Paediatric Respiratory Flashcards

Question

State some factors for when to consider admission for croup

Answer 1

- Previous history of severe airway obstruction - Very young (< 6 months) - Immunocompromised - Inadequate fluid intake - Poor response to initial treatment - Uncertain diagnosis - Significant parental anxiety

Answer 2

Time Course: Croup = days Epiglottitis = hours Features prior: Croup = coryzal Epiglottitis = none Cough: Croup = barking Epiglottitis = slight if any Feeding: Croup = can drink Epiglottitis = none Mouth: Croup = closed Epiglottitis = open, drooling saliva Fever Croup = < 38.5 (no fever) Epiglottitis = > 38.5 (fever) Stridor: Croup = rasping Epiglottitis = soft Voice Croup = hoarse Epiglottitis = weak / silent

Answer 3

Pathophysiology: - Acute inflammation and swelling of epiglottis - Usually caused by infection, specifically Haemophilus influenza B (also streptococcus pneumoniae) Presentation: 4 D’s! - Drooling - Dyspnoea (difficult breathe) - Dysphagia (painful / difficult swallow) - Dysphonia (muffled “hot potato” voice) - Tripod position - High fever Investigations: No examinations! - Lateral x-ray shows thumbprint sign or can exclude foreign body Management: - Keep child as comfortable as possible, no examinations - Immediate escalation to senior paediatrician and anaesthetist - Most recover okay, but prepare for intubation or tracheostomy - Once secure airway, IV antibiotics and Dexamethosone

Answer 4

Epiglottic abscess - Treatment similar to epiglottitis

Answer 5

- Croup - Inhaled foreign body - Retropharyngeal abscess - Tonsillitis - Peritonsillar Abscess - Diphtheria

Answer 6

Pathophysiology: - Highly contagious upper respiratory tract infection - Caused by Bordetella pertussis (gram negative bacteria), which paralyses cilia and promote inflammation - Under 3 months have yet to be vaccinated (vulnerable) Presentation: - Starts with mild coryzal symptoms, low grade fever and mild dry cough - Then severe coughing fits, getting progressively worse - After coughing fits, large loud inspiratory 'whoop' (apnoea more common if < 3 months) Investigations: If 2-3 weeks since onset = Nasal swab PCR for Bordetella pertussis If > 3 weeks, can use anti-pertussis toxin test for IgG antibodies Management: - NOTIFIABLE DISEASE (contact public health) - Simple supportive care in most cases, admission is severe or respiratory distress - Can use Macrolide antibiotics e.g. Azithromycin in early stages to reduce further spread - If close contacts vulnerable, can give prophylactic antibiotics *Cough can last up to 100 days after infection*

Answer 7

Bronchiectasis

Answer 8

- Bronchiolitis / viral respiratory infection - Pneumonia - Asthma - TB

Answer 9

Pathophysiology: - Autosomal recessive genetic condition affecting mucus glands - Defect in the chloride ion transporter (CFTR) - Affects osmotic gradient for water, leading to thicker mucus and impaired clearance Ways in which CF can present: - Newborn spot test - Meconium ileus - Recurrent chest infections - Difficulties gaining weight / failure to thrive - Pancreatitis - Male infertility Symptoms of CF: - Chronic cough and thick sputum - Recurrent chest infections - Steatorrhoea - Abdominal pain and bloating Investigations - 3 methods: - Newborn spot test - Sweat test (gold standard for diagnosis) - Genetic testing for CFTR gene Management: - Ensure up to date on vaccinations - Chest physiotherapy and exercise - Creon tablets and high calorie diet - Prophylactic Flucloxacillin and treatment of chest infections - Bronchodilators e.g. Salbutamol - Nebulised saline

Answer 10

1. Pancreatic and biliary ducts - leads to lack of digestive enzymes in the digestive tract and reduced ability to break down and absorb nutrients 2. Thick airway secretions - reduce airway clearance leading to increased respiratory infections 3. Congenital bilateral absence of vas deferens leading to male infertility

Answer 11

Meconium ileus - Thick and stick meconium - Failure to pass meconium within the first 24 hours of life (in 20% of CF babies) - Leads to abdominal distension and vomiting

Answer 12

- Staph aureus (take long term prophylactic Flucloxacillin) - Pseudomonas aeruginosa (very difficult to get rid of once infected = significant increase in mortality and morbidity)

Answer 13

- Diabetes (pancreatic insufficiency) - Vitamin D deficiency / osteoporosis - Liver failure

Answer 14

Pathophysiology: - Describes an acute wheezy illness, caused by a viral infection - Young children tend to have small airways and a viral illness can cause inflammation and oedema - This restriction of an already small airway can lead to obstructive flow and a wheeze - Commonly RSV and rhinovirus - Some children are more susceptible than others to swelling (hereditary element?) Most common age: - Under 3 years (smaller airways) Presentation: Similar to asthma! - Expiratory wheeze = widespread - Fever (1-2 days prior) - Cough (1-2 days prior) - Coryzal (1-2 days prior) - SOB - Signs of respiratory distress Investigations: - PEFR Management: - Same management for acute asthma (child)

Answer 15

- Viral wheeze presents before 3 years old (asthma tends to be later) - No atopic history - Occurs in tandem with viral infection Asthma can also be triggered by viral/bacterial infections, however it's generally trigger by other things as well e.g. exercise, cold

Answer 16

- Asthma - Bronchiolitis - Inhaled foreign body - Atypical lower respiratory tract infections - Cystic fibrosis - GORD - Structural airway problems

