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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Bronchiolitis common pathogen

A 
RSV 80%
Parainfluenza
Rhinovirus
Adenovirus
Influenza virus
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2
Q

3 patterns of wheezing

A

Viral episodic-in response to infection
Multi-trigger- likely to develop into asthma
Asthma

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3
Q

Causes of recurrent/persistent wheeze

A

Viral episodic wheeze
Multiple trigger wheeze
Asthma
Recurrent anaphylaxis (e.g. in food allergy) Chronic aspiration
Cystic fibrosis Bronchopulmonary dysplasia Bronchiolitis obliterans Tracheo-bronchomalacia

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4
Q

Asthma treatment

A 
SABA
ICS
>5 LABA. <5 LRTA
>5 increase ICS. <5 refer
Max ICS 1600 ug. 800 ug for under 5
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5
Q

Criteria for hospital admission: asthma

A

If after high dose inhaled bronchodilator therapy:

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6
Q

Different types of URTI

A

commoncold(coryza)
sore throat (pharyngitis,tonsillitis)
Acute otitis media
Sinusitis (relatively uncommon)

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7
Q

Most common pathogen of coryza (common cold)

A

Rhinovirus
Coronavirus
Respiratory syncytial virus (RSV)

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8
Q

Common pathogens for pharyngitis

A

Adenovirus
Enterovirus
Group A B-Haemolytic streptococcus

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9
Q

Common pathogens Tonsillitis

A

Group A beta haemolytic streptococcus

Epstein-Barr virus (infectious mononucleosis)

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10
Q

Treatment of bacterial tonsillitis

A

Penicillin V or erythromycin m

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11
Q

Acute otitis media pathogens

A

RSV
Rhinovirus
Pneumococcus
Non typical H.Influenza

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12
Q

Common indications for tonsillectomy

A 
Recurrent severe tonsillitis 
Peritonsillar abscess (Quincy)
Obstructive sleep apnoea
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13
Q

Croup pathogens

A

Parainfluenza
Rhinovirus
Influenza virus

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14
Q

Croup peak incidence

A

6 months to 6 years

Peak at 2

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15
Q

Features of croup

A 
Coryza
Fever 
Hoarseness 
Barking cough
Harsh stridor
Symptoms often start and are worse at night
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16
Q

Croup first line Tx

A

Oral steroids
Dexamethasone, prednisolone

Nebulises steroid- budenoside

In severe cases adrenaline with oxygen via face mask

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17
Q

Acute epiglottis

A

Intense swelling of the epiglottis and surrounding tissues

Caused by Haemophilia influenza type b (HIb)

18
Q

Acute epiglottis presentation m

A

High fever in an ill looking child
Painful throat prevents child from speaking or swallowing
Saliva drools from mouth
Soft inspiratory stridor
Child sits immobile upwards with mouth open to breath

19
Q

Another name for pertussis

A

Whooping cough caused by Bordtella pertussis.

20
Q

Pertussis clinical features

A 
Week of coryza 
Paroxysmal or spasmodic cough
Inspiratory whoop
Often worse at night may have cough
Goes red/blue in the face
21
Q

Cystic fibrosis

A

Autosomal recessive disease

Misfolded CFTR

22
Q

Clinical features of CF

A

Newborn
• Diagnosed through newborn screening
• Meconium ileus

Infancy
• Prolonged neonatal jaundice
• Growth faltering
• Recurrent chest infections
• Malabsorption, steatorrhoea
Young child
• Bronchiectasis
• Rectal prolapse
• Nasal polyp
• Sinusitis
Older child and adolescent
• Allergic bronchopulmonary aspergillosis
• Diabetes mellitus
• Cirrhosis and portal hypertension
• Distal intestinal obstruction (meconium ileus
equivalent)
• Pneumothorax or recurrent haemoptysis
• Sterility in males
23
Q

Pneumothorax

A

pneumothorax may occur spontaneously in up to 2% of deliveries. It is usually asymptomatic but may cause respiratory distress. Pneumothoraces also occur secondary to meconium aspiration, respiratory distress syndrome or as a complication of mechanical ventila- tion.

