Respiratory lower airway

Question 1

Pneumonia Ix

Answer 1

CXR
FBC
U+E
SaO2 (?ABG/VBG)

Question 2

Paediatric Pneumonia severity

Answer 2

Temperature
Chest examination
BP, HR, RR
Note degree of agitation and LOC
Signs of exhaustion, cyanosis, accessory muscle use
Assess hydration status (CRT, skin turgor, dry mucous membranes, urine output)

Question 3

Admit to hospital Paediatric Pneumonia

Answer 3

persistent <92 sats OA
grunting, recesssions RR >60
seriously unwell, doesnt wake/stay awake
Temp >38 <3m
Consider if:
- dehydration, decreased activity, flaring, underlying health cond.
Give controlled supplemental oxygen if sats <92

Question 4

If admission not required Paediatric Pneumonia

Answer 4

Managed at home
all children w/pneumonia dx given Abx becuase viral/bac are indistinguishable
NB. <2y presenting w/mild respiratory Sx usually NOT pneumonia and usually not antibiotics

Question 5

Abx for Paediatric Pneumonia

Answer 5

Amoxicillin 7-14d
(alt. co-amox, cefaclor, macrolides)
macrolides can be added anytime if first line ineffective
In pneumonia a/w influenzae co-amox recommended

Question 6

PACES Paediatric Pneumonia

Answer 6

Dx: chest infection
?admission
Mx: Abx, supportive
avoid smoking
check regularly
seek advice if deterioration

Question 7

Persistent bacterial bronchitis

Answer 7

H. influenzae, Moraxella catarrhalis
High dose Abx (co-amox)
Physiotherapy

Question 8

Bronchiectasis

Answer 8

Ix: CT, bronchoscopy if foreign body expected
Exercise and nutrition
Airway clearance therapy (postural drainage, percussion, vibration)
Inhaled bronchodilator
Inhaled hypertonic saline
Long term oral macrolide
Lung Trx

Question 9

Cystic fibrosis team management

Answer 9

Specialist CF MDT at specialist CF centre
Annual r/v and at least one other r/v by CF MDT, in addition to r/vs by local paeds teams

Members of CF MDT:
Paediatrician
Nurses
PT
Dietiecian
Pharmacists
Clinical psychologists
Social worker

Question 10

Respiratory management in CF

pulmonary monitoring

Answer 10

R/v children every 8wks, adults every 3mo
At R/v:
- clinical assessment (Hx, exam, adherance)
- SpO2
- Respiratory secretion for Ix
- Spirometry

Question 11

Respiratory management in CF Airway clearance techniques

Answer 11

Offer training for parents and carers (PT)
Should be done BD
Assess effectiveness and technique regularly
Consider NIV in pts unable to sufficiently clear airways

Question 12

Mucoactive agents in CF

Answer 12

offer in CF w/clinical evidence of lung dx
1L: rhDNase (if response inadequate consider adding hypertonic saline)
Consider mannitol dry powder inhalation for infants unable to use above

Question 13

New agents in CF

Answer 13

Lumacaftor + Ivacaftor known as potentiators and correctors may be effective against F508

Question 14

Infection Mx in CF

Answer 14

Continuous proph. (fluclox) w/rescue Abx
Persistent Sx req. prompt IV Rx to limit lung damage given over 14d w/PIC
If pseudomonas: inhaled anti-pseudomonal Abx
Regular azithromycin decreases resp. exacerbations
Bilateral sequential lung Trx only option for end stage CF

Question 15

Common infections in CF

Answer 15

S aureus
P aeruginosa
Burkholderia cepacia complex
H influenzae
Non-TB mycobacteria
Aspergillus fumigatus

Question 16

Nutritional management in CF

Answer 16

oral enteric coated pancreatic replacement therapy (w/meals and snacks)
High cal diet (150% of normal) - gastrostomy feed possible
Most pts need fat soluble vitamin supplements

Question 17

Mx of teens and adults w/CF

Answer 17

DM v common
1/3 of adolescents will have liver dx (give regular ursodeoxycholic acid)
DIOS
Increase in chest infections a/w haemoptysis/pneumothorax
Fertility:
- F: normal and tolerate preg
-M; infertile but able to father w/intracytoplasmic sperm inj.
Psychological support

Question 18

Liver Dx in CF

Answer 18

hepatomegaly
Abnormal LFTs/USS
Can rarely progress to cirrhosis, portal htn, liver failure
ursodeoxycholic acid aids bile flow
Liver trx if necessary

Question 19

What is DIOS in CF

Answer 19

distal intestinal obstruction syndrome
viscid mucofaeculant material obstructs bowel
usually cleared by oral laxatives

Question 20

PACES counselling

Answer 20

Dx: lifelong thick secretions
MDT
CF centre
Outline:
- pulmonary: PT, mucolytics
- infection: proph. + rescure
- Nutrition: enzyme tablets, high cal diet, monitor growth
- Pysch: support
Offer infor on genetic counselling
Support: CF trust

Question 21

Primary ciliary dyskinesia

Answer 21

Daily PT
Proactive Mx w/ABx
Appropriate ENT follow up

Question 22

Sleep disordered breathing

Answer 22

Ix: overnight pulse ox., polsomnography
If adenotonsillar hypertrophy consider adenotonsillectomy, dramatic improvement usually
If not then CPAP or BiPAP to maintain upper airway at night