Answer 17

Pathophysiology: - Dilatation of the airways caused by destruction of bronchial tissue - Inflammatory response in response to severe infection causes structural damage and scarring, reducing number of cilia within bronchi - Commonly occurs as a result of cystic fibrosis - Potentially reversible Presentation: - Purulent sputum - Wheeze - SOB on exertion - Haemoptysis - Chest pain - History of recurrent chest infections Investigations: - HRCT (signet ring sign) = gold standard - Chest x-ray (bronchial wall thickening or airway dilatation) - Consider spirometry - Investigate underlying cause e.g. sweat test or immunoglobulin assay Management: - Chest physiotherapy - Antibiotics to treat chest infections - Can use bronchodilators - Regular follow ups

Answer 18

- Asthma - COPD (e.g. alpha 1 anti-trypsin deficiency) - Chronic sinusitis - Pneumonia - TB / lung cancer - Interstitial lung disease (ILD)

Answer 19

- Recurrent chestinfections - Pneumothorax - Haemoptysis - Lung abscess - Reduced QOL / poor growth and development Prognosis: dependent on underlying cause If post-infection, treatment should halt progression However if more complex like HIV then prognosis based on status of underlying disease

Answer 20

- Cystic fibrosis with recurrent chest infections / primary ciliary dyskinesia - Post infection e.g. strep pneumonia, adenovirus - Immunodeficiency e.g. HIV, antibody defect - Post obstructive - Young & yellow-nail syndromes

Answer 21

Airway narrowing: - Obstructive sleep apnoea - Bronchiectasis - Bronchiolitis obliterans - Tracheobronchomalacia Chest/lung problems: - Chest wall deformity - Kyphoscoliosis - Lung hypoplasia - ILD Neuromuscular disorder: - Spinal cord injury - Spinal muscular atrophy - Myasthenia gravis - Diaphragmatic dysfunction - Congenital muscular dystrophy - Brain damage e.g. post infection

Answer 22

Non-invasive: - Bi-level positive pressure (BiPAP) - Continuous positive airway pressure (CPAP) Invasive: - Tracheostomy

Answer 23

Pathophysiology: - Temporary obstruction of nose, throat or upper airway during sleep - In children, most common cause is enlarged adenoids and/or tonsils Risk factors for developing OSA: - Obesity - Sickle cell disease - Down syndrome Presentation: - Snoring - Sleep in unusual position (ease breathing) - Tiredness - Unhappy or change in behaviour - Poor growth and weight gain - Poor school performance / lack of concentration Investigations: - Sleep study (records HR, RR and O2 sats whilst sleeping as well as video/sound recording Management: - Weight loss if obesity - Surgery to remove the adenoids and/or tonsils - Non-invasive ventilation e.g. BiPAP or CPAP - Nasopharyngeal airway (splint open) - Nasal steroids or Montelukast to reduce inflammation

Answer 24

Meconium Ileus: - Failure to pass meconium within the first 12–24 hours of life - Presents with bilious vomiting and a distended abdomen Meconium Aspiration Syndrome: - Presence of meconium in the amniotic fluid - May lead to respiratory distress in the neonate

Answer 25

- Anaemia - Congenital heart problems - Respiratory disease e.g. asthma, pneumonia - Obesity - Chronic infections (viral or bacterial) - Allergies - Passive exposure to cigarette smoke / other harmful gases - Genetic conditions e.g. cystic fibrosis, muscular dystrophy

Answer 26

Primary (spontaneous) pneumothorax = no underlying lung disease Secondary pneumothorax = underlying or chronic lung disease - infection - foreign body aspiration - cystic fibrosis - asthma - interstitial lung disease

Answer 27

- Previous pneumothorax - Chronic respiratory disease e.g. cystic fibrosis, asthma - Tall and thin male - Family history of pneumothorax - Connective tissue disorders e.g. Marfan’s, Ehlers-Danlos syndrome - Prematurity / chronic lung disease of prematurity - Non-invasive ventilation e.g. CPAP - Use of recreational drugs (older children)

Answer 28

Investigation: - Chest x-ray - O2 sats Management: If tension/unstable = emergency management of 15L O2 non-rebreathe mask and emergency chest drain in anterior 2nd ICS on affected side (above rib) - If small = conservative and regular observations - If large = admission and needle aspiration

Answer 29

- Foreign body obstruction - Upper airway obstruction e.g. epiglottitis, mucus - Lower airway obstruction e.g. aspiration, constriction - Decreased respiratory effort / exhaustion e.g. CNS disorder, CNS depression from drugs

Answer 30

- Involuntary episodes where a child holds their breath - Usually triggered by something that upsets them 2 main types 1. Cyanotic breath holding spells - when child is upset, worked up and crying - can stop breathing, cyanotic and lose consciousness - regain consciousness after ~1 min 2. Reflex anoxic seizures - when the child is startled - vagus nerve sends strong signals to heart to stop it breathing - can go pale, cyanotic and lose consciousness - may have seizure like muscle twitching - regains consciousness and heart restarts in ~30 seconds Most common age: - Between 6 months and 18 months

Answer 31

Exclude any underlying pathology, especially iron deficiency anaemia (has been linked) Educate and reassure parents - most children usually grow out of them by 4-5 years old

Answer 32

- Previous near-fatal asthma - Previous admissions / A&E for asthma - 3 or more types asthma medication - Heavily relient on Salbutamol