24
Q

Bacterial tracheitis

A

This rare but dangerous condition is similar to severe epiglottitis in that the child has a high fever, appears very ill, and has rapidly progressive airways obstruction with copious thick airway secretions. It is typically caused by infection with Staphylococcus aureus. Man- agement is by intravenous antibiotics and intubation and ventilation if required.

25
Q

Laryngomalacia

A

Most common cause of stridor in infancy. Due to congenital softening of the tissues of the larynx. Hence predisposed to collapse upon inspiration and partially block airway.

26
Q

Clinical features of bronchiolitis

A 
dry wheezy cough 
• tachypnoea and tachycardia 
• subcostal and intercostal recession 
• hyperinflation of the chest 
• fine end-inspiratory crackles 
• high-pitched wheezes – expiratory > inspiratory.
27
Q

Laryngomalacia presentation

A

Feeding related vomiting choking etc
Fine inspiratory crackles
Weight loss and failure to thrive
presents at birth or within 6 weeks peaks at 6-8 months. Often Dx at 4.

28
Q

Bronchiolitis Tx

A

Humidified air

May require fluids or CPAP

29
Q

Causes of anaphylaxis

A 
Food allergy
Drugs 
Insect stings
Latex 
Exercise
30
Q

signs of anaphylaxis AABC skin

A 
Acute Onset
Airway: swelling hoarsness, stridor
Breathing: Tachypnoea, wheeze, Sp02>92%
Circulation: Clammy, Pale, hypotension, drowsy, coma
Skin: Urticaria, angiodema
31
Q

Emergency treatment of anaphylactic shock

A

ABCDE
If breathing difficult Sit up
If hypotensive- supine and elevate legs
If unconcious- recovery position and BALS.

Adrenaline- 1:1000 IM
Additional treatment: 
Establish airway High-flow oxygen 
IV fluid (20 ml/kg crystalloids) 
Chlorpheniramine (IM or slow IV) 
Hydrocortisone (IM or slow IV) 
Consider salbutamol if wheeze
32
Q

CENTOR criteria

A

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough

33
Q

What Centor score require Abx

A

3/4

34
Q

Tx for tonsillitis/pharyngitis who require Abx

A

Phenoxymethylpenicillin
1 to 11 months, 62.5 mg four times a day or 125 mg twice a day for 5 to 10 days
1 to 5 years, 125 mg four times a day or 250 mg twice a day for 5 to 10 days
6 to 11 years, 250 mg four times a day or 500 mg twice a day for 5 to 10 days

35
Q

Acute otitis media presentation

A

Most common 6-12 months
Fever
Bright red bulging with loss of light reflection
May have perforation or pus visible

36
Q

Tx for acute otitis media

A

Paracetamol or ibuprofen for the pain

Can give prescription of amoxicillin and tell parents to only give if child unwell after 2-3 days

37
Q

Tx of otitis media with effusion

A

Grommets

If persists grommet insertion with adenoidectomy

38
Q

Allergic rhinitis Tx

A

Second-generation non-sedating antihistamines (used topically or systemically)
• Topical corticosteroid nasal or eye preparations (the latter under specialist ophthalmology supervision)
• Cromoglycate eye drops
• Leukotriene receptor antagonists, e.g. montelukast
• Nasal decongestants (use for no more than 7–10 days due to risk of rebound effect)
• Allergen immunotherapy – sublingual or subcutaneous (limited by anaphylaxis risk)
• Systemic corticosteroids should not be used due to the risk of adverse effects

39
Q

Acute sinusitis

A

Often paranasal sinus as frontal sinuses do not develop until late childhood. Treat with Abx and analgaesia. Ofte secondary to URTI

40
Q

Tx for epistaxis

A

Lean forward, pinch nose cartilage firmly for 10-15mins.
If still bleeding:
Nasal cautery
Nasal Packaging
If bleeding is posterior aspect of nose admit to hospital

Paediatrics (12 decks)

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