HERMES Paediatric Respiratory flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Croup first-line drug

Dexamethasone 0.15–0.6 mg/kg as a single oral, intramuscular or intravenous dose; it reduces duration and severity of barking cough and stridor in all grades of croup, including mild disease.

Nebulised adrenaline in croup

Adrenaline 1:1000 at 0.5 mL/kg (maximum 5 mL) nebulised for moderate to severe croup or impending airway obstruction; effect lasts about two hours, so the child must be observed for rebound symptoms.

Bronchiolitis oxygen threshold

Supplemental oxygen is typically started when oxygen saturation falls below 92% in air during acute bronchiolitis; saturations should be measured in a calm child and interpreted alongside feeding and work of breathing.

Bronchiolitis feeding rule

Enteral or intravenous fluids are indicated when an infant with bronchiolitis takes less than about 50–75% of usual feeds, because dehydration and aspiration risk rise as tachypnoea worsens; nasogastric feeding is preferred to IV where tolerated.

RSV peak age

Respiratory syncytial virus bronchiolitis peaks between 2 and 6 months of age; almost all children are infected by age 2 years, and severe disease is more common in preterm infants, those with congenital heart disease and chronic lung disease.

WHO pneumonia respiratory rates

Tachypnoea thresholds for childhood pneumonia: at least 60 breaths/min under 2 months, at least 50 at 2–11 months, and at least 40 at 12–59 months, counted over a full minute when the child is calm.

Life-threatening asthma features

Silent chest, cyanosis, poor respiratory effort, exhaustion, hypotension, altered consciousness or peak expiratory flow under 33% predicted define a life-threatening asthma attack requiring oxygen, continuous bronchodilators, systemic steroids and intravenous magnesium.

IV magnesium in asthma

Magnesium sulfate 40–50 mg/kg (maximum 2 g) given intravenously over about 20 minutes is indicated for severe or life-threatening asthma not responding to inhaled beta-2 agonists, ipratropium and systemic corticosteroids.

Sweat chloride cut-offs

Sweat chloride of 60 mmol/L or more confirms cystic fibrosis; 30–59 mmol/L is intermediate and needs repeat testing, CFTR genetic analysis or extended testing; below 30 mmol/L is normal, though false negatives occur in early infancy.

Newborn CF screening

Newborn screening measures immunoreactive trypsinogen; a raised result prompts DNA testing for common CFTR mutations and/or sweat testing, and screening detects most but not all cases, so clinical suspicion still warrants testing.

CF respiratory pathogens

Staphylococcus aureus and Haemophilus influenzae appear early in cystic fibrosis; Pseudomonas aeruginosa acquisition marks worse prognosis and usually triggers eradication therapy with inhaled or systemic antibiotics, while Burkholderia cepacia signals poorer outcomes.

Preschool episodic viral wheeze

Wheeze occurring only with viral colds, with symptom-free intervals, is termed episodic viral wheeze; intermittent inhaled beta-2 agonists may help, but regular inhaled corticosteroids are not routinely justified unless attacks are frequent or severe.

Multiple-trigger preschool wheeze

Wheeze provoked by colds plus exercise, allergens, smoke or laughter suggests multiple-trigger wheeze; a trial of inhaled corticosteroid with objective review after about three months is recommended before committing to long-term therapy.

Foreign body aspiration clues

Sudden choking or cough in a previously well child, unilateral wheeze or reduced breath sounds, and a radiolucent object on plain film should raise suspicion; rigid bronchoscopy is both diagnostic and therapeutic and is urgent if distress is present.

Bacterial vs viral pneumonia

Bacterial pneumonia more often produces focal signs, high fever and lobar consolidation, whereas viral disease causes diffuse wheeze and crackles with milder fever; amoxicillin is first-line for typical community-acquired bacterial pneumonia in children.

Pneumonia in under-fives

WHO classifies pneumonia in children under five by fast breathing with or without chest indrawing; severe pneumonia includes lower chest wall indrawing, and danger signs such as inability to drink, convulsions or lethargy mandate referral.

