Respiratory Paediatrics Flashcards
What are the risks of antibiotics in children?
Diarrhoea Oral thrush Nappy rash Allergic reaction Multi resistance
What are the characteristics of rhinitis?
Very common
Most children affected by ~5-10 cases of rhinitis annually
Cases occur almost exclusively in the winter months
Usually a self limiting condition
Can also be a prodrome to a serious illness such as pneumonia, meningitis or septicaemia. Reviewal can be made if unsure as to diagnosis.
What are the characteristics of otitis media?
Common Self-limiting infection of the ear Can be primary viral infection or secondary to pneumococcal or haemophilus infection. In severe cases the drum can rupture Antibiotics usually do not help Analgesia can be given to reduce earache
What are the characteristics of tonsillitis/pharyngitis?
Common
Very hard to tell whether the infection is viral or bacterial
Throat swabs can be taken but they take two days to come back.
Management options are either to do nothing or to give ten days of penicillin.
Why should amoxicillin not be given in tonsillitis?
Amoxycillin should never be given as EBV is a possible precipitant and amoxicillin will give a severe rash if EBV is present
What are the characteristics of croup?
Commonly caused by parainfluenza type I Common Patient is systemically well Coryza (common cold) Stridor Hoarse voice Barking cough Treated with oral dexamethasone
What are the characteristics of epiglottitis?
Caused by haemophilus influenza type B Very rare but serious when does occur Patient is toxic Stridor Drooling due to inflammation of throat being so severe that nothing can be swallowed- not even saliva Managed by intubation and antibiotics
What are the common bacterial organisms associated with lower respiratory tract infections in children?
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumoniae Chlamydia pneumoniae
What are the common viral organisms associated with lower respiratory tract infections in children?
RSV Parainfluenza III Influenza A and B Adenovirus Rhinovirus
What are the characteristics of bronchitis?
Very common Loose, rattly cough Post-tussive vomit Chest free of wheeze and creps Haemophilus or pneumococcal causes common Usually self-limiting Child usually very well Parent usually very worried
What are the red flag signs of a more serious infection with bronchitis-like symptoms?
Age <6 mo, >4yr No relapse-remission Static weight Disrupts child’s life Associated SOB (when not coughing) Acute admission Other co-morbidities (neuro/gastro)
What are the characteristics of bronchiolitis?
Lower respiratory tract infection of infants <12 months
Affects 30-40% of all infants
One off- not recurring
Usually respiratory syncytial virus (RSV)
Less commonly- parainfluenza III or human metapneumovirus (HMPV)
Associated with :
-Nasal stiffness
-Tachypnoea
-Poor feeding
Crackles common +/- wheeze
What is the characteristic timeline of bronchiolitis?
Begins getting worse ~2 days after infection, with the condition worsening for ~3 days before stabilising for a couple of days before improving
How is bronchiolitis investigated and managed?
Management of bronchiolitis is based around maximal observation with minimal intervention. Diagnosis is usually clinical and there are no medications that are proven to work in bronchiolitis
What are the general features of LRTIs in children?
48hr duration Fever >38.5 Dyspnoea Cough Grunting
How is paediatric pneumonia investigated and managed?
CXR and inflammatory markers not routine in paediatrics
If symptoms are mild then give no treatment
If treatment is required then oral amoxicillin is first line and oral macrolide is second line
When are IV antibiotics given in paediatric pneumonia?
ONLY when the patient is vomiting
Why are oral antibiotics preferable to IV antibiotics in paediatric pneumonia?
Associated with a shorter hospital stay
Cheaper
What are the characteristics of pertussis?
Pertussis/whooping cough is the most common cause of cough + vomiting in school aged children. Vaccination reduces risk and severity. It is associated with coughing fits, vomiting and colour change
How are respiratory tract infections in children managed?
Generally, management of respiratory tract infections in children focuses on oxygenation, hydration and nutrition before antibiotics are thought about
In what circumstances should antibiotics be considered in paediatric respiratory tract infection? Which antibiotic should be given for each?
Bilateral otitis media <2 years old- oral amoxicillin
Tonsillitis if known streptococcal cause- penicillin
LRTI/pneumonia if two day history of fever, cough and focal signs- oral amoxicillin
What are the cardinal features of asthma?
Wheeze
Variability
Response to treatment
What tests should asthma diagnosis involve?
- Spirometry
- BDR (bronchodilator responsiveness)
- FeNO (nitric oxide)
- Peak flow
What are the characteristics of asthma?
Wheeze is essential for asthma diagnosis and it is important to clarify that what the parent reports as wheeze is actually wheeze. Other characteristics of asthma are:
•SOB at rest (indicative of 70% reduction in lung function)
•Cough- dry, nocturnal, exertional
•Parental history of asthma
•Personal history of eczema, hayfever or food allergies
