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paediatric > Paed resp > Flashcards

Paed resp Flashcards

1
Q

what are some URTI

A

coryza, pharyngitis, acute otitis media, sinusitis

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2
Q

coryza- features, causative agents, treatment

A

nasal discharge, blocked nose, pain, fever
rhinovirus, coronavirus, RSV
supportive care

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3
Q

pharyngitis main causative agents

A

adenovirus, rhinovirus,

EBV, group A beta haemolytic streptococcus

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4
Q

tonsillitis differentiate between bacterial vs viral

A

feverPAIN, high score more likely bacterial strep

fever, pus on tonsils, attended quickly (within 3d from onset), inflamed severely tonsils, no coryza or coughing

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5
Q

treatment of bacterial pharyngitis

A

penicillin or erythromycin

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6
Q

acute otitis media features

A

middle ear infection
tympanic membrane swollen red, pus maybe
pain in ear, fever

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7
Q

common age for acute otitis media

A

6-12m

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8
Q

treatment of acute otitis media

A

pain control

amoxicillin only if symptoms are severe, remained 2-3d post onset

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9
Q

causative agents acute otitis media

A

RSV, rhinovirus
strep pneumonia
haemophilus influenzae

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10
Q

sinusitis features, viral or bacterial

A

mostly viral

pain, tender, swollen sinuses

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11
Q

treatment of sinusitis

A

paracetamol, topical decongestion e.g. nasal corticosteroid or antihistamines

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12
Q

what is croup and causative organisms

A

larygnotracheobronchitis
increased secretions, subglottic oedema, mucusal inflammation
mostly viral- RSV, influenza, parainfluenza (main one)

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13
Q

most common age for croup

A

6m-6y (2y most common)

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14
Q

what is pseudomembranous croup and how do you treat

A

bacterial tracheitis, mostly staph aureus
more severe thicker exudate, cough present, fever present, 6m-14y age
flucloxacillin and cefotaxime and prepare for intubation of needed

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15
Q

features of croup and how do you assess severity

A

apyrexia or mild fever
barking cough
coryza
stridor and intercostal recessions assess severity–> at rest, at crying, none
severe features- rising RR, lethargy, restless, cyanosed

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16
Q

management of croup

A

stay calm, don’t examine throat
if mild/moderate- prednisolone or dexamethasone
if severe- have ENT, anaesthetist ready for intubation, nebulised adrenaline
monitor SPO2

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17
Q

what is epiglottitis and pathogen and common age

A

inflammation of epiglottis due to haemophilus influenzae group B, associated with sepsis, common 1-6y

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18
Q

features of epiglottitis

A

acute onset fever, sepsis looking child, can’t speak, can’t swallow (drooling), sat upright neck extended, resp difficulty, throat pain, cough not prominent

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19
Q

management of epiglottits

A 
don't examine throat, keep calm
call ent and anaesthetis for intubation, may need urgent tracheostomy
give IV cefotaxime
investigate after intubation
give rifampicin to household contacts
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20
Q

any further action to family of epiglottitis patient

A

rifampicin to close household members

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21
Q

bronchiolitis causative agents

A

RSV mostly

parainfluenza, adenovirus, rhinovirus

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22
Q

bronchiolitis RF for severe case

A

CF, premature infants with underlying respiratory abnormalities, congenital heart disease patients

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23
Q

features of bronchiolitis

A

coryza, dry cough, SOB, poor feeding, recessions, displaced liver down, hyperinflation, pallor, cyanosed, tachypnoea
(severe features and usual)

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24
Q

complication of bronchiolities

A

recurrent apnoea

25
Q

preventing bronchiolitis and who is it given to

A

palivizumab

at risk kids- premature with underlying respiratory conditions, congenital heart disease, CF

26
Q

what is the vaccine for bronchiolitis and what pathogen is it against

A

a monoclonal antibody
palivizumab
against RSV

27
Q

treatment of bronchiolitis

A

supportive IV fluids and nasogastric feed and o2 if needed

spO2 continuous

28
Q

what is pneumonia

A

inflammation of lung parenchyma w congestion

29
Q

causative pathogens for pneumonia depending on age

A

newborn- staph aureus, e.coli, group B strep, klebsiella
<5y- viral>bacterial, influenza A and B, RSV, parainfluenza, strep pneumonia, h. influenzae
>5y- strep pneumonia, mycoplasma pneumonia, chlamydia pneumonia

30
Q

features of pneumonia

A

cough difficulty breathing <14d
fever, SOB, poor feeding, inconsolable crying, purulent sputum, chest pain, pleuritic pain, cyanosed, tachypnoea (>60 if <2m, >50 if 2-11m, >40 if >11m) reduced GCS, dull percussion, lethargy, grunting