Childhood TB diagnosis

Children with tuberculosis are usually smear-negative and paucibacillary, so diagnosis uses contact tracing, tuberculin skin testing or interferon-gamma release assay, chest radiograph and culture or PCR of induced sputum or gastric aspirate.

Latent TB treatment in children

Latent tuberculosis infection in children is commonly treated with three months of isoniazid plus rifampicin, or six months of isoniazid alone, after excluding active disease; adherence support and baseline liver function assessment are needed.

Cystic fibrosis airway clearance

Daily chest physiotherapy with positive expiratory pressure or oscillating devices, nebulised mucolytics such as dornase alfa, and inhaled hypertonic saline improve mucus clearance and lung function in cystic fibrosis; exercise is an adjunct.

Pulse oximetry limitations

Oximetry is unreliable with poor perfusion, motion artefact, nail polish or abnormal haemoglobins such as carboxyhaemoglobin, and it does not measure ventilation; a normal saturation does not exclude significant respiratory disease.

Stridor timing significance

Inspiratory stridor suggests extrathoracic obstruction such as croup or laryngomalacia; expiratory or biphasic stridor suggests intrathoracic or fixed obstruction such as tracheal stenosis, vascular ring or foreign body.

Laryngomalacia features

Laryngomalacia is the commonest cause of infant stridor: inspiratory stridor worsening when supine, feeding and crying, usually appearing within weeks of birth and resolving spontaneously by 12–18 months; severe cases need supraglottoplasty.

Epiglottitis red flags

Sudden high fever, drooling, muffled voice, tripod positioning and rapidly progressive airway obstruction suggest epiglottitis; the child should not be laid flat or have the throat examined, and airway management in theatre takes priority.

Pertussis presentation

Pertussis causes paroxysmal coughing with an inspiratory whoop and post-tussive vomiting in unvaccinated children; infants may present with apnoea and no whoop, and macrolide antibiotics reduce transmission rather than symptoms.

Allergic rhinitis treatment

Intranasal corticosteroids are the most effective single treatment for persistent allergic rhinitis; add non-sedating oral antihistamines for eye symptoms, and consider allergen avoidance and immunotherapy for refractory cases in older children.

Primary ciliary dyskinesia clues

Neonatal respiratory distress, chronic daily wet cough, situs inversus, chronic otorrhoea and sinusitis suggest primary ciliary dyskinesia; diagnosis uses nasal nitric oxide, high-speed video microscopy and genetic testing.

Obstructive sleep apnoea in children

Adenotonsillar hypertrophy is the commonest cause of paediatric obstructive sleep apnoea; features include snoring, witnessed apnoeas and daytime behaviour problems, and adenotonsillectomy is first-line for most children with confirmed moderate disease.

Apnoea of prematurity

Apnoea of prematurity is a pause of 20 seconds or more, or shorter with bradycardia or desaturation, in infants under about 37 weeks postmenstrual age; caffeine citrate reduces episodes and is continued until respiratory maturity.

Allergic bronchopulmonary aspergillosis

ABPA complicates asthma or cystic fibrosis with worsening wheeze, raised total IgE, Aspergillus-specific IgE, eosinophilia and central bronchiectasis; treatment is systemic corticosteroids with an antifungal such as itraconazole.

Spacer versus nebuliser

A pressurised metered-dose inhaler with a valved spacer delivers beta-2 agonists at least as effectively as a nebuliser in most acute paediatric asthma, with fewer side effects and faster administration in mild to moderate attacks.

Chest physiotherapy evidence

Routine chest physiotherapy is not recommended in acute bronchiolitis or uncomplicated pneumonia because trials show no benefit; it is reserved for conditions with sputum retention such as cystic fibrosis, neuromuscular weakness or bronchiectasis.

Smoke and pollution exposure

Parental smoking and indoor air pollution increase lower respiratory infections, wheeze and asthma severity in children; cessation advice and reduction of biomass fuel exposure are effective preventive interventions in paediatric respiratory care.