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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is rhinitis?

A
  • URTI
  • Very common
    □ 5-10 per year
  • Winter months
  • Self-limiting condition
  • Prodrome to other illnesses
    □ Pneumonia, bronchiolitis
    □ Meningitis
    □ Septicaemia
  • Review if not sure
  • Typically lasts 11 days before they resolve but they may be a little longer
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2
Q

What is otitis media?

A
  • URTI
  • Pain and redness
  • The drum is no longer red and shiny
  • The drum is being pushed forward until it bursts and then it gets better
  • On average lasts 3 days- 1 week
  • Primary viral infection
  • Secondary infection with pneumococcus/ H’flu
  • Spontaneous rupture of the drum
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3
Q

What is the treatment of otisis media?

A
  • Antibiotic treatment usually doesn’t help
  • Oxidation, hydration, analgesia and nutrition
  • Analgesia
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4
Q

What is tonsillitis/ pharygitis and how is it diagnosed?

A
  • URTI
  • Common
  • Viral or bacterial
  • Throat swab
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5
Q

What is the treatment for tonsillitis/ pharyngitis?

A
  • Either nothing or 10 days penicillin
    □ Ongoing swinging fevers and rash give penicillin as it suggest bacterial- you can’t tell from the throat
  • Don’t give amoxycillin
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6
Q

What is Croup?

A
  • URTI
  • Para’ flu I
  • Common
  • Child is well
  • Coryza ++, stridor, hoarse voice, “barking” cough
  • Croup usually comes on at 9/10 o’clock at night
  • Treatment: oral dexamethasone
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7
Q

What is epiglotitis?

A
  • URTI
  • H. Influenzae type B
  • Rare
  • Toxic: high temp, high pulse, low BP
  • Stridor, drooling
  • Treatment: Intubation and antibiotics
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8
Q

What is the management of Lower respiratory tract infections?

A
  • Make a diagnosis (easy)
  • Assess the patient (easy)
    □ Oxygenation, hydration, nutrition
  • To treat or not to treat (grey)
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9
Q

What are the common bacterial agents of LRTI?

A 
□ Strep. Pneumoniae
□ Haemophilus influenzae 
□ Moraxella catarrhalis 
□ Mycoplasma pneumoniae 
□ Chlamydia pneumoniae
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10
Q

What are the common viral causes of LRTI?

A 
□ RSV
□ Parainfluenza III
□ Influenza A and B
□ Adenovirus 
□ Rhinovirus
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11
Q

What is bronchitis?

A
  • LRTI
  • Common ++++
  • Loose rattily cough
  • Post-tussive vomit- “glut”
  • Chest free of wheeze/ creps
  • Haemophilus/ pneumococcus
  • Mostly self-limiting
  • Child very well, parent worried
  • Symptoms have been going on for the whole winter
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12
Q

What is the mechanisms that cause bronchitis?

A 
- Disturbed mucociliary clearance
◊ Minor airway malacia 
◊ RV/ adenovirus 
- Lack of social inhibition 
- Bacterial overgrowth is secondary
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13
Q

What is the management of bronchitis?

A

□ Make the diagnosis
□ Reassure
□ Do not treat

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14
Q

What are the red flags for LRTIs?

A
  • Age <6 months and >4 years
  • No relapse-remission cycle
  • Static weight
  • Disrupts child’s life
  • Associated SOB (when not coughing)
  • Acute admission
  • Other co-morbidities (neuro/ gastro)
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15
Q

What is bronchiolitis?

A
  • LRTI
  • A clinical diagnosis
  • LRTI of infants
  • Affect 30-40% of all infants
  • Usually RSV, others include paraflu III, HMPV (human metapneuma virus)
  • Nasal stuffiness, tachypnoea, poor feeding
  • Crackles +/- wheeze
  • There is no uncertainty
    □ <12 months old
    □ One off (not recurrent)
    □ Typical history…
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16
Q

What investigations are carried out in bronchiolitis?

A 
□ NPA (nursing in same ward)
□ Oxygen saturations (severity)
□ No routine need for
® CXR
® Bloods
® Bacterial cultures
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17
Q

What is the management of bronchiolitis?

A

□ Make sure oxygen, hydration and nutrition is ok
□ Maximal observation
□ Minimal intervention

18
Q

How can you tell if it is pneumonia?

A
  • Totally academic
  • Word causes great anxiety
  • You might call it pneumonia if
    □ Signs are focal, i.e. in one area
    □ Creps
    □ High fever
  • Otherwise call it LRTI
19
Q

What investigations are done for comunity aquired pneumonia?

A

CXR and inflammatory markers not routine

20
Q

What is the management of community aquired pneumonia?

A 
® Nothing if symptoms are mild
® Always review if things are getting worse
® Oral Amoxycillin first line
® Oral Macrolide second line 
® Only for IV if vomiting
21
Q

What is Pertusis?

