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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
Q

describe pertussis

A

whooping cough!

highly contagious respiratory infection caused by the bacterium Bordetella pertussis

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26
Q

what inheritance is cystic fibrosis

A

autosomal recessive

27
Q

what is the initial test for CF

A

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
Q

chest xray shows lobar consolidation- what is the most likely cause

A

bacterial infection eg. streptococcus pneumonia

29
Q

when is palivizumab used?

A

high risk babies of RSV

monthly injection as prevention against RSV

ex premature and congenital heart disease

30
Q

what is palivizumab

A

monoclonal antibody which targets the RSV

not a true vaccine

provides passive protection

31
Q

what is croup

A

acute infective upper respiratory disease affecting young children

6 months to 2 years

32
Q

what can croup cause

A

odema in the larynx

33
Q

what is a common cause of croup

A

parainfluenza virus

34
Q

what are less common causes of croup

A

influenza
adenovirus
Respiratory syncytial virus

35
Q

what used to cause croup but has been reduced due to vaccination

A

diphtheria

leads to epiglottitis and high mortality

BE AWARE OF FOREIGN PATIENTS WITH DIFFERENT VACCINATION SCHEMES

36
Q

what is the presentation of croup

A

increased ‘work of breathing’

barking cough

hoarse voice

stridor

low grade fever

37
Q

what is the management for croup

A

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
Q

describe step wise options in severe croup to symptom control

A

oral dexamethasone

oxygen

nebulised budesonide

nebulised adrenalin

intubation and ventilation

39
Q

which infection typically causes epiglottitis?

A

haemophilus influenza type B

diphtheria

ASK FOR VACCINE HX AND FOREIGN AWARENESS

40
Q

what is the typical presentation of epiglottitis

A

-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
Q

what sign is seen on xrays positive for epiglottitis?

A

thumb sign

soft tissue shadow that looks like a thumb pressed into the trachea

42
Q

what are the key aspects of managing epiglottitis

A

NOT TO UPSET THE PATIENT

this can cause sudden closure of airway

alert senior paediatrician and anaesthetist

43
Q

what is the treatment for epiglottitis when the airway is secure?

A

IV Abx (ceftriaxone)

steroids (dexamethasone)

44
Q

describe laryngomalacia

A

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
Q

when does laryngomalacia present?

A

infancy, peaking at 6 months

presents with inspiratory stridor

46
Q

is laryngomalacia associated with respiratory distress?

A

NO

can cause feeding difficulties but not complete airway obstruction

47
Q

describe how laryngomalacia is managed

A

resolves as larynx matures and grows

unable to flop over the airway

usually no interventions required

RARELY tracheostomy may be needed

48
Q

what type of bacteria is Bordetella pertussis?

A

gram negative

49
Q

how does pertussis present

A

begins with mild coryzal symptoms, low grade fever and mild dry cough

severe coughing fits after a week or more

50
Q

describe paroxysmal cough

A

sudden and recurring attacks of coughing with cough free periods in between

51
Q

how is pertussis diagnosed

A

nasopharyngeal or nasal swab with PCR testing or bacterial culture

52
Q

how is pertussis managed if there has been a cough for more than two weeks

A

testing for the anti pertussis toxin immunoglobulin G

oral fluid for 5-16 year olds

blood for 17 and over

53
Q

how is pertussis managed

A

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
Q

how long can it take for pertussis symptoms to resolve?

A

typically 8 weeks

55
Q

what is a key complication of pertussis?

A

bronchiectasis

56
Q

what is chronic lung disease of prematurity

A

also known as bronchopulmonary dysplasia

occurs in babies born before 28 weeks gestation

57
Q

what do babies with CLDP suffer with

A

respiratory distress syndrome

58
Q

what are features of CLPD

A

low o2 sats
increased work of breathing
poor feeding and weight gain
crackles and wheezes on chest auscultation
increased susceptibility to infection

59
Q

how is the risk of CLDP reduced

A

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
Q

how is CLDP managed

A

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
Q

what is th emost common variant of the genetic mutation of the CF transmembrane conductance regulatory gene?

A

delta-F508
codes for cellular channels
- type of chloride channel

62
Q

what is the inheritance of CF

A

autosomal recessive!!!!!!!!

63
Q

what is meconium ileus

A

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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