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Y5 Paediatrics > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

What are symptoms of severe respiratory distress

A

cyanosis
tired out
reduced conscious level
oxygen sat <92%

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2
Q

explain features of STRIDOR

A

INspiratory
caused by narrowing of the upper airways (above thoracic inlet - extra thoracic)
Upper airway tissues are floppy > make noise on inspiration

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3
Q

Explain features of WHEEZE

A

EXPIRATORY
compression of bronchioles in lung (intrathoracic airway narrowing)
When you are trying to push air out, the airways become narrower

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4
Q

What are classifications of respiratory infections

A 
URTI 
Laryngeal/tracheal infection 
Bronchitis 
Bronchiolitis 
Pneumonia
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5
Q

How many URTI do children have on average per year?

A

5

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6
Q

What are conditions classed as URTI?

A

Coryza (common cold)
Pharyngitis, tonsillitis (sore throat)
Acute otitis media
Sinusitis

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7
Q

What are features of the common cold

A

Nasal discharge clear/mucopurulent

Nasal blockage

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8
Q

What are common pathogens causing the common cold

A

Rhinovirus
Coronavirus
RSV

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9
Q

How do you manage the common cold

A

Reassure patient:

  • self limiting
  • symptoms peak after 2-3 days, resolve within 2 weeks
  • encourage rest, adequate food and fluidd intake
  • Paracetamol / ibuprofen for pain relief
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10
Q

What is pharyngitis

A

inflammation of the pharynx and soft palate

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11
Q

What are causes of pharyngitis

A

Viral infection: adenoviruses, enteroviruses, rhinoviruses

in older children: Group A beta-haemolytic strep

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12
Q

What is tonsillitis

A

Intense inflammation of the tonsils, often with purulent exhudate

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13
Q

What is a common cause of tonsillitis

A

group A beta-haemolytic strep

EBV

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14
Q

What is ix for pharyngitis/tonsillitis

A

can do rapid antigen testing if bacterial tonsillitis suspected q

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15
Q

What is mx for pharyngitis/tonsillitis

A

10 day Phenoxymethylpenicillin if bacterial tonsillitis confirmed
Clarythromycin if allergy

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16
Q

What is advice for pharyngitis/tonsillitis

A

adequate fluid intake
Paracetamol/ibuprofen as necessary
Salt water gargling, lozenges, anaesthetic spray for temporary pain relief
Return to school after fever has resolved

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17
Q

What antibiotic must be avoided in pharyngitis/tonsillitis and WHY

A

Avoid AMOXICILLIN

If tonsillitis is from EBV, it will cause widespread ma culopapular rash

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18
Q

What is scarlet fever

A

Occurs following tonsillitis due to group A strep

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19
Q

What us the presentation of scarlet fever

A

headache and tonsillitis > fever
Rash: sandpaper like maculopapular rash with flushed cheeks and perioral sparing
Tongue: white, coated, sore, swollen

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20
Q

What is the management of scarlet fever

A

10 day Phenoxymethylpenicillin 4xD

Or Arythromyci

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21
Q

What else must you do if someone has scarlet fever

A

Notify PHE - this is a NOTIFIABLE DISEASE

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22
Q

What is another name for Phenoxymethylpenicillin

A

Penicillin V

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23
Q

Why are children more susceptible to otitis media?

A

Eustachian tubes aree short, horizontal, function poorly

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24
Q

What is presentationn of otitis media?

A

Ear pain, fever

Dischharge from yeeatr

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25
Q

What does the tympanic membrane look like in otitis media

A

bright red, bulging, loss of normal light reflex

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26
Q

What are causative pathogens of otitis media

A

RSV, rhinovirus, pneumococcus, H influenza, Moraxella catarrhal is

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27
Q

What are complications of otitis media

A

mastoiditis

meningitis

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28
Q

When would you admit a patient with otitis media?

A

Severe systemic infection
Complications (meningitis, mastoiditis)
If <3m old with fever >38

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29
Q

How do you manage otitis media

A

Ibuprofen or paracetamol for pain
No antibiotic prescription
Backup antibiotic prescription - not needed immediately, only use if symptoms have not improved after 3 days or worsen

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30
Q

What antibiotics can you give for otitis media

A

Amoxicillin / clarythromycin

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31
Q

What is glue year

A

otitis media with effusion

due to recurrent ear infections

32
Q

What is the presentation of glue year

A

asymptomatic

reduced hearing only

33
Q

What is the eardrum like in glue year

A

Dull and retracted

Fluid level visible

34
Q

What is the complication of glue ear

A

conductive hearing loss > interferes with normal speech development, learning difficulties

35
Q

How do you manage glue year

A

Grommet insertion
Grommet is a ventilation tube
Benefit lasts 12 months, then remove

36
Q

What is the presentation of otitis externna?

