Paediatrics Marrow Pg 121-130 (Respiratory System)
56 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which device should be used for children between 4 to 12 years old?

  • Metered Dose Inhaler (MDI) only
  • MDI, spacer, and face mask
  • Rotahaler
  • MDI plus a spacer (correct)
  • An MDI is the only device recommended for children under 4 years old.

    False

    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.

    <p>Metered Dose Inhaler (MDI)</p> Signup and view all the answers

    Match the age group with the correct asthma medication device:

    <p>Under 4 years old = MDI, spacer, and face mask 4 to 12 years old = MDI plus spacer 12 years or older = MDI only Rotahaler = Not commonly used</p> Signup and view all the answers

    Which antibiotic is typically used to treat suspected MRSA infections?

    <p>Vancomycin</p> Signup and view all the answers

    Low grade fever and cough are common features of primary atypical pneumonia.

    <p>True</p> Signup and view all the answers

    What is the most common organism associated with primary atypical pneumonia?

    <p>Mycoplasma</p> Signup and view all the answers

    The cold agglutination test is typically positive in primary atypical pneumonia, indicating __________.

    <p>hemolysis</p> Signup and view all the answers

    Match the following antibiotics with their respective classifications:

    <p>Azithromycin = Macrolide antibiotic Erythromycin = Macrolide antibiotic Co-amoxiclav = Combination antibiotic Ceftriaxone = Cephalosporin antibiotic</p> Signup and view all the answers

    What is the primary treatment for mild croup?

    <p>Oral dexamethasone</p> Signup and view all the answers

    Acute epiglottitis is commonly caused by viral infections.

    <p>False</p> Signup and view all the answers

    What is the primary mode of transmission for pneumococcal pneumonia?

    <p>Droplet</p> Signup and view all the answers

    Name one of the three 'D's associated with acute epiglottitis.

    <p>Dysphagia</p> Signup and view all the answers

    Rusty sputum is a clinical feature associated with staphylococcal pneumonia.

    <p>False</p> Signup and view all the answers

    The most common bacterium causing acute epiglottitis in India is __________.

    <p>Haemophilus influenzae type 8</p> Signup and view all the answers

    What are the two 3rd generation cephalosporins used if penicillin G is not available for treating pneumococcal pneumonia?

    <p>IV ceftriaxone and IV cefotaxime</p> Signup and view all the answers

    Match the following clinical features of acute epiglottitis with their descriptions:

    <p>Dysphagia = Difficulty swallowing Drooling = Excess saliva due to difficulty swallowing Stridor = High-pitched sound due to airway inflammation Dyspnea = Difficulty in breathing</p> Signup and view all the answers

    In infants less than 2 months, a respiratory rate greater than ______ is considered fast breathing.

    <p>60/min</p> Signup and view all the answers

    Match the findings with the type of pneumonia.

    <p>Lobar consolidation = Pneumococcal pneumonia Pneumatocele = Staphylococcal pneumonia B/L patchy consolidation = Staphylococcal pneumonia Dull note on percussion = Pneumococcal pneumonia</p> Signup and view all the answers

    What is the most common cause of croup?

    <p>Parainfluenza virus</p> Signup and view all the answers

    Stridor is only present during exertion in severe cases of croup.

    <p>False</p> Signup and view all the answers

    What age group is most commonly affected by croup?

    <p>6 months to 5 years</p> Signup and view all the answers

    In croup, the X-ray may show a narrowed air column in the subglottic area, termed the __________ sign.

    <p>steeple</p> Signup and view all the answers

    Match the types of croup with their severity levels:

    <p>Type 1 = Most severe disease Type 2 = Intermediate severity Type 3 = Mildest disease</p> Signup and view all the answers

    What is the treatment used as a controller for asthma in children?

    <p>Daily low-dose ICS therapy</p> Signup and view all the answers

    Asthma symptoms that last more than 10 days after a URI indicate a lower probability of developing asthma in the future.

    <p>False</p> Signup and view all the answers

    Name one type of wheeze classification present during respiratory infections.

    <p>Multi-trigger wheeze</p> Signup and view all the answers

    In acute exacerbation, if SpO2 levels fall to _____%, it is classified as severe.

    <p>80%</p> Signup and view all the answers

    Match the following types of exacerbation with their characteristics:

    <p>Mild = Normal sensorium, absent dyspnea retractions, SpO2 &gt; 95% Moderate = Anxious, moderately present dyspnea retractions, SpO2 90-95% Severe = Agitated, severe dyspnea retractions, SpO2 60-80%</p> Signup and view all the answers

    What is the most important initial management step for a patient with acute bronchiolitis?

