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Questions and Answers
Which device should be used for children between 4 to 12 years old?
Which device should be used for children between 4 to 12 years old?
An MDI is the only device recommended for children under 4 years old.
An MDI is the only device recommended for children under 4 years old.
False
What does the spacer do when used with an MDI?
What does the spacer do when used with an MDI?
It allows the medication to be suspended in the air for inhalation over several breaths.
Children aged 12 years or older should use a ______ to administer asthma medication.
Children aged 12 years or older should use a ______ to administer asthma medication.
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Match the age group with the correct asthma medication device:
Match the age group with the correct asthma medication device:
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Which antibiotic is typically used to treat suspected MRSA infections?
Which antibiotic is typically used to treat suspected MRSA infections?
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Low grade fever and cough are common features of primary atypical pneumonia.
Low grade fever and cough are common features of primary atypical pneumonia.
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What is the most common organism associated with primary atypical pneumonia?
What is the most common organism associated with primary atypical pneumonia?
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The cold agglutination test is typically positive in primary atypical pneumonia, indicating __________.
The cold agglutination test is typically positive in primary atypical pneumonia, indicating __________.
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Match the following antibiotics with their respective classifications:
Match the following antibiotics with their respective classifications:
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What is the primary treatment for mild croup?
What is the primary treatment for mild croup?
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Acute epiglottitis is commonly caused by viral infections.
Acute epiglottitis is commonly caused by viral infections.
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What is the primary mode of transmission for pneumococcal pneumonia?
What is the primary mode of transmission for pneumococcal pneumonia?
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Name one of the three 'D's associated with acute epiglottitis.
Name one of the three 'D's associated with acute epiglottitis.
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Rusty sputum is a clinical feature associated with staphylococcal pneumonia.
Rusty sputum is a clinical feature associated with staphylococcal pneumonia.
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The most common bacterium causing acute epiglottitis in India is __________.
The most common bacterium causing acute epiglottitis in India is __________.
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What are the two 3rd generation cephalosporins used if penicillin G is not available for treating pneumococcal pneumonia?
What are the two 3rd generation cephalosporins used if penicillin G is not available for treating pneumococcal pneumonia?
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Match the following clinical features of acute epiglottitis with their descriptions:
Match the following clinical features of acute epiglottitis with their descriptions:
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In infants less than 2 months, a respiratory rate greater than ______ is considered fast breathing.
In infants less than 2 months, a respiratory rate greater than ______ is considered fast breathing.
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Match the findings with the type of pneumonia.
Match the findings with the type of pneumonia.
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What is the most common cause of croup?
What is the most common cause of croup?
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Stridor is only present during exertion in severe cases of croup.
Stridor is only present during exertion in severe cases of croup.
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What age group is most commonly affected by croup?
What age group is most commonly affected by croup?
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In croup, the X-ray may show a narrowed air column in the subglottic area, termed the __________ sign.
In croup, the X-ray may show a narrowed air column in the subglottic area, termed the __________ sign.
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Match the types of croup with their severity levels:
Match the types of croup with their severity levels:
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What is the treatment used as a controller for asthma in children?
What is the treatment used as a controller for asthma in children?
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Asthma symptoms that last more than 10 days after a URI indicate a lower probability of developing asthma in the future.
Asthma symptoms that last more than 10 days after a URI indicate a lower probability of developing asthma in the future.
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Name one type of wheeze classification present during respiratory infections.
Name one type of wheeze classification present during respiratory infections.
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In acute exacerbation, if SpO2 levels fall to _____%, it is classified as severe.
In acute exacerbation, if SpO2 levels fall to _____%, it is classified as severe.
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Match the following types of exacerbation with their characteristics:
Match the following types of exacerbation with their characteristics:
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What is the most important initial management step for a patient with acute bronchiolitis?
What is the most important initial management step for a patient with acute bronchiolitis?
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Acute bronchiolitis is primarily caused by Influenza virus.
Acute bronchiolitis is primarily caused by Influenza virus.
