Respiratory Flashcards
How common is rhinitis?
Very common
Most kids get 5-10 per year
Esp in winter months (35thwk - march)
Is rhinitis serious?
Self-limiting but may be prodome to more serious illnesses (e.g. pneumonia, bronchitis, meningitis, septicaemia)
What is otitis media? What is the appearance of an otitis media?
Middle ear infection
Ear appears red and is painful, drum no longer transparent and shiny & is bulging due to pus in middle ear
What causes otitis media?
Primary viral infection (may get secondary bacterial infection (h’flu/pneumococcus)
How do you Rx otitis media?
Analgesia
How do you investigate tonsillitis/pharyngitis?
Throat swab
How do you Rx tonsillitis/pharyngitis?
Nothing/penicillin for 10 days
What can cause tonsillitis/pharyngitis?
EBV/group A strep
What is group?
Laryngotracheobronchitis
What causes group?
Para’flu 1
What are the symptoms of croup?
Coryza, stridor, hoarse voice, barking cough
Child v. well
How do you Rx croup?
Oral dexamethasone
What is the presentation of epiglottitis?
Toxic, stridor, drooling
What causes epiglottitis?
Hib
How do you Rx epiglottitis?
Antibiotics, intubation
What are LRTIs usually due to?
Viral infection which disrupts the normal commensal bacteria
Most pathogenic bacterial (e.g. pneumococcus, Moraxella, staph, haemophilus) are already present in LRT (except pertussis)
What features would indicate a LRTI?
Fever (>38.5C), coughing, grunting
Reduced/bronchial breath sounds
What is the presentation of bronchitis?
Loose rattly cough, post-tussive vomit (glut)
No creps/wheeze
Tends to be cycle of getting viral infection –> clearance stops (cough for 4wks) –> clears up –> gets another one
What causes bronchitis?
Haemophilus/pneumococcus
Usually due to primary viral infection (RSV/adenovirus) which disrupts mucociliary escalator
Therefore only way to clear it is coughing up secretions
What red flags might make you worry about bronchiectasis or another diagnosis other than bronchitis?
<6m, >4y, static weight, disrupts child life, assoc. SoB, acute admission, other comorbs (neuro/gastro)
How do you Rx bronchitis?
Conservative
What is bronchiolitis?
Most common cause of LRTI in infants (peaking at 3m)
What can cause bronchiolitis?
Paraflu III, HMPV
What symptoms result from bronchiolitis?
Nasal stuffiness, poor feed, crackles +/- wheeze
Cough –> get worse (poor feeding, sooking in ribs), stabilise –> better
What features will help you make sure is it bronchiolitis?
<12m, ONE OFF, typical hx
How do you Rx bronchiolitis?
Cohort, o2 sats, no proven meds
How do you diagnose pneumonia?
Creps, focal signs, high fever
Need XRay but prefer not to iridate kids
How do you Rx pneumonia?
Amoxycillin/macrolide
If mild can leave it
What features are typical of pertussis?
Coughing fits, vomiting, colour change, conjunctival haematoma
Vaccine reduces chance of getting it/severity of infection but won’t stop you getting it
What features are classical of asthma?
Chronic wheeze, SoB, cough
SoB at rest good marker of airway obstruction and lung function <30%
Cough is dry, nocturnal or exertional
What can trigger asthma symptoms?
Exercise, cold, allergens, URTI
What is the key feature of asthma compared to COPD?
Reversible and variable
How common is asthma?
5% of UK children are on inhaled CS
What is the aetiology of asthma?
Multiple hit theory based on genes, early onset atopy, inherently abnormal lungs and later environmental exposures (e.g. rhinovirus, exercise, smoking)
How do you investigate asthma?
Peak flow and spirometry not great/specific
Exhaled NO unproven
Better to use Hx (esp if FH of asthma, PMH of eczema/allergy/hayfever)
Asthma like symptoms in <18m most likely to be…
Infection
Asthma like symptoms in >5y more likely to be…
Asthma
What are the goals of treatment of asthma?
Minimal symptoms during the day and night, no asthma attacks or limitation of physical activity, minimal need for reliever medication
Normal lung function (FEV1 +/- PEF >80 best/predicted)
What is the SANE nmenomic used to measure asthma symptoms?
SABA use/wk (aim for less than 3)
Absences from school/nursery
Noctural symptoms/wk (aim for 1)
Exertional symptoms/wk
If asthma is not well controlled what should you explore?
Compliance
Correct technique?
Incorrect diagnosis?
Req. step up in Rx?
What is the asthma treatment ladder?
V. low dose ICS 2m trial –> low dose ICS/LTRA in <5y –> v. low dose ICS + LABA –> no response LABA stop increase ICS dose to low, some response but inadequate –> keep on LABA increase ICS dose to low +/- consider trial of another therapy (e.g. LRTA) –> REFER –> consider trial ICS medium dose/add fourth therapy (e.g. SR theophylline) –> oral daily steroids + other Rx
What is the max dose for ICS in kids?
800mirog (<12)
What is the first line preventer in under 5s?
LTRA
When should you go on to having a regular preventer?
SABA >2d/wk, symptomatic 3x/wk, waking 1night/wk, exertional asthma in last 2y
What are the side effects of ICS?
Oral candidiasis - prevent by brushing teeth after
0/5-1cm height suppression
Adrenocortical suppression if higher dose purple inhaler
What is the only LTRA licensed in kids? How effective is it?
Montelukast
Rule of 1/3rds (brilliant in 1/3rd, okay in 1/3rd, ineffective in 1/3rd)
What are other treatments you can try?
Experimental medicine
Explore psychiatric (anxiety)/compliance issues
Question diagnosis
Biologics - omalizumab
Why should you always use spacers with kids?
More lung deposition (20% as opposed to 5%)
They increase deposition by 100%
How do you use spacers to ensure their maximal efficacy?
Shake between puffs, clean every month to remove static
What other advice can you give to parents to help their child’s asthma?
Stop smoke exposure and remove environmental triggers (pets/HDM?)