    <p>Secure airway</p> Signup and view all the answers

    Acute bronchiolitis is primarily caused by Influenza virus.

    <p>False</p> Signup and view all the answers

    What type of antibodies are used in the prevention of RSV in at-risk infants?

    <p>Palivizumab</p> Signup and view all the answers

    The primary pathogen responsible for acute bronchiolitis is __________.

    <p>Respiratory Syncytial Virus (RSV)</p> Signup and view all the answers

    Match the following complications or characteristics with their corresponding descriptions:

    <p>Increased mucus production = Leads to airway narrowing Hyper-resonance on percussion = Clinical finding due to air trapping Palivizumab = Monoclonal antibody for RSV prevention Tracheostomy = Performed if intubation is not possible</p> Signup and view all the answers

    What type of mutation is commonly associated with cystic fibrosis?

    <p>ΔF508</p> Signup and view all the answers

    Cystic fibrosis is exclusively a respiratory disease.

    <p>False</p> Signup and view all the answers

    What is the significance of meconium ileus in cystic fibrosis?

    <p>It is virtually diagnostic of cystic fibrosis.</p> Signup and view all the answers

    The CFTR gene is located on chromosome ______.

    <p>7</p> Signup and view all the answers

    Which of the following clinical features is commonly seen in cystic fibrosis patients?

    <p>Abdominal distension</p> Signup and view all the answers

    Match the radiographic findings to their descriptions:

    <p>Microcolon = Narrowed colon observed in cystic fibrosis Distended small intestine = Enlarged intestine due to obstruction Terminal ileum = Final part of the small intestine Ground glass appearance = X-ray appearance due to thickened secretions</p> Signup and view all the answers

    What diagnostic tool is used to visualize the bowel in patients with cystic fibrosis?

    <p>Contrast enema</p> Signup and view all the answers

    The CFTR protein functions as a chloride channel.

    <p>True</p> Signup and view all the answers

    Which organism is most commonly associated with recurrent infections in early childhood for patients with cystic fibrosis?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    Diabetes mellitus develops in the first decade of life for patients with pancreatic insufficiency.

    <p>False</p> Signup and view all the answers

    What condition leads to the failure of wolffian duct development in males?

    <p>Cystic fibrosis</p> Signup and view all the answers

    Patients with cystic fibrosis often experience __________ skin due to increased loss of Na+/Cl in sweat.

    <p>salty</p> Signup and view all the answers

    Match the following features of cystic fibrosis with their corresponding descriptions:

    <p>Steatorrhea = Fatty stools due to malabsorption Azoospermia = Absence of sperm in semen Biliary cirrhosis = Liver damage due to bile obstruction Recurrent respiratory infections = Frequent lung infections caused by bacteria</p> Signup and view all the answers

    Which of the following is the most common bacterial cause of pneumonia in children?

    <p>Streptococcus pneumonia</p> Signup and view all the answers

    Tachypnea is not a clinical feature of pneumonia in children.

    <p>False</p> Signup and view all the answers

    Name one viral cause of pneumonia in children.

    <p>RSV</p> Signup and view all the answers

    Children with pneumonia but with a normal $SpO_2$ should be treated with _____ and oral amoxicillin for 5 days.

    <p>Paracetamol (PCT)</p> Signup and view all the answers

    Match the categories of pneumonia with their corresponding features:

    <p>No Pneumonia = Fever, cough/cold Pneumonia = Fever, cough/cold + fast breathing and/or chest indrawing Severe Pneumonia = $SpO_2$ &lt; 90% OR 21 danger signs</p> Signup and view all the answers

    What should be administered to a child with severe pneumonia before referral to a tertiary care hospital?

    <p>IV antibiotics (Ampicillin + gentamycin)</p> Signup and view all the answers

    The most common clinical feature of pneumonia in children is a productive wet cough.

    <p>True</p> Signup and view all the answers

    What is a possible management step if a child's cough persists longer than 2 weeks?

    <p>Evaluate for tuberculosis</p> Signup and view all the answers

    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.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    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.

    More Like This

    Asthma Medications
    6 questions
    Asthma Medications: Corticosteroids and Beta Agonists
    10 questions
    COPD and Asthma Treatments Overview
    21 questions
    Use Quizgecko on...
    Browser
    Browser