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1
Q

Organisms which cause bronchiolitis

A

RSV (80%)
Mycoplasma, adenovirus

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2
Q

How does bronchiolitis present

A

a coryzal phase preceding respiratory symptoms such as dry cough, increased work of breathing, wheezing, feeding difficulties due to dyspnoea

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3
Q

If patient with bronchiolitis presents to GP with bronchiolitis when should call 999 or refer to hospital

A

999
- RR over 70
- seriously unwell
- severe rep distress (chest recession etc)
- cyanosis
- sats less than 92

Hospital
- RR over 60
- clinical dehydration (50-75% of normal volume)
- difficulty feeding

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4
Q

Management of bronchiolitis

A

Largely supportive
Humidified oxygen via head box if sats less than 92
CPAP if impending resp failure

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5
Q

Examination finding of bronchiolitis

A

Wheeze
Fine inspiratory crackles

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6
Q

What causes croup

A

Parainfluenza viruses

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7
Q

Presentation of croup

A

Stridor
Barking cough worse at night
Fever
Corzyal symptoms

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8
Q

Management of croup

A

Give all patients 0.15mg/kg of dexamethasone
If too unwell/vomiting give inhaled budenoside or IM dexamethasone
Determine if mild, moderate or severe- admit if moderate or severe
Also admit if
- immunocompromised
- under 3 months
- chronic lung disease
- congenital heart disease
- dehydrated

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9
Q

Categorising croup

A

Mild- seal like barking but no stridor or recession at rest
Moderate- seal like barking cough with stridor and sternal recession with no agitation or lethargy
Severe- seal like barking, stridor, recession, agitation

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10
Q

What to do if reduced barking cough in croup

A

Suggests impending resp distress- call ambulance

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11
Q

How is croup diagnosed

A

Normally clinically but can do CXR
PA or lateral

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12
Q

PA versus lateral CXR finding in croup

A

PA- shows subglottic narrowing (steeple sign)
Lateral- acute epiglottis (thumb sign)

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13
Q

When can those with whooping cough return to school

A

2 days after commencing antibiotics

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14
Q

How does congenital diaphragmatic hernia present

A

Respiratory distress as bronchopulmonary hypoplasia
Hypertension
Bowel sounds on ausculation of lungs

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15
Q

What would cause tinking bowel sounds on auscultation

A

Diaphragmatic hernia

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16
Q

Initial management of congenital diaphragmatic hernia

A

NG to keep air out of the gut
If patient cyanosed intubate

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17
Q

Cause of stridor in a child

A

Foreign object
Croup
Acute epiglottitis
Laryngomalacia

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18
Q

What is laryngomalacia

A

Congenital abnormality of the larynx which presents around 4 weeks of age

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19
Q

Causes of snoring in a child

A

obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism

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20
Q

Management of acute epiglottitis

A

DO NOT lie patient down or examine their mouth
Imeediate referral to ENT, paediatrics and anaesthetics
Secure airway with endotracheal intubation
Blood cultures
Cephalosporin and dexamethasone

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21
Q

How to treat severe croup

A

Oxygen
Nebulised adrenaline

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22
Q

Best way to diagnose pertussis

A

Per nasal swab
PCR the most specific

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23
Q

Pneumonia management of children

A

First line - amoxicillin
Second line- add macrolide if fail to respond
Chlamydia or mycoplasma use macrolide
If influenza suspected use co-amoxiclav

