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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How common is rhinitis?

A

Very common
Most kids get 5-10 per year
Esp in winter months (35thwk - march)

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2
Q

Is rhinitis serious?

A

Self-limiting but may be prodome to more serious illnesses (e.g. pneumonia, bronchitis, meningitis, septicaemia)

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3
Q

What is otitis media? What is the appearance of an otitis media?

A

Middle ear infection

Ear appears red and is painful, drum no longer transparent and shiny & is bulging due to pus in middle ear

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4
Q

What causes otitis media?

A

Primary viral infection (may get secondary bacterial infection (h’flu/pneumococcus)

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5
Q

How do you Rx otitis media?

A

Analgesia

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6
Q

How do you investigate tonsillitis/pharyngitis?

A

Throat swab

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7
Q

How do you Rx tonsillitis/pharyngitis?

A

Nothing/penicillin for 10 days

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8
Q

What can cause tonsillitis/pharyngitis?

A

EBV/group A strep

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9
Q

What is group?

A

Laryngotracheobronchitis

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10
Q

What causes group?

A

Para’flu 1

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11
Q

What are the symptoms of croup?

A

Coryza, stridor, hoarse voice, barking cough

Child v. well

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12
Q

How do you Rx croup?

A

Oral dexamethasone

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13
Q

What is the presentation of epiglottitis?

A

Toxic, stridor, drooling

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14
Q

What causes epiglottitis?

A

Hib

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15
Q

How do you Rx epiglottitis?

A

Antibiotics, intubation

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16
Q

What are LRTIs usually due to?

A

Viral infection which disrupts the normal commensal bacteria
Most pathogenic bacterial (e.g. pneumococcus, Moraxella, staph, haemophilus) are already present in LRT (except pertussis)

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17
Q

What features would indicate a LRTI?

A

Fever (>38.5C), coughing, grunting

Reduced/bronchial breath sounds

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18
Q

What is the presentation of bronchitis?

A

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

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19
Q

What causes bronchitis?

A

Haemophilus/pneumococcus
Usually due to primary viral infection (RSV/adenovirus) which disrupts mucociliary escalator
Therefore only way to clear it is coughing up secretions

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20
Q

What red flags might make you worry about bronchiectasis or another diagnosis other than bronchitis?

A

<6m, >4y, static weight, disrupts child life, assoc. SoB, acute admission, other comorbs (neuro/gastro)

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21
Q

How do you Rx bronchitis?

A

Conservative

22
Q

What is bronchiolitis?

A

Most common cause of LRTI in infants (peaking at 3m)

23
Q

What can cause bronchiolitis?

A

Paraflu III, HMPV

24
Q

What symptoms result from bronchiolitis?

A

Nasal stuffiness, poor feed, crackles +/- wheeze

Cough –> get worse (poor feeding, sooking in ribs), stabilise –> better

25
Q

What features will help you make sure is it bronchiolitis?

A

<12m, ONE OFF, typical hx

26
Q

How do you Rx bronchiolitis?

A

Cohort, o2 sats, no proven meds

27
Q

How do you diagnose pneumonia?

A

Creps, focal signs, high fever

Need XRay but prefer not to iridate kids

28
Q

How do you Rx pneumonia?

A

Amoxycillin/macrolide

If mild can leave it

29
Q

What features are typical of pertussis?

A

Coughing fits, vomiting, colour change, conjunctival haematoma
Vaccine reduces chance of getting it/severity of infection but won’t stop you getting it

30
Q

What features are classical of asthma?

A

Chronic wheeze, SoB, cough
SoB at rest good marker of airway obstruction and lung function <30%
Cough is dry, nocturnal or exertional

31
Q

What can trigger asthma symptoms?

A

Exercise, cold, allergens, URTI

32
Q

What is the key feature of asthma compared to COPD?

A

Reversible and variable

33
Q

How common is asthma?

A

5% of UK children are on inhaled CS

34
Q

What is the aetiology of asthma?

A

Multiple hit theory based on genes, early onset atopy, inherently abnormal lungs and later environmental exposures (e.g. rhinovirus, exercise, smoking)

35
Q

How do you investigate asthma?

A

Peak flow and spirometry not great/specific
Exhaled NO unproven
Better to use Hx (esp if FH of asthma, PMH of eczema/allergy/hayfever)

36
Q

Asthma like symptoms in <18m most likely to be…

A

Infection

37
Q

Asthma like symptoms in >5y more likely to be…

A

Asthma

38
Q

What are the goals of treatment of asthma?

A

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)

39
Q

What is the SANE nmenomic used to measure asthma symptoms?

A

SABA use/wk (aim for less than 3)
Absences from school/nursery
Noctural symptoms/wk (aim for 1)
Exertional symptoms/wk

40
Q

If asthma is not well controlled what should you explore?

A

Compliance
Correct technique?
Incorrect diagnosis?
Req. step up in Rx?

41
Q

What is the asthma treatment ladder?

A

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

42
Q

What is the max dose for ICS in kids?

A

800mirog (<12)

43
Q

What is the first line preventer in under 5s?

A

LTRA

44
Q

When should you go on to having a regular preventer?

A

SABA >2d/wk, symptomatic 3x/wk, waking 1night/wk, exertional asthma in last 2y

45
Q

What are the side effects of ICS?

A

Oral candidiasis - prevent by brushing teeth after
0/5-1cm height suppression
Adrenocortical suppression if higher dose purple inhaler

46
Q

What is the only LTRA licensed in kids? How effective is it?

A

Montelukast

Rule of 1/3rds (brilliant in 1/3rd, okay in 1/3rd, ineffective in 1/3rd)

47
Q

What are other treatments you can try?

A

Experimental medicine
Explore psychiatric (anxiety)/compliance issues
Question diagnosis
Biologics - omalizumab

48
Q

Why should you always use spacers with kids?

A

More lung deposition (20% as opposed to 5%)

They increase deposition by 100%

49
Q

How do you use spacers to ensure their maximal efficacy?

A

Shake between puffs, clean every month to remove static

50
Q

What other advice can you give to parents to help their child’s asthma?

A

Stop smoke exposure and remove environmental triggers (pets/HDM?)

Paediatrics (35 decks)

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