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Paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How do you confirm otitis media?

A

Kid with a sore ear

Look in to see redness and bulging drum –> Spontaneous rupture

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2
Q

How do you treat otitis media?

A

It’s self limiting and generally viral so just analgesia

If it’s bilateral or <2yrs you could use oral amoxycillin

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3
Q

How would you investigate a case of tonsillitis?

A

1) Examine by looking in their mouth

2) Throat swab for viral vs bacterial

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4
Q

How do you treat tonsillitis?

A

If you confirm its bacterial you can give Penicillin
Otherwise nothing but analgesia

Do not give Amoxycillin! causes rash

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5
Q

kid presents with Coryza, stridor, hoarse voice and a “barking” seal-like cough, what’s the likely diagnosis?

A

Croup

These patients tend to be overall quite well

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6
Q

What causes Croup

A

Parainfluenza Type 1

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7
Q

How do oyu handle croup?

A

Oral Dexamethasone

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8
Q

What management should be enacted for any kid with a respiratory infection?

A

Assess their oxygenation, hydration and nutritional status then attend to these if necessary, Most kids won’t need anything more than this for Respiratory infections

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9
Q

Kid presents systemically very unwell with stridor and drooling, what do you think might be happening?

A

Epiglottitis

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10
Q

What cause epiglottitis?

A

H. Influenzae B

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11
Q

How would you manage epiglottitis?

A

Intubation & Abx

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12
Q

List atleast 3 bacteria and viruses known to cause LRTIs?

A
  • Pneumococcus
  • H Influenzae
  • Morazella Catarrhalis
  • Mycoplasma Pneumoniae
  • Chlamydia Pneumoniae
  • RSV
  • Adenovirus
  • Parainfluenzae 3
  • Influenzae A & B
  • Rhinovirus
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13
Q

What’s the most common LRTI in infants?

A

Bronchiolitis

Caused mostly by RSV or sometimes parainfluenzae 4 or HMPV

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14
Q

How would you expect bronchiolitis to present?

A

<12 months old
One off episode of:
- Nasal stuffiness (e.g. common cold)
- ~3day h/o progressive tachypnoea, feeding problems, crackles +/- wheeze

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15
Q

How would you investigate and treat an infant with bronchiolitis?

A

A NPA & O2 sats is all that’s needed

Focus on their oxygen, hydration & nutrition and most will recover on their own
(Remember it’s viral so it can’t be treated with Abx)

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16
Q

Mom brings in her son saying he’s been going through episodes all winter of a rattly cough & post-coughing vomit that’s mucousy. What does it sound like?

A

Bronchitis

Tend to see:

  • Mostly well kid
  • 6months to 4 yrs
  • Relapsing remitting pattern
  • Loose Rattyl Cough
  • Post-tussive Vomit (“glut”)
  • No wheeze/creps
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17
Q

What causes bronchitis?

A

Usually a viral infection e.g. RSV disturbs the mucocilliary escalator leading to a secondary bacterial infection with:

  • Haemophilus Influenzae
  • Pneumococcus
18
Q

Bronchitis is generally managed with reassurance and waiting, when would we be more worries?

A

Red Flags include:

  • <6months / 4yrs
  • Static or dropping weight
  • Disrupts Child’s Life
  • SOB when not coughing
  • Acute admission
  • Co-morbidities e.g. neuro/gastro
19
Q

Kid comes in with mum complaining of a 2 day history of Fever, SOB & Coughing, what do we call that?

A

A LRTI or Chest Infection

Characterized by 48hrs of fever, sob, cough +/- wheeze, reduced/bronchial breath sounds & creps

Don’t call it pneumoniae as it unnessarily scares parents

20
Q

How do you investigate and treat a LRTI/chest infection?

A

Generally no need for inflammatory markers, CXR or medications, if its bad you can do FBC, CRP, CXR etc.

  • Mild = no meds
  • Worse? = Oral amoxycillin –> Oral Macrolide 2nd line –> IV if vomiting
21
Q

What characterizes Pertussis?

