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4th year passmedicine by topic > Child Health Respiratory > Flashcards

Child Health Respiratory Flashcards

1
Q

Croup epidemiology

A

peak incidence at 6 months - 3 years

more common in autumn

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2
Q

Croup sx

A

stridor which is caused by a combination of laryngeal oedema and secretions

barking cough (worse at night)
fever
coryzal symptoms

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3
Q

Croup causative organism

A

Parainfluenza viruses account for the majority of cases.

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4
Q

Features of mild croup

A

Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play

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5
Q

Features of moderate croup

A

Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings

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6
Q

Features of severe croup

A

Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemia

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7
Q

CKS suggest admitting any child with moderate or severe croup. Other features which should prompt admission include:

A

< 6 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis

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8
Q

Croup the vast majority of children are diagnosed clinically

A

true

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9
Q

Croup CXR would show

A

a posterior-anterior view will show subglottic narrowing, commonly called the ‘steeple sign’

in contrast, a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’

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10
Q

Croup mx

A

single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

prednisolone is an alternative

Emergency treatment -high-flow oxygen, nebulised adrenaline

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11
Q

Bronchiolitis is a condition characterised by acute bronchiolar inflammation causative organism is?

A

Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases

other causes: mycoplasma, adenoviruses

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12
Q

Bronchiolitis epidemiology?

A

most common cause of a serious lower respiratory tract infection in < 1yr olds

higher incidence in winter

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13
Q

Maternal IgG provides protection to newborns against RSV

A

true

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14
Q

Bronchiolitis is more serious if?

A

bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis

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15
Q

Bronchiolitis sx

A

coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

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16
Q

Bronchiolitis NICE recommend immediate referral (usually by 999 ambulance) if they have any of the following:

A

apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

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17
Q

Bronchiolitis NICE recommend that clinicians ‘consider’ referring to hospital if any of the following apply:

A

a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration.

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18
Q

Bronchiolitis ix

A

immunofluorescence of nasopharyngeal secretions may show RSV

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19
Q

Bronchiolitis mx

A

Management is largely supportive

humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%

nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
suction is sometimes used for excessive upper airway secretions

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20
Q

Whooping cough (pertussis) is an infectious disease caused by

A

Gram-negative bacterium Bordetella pertussis.

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21
Q

Whooping cough (pertussis)infants are routinely immunised at

A

2, 3, 4 months and 3-5 years.

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22
Q

Whooping cough (pertussis)immunisation results in lifelong protection

A

false
neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations

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23
Q

Whooping cough (pertussis) sx

A

Features, 2-3 days of coryza precede onset of:
coughing bouts
inspiratory whoop
infants may have spells of apnoea
persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures

symptoms may last 10-14 weeks* and tend to be more severe in infants
marked lymphocytosis

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24
Q

Whooping cough (pertussis)Diagnostic criteria

A

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:

Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

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25
Q

Whooping cough (pertussis)Diagnosis

A

PCR and serology

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26
Q

Whooping cough (pertussis)Management

A

infants under 6 months with suspect pertussis should be admitted

an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread

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27
Q

Whooping cough (pertussis) in the UK pertussis is a notifiable disease

A

true

28
Q

Whooping cough (pertussis) household contacts should be offered antibiotic prophylaxis

A

true

29
Q

Whooping cough (pertussis) school exclusion?

A

48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

30
Q

Whooping cough (pertussis) complications?

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

31
Q

Snoring in children

Causes

A 
obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down's syndrome
hypothyroidism
32
Q

episodic viral wheeze is?

A

only wheezes when has a viral upper respiratory tract infection (URTI) and is symptom free inbetween episodes

33
Q

multiple trigger wheeze is

A

as well as viral URTIs, other factors appear to trigger the wheeze such as exercise, allergens and cigarette smoke

34
Q

Episodic viral wheeze is not associated with an increased risk of asthma in later life although a proportion of children with multiple trigger wheeze will develop asthma.

A

true

35
Q

Episodic viral wheeze mx

A

treatment is symptomatic only
first-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both

36
Q

Multiple trigger wheeze mx

A

trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks

37
Q

Acute epiglottitis is rare but serious infection caused by

A

Haemophilus influenzae type B.

