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Paediatrics > Ch 16 - Respiratory diseases > Flashcards

Ch 16 - Respiratory diseases Flashcards

1
Q

URTI can refer to a few conditions, name 3

A

Common cold (coryza)
Sore throat - pharyngitis/ tonsillitis
Otitis media
Sinusitis (uncommon)

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2
Q

Coryza: causes (3), features (3)

A

Rhinovirus, coronavirus, RSV
Classical: clear/mucopurulent discharge from nose + nasal blockage, cough, sore throat, fever +/- ear ache (the only bit that has to be there is the runny nose)

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3
Q

Coryza: management (2)

A

Educate parents that cold is self limiting and ABs of no benefit; esp if

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4
Q

Pharyngitis (sore throat) causes (3)

A

Viral - adeno/entero/rhino viruses

Bacterial - in older children Group A strep (pyogenes)

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5
Q

Tonsilitis definition + causes(2)

A

Pharyngitis + tonsillar inflammation, often with purulent exudate
Causes - S. pyogenes, EBV

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6
Q

Tonsilitis: features (3) + management (1)

A 
More marked consitutional disturbance - headache/ abdo pain
White tonsilar exudate (bacterial infection) 
Cervical lymphadenopathy (bacterial infection)
Manage with AB: erythromycin/ penicillin (amox is avoided because it causes a rash with EBV)
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7
Q

Acute otitis media (acute middle ear infection): causes (4)

A

Children particularly prone to middle ear infections because they have short & horizontal eustachian tubes
Causes: viral - RSV, rhinovirus
bacterial - S. pneumoniae, H. influenza, M. catarrhalis

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8
Q

Features of acute otitis media ( 4) + complications (2)

A

Fever, pain, red bulging tympanic membrane with loss of normal light reflection
Complication - can perforate in which case pus will be visible in external canal; can result in MASTOIDITIS or MENINGITIS

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9
Q

Management of Acute otitis media (1) also neonatal management (1)

A

Spontaneous resolution; amoxicillin - shorten duration of pain
Neonate - IV Cefotaxine

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10
Q

Glue ear (serious otitis media/ otitis media with effusion): cause (1), features (3)

A

Cause - recurrent ear infections lead to otitis media + effusion aka glue ear
Features - reduced hearing, eardrum is dull, retracted + fluid level is visible

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11
Q

Glue ear (serious otitis media/ otitis media with effusion): Diagnosis (3)

A

1st establish reduced hearing: if >4 can show conuctive loss on pure tone audiometry, if

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12
Q

Glue ear (serious otitis media/ otitis media with effusion): management (2)

A

Grommet insertion

if recurrence grommet insertion + adenoidectomy

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13
Q

Sinusitis: Cause (1), Features (3), Management (3)

A

Viral infection of paranasal sinuses (occurs with URTIs)
Features - often 2ndary bacterial infection occurs > pain, swelling, tenderness over cheek - from maxillary sinus infection
management - ABs + analgesia + topical decongestants

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14
Q

Give 3 indications for tonsillectomy

A

Recurrent severe tonsillitis
Sleep apnoea
peritonsilar abscess
NB- remember many children have large tonsils and they shrink spontaneously in late childhood - so large tonsils itself is not an indication

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15
Q

Give 2 indications for adenoidectomy

A

Recurrent Otitis media + effusion and hearing loss

obstructive sleep apnoea

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16
Q

Acute URT obstruction: causes (5)

A

Most common - viral laryngotracheobronchitis aka CROUP

Rare causes: epiglottitis, foreign body, allergic laryngeal angiooedema, bacterial trachitis,

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17
Q

Acute URT obstruction: features (4)

A

Stridor - rasping sound heard on inspiration
Barking cough
SOB
hoarseness due to inflammation of vocal cords

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18
Q

Acute URT obstruction: assessement of severity (2)

A

assess severity by degree of chest retraction: none, on crying, at rest (severe)
& degree of stridor: none, on crying, at rest/biphasic (severe)

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19
Q

Croup: causes (3), features (6)

A

Causes: parainfluenza viruses, RSV, influenza virus
Features: age 6 months - 6yrs
Onset over days; fever + coryza > BARKING COUGH, STRIDOR, HOARSENESS.
Symptoms start at night + WORSE at night
Chest recession (mild or severe)

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20
Q

Croup: Scoring (5 categories)

