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Paediatrics - Things I forget > Respiratory disorders > Flashcards

Respiratory disorders Flashcards

1
Q

What are the clinical features of Cow’s milk protein allergy?

A 
GI symptoms:
	• Vomiting
	• Abdominal pain
	• Blood in stool
	• Diarrhoea

Skin symptoms:
• Hives
• Eczema

Babies:
	• Wheezing
	• Facial swelling
	• Poor growth
	• Irritability
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2
Q

What is the management of Cow’s milk protein allergy?

A

Investigation:
• Skin prick
• Specific IgE antibody test

Treatment:
• Remove cow’s milk from diet
• Dietician review

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3
Q

What is the management of allergic rhinitis?

A

For relief of immediate symptoms:
• <5 = Oral antihistamine (Cetirizine)
• >5 = Intranasal antihistamine (azelastine)

For preventative treatment:
• Nasal blockage/polyp = Intranasal corticosteroid
• Sneezing = Oral antihistamine (Or intranasal corticosteroid)

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4
Q

What are the clinical features of tonsillitis/pharyngitis?

A

Causes of pharyngitis: Adenovirus, Enterovirus, Rhinovirus. Group A Strep in older children
Causes of tonsillitis: Group A Strep + EBV

Bacterial infections typically present with constitutional disturbances:
	• Headache
	• Abdominal pain
	• White tonsillar exudate 
	• Cervical lymphadenopathy
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5
Q

What is the management of tonsillitis/pharyngitis?

A

If not severe, low centor score, then symptom relief (paracetamol)

Arrange admission if:
	• Difficulty breathing
	• Clinical dehydration
	• Tonsillar abscess 
	• Signs of sepsis

Medication:
• Phenoxymethylpenicillin
• Clarithromycin if allergic to penicillin

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6
Q

What are the clinical features of otitis media?

A

Most common age: 6 months - 1 year
Due to children having short and straight eustachian tubes

Symptoms:
• Fever
• Ear pain
NOTE: Any child presenting with fever should have tympanic membrane examined

Examination:
• Red, bulging tympanic membrane with loss of normal light reflection

Causative organism:
• RSV
• Rhinovirus
• Pneumococcus

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7
Q

What is the management of otitis media?

A

In most cases, it will resolve by itself in 3 days
If no improvement after 3 days or have become worse, prescribe amoxicillin 5-7 days

Admit if:
• Signs of complications (Meningitis, mastoiditis)
• <3 months old + >38 degrees
• Severe systemic infection

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8
Q

What is the complication of recurrent otitis media?

A

Glue ear (Otitis media with effusion)
Children are asymptomatic but suffer from hearing loss
Eardrum is dull and retracted with visible fluid level

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9
Q

What is the management of otitis media with effusion?

A

Usually resolves spontaneously

However if child suffers from hearing loss, a grommet (ventilation tube in ear) can be inserted

If after removal of grommet, hearing loss is still present, reinsertion plus adenoidectomy is required

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10
Q

What are the clinical features of sinusitis?

A 
Infection of nasal sinuses via viral URTIs
	• Post nasal drip
	• Nasal discharge (Green)
	• Headache
	• Face ache
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11
Q

What is the management of sinusitis?

A 
<10 days:
	• NO ANTIBIOTICS
	• Simple analgesia 
	• Nasal decongestants 
	• Resolves after 2-3 weeks

> 10 days:
• High-dose corticosteroids for 2 weeks
• Symptoms will improve but duration likely to stay the same

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12
Q

What are the indications for tonsillectomy and adenoidectomy?

A

Tonsillectomy alone:
• Recurrent severe tonsillitis
• Tonsillar abscesses (Quinsy)

Tonsillectomy and adenoidectomy:
• Obstructive sleep apnoea
• Otitis media with effusion associated with hearing loss and failure to treat with grommet

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13
Q

What are the clinical features of stridor?

A

Typically causes by parainfluenza virus
Commonly presents at 6 months - 6 years

* Fever
* Coryza
* Stridor
* Barking cough
* Chest recession

Thumb sign & steeple sign on x-ray (though diagnosis is normally clinical)

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14
Q

What are the levels of severity of croup?

A

Mild = Barking cough, but no stridor or recession

Moderate = Barking cough, stridor and sternal recession at rest. No lethargy or agitation

Severe = Barking cough, stridor, sternal/intercostal recession, lethargy and agitation

Impending respiratory failure = Pallor, cyanosis, reduced consciousness, RR >70 breaths per minute

If worse than mild: REQUIRES ADMISSION

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15
Q

What is the management of croup?

A

If mild/no admission necessary: Single dose oral dexamethasone immediately
• Resolves after 48 hours

If severe, nebulised adrenaline with oxygen

NOTE: Never perform a throat examination on a patient with croup as it can lead to airway obstruction

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16
Q

What are the clinical features of acute epiglottitis?

