Paed:Resp Flashcards
3 main pathophys features of Asthma
- Chronic airway inflammation
- Bronchial Hyper reactivity
- Reversible airway obstruction
Causes of asthma
Genetic predisposition
Atopy
Environmental triggers
What are the two types of wheeze?
- Transient early wheezing (small airways more likely to be narrow) (episodic)
- Persistent and recurring wheezing (Ass w/ common inhaled allergens and atopy)
Clinical features of asthma
worse at night or early in the morning triggering factors interval symptoms SOB Cough
Examination features in asthma
barrel shaped chest
hyperinflation
wheeze
prolonged expiration
Investigations of asthma
Spirometry: PEFR<80%, FEV1/FVC<80%, 15%improvement after bronchodilator
Skin prick test
CXR: Hyperinflation, flattened hemidiaprhagm, peribronchial cuffing, atelectasis
FENO
Management of asthma
Stepwise approach:
1) Mild intermittend asthma: Inhaled SABA
2)Regular preventer therapy: Add inhaled steroid (beclometasone) or if <5 oral LTRA (montelukast)
3) >5 LABA (salmaterol)
<5 LTRA
4) increase steroids
5) Oral steroidz babyy
S/e of long term ICS use?
Adrenal suppression
Growth suppression
Osteoporosis
Features of acute asthma attack
Wheeze Tachypnoea Use of accessory msucles Pulsus pardoxus SOB interferes with talking Cyanosis, fatigue, drowsiness o2 sats below 90%
Management of asthma attack
oxygen
nebulised b2 agonsit and ipatropium bromide
IV hydrocortisone
What viruses cause the common cold?
Rhinoviruses, coronaviruses, RSV
What viruses cause sore throat/pharyngitis?
Adenovirus, enterovirus, rhinovirus
In the older age grup, what could be a bacterial cause of sore throat
Group A beta-haemolytic strep
Tonsillitis - causes and treatment?
Group A beta haemolytic strep, EBV. Penicillin if severe
Why are kids prone to otitis media?
Shorter eustachian tubes
What would the tympanic membrane look like in OM?
Bright red, bulging, loss of normal light reflection
Causes of OM
RSV, rhinovirus
Pneumococcus, H.Influenzae, Moraxella Catarrhlis
Complications of OM
Mastoiditis, meningitis, OM w/effusion (glue ear) can cause hearing loss
What is croup?
Laryngotracheobronchitis is mucosal inflammation of the airway.
What causes Croup?
90% viral.
Viral: parainfulenza virus normally. also: Human metapneumovirus, RSV, influenza
Typical features of Croup?
Barking cough Harsh stridor Hoarseness Symptoms worse at night. Preceded by fever and coryza
Treatment of Croup
Oral dexamethasone, oral prednisolone, nebulised steroids
What is the most common cause of Epiglottitis
Haemophilus Influenzae - not anymore cus of the vaccine lol!
What is epiglottitis?
Intense swelling of epiglottis and nearby tissues
features of epiglottitis?
Acute onset of high fever, painful throat with drooling/not speaking child. Stridor. Child often upright with open mouth. Unwell.
Treatment of epiglottitis
Tracheal intubation
Cefuroxime
Main symptoms of bronchitis
cough and fever
What causes Whooping Cough?
Bordetella Pertussis
What is the key feature of whooping cough?
Characteristic cough followed by characteristic inspiratory whoop.
Worse at night and can be followed by vomiting
Investigations for whooping cough
Culture nasal swab, PCR, lymphocytosis on FBC
Management of WhoopCough
Clarithromycin.
Give Erythromycin if pregnant woman.
Close contacts get erythromycin
What is the main cause of Bronchiolitis?
Respiratory syncytial virus.
Other causes: Parainfluenza, rhinoviruses, adenoviruses and more
What does bronchiolitis cause?
Pulmonary hyperinflation and atelctasis
Signs and sx of bronchiolitis
Sharp dry cough tachypnoea intercostal recession hyperinflation fine end inspiratory crackles high pitched wheeze tachycardia cyanosis/ pallor
Investigations for bronchiolitis
Pulse Oximetry
ABG
CXR (often not needed) shows Hyperinflation, air trapping, focal atelectasis
PCR of Nasoharyngeal swabs
Management of bronchiolitis
OXygen
NGT
Bronchodilators
Prophylaxis of bronchiolitis
Palivizumab
What are the causative organisms for pneumonia by age group?
