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paeds > resp > Flashcards

resp Flashcards

1
Q

mx of sinusitis

A

refer if systemic infection, signs of orbital problems, neuro signs

If symptoms <10 days don’t give Abx
can use nasal saline

symptoms >10 days give intranasal corticosteroids (if child >12) consider back up Abx if nothing has changed in 7 days

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2
Q

how does whooping cough present

A

week of coryza followed by paroxysmal cough and then inspiratory whoop (cough can cause vomiting)
symptoms can go on for 3 months

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3
Q

Mx of whooping coufh

A

Admit if:
< 6 months
severe breathing difficulties (paroxysms, apnoea)
significant complications (seizures etc.)

If admission not needed give abx (MACROLIDE -clari)

Advice:
don’t go to school til 48 hours after Abx have been finished or 21 days after cough started if not treated
despite Abx they will have protracted non-infectious cough

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4
Q

mx of foreign body

A 
Conscious:
encourage coughing
back manoeuvres
removal of foreign body - rigid bronchoscopy if stridor asphyxia, radio opaque objects on CXR, hx of inhalation, reduced breath sounds in one area (if acute); if not do flex bronschoscopy
surgery

Unsconscious:
secure airway

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5
Q

Causes of bronchiectasis

A 
general:
CF
primary ciliary diskinesia
imunodeficiency
chronic aspiration

localised:
previous pneumonia
congenital lung abnormality
obstruction by foreign body

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6
Q

mx bronchiectasis

A 
improve nutrition 
airway cleaning physio
long term macrolide
inhaled bronchodilator
inhaled saline
vaccination against strep + flu

acute exacerbation:
from sputum cultures

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7
Q

What is a serious complication of bronchiolitis

A

recurrent apnoea

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8
Q

When to admit a child with bronchiolitis

A

immediate:
apnoea, child looks generally unwell
severe resp distress (grunting, marked recession, RR >70), central cyanosis, 92 sat <92%

consider if:
RR>60
poor feeding and hydration
clinically dehydrated

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9
Q

mx bronchiolitis

A

Humidified O2 if sats <92%
CPAP if impending resp failure
upper airway suction if secretions
fluids (NG if not feeding)

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10
Q

what are the 3 types of wheeze

A

Viral induced
multiple trigger (this usually becomes asthma)
asthma

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11
Q

mx of viral episodic wheeze

A
  1. salbutamol inhaler w/ spacer
    burst therapy - 10 puffs in an hour and then reassessed, if they’re ok they can go home
  2. leukotriene antagonist /inhaled steroid

encourage parents to stop smoking

safety net:
return if symptoms don’t get better in 2 days
if no response after 10 puffs seek help
if they have symptoms in between viral illness they’re at increased risk of asthma

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12
Q

what does asthmatic wheeze sound like on auscultation

A

polyphonic

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13
Q

what is multiple trigger wheeze

A

wheeze triggered by different allergens

has a high likelihood of progressing to asthma

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14
Q

when to suspect multiple trigger wheeze/asthma

A 
symptoms worse at nigh + early morning
interval symptoms 
non-viral triggers
FHx
\+ve response to asthma treatment
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15
Q

Important questions to ask for asthma hx?

A

does it interfere with sleep
does it interfere with sport
how much school has been missed

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16
Q

Ix for asthma

A

< 5 years - clinical

> 5 years - spirometry (FV1/FVC), bronchodilator reversal, PEF variability for 2-4 weeks

17
Q

mx asthma in children <5

A

NB - they will have a high index of suspicion
1. SABA reliever
go to stage 2 if they need it more than 3 times a week or they wake up in the middle of the night
2. paediatric moderate-dose ICS for 8 week trial
if symptoms resolve at 8 weeks stop ICS. If symptoms reoccur within 4 weeks restart ICS at low dose, if symptoms reoccur after 4 weeks repeat 8 week trial
3. ICS and LTRA
4. stop LTRA and refer to expert

18
Q

mx asthma 5-16

A
  1. SABA
    go to stage 2 if they need it more than 3 times a week or they wake up in the middle of the night
  2. SABA + paediatric low dose ICS
  3. SABA + ICS + LRTA
  4. SABA + ICS + LABA
  5. switch ICS + LABA to MART (maintenance and reliever therapy) w/ paed ICS
  6. increase to moderate dose ICS + LABA w/ SABA reliever
  7. seek advice
19
Q

what things are important to council in asthma

A

teach technique
personalised asthma action plan
routine immunisations
trigger avoidance

confirm adheremce
review technique and medications

20
Q

Mx life threatening asthma

A

admit
high flow o2 if life threatening or O2 <94% (aim for 94-98)
SABA nebs - 5mg if >5yrs, 2.5mg if 2-5 years. ideally oxygen driven
ipratropium bromide nebs (with SABA)
magnesium sulphate nebs
corticosteroids (IM or oral)

2nd line:
IV salbutamol, IV aminophylline, IV MgSO4

21
Q

mx moderate asthma exacerbation requiring hospitalisation

A

admit if worsening symptoms despite tx and/or if they’ve had previous serious attack

admit
o2 if less than 94%
SABA - pressurised inhaler with spacer. 1 puff every 30-60 seconds
Ipratropium bromide
corticosteroids
22
Q

mild exacerbation

A

O2
Saba (SABA - pressurised inhaler with spacer. 1 puff every 30-60 seconds)
prednisolone (3-5 days)

23
Q

Follow up for asthma attack

A

follow up within 2 days

review medications, technique etc.

24
Q

When are croup symptoms worse

A

at night

if mild chest recession and stridor resolves at rest

25
Q

Ranking of severity of croup

A

mild - seal like barking cough
moderate - barking cough + stridor and recession
severe - barking cough + stridor and recession + agitation/lethargy, RR>70

26
Q

mx croup

A

admit anyone who’s moderate or above (put on oxygen and nebulised adrenaline if severe)
give single dose of oral dexa immediately to everyone

Safety net
return to hospital if continuous stridor or recession
call ambulance if pale, drowsy, can’t breather

27
Q

Mx pneumonia

A 
Refer to hospital admission immediately if:
O2 <92%
Grunting
recession 
cyanosis
RR >60
temp >38 in a child <3 months

If hospital admission not needed:
amoxicillin for 7-14 days
paracetamol for pyrexia

28
Q

Features of cystic fibrosis through age

neonate, infant, young child, adolescents

A

neonate - meconium ileus
infant - jaundice, malabsorption and steatorrhea, failure to thrive, chest infection
young child - bronchiectasis, nasal polyps, rectal prolapse, sinusitis
adolescents - ABPA, DM, portal HTN, male sterility, pneumothorax, atypical chest infection (h.influenza and s.aureus when young, p.aeurginosa when older)

29
Q

what are some examination findings of cystic fibrosis

A

hyperinflation due to air trapping
coarse inspiratory crackles
expiratory wheeze
finger clubbing

30
Q

Diagnosis of CF

A

heel prick at birth

clinical manifestations + sweat test later

31
Q

mx CF

A

delta F508 - lumacaftor

Pulmonary mx:
airway clearance techniques
mucoactive agents (rhDNase, hypertonic saline +rhDNase, mannitol dry powder)

infection mx:
flucloxacillin for staph a. prophylaxis
for pseudomonas inf:
acute infection - tx w/ abx as per local guidelines
chronic infection - nebulised colistemethate sodium + oral abx

GI mx:
high calorie diet
pancreatic enzyme replacement
H2 receptor antagonist or PPI if malabsorption persistent

paeds (19 decks)

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