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Paediatrics - MRCPCH > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

What is the prevalence of asthma in the paediatric population?

A

Around 10%

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2
Q

What should be asked in the history of a child to try and make a diagnosis of asthma?

A 
Recurrent symptoms: (wheeze, cough, SOB, chest tightness)
Triggers: (URTI, allergens, exercise)
Cough after exercise or during sleep
Daily or seasonal variation
History of atopy
FHx of atopy
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3
Q

What positive findings may examination show in a child with asthma?

A

Barrell-shaped chest
Hyperinflation -> hyperresonance
Wheeze and prolonged expiratory phase of respiration

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4
Q

Although CXR is rarely useful in a child with asthma, what might it show?

A 
Hyperinflation (flattened hemidiaphragm and increased anterior rib spacing)
Peribronchial cuffing (https://test3.teachingmedicine.com/tutorial/CHF/Peribronchial_cuffing)
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5
Q

PEFR can be useful in assessing for asthma, at what level below normal would it be considered a positive finding?

A

> 20%

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6
Q

FEV1/FVC is a positive findings in asthma at what level below normal?

A

<70% of lower limit for age and height

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7
Q

In asthma what shape would the expiratory flow-volume curve be expected to be?

A

Concave, scooped shape
https://www.researchgate.net/figure/Flow-volume-curve-of-a-child-with-asthma-showing-the-characteristic-concave-expiratory_fig2_9014150

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8
Q

What levels dictate a positive response to bronchodilators in spirometry

A

> 12% increase in FEV1 or PEFR

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9
Q

FeNO is +ve in ages 4-16 at what level?

A

> 35ppb

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10
Q

Other than spirometry and CXR what other tests may prove useful in a diagnosis of asthma?

A 
Allergen testing (serum or skin)
Blood eosinophil count
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11
Q

What percentage of variability of PEFR over 30 days is indicative of asthma?

A

> 20%

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12
Q

What is the 1st line treatment for asthma in children?

A 
PRN SABA (salbutamol)
Trigger avoidance
Patient/carer education
Create an asthma action plan
Smoking avoidance
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13
Q

What is the 2nd step treatment in asthma?

A

Low dose inhaled corticosteroid

+ SABA

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14
Q

What alternatives to corticosteroid can be given at stage 2 in the asthma treatment plan for 0-4 year olds?

A

Montelukast (0-4)

+ SABA

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15
Q

What alternatives to corticosteroid can be given at stage 2 in the asthma treatment plan for 5-11 year olds?

A 
Leukotriene receptor antagonist (LRA) - (Montelukast/zafirlukast)
OR
Sodium cromoglicate
OR
Nedocromil
OR
Theophylline

AND
SABA

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16
Q

What alternatives to corticosteroid can be given at stage 2 in the asthma treatment plan for >=12 year olds?

A 
LRA
OR
Sodium chromoglicate
OR
Nedocromil
OR
Theophylline

AND
SABA

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17
Q

What is stage 3 treatment in asthma?

A

Medium-dose inhaled corticosteroid

+ SABA

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18
Q

What alternatives to standard plan corticosteroid can be given at stage 3 in the asthma treatment plan for 5-11 year olds?

A

Low dose inhaled corticosteroid
AND

LABA (salmeterol)
OR
Theophylline
OR
LRA

AND
SABA

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19
Q

What alternatives to standard plan corticosteroid can be given at stage 3 in the asthma treatment plan for >=12 year olds?

A

Low dose corticosteroid
AND

LABA
OR
LRA
OR
Theophylline

AND
SABA

20
Q

What is the stage 4 treatment for asthma for 0-4 year olds?

A 
Medium-dose inhaled corticosteroid
AND
SABA
AND 
Monteluakst
21
Q

What is the stage 4 treatment for asthma for >=5 year olds?

A

Medium dose inhaled corticosteroids
AND

LABA
OR
LRA
OR
Theophylline

AND
SABA

22
Q

What is the stage 5 treatment for asthma for 0-4 year olds?

A 
High dose inhaled corticosteroid 
AND
Montelukast
AND
SABA
23
Q

What is the stage 5 treatment for asthma for 5-11 year olds?

A

High-dose inhaled corticosteroids
AND

LABA
OR
LRA
OR
Theophylline

AND
SABA

+/- immunomodulator (omalizumab)

24
Q

What is the stage 6 treatment for asthma for 0-4 year olds?

