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Martha Phase 3a > Child Health- Respiratory > Flashcards

Child Health- Respiratory Flashcards

1
Q

describe the foetal lungs

A

filled with fluid
-increased pressure, too little fluid in the lungs will cause problems
surfactant to build surface tension and keep alveoli open

premature babies are not ready for life

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2
Q

what does crying at birth stimulate

A

moving fluid out of the lungs and into

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3
Q

where is surfactant produced?

A

type II pneumocytes

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4
Q

what is the generally accepted guidance on when a baby is viable

A

24 weeks
this is when surfactant production starts

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5
Q

describe oxygenation

A

assessed with oxygen sats and ABG (in adults)
how efficiently oxygen is entering red blood cells via gas exchange in alveoli

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6
Q

describe ventilation

A

mechanical process of moving air in and out of lungs
assessed by resp rate and work of breathing eg recession, accessory muscle recruitment, head bobbing
blood gas measures of CO2 will provide information about ventilation

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7
Q

respiratory distress syndome of prematurity

A

lack of surfactant causes decreased surface tension, alveoli not open causing poor gas exchange.

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8
Q

how is surfactant provided to the child in RDS

A

endotracheal tube

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9
Q

chronic lung disease in children

A

oxygen at discharge in prematurely born babies.
poor lung development, prone to resp infections and much more poorly than others the same age.

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10
Q

describe bronchiolitis

A

inflammation of the bronchioles, causing narrowing of the airways. often affects patients under 1yo, can affect up to two year old.

commonly caused by respiratory syncytial virus

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11
Q

treatment for bronchiolitis

A

oxygen, CPAP, high flow
invasive ventilation is last

when not feeding NG tube is used.
interval feeding may be used to reduce stomach content so there is space for expansion

if no improvements with ventilation and NG, IV fluid can be used to maintain fluid balance.

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12
Q

when is a wheeze heard

A

expiration

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13
Q

when is stridor heard

A

inspiration

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14
Q

distinguish between viral induced wheeze and asthma

A

presentation of VIW is prior to 5 yo. presentation and pathology is the same, but VIW will often resolve in the child.

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15
Q

management of VIW and asthma

A

in acutely unwell patient (sats<85%) oxygen is used.
bronchodilators (salbutamol, albuterol)
nebulisers are used in patients who require oxygen.
give steroids as quickly as possible as they take a long time to take affect.

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16
Q

treatments for wheeze

A

magnesium (nebuliser, IV)
salbutamol (IV)

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17
Q

differentials for stridor

A

foreign body (in previously well child)
croup (parainfluenza virus)
epiglottitis (very serious, unwell patient)

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18
Q

how to deal with epiglottitis

A

dont examine! anaesthetise and intubate

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19
Q

how to treat croup

A

dexamethasone
inhaled steroid
adrenaline

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20
Q

why are presentations of epiglottitis reduced?

A

Haemophilus influenza vaccination scheme.

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21
Q

what is most likely differential for collapsed consolidation in the lung on x ray

A

pneumonia
viral infection is normally bilateral
bacterial is unilateral and focal

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22
Q

when should a chest xray be repeated post pneumonia

A

6 weeks after Tx

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23
Q

describe cystic fibrosis

A

a defect in the CFTR gene (which produces the CFTR protein) causes dysfunction in chlorine channels
this causes thickened mucous, affecting the lungs, pancreas and gastro intestinal tract.

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24
Q

describe bronchiectasis

A

condition which permanently opens the airways in the lungs, leading to a buildup of mucus, making the patient prone to infection.