Neonates: Group B strep, E Coli, Klebsiella, Staph Aureus
Infants: Strep Pneumoniae, Chlamydia
Children >5: Strep Pneumoniae, staph aureus, group A strep, bordetella pertussis,
Viral causes: RSV, influenza A or B
Clinical features of pneumonia
Fever >38.5
SOB
Cough w/ sputum
Examination features of penumonia
Tachypnoea
grunting
use of accessory muscles
Desaturation and cyanosis
Auscultation of pneumonia reveals
dull to percussion crackles decreased breath sounds tactile vocal fremitus bronchial breathing
investigations for pneumonia
Sputum culture nasopharyngeal aspirate blood culture CXR Viral titres
Treatment of pneumonia
oral abx: <5: Amox, co-amox, cefaclor
>5: amox or fluclox
What is cystic fibrosis?
CF is an autosomal recessive disorder casuing a defect in the CFTR protein leading to defective ion transport in exocrine glands.
Clinical features of CF
Persistent loose cough, purulent sputum, sob, haemoptyis, weight loss, fatty stools, FtT, prolonged neonatal jaundice, DM
What is a common reccurent infection in CF?
Pseudomonas Auergionsa
Diagnosis of CF
Sweat test - Chloride ions above 60mmol/L
Gene abnormalities on CFTR protein on Chromosome 7
Faecal testing shows decreased elastase
management of CF
Abx (for infections and prophylaxis)
- oral fluclox and nebulised ciprofloxacin
Physiotherapy - chest percussion, postural drainage
Nebulised DNAse
Pancreatic replacement etc
How is TB spread?
Usually by resp route, droplet spread.
Clinical presentation of TB
Fever
Anorexia + w loss
Malaise
Cough
Diagnosis of TB
Sputum sample -> gastric washings
mantoux test
Interferon gamma release assays
Also: Urine, CXR, CSF
Treatment of TB
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol. First 2 for 6 months baby.
Pyridoxine after puberty to prevent peripheral neuropathy
What is Periorobital cellulitis?
URTI followed by painful swollen eye
Proptosis
Red colour vision –> optic nerve compromise
Mangagement of Perioribital cellulits
Abx
Incision and drain of abcess
What is strabismus?
Misalignment of the visual axes.
What is meant by latent strabismus?
Eyes are straight when both eyes open, but a deviation of the visual axes can be elicited when each eye is covered.
What is Hypertropia?
Upward eye
What is Hypotropia?
Downward eye
What is esotropia?
Inwards eye
What is exotropia?
Outwards eye
Causes of strabismus?
Hereditary Refractive errors Neurological deficit eg. CP Craniofacial synostosis Febrile illness can precede onset. Secondary to loss of vision
Investigations of strabismus?
Corneal reflection.?Symettrical
Cover test: - Exotropia for distance
- Exophoria for close.
What is ambylopia?
defective visual activity which persists after the correction of refractive error and removal of any pathology
Treatment of ambylopia?
Refractive adaptation
Occlusion of the better seeing eye
Atropine drops (dilates pupil and paralyses accom so blurry vision in good eye so the bad eye must sort it’s self out)
management of strabismus?
Conservative: Glasses, prisms, orthoptic exercises
Pharm: Botox under ketamine anaesthesia. Injected into medial rectus if esotropia and lateral rectus if exotropia.
Surgery
What are grommets?
Ventilation tubes that can help with otitis media w/effusion
What are some causes of sensorineural deafness?
Inherited:Treacher-Collins syndrome, Waardenburg syndrome
Antenatal/Perinatal: Congenital infection eg. rubella, CMV, syphilis
Preterm: Birth asphyxia, hyperbilirubinaemia
Post natal/ childhood: Drugs eg aminoglycosides, Meningitis, head injury
What are some causes of Conductive deafness?
Secretory otitis media (glue ear)
Eustachian tube dysfunction (Down syndrome, cleft palate, micrognathia, mid facial hypoplasia)
What decibel loss affects development?
over 40dB will affect speech and language development
