Respiratory Conditions Flashcards
What are some side effects of antibiotic treatment in children?
Diarrhoea Oral thrush Nappy rash Allergic reaction Multi resistance
What are some features of Rhinitis?
Common cold, runny nose. 5-10 per year is normal. Winter months Self-limiting 14-21 day duration Can be a prodrome to pneumonia, bronchiolitis, meningitis or septicaemia.
What are the features of Otitis Media?
Red and inflamed tympanic membrane which is about to burst.
Fever, ear pain and discharge.
Primary viral infection
Secondary infection with pneumococcus/H’flu.
Antibiotics usually do NOT help.
Watch and wait as self limiting.
What are the features of Tonsillitis/pharyngitis?
Sore throat, red swollen tonsils, pus-sy spots.
Common
Can be viral or bacterial
Throat swab - 2 days for results.
Either watch and wait or Penicillin.
Do not give Amoxicillin as gives rash if have EBV.
What are some features of Croup?
Laryngotracheo bronchitis. Para'flu I Child is well just sounds bad. Barking cough, stridor, hoarse voice, coryza (runny nose). Treat oral dexamethasone.
What are the features of Epiglottitis?
Rare H. Influenzae type B Child is severely unwell - emergency. Worse sore throat ever, can't swallow so drooling, stridor, high pulse/temp and low BP. Treat with intubation and antibiotics.
What are some common agents that cause lower respiratory. tract infections?
Bacterial overgrowth - strep pneumoniae, Haemophillus infulenzae, Moraxella catarrhalis, mycoplasma pneumoniae, chlamydia pneumoniae.
Viral infection - RSV, parainfluenza III, influenza A and B, adenovirus, rhinovirus.
What are the principles of management for LRTIs?
Make diagnosis
Assess patient - oxygenation, hydration, nutrition.
Treat or don’t treat.
What are the features of Bronchitis?
Common Loose rattly cough Post-tussive vomit (after coughing fit phlegm). Chest free of wheeze/creps Haemophillus or Pneumococcus - disturbed mucocilliary clearance. Mostly self-limiting Child very well. Antibiotics won't help.
What is the cycle of bronchitis in winter?
Resp virus Mucocilliary clearance stops for <4 weeks. Cough and rattle Clearance almost recovers Cycle repeats.
What are some red flags for Bronchitis in children?
Age <6months or >4years No relapse remission Static weight Disrupts child's life Associated SOB when not coughing. Acute admission Other co-morbidities
What are the features of Bronchiolitis?
LRTI of infants peak at around 3months.
Usually RSV but can be para’flu III, HMPV.
Nasal stuffiness, tachypnoea, poor feeding.
Crackles and/or wheeze.
7-14day duration.
Worse by day 4/5, stabilises after this.
Monitor oxygenation, hydration and nutrition.
August to December
What are some features of LRTI?
48hrs, fever, SOB, cough and grunting. Wheeze makes bacterial cause unlikely. Reduced or bronchial breath sounds. Virus + commensal bacteria. Treat with nothing if mild, oral amoxycillin 1st line, macrolide 2nd and IV only if vomiting.
What are some features of Pertussis?
Whooping cough
Common even if vaccinated against it.
Coughing fits >2weeks
Vomiting and colour change.
What are the key features of Asthma?
Wheeze and cough
Variability - relapse and remission.
Responds to treatment - inhaled corticosteroids.
Airflow obstruction.
What known genes are involved in asthma predisposition?
ADAM33
ORMDL3
10 other variants making modest contribution.
Interact with environment.
What causes asthma?
Primary epithelial abnormality (skin/gut/airway) results in eczema, asthma etc.
Allergy then occurs which fuels the eczema, asthma etc.
How does asthma affect spirometry?
Reduced spirometry.
Cannot diagnose asthma.
What are the tests for asthma according to the NICE guidelines?
Spirometry
BDR - broncho-dilator reversibility
FeNO
Peak Flow
What are the symptoms of asthma?
Cough - dry, nocturnal and exertional.
SOB at rest - cooking in of ribs with wheeze.
Parental history
Personal Hx of eczema, hay fever, food allergies.
What is the 1st line treatment for asthma?
Inhaled corticosteroids for 2 months.
Brown inhaler.
What are the goals of asthma treatment?
Minimal symptoms during day and night.
Minimal need for reliever
No attacks
No limitation of physical activity.
What are some questions to aid assessment of asthma control?
SANE
How many times a week do you use Short acting beta agonist?
Absence from school/nursery?
Nocturnal symptoms/week?
Excertional symptoms/week?
Child asthma Control test out of 27 is also useful.
What is step 2 of asthma treatment?
Add a regular preventer if need beta agonists >2 days a week or symptomatic 3x a week or waking 1 night a week.
Low dose ICS or LTRA in <5s.
What is step 3 of asthma treatment?
Add on LABA or LTRA (montelukast).
In some cases increase ICS dose.
Depends on what works for child.
What is the treatment for Mild acute episodes of asthma?
SABA via spacer
SABA via spacer + prednisolone.
What is the treatment for moderate acute episodes of asthma?
SABA via neb + prednisolone.
SABA + ipra via neb + prednisolone.
What is the treatment fo severe acute episodes of Asthma?
IV salbutamol, IV aminophylline, Iv magnesium (neb), IV hydrocortisone
Intubate and ventilate.