A

Westley score: cyanosis (5 points), consciousness (5 points), intercostal recession (3 points), air entry (2), stridor (2)
So max 17 points: 6 = severe

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21
Q

Croup: Management (4)

A

Oral dexamethasone, oral pred
Nebulised steroids e.g. Budesonide
Nebulised adrenaline + O2 via face mask
Tracheal intubation if v. severe

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22
Q

Bacterial trachitis: cause(1), features(3), management (3)

A

Cause - S. Aureus (much rarer than viral croup)
Features - similar to viral croup but high fever, child looks toxic, loud harsh stridor + copious thick airway secretions
Management: IV Abs + intubation +/- ventilation

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23
Q

Acute epiglottitis: Cause (1), Features (5)

A

Cause: H. Influenza B (99% reduction since vaccination)
Features: ACUTE onset (over hours), HIGH FEVER, no cough, SOFT INSP STRIDOR, painful throat - preventing speaking, intense epiglottic swelling, septicaemia, toxic looking child

24
Q

Acute epiglotitis: management (3)

A 
Immidiate intubation (under GA)
IV Cefuroxime + blood culture
25
Q

Laryngomalacia - feature

A

Recurrent/continuous stridor since birth

26
Q

Whooping cough: Cause, features

A

Cause - bordatella pertussis
Features - 1 week of coryza > characterisitic paroxsymal/spasmodic cough followed by insp whoop +/- vomitting
often worse at night
red/blue coloration of child

27
Q

Whooping cough: Ix (2), management (1)

A

lymphocytosis
culture from nasal swab
Management - PO erythromycin

28
Q

Bronchiolitis (

A

Causes - RSV, adenovirus, rhinovirus, parainfluenza
Features - coryzal symps precede dry cough & increasing SOB
Sharp dry cough
tachypnoea
feeding difficulty,
recession
hyperfinflation of chest (prominent sternum, displacement of liver downwards)
High pitched wheezes - exp > insp
fine end-insp crackles

29
Q

Bronchiolitis: Diagnosis (2)

A

PCR analysis of nasal secretions (resp viruses are usually identified via this method)
CxR usually unessecary - shows hyperinflation + focal atelectasis

30
Q

Bronchiolitis: Management (2), conditions for hospital admission (3)

A

general - supportive; humidified O2 via nasal cannula, IV fluids, ventilation, paracetamol
Hosp admission if: sats 70

31
Q

Bronchiolitis: Prevention (1)

A

IM palivuzimab - anti RSV monoclonal ab

32
Q

Pneumonia: causative pathogens in: newborn (2), infants + young children (4), Children > 5yrs (3)
NB consider M. TB at all ages

A

Newborn: pathogens from mums genital tract - GBS main, also gram -ve enterococci
Infants + young children: resp viruses e.g. RSV main, bacterial - S. pneumonia, H. influenza. Bortedella pertussis
Children > 5 - Mycoplasma pneumoniae, S. pneumoniae, Chlamydia pneumoniae

33
Q

Pneumonia: features (5)

A

Fever + SOB commonest presentation (often preceded by URTI)
Poor feeding, lethargy
Coarse crackles
Dullness on percussion
Decreased breath sounds, bronchial breathing
tachypnoea - signs of work of breathing e.g. flaring

34
Q

Pneumonia: Ix (1)

A

CxR - cannot differentiate between bacterial & viral, with exception of lobar pneumonia which is feature of S. pneumonia

35
Q

Pneumonia: management (2)

A

Newborns - broad spectrum IV Ab
Infants - PO amoxicillin
>5 yrs - amoxicillin/ erythromycin

36
Q

Asthma: 2 categories of wheezing - early transient & recurrent. Describe their characteristics

A

Early transient wheezing - episodic wheezing due to viral infection - resolves by 5
Persistent recurrent wheeze - recurrent wheeze + evidence of allergy (IgE) to an inhaled allergen - proven by skin prick test or IgE blood test = ATOPIC ASTHMA

37
Q

Pathophysiology of asthma (7)

A

Atopy + environemental trigger e.g. URTI, Allergen, smoking, cold air etc. lead to BRONCHIAL INFLAMMATION (oedema + excess mucus+ infiltration of cells e.g. mast cells)
Leads to Bronchial HYPERRESPONSIVENESS (exaggerated response to inhaled stimuli)
Results in airway NARROWING (reversible obstruction - seen as peak flow variability)
Which produes classic symptoms - wheeze, cough, tightness, SOB