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24
Q

Influenza pneumonia management

A

Co-amoxiclav

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25
2 prognostic factors of CDH
Lung in thorax Lungs to head ratio
26
What is antenatal finding of TOF or oesophageal atresia
Polyhydramnios as never swallowed amniotic fluid
27
How can allergic rhinitis present
Nasal discharge Postnasal drip causes nocturnal cough Cough can be so severe get vomiting and noisy breathing
28
Causes of bronchiectasis in kids
CF Post infection like pertussis Foreign body
29
Different presentations of CF
Neonates- meconeum ileus Childhood- chronic cough, recurrent chest infections, malabsorption and pancreatic insufficiency, nasal polyps, short stature, rectal prolapse from being ill all the time
30
Later presentation of CF
DM Bronchiectasis Sterility Cirrhosis
31
Management of chronic cough and recurrent infection in CF
Physio twice a day Nubulised hypertonic saline or DNAase ABx prophylaxis- flucloxacillin and azithromycin Annual spirometry
32
Management of pancreatic insufficiency in CF
Vitamin supplementation Creon after meals
33
Management of infection susceptibility in CF
Vaccination Abx prophylaxis- flucloxacillin and azihromycin
34
Moderate asthma/viral induced wheeze features
PEFR at least 50% of best Normal speech No severe/life threatening features
35
Severe asthma/viral induced wheeze features
O2 sats must be greater than 91! PEFR- 33-50% best Inability to complete sentences Accessory muscle use Inability to feed RR - over 25 if over 12 - over 30 if 5-15 - over 40 if 2-5 HR - over 110 if over 12 - over 125 if 5-12 - over 140 if 2-5
36
Life threatening asthma/viral induced wheeze features
PEFR under 33% O2 sats less than 92% Altered consciousness/confusion Arrythmia Hyotension Cyanosis Poor resp effort Silent chest Exhaustion
37
When to admit someone with acute asthma/viral induced attack
Life threatening Fail to respond to bronchodilator if severe Moderate- getting worse or has been near fatal attack previously Factors which would lower threshold for admitting - premature - congenital issue - CF - immune deficiency - assess cares ability
38
Management of acute asthma/viral induced wheeze waiting for admission
Life threatening - maintain O2 over 94 - nebulised salbutamol Severe - nebulised salbutamol Moderate - MDI salbutamol with spacer NOTE- if nebulsier not available use MDI
39
Management of asthmatic child at GP without needing hospital admission
SABA every 30-60 seconds do 10 times If responds well to these can prescribe SABA for at home PRN If history of atopy or confirmed asthma give oral pred course
40
Management of infective excacerbation of asthma
Amoxicillin If contraindicated - 12 and over doxycycline - under 12 macrolide or cefaclor
41
Management of infective excacerbation of asthma
Amoxicillin If contraindicated - 12 and over doxycycline - under 12 macrolide or cefaclor
42
Asthma guidelines under 5
Under 5 1. SABA 2. Paediatric moderate dose ICS for 8 weeks and monitor - if no resolvement consider different diagnosis - sx reoccurred within 4 weeks of stopping ICS restart low dose ICS as maintenance - sx reoccurred beyond 4 weeks restart moderate dose ICS 3. SABA, low dose ICS, LTRA 4. Stop LTRA and refer to paediatric asthma specialist
43
Asthma guidelines 5-16
1. SABA 2. SABA+paediatric low dose ICS 3. SABA+paediatric low dose ICS+LTRA 4. SABA+paediatric low dose ICS+LABA (stop LTRA) 5. SABA +MART combining LABA and low dose ICS 6. SABA + moderate dose ICS MART 7. SABA + one of; - increase ICS mart to high dose - add theophylline - refer to expert
44
What factors are associated with worse prognosis in CF
Burkholderia or pseudomonas infection chronically
45
Diagnosing CF
Sweat test CFTR gene karyotyping- can determine management
46
Why is genetic testing significant in CF
If suffer from delta F508 deletion mutation then can give Kaftrio- combination of ivacaftor, tezacaftor and elexacaftor
47
What causes whooping cough
Bordatella pertussis
48
What are the stages to whooping cough
Cattarheal- prodromal malaise, dry cough, sore throat Paroxysmal- expiratory burst then subsequent gasp on inspiration giving whoop Convalescent- improval in cough severity and frequency
49
What factors can trigger whooping
Cold Exercise Worse at night
50
When to suspect pertussis
If cough for over 14 days with 1 of following - paroxysmal - post coughing vomiting - whoop - apnoeic episodes in infants
51
Management of whooping cough
Admit if necessary Offer antiobiotic if cough has lasted less than 21 days - clarithomycin if less than 1 month - clarithomycin or azithromycin if over 1 month If contraindicated use co-trimoxazole (not licensed if under 6 weeks) Management of contacts if been in same room over night in first 21 days - pregnant - unimmunised children - working with children Give macrolide and co trimoxazole if contraindicated
52
When can go back to school with pertussis
48 hours of antibiotics 21 days after cough started
53
Who admit for pertussis
Is 6 months of age or younger and acutely unwell. Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis). Has a significant complication (for example seizures or pneumonia) Must inform hospital before to ensure adequate isolation
54
Recommended diet for CF
High calories High fat Pancreatic enzyme replacement with every meal
55
What drugs are contraindicated in asthma
Beta blockers NSAIDS Adenosine ACEi
56
Long term asthma examination findings
Hyperinflated chest Harrison sulci- under costal margin
57
Why do children wheeze more when get viral infections under 5
Airways narrower
58
What does short stature suggest with a rectal prolapse
CF
59
Pathophysiology of CF
Autosomal recessive disease caused by a mutation in the CFTR (chloride channel) Leads to reduced movement of chloride out of cells, leading to thick mucus
60
Which infections are common in CF people
Staphylococcus aureus Pseudomonas aeruginosa Haemophilus influenzae Aspergillus fumigatus Non-tuberculous mycobacteria
61
When is only do a CXR in bronchiolitis
Being transferred to ITU May see peribronchial thickening
62
Management of laryngomalacia
Typically with resolve within a few months If apnoeic episodes, cyanosis or poor feeding and development then can consider surgery- supraglottoplasty
63
When consider pneumonia over bronchiolitis
Fever over 39 Persistant localised crackles
64
What lobe are foreign objects typically seen in
Right middle lobe
65
Features of kartageners syndrome
Sinusitis Bronchiectasis Infertility Dextrocardia
66
What is most common cause of pneumonia in children
Under 4s- strep pneumoniae over 4- mycoplasma
67
What is dose of dexamethasone used for croup
0.15ml/kg
68
What is best test for diagnosing asthma
FEV1 on a spirometer 12% improvement with bronchodilator positive
69
Management guidelines for pneumothorax
Breathless or over 2 cm= needle aspiration -> if fails chest drain Any intervention needs followup in 2 weeks in OPD Under 2cm= discharge and see in OPD in 2 weeks
70
Pneumonia in a neonate
GBS Gram neg enterococcus
71
Pneumonia in an infant and young kids
Strep p Haemophilus influenza
72
Cough that worsens when cry
Croup
73
If spirometry fails to identify asthma what do
FeNO
74
If someone with desaturates quickly with meconium aspiration syndrome, what is diagnosis
Pneumothorax
75
What is severe complication of bronchiolitis
Bronchiolitis obliterans
76
What is bronchiolitis obliterans and what causes it
Repair of lung tissues is in overdrive leading to scar tissue formation Adenovirus
77
How does bacterial tracheitis present
Croup like Very high fever Copious airway secretions
78
What is most common cause of bacterial tracheitis
Staph aureus

Paeds (17 decks)

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