A

Whooping cough:

  • “coughing fits”
  • vomiting
  • Colour change
22
Q

What is needed to diagnose Asthma?

A

Chronic
Episodes of wheeze, cough & SOB at rest
Variable/Reversible
Responds to asthma meds

It can help to look for a h/o or FH/o asthma & atopic conditions e.g. hayfever, eczema or food allergy

23
Q

How do we test for asthma>

A

You don’t really
Spirometry, peak flow monitoring & allergy testing are often done but not reliable/definitive

Trial for 2 monhts with low dose ICS –> Gets better = asthma

24
Q

What mnemonic can you use to assess how well the child’s asthma is controlled?

A

SANE:

  • SABA /wk
  • Absence from school/nursery
  • Nocturnal symptoms /wk
  • Exertional symptoms /wk
25
Q

What’s first line for treating asthma?

A

SABA as required e.g. salbutamol

26
Q

What’s second line for Asthma?

A

A low dose ICS or if <5yrs a LTRA (Montelukast)

27
Q

When would you progress to 2nd line asthma meds?

A

IF using the B2 agonists >2days/wk

If symptomatic >3x/wk

Or if Waking >1night/wk

28
Q

What’s third line for childhood asthma?

A

Inhaled LABA

After that you can adjust doses or experiment with theophylline or biologics e.g. omalizumab

29
Q

What non-medical things actually help with asthma?

A

Stopping smoke exposure
Removing environmental triggers e.g. cat or dog

Diet, humidity, wt & hypoallergic duvets etc don’t help

30
Q

What’s different about childhood to adult asthma treatment?

A

Kids have lower max ICS doses

Use LTRAs early in <5yrs

No LAMAs in kids

31
Q

How do you deliver inhaled drugs in kids?

A

MDI Spacer

Dry powder inhaler, only start using it properly when they’re about 8

32
Q

Summary of Asthma meds:

A

1) SABA as required
2) Low Dose ICS
3) Inhaled LABA
4) LTRA
5) Dose adjustments, theophylline & biologics

In <5yrs move LTRA up to step 2

33
Q

Which respiratory infections would we use Abx for?

A
  • Otitis media only if bilateral & <2yrs
  • Tonsilitis if you’ve done a throat swab so you’re sure it’s bacterial (Penicillin, NOT Amoxycillin)
  • Epiglottitis (along with intubation)
  • Bad LRTI/chest infection (Amoxycillin –> Macrolide)
34
Q

quick summary of bronchiolitis?

A
  • Infants
  • Viral (RSV)
  • One off episode of nasal stuffiness, progressive tachypnoea, poor feedings, crackles over a few days

Supportive therapy, monitor O2 sats and do NPA

35
Q

Quick summary of Bronchitis?

A
  • 6months to 4yrs
  • Bacterial secondary to viral (H influenzae or Pneumococcus)
  • Well child
  • Relapsing remitting pattern of loose rattly cough & post-tussive vomit

Reassure & don’t treat

36
Q

Quick Summary of LRTI/chest infection?

A
  • Commensal bacterial overgrowth secondary to viral infection
  • 48hrs of fever, SOB & coughing
  • Intercostal recession
  • If there is a wheeze it is unlikely to be bacterial
    Oral amoxycillin only if it’s bad, macrolide as 2nd line and IV if vomiting
37
Q

Quick Summary of Croup?

A
  • 6 months to 6 years
  • Coryza, stridor, Hoarse, “Barking” Cough
  • Viral (Parainfluenzae 1)

Treat with Oral Dexamethasone

38
Q

What is the max dose of ICS which should be given?

A

800 micrograms

39
Q

How to manage acute MILD asthma

A

SABA via spacer

SABA via spare + predinosone

40
Q

How to manage MODERATE asthma?

A

SABA via nebuliser + predinosone

41
Q

How to manage SEVERE asthma?

A 
IV Salbutamol 
IV amimophylline
IV magnesium 
IV hydrocortisone 
Intubate and ventilate

Paeds (35 decks)

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