A

High dose inhaled corticosteroid
AND

LABA
OR
Montelukast

AND
Oral corticosteroid

25
Q

What is the stage 6 treatment for asthma for 5-11 year olds?

A

High-dose inhaled corticosteroids
AND

LABA
OR
LRA
OR
Theophylline

AND
Oral corticosteroid

AND
SABA

+/- immunomodulator (omalizumab)

26
Q

What is the stage 5 treatment for asthma for >=12 year olds?

A

High-dose inhaled corticosteroids
AND

LABA
OR
LRA
OR
Theophylline

AND
Oral corticosteroid

AND
SABA

+/- tiotropium

+/- immunomodulator (omalizumab)

27
Q

What is the stage 6 treatment for asthma for >=12year olds?

A

High-dose inhaled corticosteroids
AND

LABA
OR
LRA
OR
Theophylline

AND
SABA

+/- tiotropium

+/- immunomodulator (omalizumab)

28
Q

What are the 2 types of preschool wheeze?

A

Episodic viral wheeze (commonest)

Multi-trigger wheeze (resembles asthma)

29
Q

What are the risk factors for preschool wheeze?

A

Tobacco smoke exposure
Prematurity
IUGR
Exposure to viruses, bacteria and allergens

30
Q

What is the treatment plan for preschool wheeze?

A 
Tobacco smoke/allergen avoidance
SABA trial
PO corticosteroids if hospitalised
Trial of inhaled corticosteroids if persistent
Trial of leukotriene if persistent still
31
Q

What are some common comorbidities for adolescent asthma?

A

Anxiety disorder
Major depression
Panic attacks

32
Q

What are the side affects of steroid use in asthma?

A 
Mainly with prolonger oral or high-dose steroids:
Impaired growth
Adrenal suppression
Oral candidiasis
Altered bone metabolism
33
Q

What are the side effects of theophylline use in asthma?

A 
Vomiting
Sleep disturbance
Headaches
Poor concentration
Arrythmias
34
Q

What characteristics does status asthmaticus have?

A

SpO2 <90%
PEFR <33%
Silent chest/poor resp effort

35
Q

What are end stage signs in status asthmaticus?

A

Raised PCO2/PaCO2
Hypotension
Exhaustion

36
Q

What is the treatment for life-threatening status asthmaticus?

A

IV bronchodilators

Anaesthetist review

37
Q

How does a severe asthma attack present?

A

PEFR 33-50%

Speaking in short sentances

38
Q

What is stage 1 in treatment of severe asthma attack?

A

Inhaled bronchodilator
10x puffs salbutamol via MDI and spacer
OR
2.5-5mg nebulized

39
Q

What is stage 2 in treatment of severe asthma attack?

A

Ipratropium bromide

250mcg nebulised and mixed with salbutamol if no response to stage 1

40
Q

What is stage 3 in treatment of severe asthma attack?

A

Magnesium sulphate

250mcg can be added to ipratropium and salbutamol nebs in 1st hour for acute severe onset asthma

41
Q

What is stage 4 in treatment of severe asthma attack?

A

Steroids
Give oral steroids early (pred)
If already on maintenance dose give 2mg/kg upto max 60mg
If life-threatening consider IV hydrocortisone

42
Q

What is stage 5 in treatment of severe asthma attack?

A

IV magnesium sulphate

40mg/kg for children who respond poorly to initial treatment

43
Q

What is stage 6 in treatment of severe asthma attack?

A

IV salbutamol
Consider early bolus in life-threatening cases
(15mcg/kg over 10 mins as bolus, then infusion (1mcg/kg/min (max 20mcg/kg)))
Monitor for toxicity (lactic acidosis, jitteriness, N&V, hypokalaemia)

44
Q

What is stage 7 in treatment of severe asthma attack?

A

IV aminophylline
If unresponsive to bronchodilators and steroids
5mg/kg IV loading dose followed by infusion
Monitor for toxicity (headaches, gastric irritation, arrthymias)
Use continuous cardiac monitoring
Sample plasma theophylline levels every 12 hours

45
Q

When is it safe to discharge a patient who has had an asthma exacerbation?

A

SpO2 >94% in air
3-4hourly inhaled bronchodilator therapy
Follow-up within 2 days in community

Paediatrics - MRCPCH (3 decks)

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