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Paediatrics > Respiratory and ENT > Flashcards

Respiratory and ENT Flashcards

1
Q

What are the symptoms of mild asthma?

A
  • Breathlessness

- PEFR = reduced by still normal (>50%)

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2
Q

What are the symptoms of severe asthma?

A
  • Too breathless to talk or feed
  • RR >50
  • PR >130
  • PEFR <50%
  • Tracheal tug
  • Head bobbing in infants
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3
Q

What are the symptoms of life-threatening asthma?

A
  • PEFR <33%
  • Silent chest
  • Fatigue, drowsiness confusion
  • HYPOTENSION
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4
Q

After what age is asthma usually diagnosed?

A

5 years

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5
Q

How would you manage mild- moderate asthma?

A
  • ABCDE
  • Up to 10x inhaler puffs of 2.5mg or NEB
  • Oral prednisolone
  • Reasses in 1 hr
  • Swap for salbutamol 5mg NEB
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6
Q

How would you manage severe asthma?

A
  • Ipatropium bromide + salbutamol NEB

- IV hydrocortisone

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7
Q

How would you manage life-threatening asthma?

A
  • IV salbutamol
  • IV aminophylline
  • IV Magnesium
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8
Q

On discharge, when O2 is no longer required, how would you manage asthma?

A
  • 6-10puffs every 4 hours
  • PO prednisolone for several days
  • Asthma clinic referral
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9
Q

What alternative medication are there for home use?

A
  • Beclomethasone inhaler
  • Salmetrol
  • Montelukast
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10
Q

How does Salmetrol work?

A
  • Long acting B-2 agonist
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11
Q

How does Montelukast work?

A
  • Leukotrine receptor antagonist
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12
Q

What differentials are there for ashtma?

A
  • Pertussis
  • Croup
  • Pneumonia
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13
Q

What is the main cause of bronchiolitis?

A

Respiratory Syncytial Virus

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14
Q

What are the risk factors for bronchiolitis?

A
  • Premature birth
  • Young age <1
  • Cardiac/respiratory chronic diseases
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15
Q

What are the main symptoms of bronchiolitis?

A
  • Dry cough
  • Coryza
  • Low grade fever
  • Loss of appetite
  • Subcostal recession
  • Prominent sternum
  • Hyperinflation of chest
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16
Q

What would you expect to find on examination of a child with bronchiolitis?

A
  • Widespread wheeze
  • Fine crackles
  • Overexpansion of chest
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17
Q

What time of virus is RSV?

A

Single stranded RNA virus

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18
Q

What main investigation would you perform to diagnose RSV bronchiolitis?

A
  • Nasopharyngeal aspirate to detect RSV by immunofluorescence
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19
Q

Under what circumstances would you admit a child with bronchiolitis?

A
  • Poor feeding
  • Apnoea
  • Increased respiratory distress sign
  • Low O2
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20
Q

How would you manage bronchiolitis?

A
  • Supportive

- O2 if SaO2 <92%

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21
Q

What is croup?

A

Acute laryngotracheobronchitis

- Inflammation of all the upper airways

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22
Q

What causes croup?

A
  • Mostly Para-influenzae
  • RSV
  • Rarely measles
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23
Q

What are the symptoms of croup?

A
  • Stridor
  • Coryzal
  • Barking cough
  • Wheeze
  • Hoarse voice
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24
Q

What is the main pathology of croup?

A

Sub-glottic oedema

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25
Q

When would you admit a child with croup?

A
  • Increased work of breathing

- Cyanosis

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26
Q

How would you manage croup?

A
  • Every child has one single dose of oral dexamethasone
  • Prednisolone if dexamethasone not possible
  • Moderate - NEB budenoside
  • In emergency - high-flow O2 and NEB adrenaline and steroids
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27
Q

What is the main cause of Epiglottitis?

A
  • Haemophilus influenzae
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28
Q

What is the difference between the ages of those affected by epiglottitis and croup?

A
  • E = 2-6 years

- C = 6m - 3years

29
Q

Why have the number of epiglottitis cases reduced?

A
  • Haemophilus influenzae B vaccine introduced as part of routine vaccinations
30
Q

What is the difference between the areas affected by croup and epiglottitis?

A
  • E = supraglottic

- C = subglottic

31
Q

What are the main signs/symtoms of epiglottitis?

A 
A - Airway closed
I - Increased pulse
R - Restlessness
R - Retractions
A - Anxiety
I - Inspiratory stridor
D - Drooling

High fever
Severely septic
Leaning forwards

32
Q

What type of bacteria is Haemophilus?

A

Gram -ve Coccobacilli

33
Q

What are the main investigations of epiglottitis?

A

NONE UNTIL AIRWAY SECURED

  • Laryngoscopy
  • Blood cultures
34
Q

How would you manage epiglottitis?