38
Q

Acute epiglottitis sx

A 
rapid onset
high temperature, generally unwell
stridor
drooling of saliva
'tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
39
Q

Acute epiglottitis Diagnosis is made by direct visualisation

A

true

40
Q

Acute epiglottitis mx

A

immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)

endotracheal intubation may be necessary to protect the airway
if suspected do NOT examine the throat due to the risk of acute airway obstruction

oxygen
intravenous antibiotics

41
Q

Causes of stridor in children include:

A

Croup
Acute epiglottitis
Inhaled foreign body
Laryngomalacia

42
Q

Laryngomalacia Infants typical present at 4 weeks of age with:

A

stridor

43
Q

most likely causative agent of a bacterial pneumonia in children

A

S .pneumoniae

44
Q

bacterial pneumonia in children mx

A

Amoxicillin is first-line for all children with pneumonia
Macrolides may be added if there is no response to first line therapy
Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended

45
Q

Asthma - definitions of what constitutes a low, moderate or high-dose ICS have also changed. In contrast to the BTS guidelines NICE also have different definitions for adults and children. For children:

A

<= 200 micrograms budesonide or equivalent = paediatric low dose
200 micrograms - 400 micrograms budesonide or equivalent = paediatric moderate dose
> 400 micrograms budesonide or equivalent= paediatric high dose.

46
Q

Children aged less than 5 years asthma mx

A
  1. SABA
  2. SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)
  3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  4. refer
47
Q

Asthma mx Children and young people aged 5 to 16

A
  1. SABA
  2. SABA + paediatric low-dose inhaled corticosteroid (ICS)
  3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  4. SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
  5. SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS
  6. SABA + paediatric moderate-dose ICS MART

OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA

  1. SABA + one of the following options:
    increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
    a trial of an additional drug (for example theophylline)
    seeking advice from a healthcare professional with expertise in asthma
48
Q

Children between 2 and 5 years of age acute asthma attack severity scale?

A

Moderate attack
SpO2 > 92%
No clinical features of severe asthma

Severe attack
SpO2 < 92%
Too breathless to talk or feed
Heart rate > 140/min
Respiratory rate > 40/min
Use of accessory neck muscles
Life-threatening attack
SpO2 <92%
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis
49
Q

Children greater than 5 years of age acute asthma attack severity scale?

A 
Moderate attack
SpO2 > 92%
PEF > 50% best or predicted
No clinical features of
severe asthm
Severe attack
SpO2 < 92%
PEF 33-50% best or predicted
Can't complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min
Respiratory rate > 30/min
Use of accessory neck muscles
Life-threatening attack
SpO2 < 92%
PEF < 33% best or predicted
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
50
Q

For children with mild to moderate acute asthma:

A

Bronchodilator therapy
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital

Steroid therapy
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days

51
Q

Cystic fibrosis (CF) is an autosomal dominant disorder

A

false

recessive

52
Q

Cystic fibrosis (CF) is due to

A

increased viscosity of secretions (e.g. lungs and pancreas). It is due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel

53
Q

Organisms which may colonise CF patients

A

Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus

54
Q

Cystic fibrosis: features

neonatal sx

A

meconium ileus, less commonly prolonged jaundice

55
Q

Cystic fibrosis

sx

A

recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease

56
Q

Cystic fibrosis assoc short stature

A

true

57
Q

Cystic fibrosis

PMH

A 
diabetes mellitus
delayed puberty
rectal prolapse (due to bulky stools)
nasal polyps
male infertility, female subfertility
58
Q

Cystic fibrosis: diagnosis

A

Sweat test
patient’s with CF have abnormally high sweat chloride
normal value < 40 mEq/l, CF indicated by > 60 mEq/l

59
Q

Cystic fibrosis: diagnosis

Causes of false positive sweat test

A 
malnutrition
adrenal insufficiency
glycogen storage diseases
nephrogenic diabetes insipidus
hypothyroidism, hypoparathyroidism
G6PD
ectodermal dysplasia
60
Q

Cystic fibrosis: diagnosis

Causes of false negative sweat test

A

skin oedema, often due to hypoalbuminaemia/ hypoproteinaemia secondary to pancreatic exocrine insufficiency.

61
Q

Cystic fibrosis: management

physio

A

regular (at least twice daily) chest physiotherapy and postural drainage. Parents are usually taught to do this. Deep breathing exercises are also useful

62
Q

Cystic fibrosis: management

diet

A

high calorie diet, including high fat intake
vitamin supplementation
pancreatic enzyme supplements taken with meals

63
Q

Cystic fibrosis: management patients with CF should try to minimise contact with each other to prevent cross infection with Burkholderia cepacia complex and Pseudomonas aeruginosa

A

true

64
Q

Cystic fibrosis: management

CF-specific contraindication to lung transplantation

A

chronic infection with Burkholderia cepacia

65
Q

Cystic fibrosis: management

what is used to treat cystic fibrosis patients who are homozygous for the delta F508 mutation

A

Lumacaftor/Ivacaftor (Orkambi)

4th year passmedicine by topic (96 decks)

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