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What type of antibodies are used in the prevention of RSV in at-risk infants?
What type of antibodies are used in the prevention of RSV in at-risk infants?
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The primary pathogen responsible for acute bronchiolitis is __________.
The primary pathogen responsible for acute bronchiolitis is __________.
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Match the following complications or characteristics with their corresponding descriptions:
Match the following complications or characteristics with their corresponding descriptions:
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What type of mutation is commonly associated with cystic fibrosis?
What type of mutation is commonly associated with cystic fibrosis?
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Cystic fibrosis is exclusively a respiratory disease.
Cystic fibrosis is exclusively a respiratory disease.
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What is the significance of meconium ileus in cystic fibrosis?
What is the significance of meconium ileus in cystic fibrosis?
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The CFTR gene is located on chromosome ______.
The CFTR gene is located on chromosome ______.
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Which of the following clinical features is commonly seen in cystic fibrosis patients?
Which of the following clinical features is commonly seen in cystic fibrosis patients?
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Match the radiographic findings to their descriptions:
Match the radiographic findings to their descriptions:
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What diagnostic tool is used to visualize the bowel in patients with cystic fibrosis?
What diagnostic tool is used to visualize the bowel in patients with cystic fibrosis?
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The CFTR protein functions as a chloride channel.
The CFTR protein functions as a chloride channel.
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Which organism is most commonly associated with recurrent infections in early childhood for patients with cystic fibrosis?
Which organism is most commonly associated with recurrent infections in early childhood for patients with cystic fibrosis?
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Diabetes mellitus develops in the first decade of life for patients with pancreatic insufficiency.
Diabetes mellitus develops in the first decade of life for patients with pancreatic insufficiency.
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What condition leads to the failure of wolffian duct development in males?
What condition leads to the failure of wolffian duct development in males?
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Patients with cystic fibrosis often experience __________ skin due to increased loss of Na+/Cl in sweat.
Patients with cystic fibrosis often experience __________ skin due to increased loss of Na+/Cl in sweat.
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Match the following features of cystic fibrosis with their corresponding descriptions:
Match the following features of cystic fibrosis with their corresponding descriptions:
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Which of the following is the most common bacterial cause of pneumonia in children?
Which of the following is the most common bacterial cause of pneumonia in children?
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Tachypnea is not a clinical feature of pneumonia in children.
Tachypnea is not a clinical feature of pneumonia in children.
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Name one viral cause of pneumonia in children.
Name one viral cause of pneumonia in children.
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Children with pneumonia but with a normal $SpO_2$ should be treated with _____ and oral amoxicillin for 5 days.
Children with pneumonia but with a normal $SpO_2$ should be treated with _____ and oral amoxicillin for 5 days.
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Match the categories of pneumonia with their corresponding features:
Match the categories of pneumonia with their corresponding features:
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What should be administered to a child with severe pneumonia before referral to a tertiary care hospital?
What should be administered to a child with severe pneumonia before referral to a tertiary care hospital?
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The most common clinical feature of pneumonia in children is a productive wet cough.
The most common clinical feature of pneumonia in children is a productive wet cough.
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What is a possible management step if a child's cough persists longer than 2 weeks?
What is a possible management step if a child's cough persists longer than 2 weeks?
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Study Notes
Asthma Medication Devices
- Metered Dose Inhalers (MDIs) are commonly used for asthma medication, and the use of spacers is recommended for children aged 4 to 12 years old.
- For children under 4 years old, MDIs with spacers and face masks are used to ensure accurate medication delivery.
- Rotahalers are not as widely used as MDIs.
Respiratory System
- Treatment for suspected MRSA infection is Vancomycin.
- Primary atypical pneumonia is commonly caused by Mycoplasma.
- Common features of primary atypical pneumonia in children greater than 5 years old include low-grade fever, cough, scattered crepitations, and hemolysis.
- Macrolides, like azithromycin and erythromycin, are effective treatments for primary atypical pneumonia, and should be administered orally for 7-10 days.
