Paediatric Respiratory Flashcards

1
Q

What is your DDx for wheezing in a child?

A
  1. Intraluminal airway obstruction
    - inhaled foreign object
    - blood, mucus, pus
    - food/milk in GORD or TOF
  2. Intrinsic change in lower airway dimension
    - asthma
    - bronchiolitis and other viral LRTIs
    - bronchiolitis obliterans
    - bronchitis
    - bronchiectasis
    - CF and PCDs
    - bronchomalacia
  3. Extrinsic lower airway compression
    - lung parenchyma: pneumonia, pulmonary oedema (CHD, HF), bronchogenic cyst
    - lymphadenopathy
    - chest wall deformity e.g. scoliosis
    - vascular e.g. enlarged LA, pulmonary artery vascular ring
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2
Q

Name common organisms causing typical and atypical CAP.

A
Typical pneumonias often caused by viruses:
- influenza A
- RSV
But can also be caused by bacteria:
- Streptococcus pneumoniae (most common)
- Haemophilus influenzae 
- Staphylococcus aureus
- Klebsiella pneumoniae

Atypical CAP can be cause by:

  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydophila pneumoniae
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3
Q

Which clinical features suggest whether a CAP is viral or bacterial?

A

Viral:

  • temp <38.5
  • wheeze present
  • rhinorrhoea present

Bacterial:

  • temp >38.5
  • wheeze absent
  • rhinorrhoea absent
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4
Q

Which Ix would you request for a child admitted with suspected severe or atypical CAP?

A
  1. bloods
    - FBC, CRP, U+Es
    - blood culture
    - mycoplasma serology
  2. urine
    - test for Legionella + Pneumococcal antigen
  3. NPA for RSV + influenza
  4. CXR
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5
Q

what are the indications for IV Abx in children with CAP?

A
  1. severe CAP
  2. complicated CAP e.g. effusion
  3. unable to tolerate oral Abx e.g. vomiting
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6
Q

What Abx would you prescribe for non-severe CAP? For severe/complicated CAP? For suspected aspiration pneumonia?

A

Non-severe CAP: 5 days PO AMOXICILLIN (clarithryomycin if penicllin allergy)

Severe/complicated CAP: IV CO-AMOXICLAV + CLARITHROMYCIN (cefuroxime + clarithromycin if penicillin allergy). r/v and switch to PO. Total of 4 weeks.

Aspiration pneumonia: PO/IV CO-AMOXICLAV

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7
Q

Name the common causative agents of bronchiolitis.

A
  • RSV (80%)
  • influenza A + B
  • parainfluenza
  • adenovirus
  • rhinovirus
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8
Q

Name possible risk factors for development of bronchiolitis

A
  • age 3-6 mths
  • older siblings
  • nursery attendance
  • passive smoking
  • winter months (oct-march)
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9
Q

Describe the classical signs and symptoms of bronchiolitis.

A

Symptoms

  • 1-3 days coryzal symptoms
  • cough
  • poor feeding
  • fever (usually <39)

Signs

  • widespread wheeze + crackles on auscultation
  • apnoea
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10
Q

Which investigations would you request for a baby presenting with suspected bronchiolitis?

A
  • NPA for RSV + influenza

- CXR, bloods + blood gases only if deterioration/diagnostic uncertainty

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11
Q

A baby with bronchiolitis is admitted to hospital in respiratory distress. How would you manage them?

A
  • O2 if sPO2 <92%
  • vapotherm (high-flow nasal cannula O2)
  • CPAP if impending resp. failure
  • NG feeding or IV fluids where necessary
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12
Q

How can babies at high risk of bronchiolitis be protected?

A

Prophylactic PALIVIZUMAB IM injections once per month during season.

For children with:

  • BPD due to prematurity or chronic lung disease
  • CHD
  • SCID
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13
Q

Suggest possible risk factors for asthma in children.

A
  1. Atopy e.g. atopic eczema, hay fever, food allergy esp. to eggs
  2. FHx of asthma or atopy
  3. Parental smoking
  4. PMH of prematurity, mechanical ventilation, bronchiolitis requiring hospitalisation
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14
Q

Describe the key clinical features of asthma.

A

Recurrent and frequent:

  • wheeze (polyphonic)
  • cough, esp. nocturnal
  • SOB/chest tightness

Features:

  • Sx are worse at night and in early morning
  • Sx have non-viral triggers e.g. exercise, pets, cold, emotion (as well as viral)
  • personal or FHx of an atopic disease
  • positive response to asthma therapy
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15
Q

What features might you see on examination of a child with long-standing asthma?

A
  • chest hyperinflation
  • generalised polyphonic expiratory wheeze
  • Harrison’s sulci (depressions at base of thorax associated with muscular insertion of diaphragm)
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16
Q

Which organisms usually cause croup?

A

URTI usually caused by

  • parainfluenza virus (80%)
  • other organisms: RSV, adenovirus, enterovirus, influenza A and B
17
Q

describe the typical presentation of croup.

A

Peak incidence at 6 mths-3 yrs.

  • non-specific Sx: fever, coryzal Sx, sore throat
  • barking cough (worse at night)
  • stridor
18
Q

How would you manage a child with severe croup?

A
  1. supportive management e.g.
    - O2
    - paracetamol/ibuprofen
  2. steroids: dexamethasone PO/IM, prednisolone PO or budesonide nebs
  3. nebulised adrenaline if moderate-severe distress