Respiratory conditions Flashcards
A 4mth old baby presents with a 2/7 Hx of coryza + cough, with increasing work of breathing and decreased wet nappies. O/E: temp 37.8, RR 60, recessions, SpO2 91%, diffuse wheeze + fine crepitations.
What is your differential diagnosis?
- bronchiolitis
- viral episodic wheeze (but would have no creps)
- pneumonia (but would have higher temp, focal creps/crackles, etc.)
What are the most common causative agents for bronchiolitis? For VIW?
Bronchiolitis:
- RSV
- influenza
- parainfluenza
- rhinovirus
- adenovirus
VIW:
- rhinovirus
A 4mth old baby presents with a 2/7 Hx of coryza + cough, with increasing work of breathing and decreased wet nappies. O/E: RR 60, recessions, SpO2 91%, diffuse wheeze + fine crepitations.
How would you investigate + manage this baby?
Investigations:
1. NPA for RVS + influenza
Management:
- Vapotherm (titrate O2 to maintain sats >92%)
- CPAP if impending respiratory failure
- Support fluids/nutrition e.g. NGT
How might risk of bronchiolitis be reduced in susceptible children?
Monthly pavalizumab IM injections during winter months
What is the most common cause of croup?
Parainfluenza virus
What are the key features of croup?
Presents in 6mths to 3yrs:
- barking cough
- stridor + hoarseness
- +/- resp. distress
Symptoms worse at night and with agitation
How would you manage a child with croup according to severity?
- mild (no stridor at rest)
- single dose dexamethasone PO 0.06-0.15mg/kg
- supportive - moderate (stridor at rest, no agitation/lethargy)
- as above +
- nebulised adrenaline - severe (stridor at rest, agitation or lethargy)
- as above +
- supplemental O2
- +/- intubation if impending resp. failure
What is the causative agent of whooping cough? How does it typically present?
Bordetella pertussis
- paroxysmal coughing
- post-tussive vomiting
- inspiratory whooping
How would you investigate + manage a child with suspected pertussis?
Ix:
- NPA for B. pertussis culture + PCR
- serology if 2-8/52 after cough onset
Mx:
- AZITHROMYCIN PO 3/7 or CLARITHROMYCIN PO 7/7 (monitor for pyloric stenosis if <1/12 as ADR of macrolides)
- school exclusion until 48hrs after start of Abx
Name common causative organisms for pneumonia in children.
- viruses: influenza A, RSV
- bacteria: strep. pneumoniae, H. influenzae, Staph. aureus
- atypical organisms: Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumophila
Which Abx would you give a child present with mild CAP? With severe/complicated CAP?
Mild-moderate:
- AMOXICILLIN PO 5/7
Severe/complicated:
- CO-AMOXICLAV + CLARITHROMYCIN IV total 4/52
A 8yo girl with known asthma presents with worsening SOB on exerice and increased noctural cough. She is currently on salbutamol inhaler as required (uses 4-5x/week) + regular budesonide.
What questions should you ask before changing her inhaler regimen?
- adherence
- inhaler technique
- environmental factors e.g. passive smoking, damp/mould
- recent chest infections
- symptoms of hayfever
Describe the asthma management options for children aged 5-16, with examples of each inhaler.
- SABA e.g. salbutamol as required
- maintenance therapy:
i) low dose ICS e.g. budesonide, fluticasone
ii) low dose ICS + LTRA e.g. montelukast
iii) low dose ICS + LABA e.g. salmeterol, formoterol
iv) MART regimen e.g. Symbicort (budesonide + formoterol) or Fostair (beclomethasone + formoterol)
v) refer to specialist to consider: increased ICS dose or additional drugs e.g. theophylline
Which neonatal screening test is used for CF? What further investigations are now required?
Heel prick screen:
- immunoreactive trypsinogen test: raised if +ve
Further tests:
- pilocarpine iontophoresis (sweat test): +ve if sweat chloride >60mmol/L
- genetic test
A young child is diagnosed with CF. What long term management will they need?
- daily chest physio
- inhaled SABAs
- inhaled mucolytics (DNAase + hypertonic saline)
- monitoring + optimising nutrition
- pancreatic enzyme replacement
- fat-soluble vitamin supplementation
