Common paediatric respiratory pathologies

Question 1

common paediatric respiratory pathologies

Answer 1

bronchiolitis, chest infections (acute laryngotracheobronchitis- croup, epiglottitis, pneumonia, pertussis (whooping cough), inhaled foreign body, CF, primary ciliary dyskinesia, asthma

Question 2

bronchiolitis

Answer 2

most common severe LRT disease in infancy, caused by human respiratory syncytial virus, initial presentation is common cold type symptoms, develops into a dry irritating cough/wheezing/ increase RR and signs of respiratory distress,

Question 3

bronchiolitis- ausc and CXR

Answer 3

CXR= hyperinflation and areas of collapse or pneumonic consolidation, auscultation- widespread inspiratory crepitations and expiratory wheezes

Question 4

bronchiolitis- MX and PT

Answer 4

MX- humidified 02, ribavirin antiviral, ventilation if required
PT- careful and regular assessment, techniques should be applied only when sputum retention or mucus plugging is a problem

Question 5

what is croup

Answer 5

viral infection in 6 months- 4 years, initial presentation is common cold type symptoms, develops into= fever, harsh barking cough and hoarse voice, stridor or signs of respiratory obstruction. Severely affected may develop respiratory failure

Question 6

croup- Mx and PT

Answer 6

Mx- humidified O2, glucocorticoids, nebulised adrenaline, respiratory support
PT- contraindicated in the non-intubated child, may be required should the child be intubated for secondary complications- sputum retention

Question 7

chest infections- Epiglottitis

Answer 7

very dangerous condition occurring in 1-7 years, caused by haemophilus influenzae, rare since the introduction of Hib vaccine

Question 8

chest infections- Epiglottitis- symptoms

Answer 8

sudden onset of severe sore throat and high temperature. Rapid development of stridor and dysphagia with the child being unable to swallow saliva and drools. acute and possibly fatal obstruction of airway can develop

Question 9

chest infections- Epiglottitis- Mx and PT

Answer 9

Mx- child should not be disturbed in any way or their throat assessed as it could lead to acute life threatening obstruction, nasal intubation or occasionally a tracheostomy
PT- contraindicated in the non-intubated child, may be required should the child be intubated for secondary complications e.g. sputum retention

Question 10

chest infections- pneumonia- causes

Answer 10

Staphylococcus aureus (neonates), RSV (infant) & Mycoplasma, Streptococcus pneumoniae or Haemophilus influenzae (child)

Question 11

chest infections- pneumonia-symptoms and CXR

Answer 11

symptoms- pyrexia, dry cough, increased RR and recession of ribs and sternum
CXR- consolidation

Question 12

chest infections- pneumonia- Mx and PT

Answer 12

Mx- fluids and humidified O2, broad spectrum antibiotics

PT- careful and regular assessment, appropriate airway clearance technique

Question 13

chest infections- whooping cough- causes

Answer 13

caused by bordetella pertussis, cough becomes paroxysmal, worse at night. Spasms of coughing may cause hypoxia and apnoea

Question 14

chest infections- whooping cough- symptoms

Answer 14

at end of coughing there is inspiratory stridor, often bouts of coughing lead to vomiting and expectoration of sputum, coughing phase can last 6-8 weeks

Question 15

chest infections- whooping cough- Mx and PT

Answer 15

Mx- most managed at home, treatment is supportive, minimal handling to reduce disturbance which may precipitate coughing spasms
PT- contraindicated during the early stages as may induce coughing, may be required should the child be intubated for secondary complications (e.g. sputum retention)

Question 16

cystic fibrosis

Answer 16

Chromosome 7, which encodes for the CF transmembrane conductance regulator (CFTR), is defective. This leads to a problem in ion transport which results in low or abnormal salt concentration → increased mucus viscosity, Impaired mucociliary clearance → recurrent chest infections with gradual lung destruction. Primary areas affected are respiratory tract & digestive tracts but it is a multisystem disorder,

Question 17

cystic fibrosis- Mx and PT

Answer 17

Mx- MDT approach, drug therapy, organ transplant in later life
PT- at point of diagnosis chest clearance techniques are introduced and taught to parents/carers, education of self management as child grows up

Question 18

primary ciliary dyskinesia

Answer 18

rare genetic disorder, leads to either abnormal structure of the cilia, normal structure of the cilia- but abnormal function and absence of cilia, results in recurrent infections of ears/ nose/ sinuses and lungs and fertility issues

Question 19

primary ciliary dyskinesia- Mx and OT

Answer 19

Mx- drug therapy, monitoring +/- hearing aids, assisted conception may be needed in adulthood
PT- at point of diagnosis chest clearance techniques are introduced and taught to parents/carers, education of self management as child grows up

Question 20

asthma

Answer 20

increased responsiveness of smooth muscles in bronchial walls to various stimuli causing constriction and airway inflammation. Hypertrophy of mucous glands may lead to mucus plugging, airway obstruction, which may become chronic and severe. Children are more likely to develop it if parents or close relatives are ashtmatic.

Question 21

asthma- links

Answer 21

low socioeconomic background, outdoor pollution, dietary factors and passive smoking

Question 22

asthma- Mx and PT

Answer 22

Mx- drug therapy, PT- education of child and parents about condition, advise on exercise/ exercise programme, chest clearance techniques if there is sputum