31
Q

investigations for pneumonia

A

cxr, fbc, blood cultures, pulse oximetry monitor, sputum culture

32
Q

signs of pneumonia on cxr

A

consolidation, pleural effusion, infilterates

33
Q

treatment of pneumonia

A

co-amoxiclav or erythromycin empiric antibiotics

iv fluids, nasogastric feed, o2, paracetamol if needed

34
Q

child for hospital admission of pneumonia features

A

low spo2, severe tachypnoea, poor feeding, difficulty breathing, apnoea

35
Q

what is a wheeze

A

whistling in chest when child breaths out

polyphonic

36
Q

what is asthma and what are the mechanisms

A 
reversible airway obstruction
due to
bronchial muscle constriction
mucosal inflammation
increased mucus production
37
Q

types of asthma

A

eosinophilic and non-eosinophilic
(eosinophilic can be atopic or non-atopic. eosinophilic is indirect activation of mast cells)
atopic- igE present, type 1 hypersensitivity, allergic variant
non-atopic- later onset, no allergies, overlap w obesity and smoking
non-eosinophilic- not large quantities of eosinophils maybe more neutrophils, direct activation of mast cells

38
Q

which type of asthma is direct and indirect activation of mast cells

A

direct- non-eosinophilic

non-direct- eosinophilic

39
Q

which type of asthma would you see igE

A

atopic eosinophilic asthma

40
Q

which hypersensitivity reaction type is seen and in which type of asthma

A

atopic eosinophilic

type 1

41
Q

features of asthma

A

cough esp at night, diurnal (am worse), SOB, intermittent symptoms, wheeze, sputum, tachypnoea

42
Q

signs of asthma

A

hyperinflated chest, hyper-resonant percussion

43
Q

percipitants of asthma

A

cold air, infection, NSAIDs, allergens, smoking, pollution

44
Q

effects on daily life from asthma

A

disturbed sleep, days off school, lots of gp visits

45
Q

other conditions associated with asthma

A

hayfever, eczema, allergies, acid reflux, fhx of atopic conditions

46
Q

investigations for asthma (not acute attack)

A

FBC (type of asthma help differentiate), PEF monitor, spirometer, reversibility testing (should improve by 12%), CXR, skin prick test, check growth development throughout

47
Q

acute attack of asthma investigations

A

pulse oximetry, ABG, Blood culture, sputum culture

48
Q

management of chronic asthma and steps

A
  1. short acting beta agonist salbutamol
  2. add inhaled corticosteroid and titrate as necessary (if can’t tale steroid- montelukast
  3. add LABA
  4. increase steroid dose, add theophylline
  5. oral prednisalone
  6. some biological therapy e.g. omalizumab
49
Q

asthma attach severity features

A

severe- can’t finish sentences, RR >25 HR>110

life threatening- coma, confusion, low RR and HR, low O2, high or normal CO2

50
Q

treatment of acute asthma attack

A 
O SHIT ME
oxygen
salbutamol (IV if young child easier)
Hydrocortisone
Ipratropium
theophylline
magnesium sulphate
escalate
51
Q

reasons for poor response to medication to check before moving up in management for asthma

A

poor compliance, check technique, use spacer
check family smokers
environment changes
wrong diagnosis? recheck, avoid precipitants

52
Q

what is episodic wheeze

A

viral induced episodic
small airway more likely to narrow and obstruct
due to immune or inflammatory response to viral infection

53
Q

features if episodic wheeze

A

wheeze when viral infection, episodic, no interval symptoms

54
Q

what is cystic fibrosis and what is the inheritence

A

mutation in cystic fibrosis transmemranous conductance regulator gene, dysfunction Na Cl channels
autosomal recessive

55
Q

what systems are affected in CF and what happens

A

airways- impaired ciliary function, retention of mucus secretions, dysregulation of inflammation, bronchiectasis
intestines- meconium ileus (meconium thick, doesn’t pass, obstruction, washout enema may help)
pancreas- blocked ducts, pancreatic enzyme deficiency so malabsorption, DM
male fertility reduced
sweat increased Na and Cl
liver- bile secretion malfunction

56
Q

features of CF at different ages and generally

A

wet cough, recurrent chest infections, wheeze, faltering growth
newborn- meconium ileus, new born screening
infant- prolonged neonatal jaundice, steatorrhea
young child- bronchiectasis, rectal prolapse, nasal polyps, clubbing
older child- DM, liver cirrhosis, reduced fertility, distal intestinal obstruction, pneumothorax, recurrent haemoptysis

57
Q

investigations or where is CF picked up

A

antenatal carrier testing
preimplant analysis in vitro fertilisation
Guthrie newborn screening using trypsin. sweat test high Cl, malanbsorption screen- low elastase in faeces

58
Q

management of CF

A 
genetic counselling
physiotherapy resp 3/w
monitor infection signs
prophylaxis fluclaxacillin and rescue medication if infected
eventually most will have chronic pseudomonas aeruginosa so daily nebulised antibiotic
high calorie and protein diet
pancrex powder 
vitamin supplements
omeprazole
lung transplant

paediatric (6 decks)

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