A

Caused by H. influenzae
Commonly presents in 1-6 year olds

Very acute symptoms:
	• High fever
	• Intensely painful throat, can't speak or swallow. 
	• Drooling heavily
	• Child sits immobile with mouth open 
	• No coughing 
	• Stridor
17
Q

What is the management of acute epiglottitis?

A 
Medical emergency - Urgent ITU admission 
Secure airway and give oxygen
Blood cultures
Antibiotics (IV) - Cefuroxime 
Steroids/Adrenaline if necessary
18
Q

What are the clinical features of bronchiolitis?

A

Caused by RSV
Commonly presents in 1-9 months

* Dry cough
* Coryzal symptoms
* Wheezing 
* Dyspnoea (Leading to feeding difficulties)
* Recurrent apnoea

More common in preterm infants that develop bronchopulmonary dysplasia or have an underlying lung condition

Examination:
	• Subcostal/Intercostal recession
	• Hyperinflation of chest
	• Tachypnoea/Tachycardia
	• Wheezing/Crackles
19
Q

What is the management of bronchiolitis?

A 
Hospital admission if:
	• Apnoea
	• Persistent oxygen saturations <90%
	• Inadequate fluid intake
	• Severe respiratory distress (RR >70, marked chest recession, grunting)

Humidified oxygen supplementation vs optiflow
Fluids by nasogastric tube
Recover after 2 weeks

Palivizumab used for prevention if high risk

20
Q

What is the management of viral episodic wheeze?

A

When the child is wheezy give them up to 10 puffs of salbutamol with a spacer
If this is unsuccessful, ipratropium is tried in conjunction via spacer (2 puffs)
Inhaled corticosteroids may be offered if still no improvement
Finally an LRTA (Montelukast) may be used

21
Q

What is the management of asthma for a child <5 years?

A

Step 1: SABA (Salbutamol)

Step 2: 8 week trial of moderate dose ICS

Step 3: After 8 weeks, stop ICS treatment and monitor child:
• If ICS didn’t help, reconsider diagnosis
• If symptoms resolved, but returned within 4 weeks restart ICS at low dose
• If symptoms resolved, but returned after 4 weeks repeat 8-week moderate dose ICS trial

Step 4: If uncontrolled with low dose ICS, add LRTA (Montelukast)

Step 5: If no improvement, remove LRTA and refer to asthma specialist

22
Q

What is the management of asthma for a child >5 years?

A

Step 1: SABA (Salbutamol)

Step 2: Add low dose ICS (Beclomethasone)

Step 3: Add LRTA (Montelukast) and review after 4-8 weeks

Step 4: If unsuccessful, remove LRTA and add a LABA (Salmeterol)

Step 5: Change ICS and LABA to MART regime

Step 6: Increase ICS to moderate dose

Step 7: Refer to allergy specialist

23
Q

What are the features of sever acute asthma?

A
  • PEFR 33-50%
  • RR >25
  • HR > 110 BPM
  • Inability to complete sentences in one breath
  • Inability to feed
  • SPO2 = >92% (Below in life threatening asthma)
24
Q

What is the management of foreign body inhalation?

A 
Conscious:
• Encourage coughing
• Back blows
• Infant = Chest thrusts
• Child = Abdominal thrusts
• Removal of foreign body:
	○ Flexible bronchoscopy 
	○ Rigid bronchoscopy if stridor, asphyxia, decreased breath sounds or obstructive hyperinflation

Unconscious:
• Secure airways with endotracheal tube
• Removal of foreign body using above methods

25
Q

What are the clinical features of pertussis?

A

Catarrhal phase:
• Coryzal symptoms for a week

Paroxysmal phase:
• Paroxysmal cough followed by inspiratory whoop
• These spasms are worse at night and may lead to vomiting
• Child may go red/blue during coughing
• Lasts for 3 months

26
Q

What is the management of pertussis?

A

Investigations:
• Culture of perinasal swab
• PCR (Most sensitive)
• Marked lymphocytosis

Treatment:
Admit if:
	• <6 months or acutely unwell
	• Significant breathing problems 
	• Complications (Seizures, pneumonia)

If admission is not needed, prescribe antibiotics if the onset of cough is within 21 days;
• <1 month = Clarithromycin
• >1 month = Azithromycin
• Pregnant adult = Erythromycin

Avoid nursery/school until after 48 hours of antibiotic treatment or 21 days of cough onset

27
Q

What are the clinical features of primary ciliary dyskinesia?

A

Caused by a congenital abnormality in the structure or function of cilia lining the respiratory tract

Results in impaired mucociliary clearance
	• Recurrent URTIs and LRTIs
	• Recurrent productive cough
	• Purulent nasal discharge
	• Chronic ear infections
	• If untreated, leads to bronchiectasis

50% of PCD patients will have dextrocardia and situs inversus (Kartagener syndrome)

28
Q

What is the management of primary ciliary dyskinesia?

A

Daily physiotherapy
Proactive treatment of infections with antibiotics
Appropriate ENT follow-up

Paediatrics - Things I forget (11 decks)

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