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Respiratory > Paediatric respiratory > Flashcards

Paediatric respiratory Flashcards

1
Q

What is a neonate?

A

Baby in the first 28 days of life

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2
Q

What is a ‘term baby’?

A

Baby born between 37 and 42 weeks gestation

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3
Q

What is the normal respiratory rate and heart rate for a neonate?

A 
RR = 30-50
HR = 120-160
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4
Q

What is a UAC and a UVC?

A

Umbilical artery catheter

Umbilical venous catheter

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5
Q

What are the sigsn of respiratory distress syndrome in a neonate?

A

Tracheal tug, expiratory grunting and marked sternal recession (as the bones are not fully ossified)

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6
Q

What might the CXR of a neonate with RDS show?

A

Opaque lung fields as there is fluid on the lungs and some alveolar collapse

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7
Q

What causes RDS in the neonate?

A

Surfactant deficiency. Type 2 pneumocytes develop between 24 and 34 weeks gestation.
Premature babies may nt have produced sufficient surfactant

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8
Q

How often does RDS occur?

A

Effects 1% of all births but more common in premature births

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9
Q

What is the function of surfactant?

A

To reduce alveolar surface tension to prevent alveolar collapse

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10
Q

What does surfactant contain?

A

Phospholipid and apoproteins

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11
Q

What happens when not enough surfactant is produced in the neonate?

A

Atelectasis and impaired gas exchange

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12
Q

If a mother presents in premature labour, what can be done to prevent or reduce RDS?

A

Given 2 steroid injections, preferably 12 hours apart, which stimulates surfactant production.

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13
Q

At what stage in gestation will babies always be incubated?

A

<29 weeks and they will have artificial surfactant delivered to the lungs

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14
Q

What is ventilation?

A

Breathing for someone and controlling the rate, volume and pressure entering the lungs

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15
Q

What are the risks of ventilating a neonate and in what forms of ventilation are these risks greater and how can you prevent them?

A

Pneumothorax as you are forcing air into the lungs
Greater risk with intermittent positive airway pressure (IPPV), Continuous positive airway pressure (CPAP)
Prevent risks by limiting ventilation, flow and pressure

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16
Q

In what percentage of vaginal births does a pneumothorax occur spontaneously and when does this require treatment?

A

1%

Only when it’s tension pneumothorax and you would insert a chest drain

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17
Q

What is ‘chronic lung disease’ in a neonate?

A

An oxygen requirement beyond 36 weeks corrected gestational age with evidence of pulmonary parenchymal disease on CXR

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18
Q

What often causes ‘chronic lung disease’ in a neonate?

A

Following RDS due to barrotrauma, volume trauma or high inspire oxygen

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19
Q

What is the treatment for ‘chronic lung disease’ in a neonate?

A

Given oxygen- carried around in a cinder. Corrects itself as lungs grow and develop over 2-3 years but can be restrictive and children are wheezy

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20
Q

What is dextrocardia?

A

Heart on the right hand side of the body

21
Q

What is a diaphragmatic hernia?

A

Where some of the gut develops in the thorax

22
Q

How often does a diaphragmatic hernia occur?

A

1 in 2400 births

23
Q

What are the associated problems with a diaphragmatic hernia and what is the most common type?

A

Problems: the lungs have not had space to develop as the gut is in the way => pulmonary hypoplasia
Most common: posteriolateral left sided

24
Q

How is a diaphragmatic hernia corrected?

A

Surgical correction

25
Q

What treatment should not be given to babies with a diaphragmatic hernia and why?

A

Must avoid bag mask IPPV as when you push air into the mouth some will go into the oesophagus and small bowel making the diaphragmatic hernia worse. Must insert a tube into the trachea instead

26
Q

When is transient tachypnoea of the newborn most likely and why?

A

In babies born by C section because the stress of labour causes babies to reabsorb some of the fluid on the lungs but C section babies do not get this => poor gas exchange, tachypnoea and a greater risk of infection

27
Q

What are the challenges with doing spirometry with children and what would you examine on children?

A

The reference values change with age
Only children over 7/8 can follow instructions and understand what they are doing
Examination = height and weight, chest shape and auscletation

28
Q

What are the signs of CF in a newborn?

A

Prolonged history of cough, loose stool and failure to thrive
Raised immune reactive trypsin levels
All babies are screened at 6 days old using the heel prick blood test

29
Q

What are the differential diagnoses of CF in a newborn?

A

Immune deficiency, ciliary dyskinesia, asthma, Kartagner’s syndrome, citis invertis

30
Q

If a babies has CF, what treatment are they given?

A

Flucloxacillin from birth to prevent S. aureus infection

31
Q

What are the clinical features that increase the probability of asthma in children?

A

One or more of: wheeze, cough, chest tightness, difficulty breathing
Atopy- personal or family history
Widespread wheeze on auscultation
Responsive to treatment (salbutamol inhaler)

32
Q

What should be done if there is a high probability the child has asthma?

A

Trial treatment and further investigations if the response is poor

33
Q

What should be done if there is a intermediate probability the child has asthma?

A

Watchful waiting, ?Spirometry if the child is old enough and ?treatment trial and evaluate

34
Q

What should be done if there is a low probability the child has asthma?

A

Investigations and referral to a specialist paediatric team

35
Q

What are some of the consequences of passive smoking around children?

A

Asthmatic children are 4 times more likely to die of an asthma attack

36
Q

What are the consequences of smoking in pregnancy?

A 
Reduced birth weight by 250g
4500 Miscarriages 
30% increase in perinatal mortality 
Tetratogenic: airways, cleft lip/palate
Glue ear
Carcinogenic
37
Q

What is the treatment for a child having an acute asthma attack?

A

High flow oxygen and nebulised bronchodilator
Oral prednisalone
IV salbutamol, aminophyline and magnesium (smooth muscle relaxant)
Ventelatory support

38
Q

What is bronchiolitis and what is the most common aetiological organism?

A

Viral infection usually caused by RSV and children are usually under 18 mouths old

39
Q

When is bronchiolitis more severe?

A

More severe in younger babies, premature babies and if family smokes

40
Q

What are the clinical signs of bronchiolitis?

A

Tachyponea, poor feeding, irritating cough

Apneoa in small babies- not breathing for 20 seconds

41
Q

What is the treatment for bronchiolitis?

A

Supportive. If hypoxic = oxygen. If not feeding = NG tube. If coughing = cough syrup. If fever = calpol

42
Q

What organisms cause pneumonia in neonates?

A

GBS, E. coli, Klebsiella, Staph aureus

43
Q

What organisms cause pneumonia in infants?

A

Strep pneumoniae, Chlamydia

44
Q

What organisms cause pneumonia in school aged children?

A

Strep pneumoniae, Staph aureus, Bordatella, Mycoplasma, Legionella and group A strep

45
Q

What are the signs of pneumonia in children?

A

Cough, high fever, sputum, dull percussion and bronchial breathing

46
Q

What are the differential diagnosis of a sudden onset cough and difficulty breathing in children?

A

Inhaled foreign body, Laryngomalacia, eppiglottitis/bacterial trachitis, allergy, croup

47
Q

What is croup and what are the symptoms?

A

Viral larygnotracheobronchitis

Stridor and cough

48
Q

What is the classical sign on a CXR of croup?

A

Steeple sign (hypopharynx distention and narrowing of air column)

49
Q

What is the treatment for croup?

A

Oral steroids

Respiratory (26 decks)

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