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Systems: Paediatrics AB > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What can rhinitis be a prodrome to?

A
  • Pneumonia
  • Bronchiolitis
  • Meningitis
  • Septicaemia
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2
Q

When does rhinitis usually occur?

A

Very common 5-10 per year but concentrated in the Winter months

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3
Q

How long does a runny nose usually last?

A

10-14 days

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4
Q

How long can earache last?

A

Up to 8 days usually

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5
Q

What is otitis media?

A

A common self-limiting infection of the ear

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6
Q

How does otitis media present?

A
  • Painful ear
  • Erythema in ear
  • Bulging drum (may spontaneously rupture)
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7
Q

What organisms can cause otitis media?

A
  • Primary viral infection

- Secondary infection with pneumococcus or haemophilus influenza

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8
Q

How is otitis media managed?

A
  • Analgesics

- Antibiotics have more side effects than benefits so are generally not used

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9
Q

What antibiotic should not given in tonsillitis/pharyngitis?

A

Amoxicillin

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10
Q

How long does a sore throat usually last?

A

About 2-7 days

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11
Q

How is tonsillitis/pharyngitis treated?

A

Either nothing or 10 days of penicillin if known strep infection

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12
Q

What organism is responsible for croup?

A

Para’flu I

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13
Q

What organism is responsible for epiglottitis?

A

H. influenza type B

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14
Q

How does croup present?

A
  • Coryza
  • Stridor
  • Hoarse voice
  • Barking cough
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15
Q

How does epiglottis present?

A

Stridor and drooling

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16
Q

How is croup treated?

A

Oral dexamethasone

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17
Q

How is epiglottitis treated?

A

Intubation and IV antibiotics

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18
Q

How long does croup usually last?

A

2-3 days

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19
Q

What common agents are implicated in LRTI?

A

Bacterial overgrowth

  • Strep pneumoniae
  • Haemophilus influenza
  • Moraxella cararrhalis
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae

Viral infection

  • RSV
  • Parainfluenza III
  • Influenza A and B
  • Adenovirus
  • Rhinovirus
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20
Q

What are the principles of management for LRTI?

A
  • Make a diagnosis
  • Assess the patient (oxygenation, hydration, nutrition)
  • Treat or wait for resolve
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21
Q

What is the most common LRTI of childhood?

A

Bronchitis

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22
Q

How does bronchitis present?

A
  • Loose rattly cough
  • Post-tussive vomit - “glut”
  • Chest free of wheeze/creps
  • Child very well
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23
Q

What organisms are associated with bronchitis?

A
  • Haemophilus

- Pneumococcus

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24
Q

What is the mechanism of bacterial bronchitis?

A
  • Disturbed mucociliary clearance due to Minor airway malacia and RSV/adenovirus
  • Lack of social inhibition!
  • Bacterial overgrowth is secondary
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25
Q

What is the cycle of bronchitis?

A
  • Resp virus obtained
  • Clearance stops for <4 weeks
  • Cough and rattle
  • Clearance almost recovered
  • Child picks up another virus
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26
Q

What are the red flags of bronchitis?

A
  • Age <6 mo, >4yr
  • Static weight
  • Disrupts child’s life
  • Associated SOB (when not coughing)
  • Acute admission
  • Other co-morbidities (neuro/gastro)
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27
Q

How long does a cough usually last?

A

Can be 4-25 days

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28
Q

What are the 3 points in the management of persistent bacterial bronchitis?

A
  • Make the diagnosis
  • Reassure
  • Do not treat
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29
Q

What organisms can cause bronchiolitis?

A
  • RSV
  • Paraflu III
  • HMPV
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30
Q

How does bronchiolitis present?

A
  • Nasal stuffiness
  • Tachynpnoea
  • Poor feeding
  • Crackles +/- wheeze
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31
Q

What is the incidence of bronchiolitis?

A

Affects 30-40% of all infants

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32
Q

What is the expected course of bronchiolitis/

A
  • Child is well days 1+2 of cough
  • Gets worse days3-5
  • Parent usually seeks medical attention about day 5
  • Child stabilises days 6+7
  • Recovery days 7-14
33
Q

When does RSV infection usually occur?

A

Christmas period

34
Q

When does bronchiolitis incidence peak?

A

Around 3 months old

35
Q

When is it bronchiolitis?

A
  • <12 months old
  • One off
  • Follows the typical history
36
Q

How is bronchiolitis managed?

A
  • Maximal observation

- Minimal intervention

37
Q

How is bronchiolitis investigated?

A
  • NPA (nursing in same ward/ cubicles)

- Oxygen saturation for severity

38
Q

What is there no routine need for in bronchiolitis?

A
  • CXR
  • Bloods
  • Bacterial cultures
39
Q

What medications are proven to work in bronchiolitis?

A

NONE

40
Q

When should an LRTI be suspected?

A
  • 48 hrs, fever (>38.5oC), SOB, cough, grunting
  • Wheeze makes bacterial cause unlikely
  • Reduced or bronchial breath sounds
41
Q

When can you call a LRTI pneumonia?

A
  • Signs are focal
  • Crepitation’s
  • High fever
42
Q

What is the BTS guidelines for the management of community acquired pneumonia?

A
  • Nothing is symptoms are mild
  • Oral Amoxycillin first line
  • Oral Macrolide second choice
  • Only for iv if vomiting
43
Q

How is pertussis characterised?

A

Coughing fits with vomiting and colour change

44
Q

Why does pertussis still occur despite vaccination?

A

-Vaccination reduces risk and severity but does not eliminate the possibility

45
Q

When is otitis media treated?

A

Oral amoxicillin if <2 years with bilateral OM

46
Q

When is LRTI/pneumonia treated?

A

History of 2 days fever, cough and focal signs then treat with oral amoxycillin

47
Q

What is treatment for acute respiratory infections aimed at?

A

Maintaining oxygenation, hydration and nutrition

48
Q

What is asthma?

A
  • Chronic respiratory condition characterised by variability and reversibility
  • Presents with wheeze, cough and SOB
  • Multiple triggers
  • Responds to asthma treatment
49
Q

Give examples of asthma triggers.

A
  • URTI
  • Exercise
  • Allergen
  • Cold weather
50
Q

What are the key words associated with asthma?

A
  • Wheeze
  • Variability
  • Response to treatment
51
Q

What is the epidemiology of asthma?

A
  • 1 million UK children
  • 100, 000 in Scotland
  • 5% of UK children on inhaled steroids!
52
Q

What is the multiple hits theory of asthma?

A
  • Genes
  • Inherently abnormal lungs
  • Early onset atopy
  • Later environmental exposure including rhinovirus, exercise and smoking
53
Q

What type of asthma does not exist?

A

Cough variant

54
Q

How can we differentiate wheeze form other sounds?

A
  • Over half of parents report generic respiratory sounds as wheeze
  • True wheeze sounds like a whistle on expiration
55
Q

How can SOB at rest be identified?

A
  • Significant respiratory difficulty
  • Airway obstruction
  • Sooking in of ribs
56
Q

What is the association between asthma and atopy?

A
  • Secondary to the same process
  • May have FMH
  • May have personal history of eczema, hayfever or food allergies
57
Q

How is asthma treatment trialled?

A

2 month trial of ICS with steroid holiday after

58
Q

What is the ideal presentation for asthma diagnosis?

A
  • Wheeze with and without URTI
  • SOB at rest
  • Parental asthma
  • Responds to treatment
59
Q

What is the differential diagnosis for asthma with onset <5 years?

A
  • Congenital
  • CF
  • PCD
  • Bronchitis
  • Foreign body
60
Q

What is the differential diagnosis for asthma with onset >5 years?

A
  • Dysfunctional breathing
  • Vocal cord dysfunction
  • Habitual cough
  • Pertussis
61
Q

When is it unlikely to be asthma?

A

Symptoms in under 18 months

  • Most likely to be infection
  • STILL MAY BE ASTHMA
62
Q

What are the goals of asthma treatment?

A
  • “Minimal” symptoms during day and night
  • Minimal need for reliever medication
  • No attacks (exacerbations)
  • No limitation of physical activity
  • Normal lung function
63
Q

How is asthma control assessed?

A

SANE Questions

  • Short acting beta agonist/week
  • Absence school/nursery
  • Nocturnal symptoms/week
  • Excertional symptoms/week
64
Q

What must be checked if asthma remains uncontrolled while on treatment?

A
  • Compliance
  • Taking medication correctly
  • Diagnosis
65
Q

What is the step up, step down approach to asthma?

A
  • Start on low dose ICS

- Review after 2 months

66
Q

What classes of medication can be used in asthma?

A
  • Short acting beta agonists
  • Inhaled corticosteroids (ICS)
  • Long acting beta agonists
  • Leukotriene receptor antagonists
  • Theophyllines
  • Oral steroids
67
Q

How does child asthma management differ from adults?

A
  • Max dose ICS 800 microg (<12 yo)
  • No oral B2 tablet
  • LTRA first line preventer in <5s
  • No LAMAs
  • Only two biologicals
68
Q

When should a regular asthma preventer be added?

A
  • Diagnostic test
  • B2 agonists >two days a week
  • Symptomatic three times a week or more, or waking one night a week.
69
Q

What adverse effects can occur with ICS?

A
  • Height suppression (0.5-1cm)
  • Oral candidiasis
  • Adenocortical suppression (mainly fluticasone inhalers)
70
Q

What 2 things do you need to remember about using a LABA in kids?

A
  • Do not use without ICS

- Use as fixed dose inhaler

71
Q

What is step 3 in asthma management?

A

Add on LABA

72
Q

What leukotriene receptor antagonist is available for kids?

A

Montelukast

73
Q

What biologic may be used with extremely resistant asthma?

A

Omalizumab

74
Q

What types of delivery systems are used for children’s asthma medication?

A
  • MDI with spacer

- Dry powder device

75
Q

How can medication delivery be increased with a spacer?

A
  • Shake inhaler between puffs

- Wash spacer monthly to reduce static

76
Q

What is the role of dry powder inhalers in childhood asthma?

A
  • Licensed in the over 5s
  • Not used in the under 8s
  • Achieve 20% lung deposition
  • Generally girls use them at an earlier age than boys
77
Q

What are the advantages of MDIs compare to nebulisers?

A
  • Quieter
  • Quicker
  • Valve mechanism
  • Don’t break down
  • Portable
  • Cheaper
78
Q

What non-pharmacological management of asthma is there?

A
  • Stop tobacco and smoke exposure

- Remove environmental triggers including animals

79
Q

How are steroids used in asthma?

A
  • Chronic/maintenance treatment= inhaled

- Acute treatment= oral

Systems: Paediatrics AB (31 decks)

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