A
  • Whooping cough
  • Common
  • Vaccination reduced risk
  • Vaccination reduces severity
  • “coughing fits”
  • Vomiting and colour change
22
Q

Do you give antibiotics to a child with otitis media?

A

No unless age under two years AND bliateral OM give oral amaxycillin

23
Q

Do you give antibiotics to a child with Bronchiolitis?

A

No

24
Q

Do you give antibiotics to a child with Tonsillitis?

A

Yes (if you know it is strep.) give penicillin

25
Q

Do you give antibiotics to a child with LRTI/ pneumonia?

A

No, unless 2 day history of fevere, cough and focal signs then give oral amoxycillin

26
Q

Do you give antibiotics to a child with Bronchitis?

A

No

27
Q

What is asthma?

A
  • Chronic
  • Wheeze, cough, SOB
  • Variable/ reversable
  • Responds to asthma treatment
  • No uniform definition
28
Q

What are the triggers of asthma

A
  • URTI
  • Exrercise
  • Allergen
  • Cold weather
  • ETC.
29
Q

What is the aetiology of asthma?

A 
- Genes
□ ~10 variants making modest contribution 
□ ADAM33, ORMDL3
- Interact with the environment 
□ Rhinovirus
□ Exercise
□ Smoking
- Epigenetics
30
Q

How is asthma diagnosed in children?

A
  • All in the history
  • Examination unhelpful
    □ Unlikely to be wheezing
    □ Stethoscope never important (often unhelpful)
  • No asthma test in children
    □ Peak flow random number generator
    □ Allergy test irrelevant
    □ Spirometry lacks specificity
    □ Exhaled nitric oxide unproven
31
Q

How is one able to tell if a child has asthma?

A 
- Wheeze
□ A must have
□ Cough variant asthma does not exist
□ Cough predominant asthma not uncommon
- SOB at rest
□ Lost 70% lung function
□ Using their abdomen to breath
- Cough
□ Everyone coughs
□ Dry
□ Nocturnal (just after falling asleep)  
□ Exertional 
- Responds to treatment
□ What has asthma symptoms and responds to asthma treatment?
□ Asthma treatment= ICS for 2 months
□ Remember "false positive responses"- holiday
32
Q

What is the differential diagnosis for asthma if the onset is under 5 years?

A 
□ Congenital
□ CF
□ Primary ciliary dyskinesia 
□ Bronchitis 
□ Foreign body
33
Q

What is the differential diagnosis for asthma if the onset is over 5 years?

A

□ Dysfunctional breathing
□ Vocal cord dysfunction
□ Habitual cough
□ Pertussis

34
Q

What are the goals of treatment in asthma?

A

□ “Minimal” symptoms during day and night
□ Minimal need for reliever medication
□ No attacks (exacerbations)
□ No limitation of physical activity

35
Q

How is asthma monitored?

A

® Closed questions
® SANE
◊ Short acting beta agonist/ week (>2 days a week then asthma is poorly controlled)
◊ Absence school/ nursery
◊ Nocturnal symptoms (if you get it once a week)
◊ Exertional symptoms/ week

36
Q

What are the classes of asthma medication?

A 
® Short acting beta agonists
® Inhaled corticosteroids
® Long acting beta agonists*
® Leukotriene receptor antagonists*
® Theophylline
® Oral steroids
® *=add ons
37
Q

Explain inhaled corticosteroids

A 
◊ Very useful for diagnosis
◊ Very effective
◊ Very safe (when prescribed correctly)
◊ Adverse effects
- Hight suppression (0.5-1cm)
- Oral canditis 
- Adrenocortical suppression
- Doesn't cause hypertension
- Doesn't cause cataracts
38
Q

When should you use a regular preventer in asthma?

A

◊ Diagnostic test
◊ B2 agonist >2 days a week
◊ Symptomatic three times a week or more, or waking one night a week

39
Q

What should be used as a regular preventer in asthma>

A

Start with low dose inhaled corticosteroids (or LTRA in <5s)

40
Q

What non-medication interventions should be done in asthma?

A 
□ Stop tobacco smoke exposure
□ Remove environmental triggers 
® Cat, Dog
® HM??
□ Diet- evidence negative
□ Alter humidity- no evidence
® Air ionisers increase cough
□ Weight reduction- no evidence
41
Q

What is the step-up step-down approach to treating asthma in children?

A

□ Start on low dose ICS
® Severe may respond to minimal treatment
□ Review after 2 months
® No routine test to monitor progress
® Stepping up easier than down
® Need an inhaler holiday when Easter comes round

42
Q

What is the initial add on preventer?

A 
□ Gets complicated
® Add on LABA or LTRA (BTS/SIGN)
® Add on LTRA (NICE)
® Increase ICS dose (GINA)
® Add on LABA but keep an open mind (clinician)
□ Long acting beta agonist***
® Do not use without ICS
® Use as fixed dose inhaler
□ Leukotriene receptor agonist
® Montelukast only 
® Rule of thirds
® Better adherence 
® Granules for reluctant toddlers

Paediatrics (13 decks)

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