Asthma Management in Children
- Asthma may resolve after 5 years of age in some children.
- Children less than 5 years old with episodic wheezing during viral infections and multi-trigger wheezing (during respiratory infections, cold, exertion, food), have an increased probability of developing asthma if symptoms last longer than 10 days after a URI and occur more than 3 times.
- Daily low-dose ICS therapy is recommended as a controller medication and SABA as a reliever medication.
Acute Exacerbation and Its Management
- During an acute exacerbation, the severity of the asthma attack is assessed by the patient's sensorium, dyspnea retractions, and SpO2 levels.
- In severe asthma exacerbations, treatment may include nebulised salbutamol and ipratropium, oral prednisolone or IV Hydrocortisone, and injections of magnesium sulfate.
Respiratory Infections
- Croup is an infection of the upper respiratory tract, commonly caused by parainfluenza virus, that affects children between 6 months and 5 years old.
- Croup's main symptoms include a barking cough, stridor, and respiratory distress.
- The severity of croup is classified by the presence of stridor and respiratory distress.
- X-ray findings of croup show a narrowed subglottic air column, often described as a steeple or inverted-V sign.
Fast Breathing Criteria
- Children younger than 2 months old are considered to be fast breathing if their respiratory rate is greater than 60 breaths per minute.
- Children between 2 and 12 months old are considered to be fast breathing if their respiratory rate is greater than 50 breaths per minute.
- Children older than 12 months old are considered to be fast breathing if their respiratory rate is greater than 40 breaths per minute.
Pneumococcal Pneumonia
- Pneumococcal pneumonia is spread through droplets and is characterized by lobar consolidation on chest x-ray.
- Clinical findings include decreased air entry, crepitations, rusty sputum, bronchial sounds, and dullness/impaired note on percussion.
- Treatment includes penicillin G IV for 5-7 days or 3rd generation cephalosporins (ceftriaxone or cefotaxime).
Staphylococcal Pneumonia
- Staphylococcal pneumonia may result from the spread of a different infection, secondary to viral infection (measles, influenza) or due to cystic fibrosis and recurrent pneumonia.
- Staphylococcal pneumonia is associated with air-filled cystic spaces, known as pneumatocele, on x-ray.
- It is also associated with bilateral patchy consolidation, pneumothorax, empyema (especially in children younger than 2 years), and purulent pericarditis.
Respiratory System Management
- Treatment for croup is primarily supportive and symptom-based.
- Oral dexamethasone is effective in reducing inflammation in mild croup.
- Moderate to severe croup may require dexamethasone, nebulised racemic epinephrine, which reduces edema in pre-capillary arterioles, and nebulised salbutamol.
Acute Epiglottitis
- Acute epiglottitis typically affects children between 3 and 6 years old.
- The most common causative agent is Haemophilus influenzae type b, especially in India.
- Other causative organisms include Streptococcus pyogenes and Streptococcus pneumoniae.
- Acute epiglottitis is a medical emergency because it can lead to airway obstruction.
Clinical Features of Acute Epiglottitis
- Characterized by a sick-looking child, high-grade fever, stridor, dysphagia, drooling, and dyspnea or respiratory distress.
- Low-grade fever is typically associated with viral infections.
Investigations
- Acute epiglottitis can be diagnosed through X-ray and laryngoscopy findings.
- X-ray findings may show a thumb sign, a swelling in the epiglottis.
- Laryngoscopy may show an inflamed cherry-red epiglottis.
- Stimulation by a laryngoscope can lead to laryngospasm, increasing the risk of respiratory arrest.
Acute Bronchiolitis
- An infection mainly affecting children under two years old, with a peak incidence between 3 to 6 months.
- Caused by the Respiratory Syncytial Virus (RSV).
- There are two strains of RSV - Type A (more severe) and Type B.
- Inflammation of the bronchioles leads to edema, increased mucus production, airway narrowing during expiration, and air-trapping in the lung fields.
