Respiratory Flashcards
Antibiotics side effects
Diarrhoea Oral thrush Nappy rash Allergic reaction Multiresistance
What is rhinitis
irritation and inflammation of the mucous membrane inside the nose
Self limiting
What can rhinitis lead to?
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
Otitis Media
Ear infection Self limiting Primary viral infection Secondary infection with pneumococcus Erythema Bulging drum
Treatment for otitis media
Analgesia
Antibiotics (may work >24 hours)
Investigation for tonsillitis/ pharyngitis
Throat swab
To determine if viral or bacterial
Treatment for tonsillitis/ pharyngitis
Amoxicillin if bacterial !
Croup cause and presentation
Larygnotracheobronchitis
Cause- para flu 1
Lasts about 3 days
Presentation: Child seems well, Coryza ++ Stridor Hoarse voice “Barking” cough
Treatment for croup
Oral dexamethasone
Can give prednisolone
Severe nebulised adrenaline
Cause of epiglottitis
And presentation?
Cause- haemophillius influenzae type B
Presentation- very unwell, stridor, drooling, severe sore throat
Eiglottitis treatment
Intubation and antibiotics
Common bacterial agents in children LRTI
Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae
Common viral infections in children causative agent
RSV Parainfluenza III Influenza A and B Adenovirus Rhinovirus
Bronchitis presentation
Loose rattly cough,
Post-tussive vomit- “glut”
No wheeze or creps
Common causative agent in bronchitis
Haemophilus/ pneumococcus
Treatment for bronchitis
Self limiting
What is happening to cause bacterial bronchitis
There is disturbed mucociliary clearance so clearance stops for about 4 weeks
Resulting in cough and rattle
Red flags in LRTI (7)
Age <6months Age >4 years No relapse-remission Static weight Disrupts child’s life Associated SOB (when coughing) Acute admission Other co-morbidities
Presentation of bronchiolitis
Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze
Common causative agent of bronchiolitis?
RSV
Paraflu III
HMPV
Prognosis of bronchiolitis
Day 2-5 gradual gets worse
Day 5-7 remains stable
Day 7-14 gradual recovery
Common age to be affected by bronchiolitis
3 months
Born in August-December
Overall typically less that 12 months
Management of bronchiolitis
Maximal observation
Minimal intervention
Investigations in bronchiolitis
Oxygen saturations
Nasopharyngeal aspirate
General lower respiratory tract infection signs
48 hours Fever, SOB, Cough, Grunting, Reduced or bronchial breath sounds
If a wheeze is present is the infection likely caused by a virus or bacteria
Virus
When would you call a LRTI pneumonia
If signs are focal,
Crepitations,
High fever
Treatment for community acquired pneumonia
Nothing if symptoms are mild
Oral amoxycillin first line
Oral macrolide second choice
IV if vomiting
Pertussis presentation
Coughing fits
Vomiting
Colour change of child (red)
First line in all URTI and LRTI treatment
Oxygenation,
Hydration,
Nutrition
When would you treat otitis media with antibiotics and which one if so?
If aged under 2 and has bilateral OM
Oral amoyxcillin
What key words are associated with asthma definitions
Wheeze
Variability
Responds to treatment
What causes asthma
Host response to environment Infection Physiology abnormal before symptoms Genes- ADAM33 ORMDL3 Primary epithelial abnormality
What are the 5 ways asthma pathways to asthma
1- infant onset 2- childhood onset 3- adult onset 4- exertional asthma 5- occupational asthma
Investigations for asthma (but not diagnostic)
Peak flow
Spirometry
Exhaled nitric oxide
Response to corticosteroids
Symptoms/signs of asthma
Wheeze,
SOB at rest (“sooking” in of ribs)
Dry cough (nocturnal and exertional)
Responds to treatment
Risk factors for asthma
Eczema
Hayfever
Food allergies
What age range is resp symptoms more likely to be asthma
Over 5 more likely asthma
Under 18 months most likely infection
Differential diagnosis for asthma under 5 years
Congenital CF PCD Bronchitis Foreign body
Primary ciliary dyskinesia
Differential diagnosis for asthma over 5 years
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
Goals of asthma treatment
“minimal” symptoms during day and night
minimal need for reliever medication
no attacks (exacerbations)
no limitation of physical activity
How to measure asthma control
SANE Short acting beta agonist/ week Absence school/nursery Nocturnal symptoms/ week Excertional symptoms/ week
Initial treatment of asthma
Low dose Inhaled corticosteroid
Review after 2 months
Classes of medications used in asthma
Short acting beta agonists Inhaled corticosteroids Long acting beta agonists Leukotriene receptor antagonists Theophyllines Oral steroids
How does treatment for asthma in children differ from adults
Max dose ICS 800micrograms for <12 years No oral B2 tablet LTRA first line preventer in <5y No LAMAs Only 2 biologicals
Step 2 of treatment of asthma
And when to go onto stage 2
Regular preventer- low dose ICS (or LTRA in <5y)
when?
-diagnostic test
-B2 agonist >2 days a week
Symptomatic 3 times a week or more or waking one night a week
Adverse effects of ICS
Height suppression Oral candidiasis Adrenocortical suppression Hypertension Cataracts
Step 3 of treatment of asthma
add on LABA or LTRA (leukotriene receptor anatagonist (montelukast) was
Step 4 of asthma treatment
Refer to specialist
Increase ICE
Add 4th drug eg theophylline
Other non-medical management for asthma
Stop tobacco smoke exposure
Remove environmental triggers
How to treat someone with acute asthma
Mild:
SABA via spacer
Or SABA via spacer and prednisolone
Moderate:
SABA via nebuliser + prednisolone
SABA + ipratropium via nebuliser + prednisolone
Severe: IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate
