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2. Senior Block- Child Health > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

Give 5 predisposing factors for bronchiolitis

A 
Winter 
Premature
Heart defect 
Weakened immune system 
<2 years old 
Smoke exposure 
Breast fed for <2 months
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2
Q

Which virus is the main cause of bronchiolitis?

A

Respiratory syncytial virus (RSV)

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3
Q

Describe the pathophysiology of bronchiolitis

A

Bronchioles are 2mm wide with no cartilage or submucosal glands. A viral infection causes the goblet cells to produce excess mucus and the bronchioles to constrict, resulting in inflammation.

Cells, oedema and mucus in the airways causes a ball-valve effect which results in hyperinflation, increased airway resistance, atelectasis and V/Q mismatch

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4
Q

How does bronchiolitis present?

A

Low grade fever, rhinorrhoea, cough and feeding difficulties increasing over 2-5 days

On examination= Tachypnoea, grunting, nasal flaring, costal recession, expiratory wheeze, hyperinflated chest, crackles, cyanosis

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5
Q

How is bronchiolitis investigated?

A 
Nasopharyngeal aspirate- RSV rapid test + viral culture
Blood + urine culture
FBC
ABG
Chest xray if atypical presentation
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6
Q

How is mild bronchiolitis managed if at home?

A 
Sit baby up 
Give oral fluids 
Keep an eye on wet nappies 
Vapour rubs 
Salt water drops
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7
Q

When should a bronchiolitis patient be admitted to hospital?

A 
O2 sats <92%
RR >70 
Respiratory distress 
Central cyanosis 
Clinical dehydration
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8
Q

How is bronchiolitis managed in hospital?

A 
Nasal cannulae O2
NG tube feeding 
Consider CPAP
Upper airway suctioning 
IV fluids if dehydrated

No role for Abx, steroids or bronchodilators

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9
Q

Give 3 complications of bronchiolitis

A 
Hypoxia 
Dehydration 
Fatigue 
Respiratory failure
Persistent cough/wheeze
Bronchiolitis obliterans- airways permanently damaged
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10
Q

Give 2 risk factors for asthma development

A 
Atopy 
Low birth weight 
Viral bronchiolitis 
Prematurity 
Parental smoking 
Family history
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11
Q

Give 4 triggers for asthma

A 
Cold air 
Exercise 
Dust 
Animal hair
Viral infection 
Pollen
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12
Q

What is the pathophysiology of asthma?

A

Susceptible individuals have an exaggerated response to certain triggers. Dendritic cells present allergens to Th2 type T cells which then leads to a disproportionate immune response.

Cytokines released and there is excessive proliferation of mast cells, eosinophils and dendritic cells. This results in bronchoconstriction and an inflammatory process.

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13
Q

Give 4 clinical features of asthma

A 
Episodic wheeze
Worse at night 
Cough 
SOB (induced by triggers) 
Chest tightness
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14
Q

How is asthma diagnosed?

A 
Clinical diagnosis
Spirometry- obstructive pattern which will revert after bronchodilator 
Peak flow 
Exhaled NO 
Chest x-ray
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15
Q

Describe the stepwise approach to asthma management

A

Step 1= SABA (Eg salbutamol) + low dose ICS (beclomethasone)
Step 2= add LTRA (Montelukast)
Step 3= add LABA (Salmeterol)
Step 4= increase ICS or add LAMA/theophylline
Step 5= oral steroids

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16
Q

What general advice can be given about managing asthma?

A

Monitor compliance to daily inhalers
Bring personalised asthma plan to all appointments
Teach inhaler technique

Return to GP if: limitation on daily activities, waking at night, using blue inhaler more than 2 times a week

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17
Q

What is the criteria for a mild asthma exacerbation?

A

> 92% O2 sats in air

Moderate tachycardia

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18
Q

What is the criteria for a moderate asthma exacerbation?

A

<92% O2 sats in air
Breathless
No accessory muscle use

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19
Q

What is the criteria for a severe asthma exacerbation?

A

<92% O2 sats in air
PEFR 33-50% of predicted
Cannot complete sentences

If >5 years: HR>125, RR>30
If 2-5 years: HR>140, RR>40

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20
Q

What is the criteria for a life-threatening asthma exacerbation?

A 
<92% O2 sats in air 
PEFR <33% of predicted 
Silent chest
Poor respiratory effort 
Cyanosis
Confusion 
Hypotension 
Exhaustion
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21
Q

How is an acute asthma exacerbation managed?

A

High flow O2
Nebulised salbutamol
Ipratropium bromide
Short course of steroids

IV salbutamol
Magnesium sulfate

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22
Q

Which gene causes cystic fibrosis?

A

CFTR gene

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23
Q

How does cystic fibrosis affect the respiratory system?

A

CFTR gene found on epithelial cells and submucosal glands.

Lack of CFTR protein means Cl- ions do not move across the cell membrane out of the cells. This means Na+ movement via the ENaC channel into the cells is reduced.

This makes the secretions salty and thicker so there is reduced mucus clearance.

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24
Q

How does cystic fibrosis affect the pancreatic system?

A

Thick secretions block the pancreatic duct which damages the pancreas and results in pancreatic insufficiency

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25
Q

How does cystic fibrosis affect the GI system?

A

Thick secretions cause viscous mucus which can cause bowel obstruction, cholestasis and CF related liver disease

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26
Q

How does cystic fibrosis affect the reproductive system?

A

Congenital absence of vas deferens in men means they are infertile.

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27
Q

How might cystic fibrosis present in neonates?

A

Meconium ileus
Failure to thrive
Neonatal jaundice

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28
Q

How might cystic fibrosis present in infants?

A

Failure to thrive
Recurrent chest infections
Steatorrhoea

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29
Q

How might cystic fibrosis present in childhood?

A

Rectal prolapse
Nasal polyps
Sinusitis

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30
Q

How might cystic fibrosis present in adolescence?

A 
Diabetes mellitus
Chronic lung disease
Gallstones 
Liver cirrhosis
Distal intestinal obstruction syndrome
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31
Q

What signs on examination might be suggestive of CF?

A 
Clubbing 
Nasal polyps 
Hyperinflation of the chest
Faecal mass on abdominal palpation 
Scars from surgeries 
Thin- pancreatic insufficiency- cannot process fat
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32
Q

How is CF diagnosed?

A

Heel prick testing at birth

Chloride sweat test

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33
Q

What tests are done to monitor CF?

A 
Chest x-ray 
Sputum sample 
Glucose intolerance test
Faecal elastase
Genetic analysis
LFTs and coagulation 
Bone profile 
Lung function tests 
Chest CT
FBC, U+Es
HbA1c
Vitamins A,D,E,K
34
Q

Who is involved in the Cystic Fibrosis MDT?

A

Respiratory consultant, Paediatrician, Dietician, CF specialist nurse, physiotherapist

35
Q

How is CF managed?

A 
Patient and family education 
2x daily physiotherapy 
Hypertonic saline 
Pancreatic enzyme supplementation 
Fat soluble vitamins- A,D,E,K
Monitor growth 
High calorie drinks for weight gain 
Treat all respiratory infections with 2 weeks of high dose Abx
Manage complications as they arise
36
Q

Give 4 potential causes of bronchiectasis

A

Cystic fibrosis
Chronic lung infection–> influenza, measles, adenovirus, strep pneumonia, TB
Immunodeficiency
Primary ciliary dyskinesia
Post-obstructive- foreign body inhalation
Congenital

37
Q

Give 5 clinical features of bronchiectasis

A 
Productive chronic cough 
Purulent sputum 
Chest pain 
Wheeze
Breathless on exertion 
Haemoptysis
Recurrent LRTIs
Clubbing 
Crackles
38
Q

How is bronchiectasis managed?

A

Chest physiotherapy
Antibiotics for LRTIs
Bronchodilators for wheeze

39
Q

Give 4 risk factors for pneumonia

A 
Not vaccinated against influenza
Household overcrowding 
Malnutrition 
Immunocompromised
Parental smoking
Indoor pollution eg. wood fires
40
Q

What is the main viral cause of pneumonia in children?

A

RSV

41
Q

What is the main bacterial cause of pneumonia in children?

A

Strep pneumoniae

H influenzae type B

42
Q

What is the main fungal cause of pneumonia in children?

A

Pneumocystis jiroveci (HIV patients)

43
Q

Give 5 clinical features of pneumonia

A 
Cough 
Fever
SOB
Feeding problems 
Convulsions 
Fever
Tachycardia
Hypoxia
Agitation 
Chest wall recessions
Wheeze
Hypothermia
Dehydration
44
Q

How is pneumonia managed?

A

Initiate sepsis 6

Controlled O2 therapy if sats <92%
IV Fluids to restore any dehydration
Antibiotics for 14 days- amoxicillin/co-amoxiclav +/- erythromycin, azithromycin, clarithromycin 
Paracetamol/ibuprofen 
Encourage oral fluids
45
Q

What is an episodic viral wheeze?