Clinical Findings of Acute Bronchiolitis
- Clinical findings include increased anteroposterior diameter of chest, hyperresonance upon percussion, and wheezing due to narrowed bronchioles.
Investigations
- X-ray findings may show peribronchial cuffing due to inflammatory exudates and bilateral hyperinflation.
- A nasopharyngeal swab PCR test can confirm the presence of RSV.
Management of Acute Bronchiolitis
- Acute bronchiolitis often resolves within 3 to 7 days.
- Supportive management includes moist oxygen inhalation, fluids (IV or oral), and antivirals.
- Inhaled Ribavirin (nebulization) is used for high-risk infants with chronic lung disease or congenital heart defects (CHDs).
Prevention of RSB Infection
- Palivizumab, a monoclonal antibody against RSV proteins, is used to prevent RSV infection in high-risk infants.
Cystic Fibrosis
- A multi-organ genetic disorder that primarily affects the gastrointestinal, respiratory, genitourinary, and sweat glands.
- Caused by mutations in the CFTR gene, located on chromosome 7, which codes for the CFTR protein, a chloride channel.
- The most common mutation, ΔF508, involves the deletion of phenylalanine at the 508 position and leads to thick mucus production in the body.
Clinical Features of Cystic Fibrosis (Gastrointestinal)
- Meconium ileus, a diagnostic feature of CF, affects 10%-15% of CF patients.
- It is caused by thickening of meconium in the ileum and can lead to bowel obstruction, abdominal distension, and delayed passage of meconium.
- Contrast enema with X-rays is used to visualize the bowel.
Radiographic Findings of Cystic Fibrosis
- X-ray findings in contrast studies may show microcolon and filling defects, distended small intestine, air fluid levels in the terminal ileum, and a ground glass appearance.
Other Features of Cystic Fibrosis (Summary)
- Pancreatic insufficiency affects 85% of CF patients.
- Pancreatic insufficiency features include steatorrhea and deficiencies in vitamins A, D, E, and K.
- Recurrent respiratory infections are common.
- In older children, constipation can lead to DIOS (distal intestinal obstruction syndrome) and rectal prolapse.
- CFTR protein inactivity leads to increased sodium and chloride loss in sweat.
Diagnosis of Cystic Fibrosis
- Diagnosis can be made based on clinical criteria and lab test confirmation.
- Clinical criteria include typical gastrointestinal, respiratory, genitourinary symptoms, a family history of CF, or a positive newborn screening test.
- Confirmatory lab tests include the immunoreactive trypsin test (IRT).
Pneumonia in Children
- Bacterial pneumonia is the most common type, with Streptococcus pneumoniae being the main causative agent.
- Viral pneumonia, mainly caused by RSV, is also common.
- X-ray findings are often more reliable for diagnosis than etiological identification.
Clinical Features of Pneumonia in Children
- Fever, productive wet cough, tachypnea, and crepitations are common features of pneumonia.
Community Management Guidelines (IMNCI)
- IMNCI guidelines categorize children based on their symptoms and provide management recommendations for children with pneumonia.
- The severity of pneumonia is classified into three categories: no pneumonia, pneumonia, and severe pneumonia.
- Severe pneumonia is characterized by SpO2 levels below 90% or the presence of at least two danger signs (lethargy, not feeding, convulsions, cyanosis).
- Management plans for pneumonia include:
- Paracetamol for fever, cough, and cold.
- Oral amoxicillin for 5 days for pneumonia.
- Salbutamol for 5 days when wheeze is present.
- Severe pneumonia requires immediate referral to a tertiary care hospital.
Management of Cystic Fibrosis
- Management focuses on controlling symptoms, preventing complications, and improving quality of life.
- Includes respiratory therapy, nutrition, pancreatic enzyme supplementation, medications to thin mucus, and lung transplantation.
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Description
This quiz covers essential information about asthma medication devices for children, including the use of metered dose inhalers and spacers. It also discusses the treatment of respiratory infections like primary atypical pneumonia in young patients. Test your knowledge on effective asthma management strategies for kids.