A
  • Call anaesthetist
  • Intubate
  • IV Cefotaxime
  • IV Flucloxillin if cultures -
    come back as staph. strain
35
Q

What are the main bacterial causes of pneumonia?

A
  • Strep. pneumoniae
  • Mycoplasma pneumoniae
  • Haemophilus influenzae
36
Q

What are the main causes of viral pneumonia?

A
  • RSV
  • Influenza
  • Parainfluenza
  • Adenovirus
  • Coxsackie virus
37
Q

What are major risk factors for pneumonia?

A
  • CF

- tracheo-oesophageal fistula

38
Q

What are the main signs/symptoms of pneumonia?

A
  • Short history of fever
  • Tachypnoea, cyanosis, grunting, cough
  • Respiratory distress
  • Anorexia
39
Q

What would you expect to hear on auscultation of a child with pneumonia?

A
  • Localised crackles

- Bronchial breathing

40
Q

How would you investigate suspected pneumonia?

A
  • Blood cultures
  • CR and MSU before ABx
  • Monitor temperatures closely
41
Q

How would you manage pneumonia?

A
  • O2 if required
  • Erythromycin + Co-Amoxiclav
  • IV Gentamicin and ampicillin
42
Q

In an URTI, why would you avoid amoxicillin?

A

In tonsillitis/pharyngitis may causes maculopapular rash if causative agent is EBV

43
Q

What is Co-Amoxiclav particularly effective against?

A

B-lactamase-producing H.influenzae

44
Q

How common is CF?

A

1 in 3000 births

45
Q

What is the cause of CF?

A
  • Genetic mutation
  • CFTR gene on chromosome 7
  • F508 mutation
46
Q

What is meconium ileus?

A
  • Bowel obstruction that occurs when the meconium in the intestine is even thicker and stickier than normal
  • Creates a blockage in a part of the small intestine
47
Q

What bacterial colonisation is common in CF

A
  • Pseudomonas Aeruginosa

- S. Aureus

48
Q

How do you treat a pseudomonas aeruginosa infection?

A
  • Tazocin
49
Q

What pancreatic insufficiency signs present with CF?

A
  • Fat malabsorption
  • Steatorrhoea
  • Failure to thrive
  • Diabetes
50
Q

What symptoms are present with CF?

A
  • Clubbing
  • Respiratory distress
  • Biliary stasis
  • Nasal polyps
  • Meconium ileus
  • Pancreatic insufficiency
51
Q

How can you test for CF?

A
  • Heel prick to test for raised immunoreactive trypsinogen
  • Sweat test - increased Na and Cl
  • Genetic testing
52
Q

How is CF managed?

A
  • Physiotherapy
  • Prophylactic Abx
  • Steroids/beta agonists
  • Pancreatic enzyme supplementation
  • Fat soluble vitamin supplementation
  • Biliary stasis - Ursodeoxycholic acid
53
Q

What is Ursodeoxycholic acid used for?

A

To improve bile flow

54
Q

What is Creon?

A

Pancreatic enzyme supplement

55
Q

Which vitamins are needed to be supplemented in CF?

A

A,D,E,K

56
Q

When may a lung transplant be indicated in CF?

A

When FEV1 <30%

57
Q

Which organism is most likely to cause Otitis Media?

A

Streptococcus Pneumonia

58
Q

What is the treatment for secretory otitis media?

A

Grommets

59
Q

What is the incubation period for whooping cough?

A

7-14 days

60
Q

What is the management for whooping cough?

A

Oral macrolide if onset within 21 days

Erythromycin for prophylaxis of others

61
Q

Which organism causes tuberculosis?

A

Mycobacterium tuberculosis

62
Q

What is the main investigation for suspected tuberculosis?

A

Mantoux skin testing

63
Q

What are the guidelines for surgical tonsillectomy?

A
  • 7+ episodes in 1 year OR
  • 5+ in each of previous 2 years OR
  • 3+ in each of previous 3 years
64
Q

What score is used for the indication of antibiotics in tonsillitis?

A
  • Centor score

- >3 or 4 = Penicillin V

65
Q

Which bacteria most commonly cause tonsillitis?

A
  • Group A strep
  • Staphylococcus
  • Moraxella catarrhalis
66
Q

What is bacterial trachieitis?

A
  • Rare but dangerous condition similar to severe viral croup except that the child has a high fever, appears toxic and has rapidly progressive airways obstruction with copious thick airway secretions.
  • It is caused by infection with Staphylococcus aureus.
  • Treatment is by IV antibiotics and intubation/ventilation if required.
67
Q

What commonly causes Pharyngitis?

A
  • Adenoviruses
  • Enteroviruses
  • Rhinoviruses

In older children - Group A Beta haemolytic streptococcus

68
Q

What is given to premature babies with chronic lung disease?

A

Palivizumab - Monoclonal antibody to RSV surface protein - monthly IM injections for 6 months

Paediatrics (11 decks)

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