38
Q

Asthma: features (6)

A

Polyphonic wheeze (lots of small airways rather than 1 large)
Triggers- laughing, cold, exercise, emotion
Positive FH & response to therapy
worse at night + early morning
Prolonged expiration
Harrison sulci - a groove along lower border of thorax - corresponding to costal insertion of diaphragm

39
Q

Asthma: Ixs (3)

A

Usually history + examination sufficient
SPT (skin prick)
If uncertainty PEFR - will see morning worse than evening & day to day variability

40
Q

Asthma: management (5)

A

Inhaled SABA e.g. salbutamol or Ipratropium Bromide (if v. young)
Add inhaled steroid e.g. beclamethasone, fluticasone
Add LABA e.g. salmeterol if > 5 or Leukotrine receptor antagonist montelukast (oral theophylline is alternative but lots of AEs e.g. headaches insomnia)
Oral prednisolone

41
Q

Acute asthma: features (5)

A

Tachypnoea, wheeze, SOB
Cyanosis
Sats

42
Q

Life threatening features of asthma (5)

A

Cyanosis

PEFR

43
Q

Acute asthma: management (initial, 1st line, 2nd line)

A

ABC, obs, oxygen
1st line: SABA + Pred. Add iprtropium bromide +/- MgSO4 if refractory
2nd line: IV salbutamol + aminophylline if life threatening

44
Q

Causes of recurrent/ persistent cough (6)

A

Recurrent resp infections
Post-specific resp infections e.g. RSV, pertussis
asthma
Suppurative lung diseases e.g. CF, Primary ciliary dyskinesia
Recurrent aspiration
foreign body
TB
airway anomalies e.g. tracheo-oesophageal fistula

45
Q

Primary ciliary dyskinesia aka Kartageners: features (3)

A

Productive cough, nasal discharge
recurrent ear infections
50% have dextrocardia and situs inversus

46
Q

Primary ciliary dyskinesia aka Kartageners: management (3)

A

Daily physio
ABs
ENT follow-up

47
Q

CF pathophysiology

A

Genetic mutation in CFTR gene (Cr7) > mutate Cl- channel > Cl- cannot be transported out into exocrine ducts > so Na+ remains static > so water doesnt follow into ducts > thick secretions

48
Q

CF features (8)

A 
recurrent chest infections
ABPA
DM
cirrhosis + portal HTN
pneumothorax
sterility in males
infancy - meconium ileus, prolonged neonatal jaundice, failure to thrive
bronchiectasis 
sinusitis
49
Q

CF Ix (2)

A

Sweat test - Cl- conc in sweat very high

confirmation can be made via gene testing

50
Q

CF management (5)

A 
MDT approach
lung function monitoring
physio
prophylactic oral ABs
pancreatic enzyme replacement
high calorie diet 1.5 times normal
adult life - regular ursodeoxycholic acid, liver transplant,
51
Q

What is the cause of sleep related breathing disorders in children?

A

Adenotonsillar hypertrophy

52
Q

What predisposes to the risk of sleep related breathing disorders? (4)

A

Anatomical abnormalities
Hypotonia
Down’s syndrome
cerebral palsy etc.

53
Q

Features of sleep related breathing disorders (4)

A

Snoring
apnoea - witnessed pauses in breathing
disturbed sleep
growth failure/obese

54
Q

Complications of sleep related breathing disorders

A

daytime sleepiness
LD
lifethreatinging cardiopulmonary events
pulmonary HTN

55
Q

Ix for sleep related breathing disorders (3)

A 
1st o/n pulse oximetry - quantify severity of desaturations
(normal pulse ox does NOT exclude condition)
Limited polysomnography (required in more complex cases - provides a lot more info and can distinguish between central and obstructive events)
Sometimes need to assess neurological arousal - EEG & submental EMG
56
Q

Mangement of sleep related breathing disorders (2)

A

Adenotonsillectomy is curative

CPAP/BiPAP at night if needed

57
Q

Indications for tracheostomy (5)

A

Narrow upper airways - laryngeal anomalies (webs, atresia), pierre robin sequence (small jaw and cleft palate), craniofacial anomalies
Lower airway anomalies - severe tracheo-bronchomalacia
Longterm ventilation - muscle weakness, head or spine injury
Wean from ventilation
Airway protection - clearance of secretions & prevention of aspiration

Paediatrics (22 decks)

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