Respiratory Pediatrics Flashcards
What are some of the negative effects of prescribing antibiotics in children?
Diarrhoea Oral thrush Nappy rash Allergic reaction Multi resistance
Rhinitis can be a prodrome to which other serious illness in children?
Pneumonia, bronchiolitis
Meningitis
Septicaemia
What would be visualized during otitis media ?
Red bulging ear drum
What type of infection is otitis media ?
Primary viral infection
Can be secondary to an infection (Pneumococcus)
What is often the outcome of otitis media ?
Spontaneous rupture of drum
Antibiotics help in otitis media, True or False ?
False, they do not help
How would you diagnose tonsillitis/pharyngitis ?
Throat swab
How would you treat tonsillitis/pharyngitis?
Nothing or 10 days penicillin - do not give amoxycillin
How would a child present if they had croup ?
Well, coryza, stridor, hoarse voice, “barking cough”
How would a child present if they had epiglottitis ?
Toxic with stridor and drooling.
How would you treat an infant with croup ?
Oral dexamethasone
How would you treat an infant with epiglottitis ?
Intubation and antibiotics
What are some of the common bacteria which cause LRTI in children ?
Strep pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae
What are some of the viral agents which cause LRTI in children?
RSV, parainfluenza III, influenza A and B, adenovirus, rhinovirus
How would a child present if they had Bronchitis?
Loose rattly cough.
Post-tussive vomit (vomiting after coughing).
The chest is often free of wheeze/creps.
Disturbed mucocilliary clearance.
The child is very well and the parent is often very worried.
What is the bacteria which causes Bronchitis ?
Haemophilus/Pneumococcus
What are the red flags in LRTI in children?
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 is the difference between Bronchiolitis and Bronchitis ?
The difference between the two terms depends upon the anatomical area of the lungs that is infected.
Bronchiolitis is often viral (RSV).
How would a child present if they had bronchiolitis ?
Nasal stuffiness, tachypnoea and poor feeding.
Crackles and wheeze.
What is the management of brocnhiolotis ?
Observation
Investigation recommended for LRTI such as bronchiolitis?
Nursing in same ward.
Monitor oxygen saturation.
No need for routine bloods and cultures.
What are the cardinal signs of LRTI in children ?
Lasts 48hrs Fever SOB Cough Grunting Wheeze makes bacterial cause unlikely. Reduced or bronchial breath sounds.
When would you refer to a LRTI as pneumonia ?
If the signs are focal (in one specific zone i.e. LLZ)
If there are creps.
If the child is pyrexic.
What is the first line and second line treatment for those with community acquired pneumonia ?
- PO Amoxycillin
- PO Macrolide
Only IV if vomitting
How would a child present if they had pertussis ?
“coughing fits”
Vomitting and colour change.
What would you treat as a priority in a sick child prior to prescribing antibiotics ?
Oxygenation
Hydration
Nutrition
When would you treat a child with antibiotics for otitis media and what antibiotics would you prescribe?
If they are under 2 years and it is a bilateral OM
Oral amoyxicillin
When would you prescribe antibiotics for tonsilitis?
If you have confirmed it is strep.
When would you prescribe antibiotics for a LRTI and what antibiotic would you prescribe ?
If theyve had 2 days of fever, cough and focal signs (i.e. one side)
Oral Amoxycillin
What causes asthma ?
Primary epithelial abnormality which is feuled by asthma/eczema etc.
Not caused by allergy
What are the common investigations used to diagnose asthma ?
Spirometry
BDR
FeNO (Exhaled Nitric Oxide)
Peak flow
No wheeze = No asthma
What other conditions would you expect in a pt with asthma ?
Hx:
Eczema
Hayfever
Food allergies
What is the ideal pattern for diagnosis of asthma in a child ?
Wheeze (without URTI)
SOB at rest
Parental asthma
Responds to treatment
When is an asthma diagnosis unlikely?
If <18 mths - infection
What is some differential diagnosis for asthma onset under 5 y/o ?
CF
PCD
Bronchitis
Forgien body
What is some differential diagnosis for asthma onset > 5y/o?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
How do you measure control of asthma ?
SANE =
Short acting Beta agonist/week.
Absence school/nursery.
Nocturnal symptoms /week.
Exertional symptoms/week.
What are the 2 main classes of medication used to treat asthma?
Short acting Beta agonists ( B2 agonists - 2 days a week) Inhaled corticosteroids (ICS)
What are the additional classes of medications which may be prescribed for asthma ?
Long acting beta agonists
Leukotriene receptor antagonists.
Theophyllines
Oral steroids
What is the maximum dose of ICS you can prescribe to a child < 12 y/o ?
800mcg
What is the first line preventer in asthma <5s ?
LTRA (Leukotriene Receptor Antagonists)
We use LAMA in children in asthma true or false ?
False
What are the adverse side effects in children of ICS ?
Height suppression (0.5-1cm)
Oral thrush
Abdrenocortical suppression
What would you add on as a 3rd step preventer of asthma on children ?
LABA or LTRA
Increase ICS dose
What must you have prescribed alongside a LABA ?
ICS
What are the 2 main types of delivery systems in medication in child asthma ?
MDI/Spacer
Dry powder device
Under 8 y/o cannot use dry powder devices true or false ?
True
What are the other forms of management of childhood asthma ?
Stop tobacco smoke exposure.
Remove environmental trigger.
