Respiratory Flashcards
What is the medical name for croup?
Laryngotracheobronchitis
What are the negatives of antibiotic use?
Diarrhoea Oral thrush Nappy rash Allergic reaction Multi-resistance
What can rhinitis be a prodrome to?
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
How many times a year might a child have rhinitis?
5-10
How will otitis media look on examination?
Erythema
Bulging drum
How is otitis media treated in children?
Self-limiting
Is otitis media viral or bacterial?
Primary viral infection
What is the treatment for otitis media?
Analgesia
Usually antibiotics don’t help
What are the two types of tonsillitis/pharyngitis?
Viral or bacterial
What is the treatment for tonsillitis/pharyngitis?
Analgesia
Nothing
OR 10 days penicillin
How to diagnose tonsillitis/pharyngitis?
Throat swab
Which antibiotic don’t you give for tonsillitis/pharyngitis?
Amoxycillin
What is the most common virus that causes croup?
Parainfluenza I
What are the signs/symptoms of croup?
Coryza++
Stridor
Hoarse voice
Barking cough
What is the treatment for croup?
Oral dexamethasone
What is the most common virus that causes epiglottitis?
H. influenzae type B
What are the signs/symptoms of epiglottitis?
Stridor
Drooling
What is the treatment for epiglottitis?
Intubation
Antibiotics
Why is epiglottitis rare these days?
Hib vaccine
What is the treatment for most URTI’s in children?
Self-limiting, no treatment
Analgesia
What are common bacterial agents in LRTI?
Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumonia Chlamydia pneumonia
What are common viral infections that cause LRTI?
RSV Parainfluenzae III Influenza A & B Adenovirus Rhinovirus
What are the principles of management of LRTI?
Make diagnosis
Assess patient: oxygen, hydration, nutrition
Treatment options
What are the signs/symptoms of bronchitis?
Loose rattly cough
Post-tussive vomit
Chest free of wheeze/creps
What are the normal causes of bronchitis?
Haemophilus
Pneumococcus
What is the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance
What is the treatment for bronchitis?
Mostly self-limiting
What are the red flags in bronchitis?
Age <6mo, >4yr No relapse-remission Static weight Disrupts child's life Associated SOB (not coughing) Acute admission Other co-morbities
What is the treatment for usual persistent bacterial bronchitis?
Reassure
Don’t treat!
What are the causes of bronchiolitis?
RSV
Paraflu III
HMPV
What are signs/symptoms of bronchiolitis?
Nasal stuffiness Tachypnoea Poor feeding Crackles +/- wheeze Cough
What are the possible interventions for bronchiolitis?
Oxygenation
Supportive care: hydration, NG tube, unblock nose
No medication
What is the best indicator of progress for bronchiolitis?
Feeding
When do symptoms peak in bronchiolitis?
Days 4-5
How long might the cough last in bronchiolitis?
1-2 weeks
Is bronchiolitis usually recurrent?
No
At what age does bronchiolitis usually occur?
<12 mo
What is RSV?
Respiratory syncytial virus
What time of year do RSV/bronchiolitis usually present?
Winter
What are the signs/symptoms of LTRI?
48hrs Fever SOB Cough Grunting Reduced/bronchial breath sounds
What is the management of a LRTI?
Nothing if symptoms mild
Oral amoxycillin first line
Oral macrolide second
IV if vomiting
When should oral antibiotic be given over IV?
Antibiotics indicated
Non-severe LRTI
Child is not vomiting
What are the benefits of oral antibiotics?
Shorter hospital stay
Cheaper
What are the signs/symptoms of pertussis?
Cough >2wks Worse at night Inspiratory whoop Vomiting Colour change
How does a vaccination help pertussis?
Reduces risk
Reduces severity
When should you give antibiotics for tonsillitis?
If you know it is Strep!
When should you give antibiotics for otitis media?
<2yrs
Bilateral OM
Which antibiotic for otitis media?
