Respiratory Flashcards
Causative organism of bronchiolitis?
RSV - respiratory syncytial virus
Criteria for admitting a child with bronchiolitis?
Child <3 months
Inadequate feeding (<1/2) - or inadequate fluid intake
Saturations <92%
If RR >60
Causative organism of Croup?
Parainfluenza viruses, type 1 and 3
Clinical features of croups
Preceding coryza - over days –> severe, seal-bark cough
Inspiratory stridor, harsh voice
Worse at night
Mild fever
Scoring system used in croup? What it means
Westley Croup Scoring System
0-3 = mild 4-6 = moderate >6 = severe
Management of croup?
Steroids - Dexamethasone 0.15-0.6 mg/Kg
+ Nebulised adrenaline + O2 if severe
Why is epiglottitis rare now?
Causative organism of Haemophilus Influenza type B - which is now vaccinated against
Clinical features of epiglottitis?
Onset over hours, with no preceding coryza
No cough present, pyrexic >38.5
Child odono/dysphagic - drooling saliva –> tripod position
Investigations in epiglottitis
DO NOT examine the throat - risk of obstruction
Refer for laryngoscopy or Lateral X-ray
Management of epiglottitis
(Oral ?) / IV antibiotics - cefuroxime/cefotaxime Can give some dexamethasone Call anaesthetist to secure airway Prophylactic rifampicin to household contacts
Most common causative organisms of pneumonia in children
Newborn - group B strep
Infants - RSV, strep
Children >5 - strep
What classifies tachypnoea in children?
0-5 months = >60
6-12 months = >50
>12 months = >40
What is the Centor criteria?
Indicates likelihood of bacterial tonsillitis:
Tonsillar exudate
No Cough
Tender cervical lymphadenopathy
Fever >38
Management of bacterial tonsillitis?
Penicillin V (benzylpenicillin) ALT - erythromycin
Avoid amoxicillin - as if EBV infection is the cause - this can cause a wide maculopapular rash
Criteria for tonsillectomy
7 documented episodes in the previous year, OR
5+ episodes, each year for 2 years, OR
3+ episodes, each year for 3 years, OR
2 episodes of quinsy
Inheritance of cystic fibrosis and pathophysiology
Autosomal recessive - defect in CFTR gene
Responsible for sodium transport across epithelium
results in high sodium secretions
Investigations in cystic fibrosis?
Detection antenatally and at birth - Guthrie blood assay
–> Immunoreactive trypsinogen (IRT)
Chloride sweat test - although clinical delayed presentation is rare
Management of cystic fibrosis?
Chest physio Prophylactic Abx and regular sputum cultures Pancreatic enzyme supplementation High protein, high calorie diet Calcium + Vitamin D supplementation
Follow up care in cystic fibrosis?
Managed by MDT - specialist CF centre 2x/year Check LFT, Insulin and glucose Counselling fertility support for males - IVF
Where is an inhaled foreign body most likely to lodge?
Right bronchus, in either middle or lower lobe
Antibiotics in acute otitis media?
Amoxicillin
Organism usually HiB or Strep p
Management of otitis media with effusion (OME)
Advise - face child when speaking, talk loud and slow
90% will resolve within a year
Surgery if Persistent bilateral OME for >3 months, or hearing loss >25-30 dB
—> Grommet insertion
What is laryngomalacia
Soft, immature soft palette, collapsing on inspiration –> stridor
What is choanal atresia?
Blockage of communication of nasal passage to pharynx
Bilateral can be severe, as babies are obligate nasal breathers