A

swollen infected ear canal, pus, no hearing loss q

37
Q

Who does chronic supportive otitis media present in

A

Older children / adolescents

38
Q

Why does CSOM present

A

Following recurrent OM / trauma as child > perforation of TM > subsequent bacterial infection > painless otorrhoea > 6 weeks

OR due to choleosteatoma

39
Q

What is presentation of CSOM

A

Painless otorrhoea >6 weeks
Hearing loss
Afebrile, no pain

40
Q

What is CSOM management

A

If <1/3 of TM involved: conservative (antibiotics), as TM will regrow
if >1/3 TM involved: replace TM with surgery

41
Q

What is sinusitis

A

Infection of the paranasal sinuses due to viral URTI

42
Q

What aree sx of sinusitis

A

pain, swelling, tenderness over check

43
Q

What is management of sinusitis

A

Advise that it is VIRAL > takes few weeks to resolve
Paracetamol / ibuprofen
nasal saline / decongestants

44
Q

What is a possible complication for sinusitis

A

overlapping bacterial infection

45
Q

what do you do if sinusitis sx last longer than 10 days q

A

high dose corticosteroids for 2 weeks

Consider antibiotic back up prescription with Penicillin V

46
Q

How do tonsils grow

A

Max size at 8 year s

Then shrink later in childhood

47
Q

What is the absolute indication for tonsillectomy

A

Recurrent severe tonsillitis, >7 episodes in previous years

48
Q

What are other indications to consider for tonsillectomy

A

Peritonsillar abscess

OSA

49
Q

What score can you use for tonsillitis

A

Fever-PAIN score

CENTOR score

50
Q

What are causes of stridor

A 
CROUP (Most common infection) 
EPIGLOTTITIS (to exclude)
Bacterial tracheitis 
Foreign body 
Anaphylaxis 
Laryngomalacia  - MOST COMMON OF ALL 
Trauma to throat
51
Q

What should you NEVER do if child has stridor

A

AVOID examining the throat
As it may precipitate total obstruction
Unless full rhesus equipment and team are at hand

52
Q

What is croup

A

inflammation of larynx and trachea

53
Q

What is the main cause of croup

A

Parainfluenza

54
Q

What age group does croup occur in

A

6 months to 6 years

55
Q

What are symptoms of croup

A

Coryza, fever, SOB
Barking cough
STRIDOR

56
Q

When are symptoms worse in croup

A

At night

57
Q

What are features of the 3 categories of croup

A

barking cough with stridor (mild)
sternal/intercostal recession (moderate
agitation/lethargy (severe)

58
Q

Who must you admit with croup

A

children with moderate / severe croup

59
Q

How do you treat croup

A

PO Dexamethasone 0.15mg/kg SINGLE DOSE IMMEDIATELY

Consider:

  • nebuliser adrenalin
  • oxygen
  • inhaled budosemide
60
Q

How long should croup take to resolve

A

48h

61
Q

What is acute epiglottitis

A

Intense swelling of epiglottis and surroundings
associated with septicaemia
LIFE THREATENING

62
Q

What is the cause of acute epiglottisi

A

H influenza type B

63
Q

Who does acute epiglottis occur in

A

1-6 years old

ESPECIALLY IF THEY HAVE MISSED IMMUNISATIONS

64
Q

What is the stridor like in epiglottitis

A

SOFT

SOFTER than in croup

65
Q

What are clinical features of epiglottis

A

very ill looking child
intensely painful throat, child cannot speak or swallow, saliva drools down
child sits immobile, upright, with open mouth to optimise aairway

66
Q

Do you get cough in croup / epiglottitis

A

You get cough with croup only

67
Q

What is management of epiglottitis

A

Urgent hospital admission and treatment
Transfer to ICU
Visualise under GA > intubate > IV ceftriaxone

68
Q

What is the pathogen causing bacterial tracheitis

A

S aureus

69
Q

How is bacterial tracheitis different to epiglottitis

A

thick airway secretions

70
Q

How do you treat bacterial tracheitis

A

IV antibiotics, intubation, ventilation

71
Q

How does laryngomalacia present

A

At 4 weeks

With stridor and poor growth + difficulty eating

72
Q

What is laryngomalacia

A

COngential abnormality of larynx

73
Q

what are RF for developing more severe bronchiolitis

A

born prematurely
bronchopulmonary dysplasia
lung disease
congenital heart disease

74
Q

explain the three sounds that occur in the resp tract and at what level

A

STERTOR: nose to larynx

STRIDOR: larynx to carina

WHEEZE: below carina

75
Q

what sign to you get on CXR of acute epiglottisis

A

thumb sign

Y5 Paediatrics (30 decks)

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