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25
describe pertussis
whooping cough! highly contagious respiratory infection caused by the bacterium Bordetella pertussis
26
what inheritance is cystic fibrosis
autosomal recessive
27
what is the initial test for CF
heel prick test! if missed at birth a sweat test can be used. there will be a higher level of chlorine in CF patients.
28
chest xray shows lobar consolidation- what is the most likely cause
bacterial infection eg. streptococcus pneumonia
29
when is palivizumab used?
high risk babies of RSV monthly injection as prevention against RSV ex premature and congenital heart disease
30
what is palivizumab
monoclonal antibody which targets the RSV not a true vaccine provides passive protection
31
what is croup
acute infective upper respiratory disease affecting young children 6 months to 2 years
32
what can croup cause
odema in the larynx
33
what is a common cause of croup
parainfluenza virus
34
what are less common causes of croup
influenza adenovirus Respiratory syncytial virus
35
what used to cause croup but has been reduced due to vaccination
diphtheria leads to epiglottitis and high mortality BE AWARE OF FOREIGN PATIENTS WITH DIFFERENT VACCINATION SCHEMES
36
what is the presentation of croup
increased 'work of breathing' barking cough hoarse voice stridor low grade fever
37
what is the management for croup
most cases can be managed at home with supportive treatment (fluids and rest) sit child up during attacks to comfort them AVOID spreading eg no school! oral dexamethasone is effective 150mcg/kg, repeated if required after 12 hours
38
describe step wise options in severe croup to symptom control
oral dexamethasone oxygen nebulised budesonide nebulised adrenalin intubation and ventilation
39
which infection typically causes epiglottitis?
haemophilus influenza type B diphtheria ASK FOR VACCINE HX AND FOREIGN AWARENESS
40
what is the typical presentation of epiglottitis
-Patient presenting with a sore throat and stridor -Drooling -Tripod position, sat forward with a hand on each knee -High fever -Difficulty or painful swallowing -Muffled voice -Scared and quiet child -Septic and unwell appearance
41
what sign is seen on xrays positive for epiglottitis?
thumb sign soft tissue shadow that looks like a thumb pressed into the trachea
42
what are the key aspects of managing epiglottitis
NOT TO UPSET THE PATIENT this can cause sudden closure of airway alert senior paediatrician and anaesthetist
43
what is the treatment for epiglottitis when the airway is secure?
IV Abx (ceftriaxone) steroids (dexamethasone)
44
describe laryngomalacia
part of the larynx above the vocal cords (supraglottic larynx) structure allows it to cause partial airway obstruction. leads to chronic stridor on inhalation
45
when does laryngomalacia present?
infancy, peaking at 6 months presents with inspiratory stridor
46
is laryngomalacia associated with respiratory distress?
NO can cause feeding difficulties but not complete airway obstruction
47
describe how laryngomalacia is managed
resolves as larynx matures and grows unable to flop over the airway usually no interventions required RARELY tracheostomy may be needed
48
what type of bacteria is Bordetella pertussis?
gram negative
49
how does pertussis present
begins with mild coryzal symptoms, low grade fever and mild dry cough severe coughing fits after a week or more
50
describe paroxysmal cough
sudden and recurring attacks of coughing with cough free periods in between
51
how is pertussis diagnosed
nasopharyngeal or nasal swab with PCR testing or bacterial culture
52
how is pertussis managed if there has been a cough for more than two weeks
testing for the anti pertussis toxin immunoglobulin G oral fluid for 5-16 year olds blood for 17 and over
53
how is pertussis managed
notifiable disease! public health needs to know supportive care- preventing spread macrolide ABx eg azithromycin, erythromycin and clarithromycin can be used in early stages (21 days from onset) or in vulnerable patients Co-trimoxazole can be used as alternative to macrolides phrophylactic ABx for those in close contact
54
how long can it take for pertussis symptoms to resolve?
typically 8 weeks
55
what is a key complication of pertussis?
bronchiectasis
56
what is chronic lung disease of prematurity
also known as bronchopulmonary dysplasia occurs in babies born before 28 weeks gestation
57
what do babies with CLDP suffer with
respiratory distress syndrome
58
what are features of CLPD
low o2 sats increased work of breathing poor feeding and weight gain crackles and wheezes on chest auscultation increased susceptibility to infection
59
how is the risk of CLDP reduced
corticosteroids to mothers that show signs of premature labour- can help speed up development of foetal lungs before birth once neonate is born - use CPAP - Use caffeine stimulate resp effort - not over oxygenating with supplementary
60
how is CLDP managed
formal sleep study to assess o2 sats -discharge may include a low dose o2 for home use protection against respiratory syncytial virus to reduce risk and severity of bronchiolitis. -monthly injections of monoclonal antibody palivizumab
61
what is th emost common variant of the genetic mutation of the CF transmembrane conductance regulatory gene?
delta-F508 codes for cellular channels - type of chloride channel
62
what is the inheritance of CF
autosomal recessive!!!!!!!!
63
what is meconium ileus
first sign of cystic fibrosis first stool a baby passes is meconium. usually black and passed within 24 hours of birth in 20% of babies with CF the meconium is thick and sticky causing it oro get stuck and obstruct the bowel. causes abdo distention and vomiting

Martha Phase 3a (27 decks)

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