Oral amoxycillin
When should give antibiotics for LRTI/pneumonia?
2 days fever, cough, focal signs (ie one side)
What antibiotic for LRTI/pneumonia?
Oral amoxycillin
What are the things key things to help diagnosis asthma?
Wheeze
Variability
Responds to treatment
What are some of the causes of asthma?
Genes
Environment
Epigenetics
What is the treatment of asthma in children?
Watchful waiting if no QoL implications of symptoms
What is the test for asthma in children?
No diagnostic test HOWEVER Spirometry BDR FeNO Peak Flow
What is BDR?
Bronchodilator responsiveness
What are the signs/symptoms of asthma?
PSignificant resp difficulty Airway obstruction SOB at rest Looking in of ribs with wheeze Cough - dry, nocturnal, exertion
What are other risk factors or associated symptoms of asthma?
Parent asthma
Eczema
Hayfever
Food allergies
What is the other factor which confirms a diagnosis of asthma?
Responds to treatment
What are the potential disadvantages of trial of treatment for asthma?
Cost
Hassle
Loss in height
Oral thrush
What are the potential advantages of trial of treatment for asthma?
Helps diagnosis
Symptoms responds
Improves QoL
Reduces risk of attacks
What are the options to approach wheeze?
Watch and see
Trial of treatment
When is it more likely a respiratory infection than asthma?
<18 mo
When is it more likely asthma age-wise?
> 5yrs
What is a DD for asthma if onset <5yrs?
Congenital CF PCD (Primary Ciliary Dyskinesia) Bronchitis Foreign body
What is a DD for asthma if onset >5yrs?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
What is VIW?
Viral induced wheeze
What is the trial of treatment for asthma?
Inhaled steroids
What is the SANE mnemonic for measuring control of asthma in children?
Short acting beta agonist/wk
Absence from nursery or school/wk
Nocturnal symptoms/wk
Excertional symptoms/wk
If asthma is not well controlled what must be assessed before treatment is increased?
Are they taking treatment?
Are they taking treatment correctly?
Do they have asthma?
What is different about asthma medication in children?
Max dose ICS 800microg (<12) No oral B2 tablet LTRA first line preventer <5 No LAMAs Only two biologicals
When would a regular preventer be prescribed in a child?
Symptomatic 3x+/wk or waking 1x/wk
What is the regular preventer you would start with in <5s with asthma?
Leukotriene receptor antagonists (LTRA)
What is the regular preventer you would start with in >5s with asthma?
Very low dose ICS
Why are ICS as a regular preventer in children?
Useful for diagnosis
Effective
Safe
What are the adverse effects of ICS?
Height suppression
?oral candidiasis
?adrenocortical suppression
What is the initial add on preventer in asthma?
Add LABA
What should you remember about long acting beta agonists (LABA)?
Do not use without ICS
Use as fixed dose inhaler
What is the leukotriene receptor antagonist you would use?
Montelukast
What are additional add-on therapies in asthma?
Increase ICS
LTRA
What are the two types of delivery systems that can be used in asthma for children?
Metered dose inhaler (MDI)/spacer
Dry powder device
What advice should you give when prescribing a spacer for asthma?
Shake inhaler between puffs
Wash spacer monthly to reduce static
What other management options are there for asthma in children beyond medication?
Stop tobacco smoke exposure
Remove environmental triggers - pets
What factors should you consider when prescribing medicine for acute asthma in children?
RR Work of breathing HR O2 sats Ability to complete sentences Confusion Air entry
What should the response be to acute asthma?
Start treatment and reassess in 1hr
Step up or down as appropriate
What is the medication for mild acute asthma?
- SABA via spacer
2. SABA via spacer + pred
What is the medication for moderate acute asthma?
- SABA via neb + pred
2. SABA + ipra via neb + pred
What is the medication for severe acute asthma?
IV salbutamol IV aminophylline IV magnesium IV hydrocortisone Intubate and ventilate
