 5 - 10 times a day

Alternative if allergic: Clarithromycin 250mg to 500mg twice a day for 5 days

Pellicin allergy in pregnancy: Erythromycin 250mg to 500mg 4 times a day

50
Q

Acute tonsillitis management in children

A

1.Phenoxymethylpenicillin:

1 month to 11 months- 62.5 mg four times a day or 125 mg twice a day for 5 to 10 days

1 year to 5 years - 125 mg four times a day or 250 mg twice a day for 5 to 10 days

6 years to 11 years - 250 mg four times a day or 500 mg twice a day for 5 to 10 days

12 years to 17 years - 500 mg four times a day or 1,000 mg twice a day for 5 to 10 days

Clarithromycin

  • 8kg: 7.5mg/kg twice daily
  • 9-11kg: 6.25mg/kg twice daily
  • 12-19kg: 125mg twice daily
  • 20 -29kg: 187.5mg twice daily
  • 30 - 40kg: 250mg twice daily
  • 12 - 17 years: 250mg twice daily, increase to 500mg severe infection
51
Q

i cause the following:

  • Middle ear inflammation
  • Sudden pain and fever
  • Inflamed bulging eardrum, purulent discharge
  • I present sometimes after a URTI

WHAT AM I?

A

OTITIS MEDIA

52
Q

How do you manage me (Otitis Media)

A
  • Self limiting within 3 days but can last a week
  • Amoxicillin for 5 days if TM perforated
    If discharge is in the ear >4 days or less than 2 years of age
53
Q

I cause the following:
- Inflammation on the external ear
- I can be Acute <3 weeks or Chronic > 3 months
- Itchy and painful external ear
- Localised OE: Folliculitis, swelling with yellow centre
Diffused OE: widespread scaly
Malignant OE: discharge, hearing loss, tissue destruction due to severe P.aeruginosa

WHAT AM I ?

A

OTITIS EXTERNA

54
Q

How do you manage me? (Otitis Externa)

A

Localised OE: Self limiting may need antibiotic for cellulitis fever or drainage acetic acid 2% ear drops or spray

DIffused OE: Oral antibiotics like Oral Flucloxacillin, Topical antibiotics Gentamicin and or corticosteroid Prednisolone (Otomize)

Malignant OE: Ciprofloxacin IV

55
Q

I cause the following:

  • Facial pain
  • Frontal forward pressure when leaning forward
  • Thick and purulent discharge
  • Nasal obstruction

WHAT AM I?

A

SINUSITIS

56
Q

What pathogen causes me? (Sinusitis)

A
  • S.pneumoniae

- Haemophilus influenzae and rhinoviruses

57
Q

How do you manage me? (Sinusitis)

A
  1. Usually caused by virus takes 2-3 weeks to resolve. Analgesia can be used paracetamol & Ibuprofen
  2. Symptoms >10 prescribe nasal corticosteroid 12 years and >: Mometasone x2 daily
  3. Antibiotics:
    1st line: >18 years phenoxymethylpenicillin 500mg x4 daily for 5 days.

2nd line: Co-amoxiclav 500/125 mg three times a day for 5 days

3rd line: Doxycycline 200 mg on the first day, then 100 mg once daily for 4 days or Clarithromycin 500mg x4 daily for 5 days

4th line: Erythromycin 250 mg to 500 mg four times a day

58
Q

How do you manage me in children? (Sinusitis)

A

Prescribe
Phenoxymethylpenicillin first-line:
1 to 11 months: 62.5 mg four times a day for 5 days.
1 to 5 years: 125 mg four times a day for 5 days.
6 to 11 years: 250 mg four times a day for 5 days.
12 to 17 years: 500 mg four times a day for 5 days.

Second line:
Prescribe co-amoxiclav

1 to 5 years: 5 mL of 125/31 suspension three times a day 5 days

6 to 11 years: 5 mL of 250/62 suspension three times a day for 5 days.

12 to 17 years: 250/125 mg three times a day for 5 days.

59
Q

I cause the following:

  • IGE mediated reaction
  • Sneezing, Nasal itching, discharge, Congestion
  • I cause symptoms when in contact with allergens

WHAT AM I?

A

Allergic rhinitis

60
Q

How do you manage me? (Allergic Rhinitis)

A

First line: Mild to moderate: Azelastine hydrochloride intranasal spray
Oral antihistamine Loratadine

Moderate to severe: Regular intranasal corticosteroid (2 weeks usually results start).

61
Q

I cause the following:

Heavy nostril bleeding
Dizziness
Fullness in nostrils

WHAT AM I?

A

EPISTAXIS

62
Q

How do you manage me? (Epistaxis)

A
  1. Asking the patient to sit with their torso forward and their mouth open.
  2. Pinch the cartilaginous (soft) area of the nose firmly for at least 20 minutes.
  3. Topical antiseptic such as Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis (Stinging)
  4. Continuous bleeding 10-15 mins, find source of bleeding. Topical local anaesthetic spray Co-phenylcaine (Silver nitrate stick) or packing.

Paediatrics - Buzz Words (3 decks)

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