A

Wheezing only in response to viral infection and no interval symptoms

46
Q

What is multiple trigger wheeze?

A

Wheeze in response to viral infection as well as other triggers such as aeroallergens and exercise. Precursor for asthma.

47
Q

How is a viral induced wheeze managed?

A

Assess severity of wheeze
Controlled O2 therapy
Nebulised salbutamol
Monitor PEFR

SABA and short course of oral steroids
Paracetamol + ibuprofen
Follow up at GP in 48 hours

48
Q

Give 3 risk factors for Croup

A

Male
Autumn/Spring time
6 months to 3 years old

49
Q

What is the pathophysiology of croup?

A

URTI causing mucosal inflammation between the nose and trachea. Can impair movement of the vocal cords.

Usually a viral cause- parainfluenza virus, RSV, adenovirus, rhinovirus, enterovirus, measles.

50
Q

Describe the clinical features found in mild, moderate and severe croup

A

Mild: occasional barking cough, no audible stridor, no suprasternal or intercostal recession, child is happy, will eat and drink + play, rhinorrhoea

Moderate: frequent barking cough, audible stridor, hoarse voice, fever, suprasternal and sternal wall retraction, child not distressed

Severe: frequent barking cough, prominent stridor, sternal wall retractions, child distressed and agitated, restless, lethargic. Tachycardia, cyanosis, laboured breathing

51
Q

When should a child be admitted for croup?

A 
<6 months old 
Immunocompromised
Poor fluid intake 
Poor response to treatment 
Uncertain diagnosis
Parental anxiety
52
Q

How is croup managed in hospital?

A

Oral dexamethasone or prednisolone (single dose)
Nebulised adrenaline
O2 therapy

53
Q

How is croup managed at home?

A

Will resolve in 48 hours
Can use ibuprofen/paracetamol
Adequate fluid intake
Oral steroid single dose

54
Q

What are the clinical features of epiglottitis?

A 
Cough
Drool saliva
Fever >38.5
Soft stridor 
Weak/silent voice
Dehydrated
55
Q

How is epiglottitis managed?

A

Do not examine child as this can cause them to become distressed and the airway to close

Establish airway + give O2

56
Q

Why is epiglottitis rare in the UK?

A

Caused by H. influenza type B (HiB) which is vaccinated against in the UK

57
Q

What is the pathophysiology of Whooping Cough?

A

Caused by Bordetella Pertussis (Gram negative bacillus) spread by aerosolized droplets.
Bacteria attach to the respiratory epithelium and produce toxins which paralyse the cilia and promote inflammation. This prevents mucus clearance

58
Q

Describe the 3 stages of whooping cough

A

Catarrhal phase= 1-2 weeks. Rhinitis, conjunctivitis, irritability, sore throat, low grade fever, dry cough

Paroxysmal phase= 2-8 weeks. Severe paroxysms of coughing followed by inspiratory gasp producing the ‘whoop’ sound. Vomiting following coughing, cyanosis

Convalescent phase= up to 3 months. Cough decreases in frequency and severity.

59
Q

How is Pertussis investigated?

A

Nasopharyngeal aspirate
Anti-pertussis toxin IgG serology
FBC

60
Q

When should a child with pertussis be admitted?

A

<6 months and acutely unwell
Significant breathing difficulty
Feeding difficulties
Complications- pneumonia, seizures

61
Q

How is pertussis managed?

A

<1 month old= Clarithromycin
>1 month old= Clarithromycin or Azithromycin

Paracetamol/ibuprofen
Fluid intake
Avoid nursery/school

62
Q

Give 3 risk factors for TB

A 
Immunocompromised
From high prevalence area
Exposure to others with TB
<5 years old 
Malnutrition
63
Q

What bacteria causes TB?

A

Mycobacterium Tuberculosis

64
Q

Give 5 features of TB

A 
Persistent cough 
Haemoptysis 
Night sweats 
Losing weight 
Losing appetite
Lymphadenopathy 
Fever 
Failure to thrive
65
Q

Give 4 investigations for TB

A

Chest x-ray
Mantoux test
Interferon gamma release assay
Lymph node biopsy

66
Q

How is TB treated?

A

Isoniazid- 6 months
Rifampicin- 6 months
Pyrazinamide- 2 months
Ethambutol- 2 months

67
Q

Give 2 risk factors for foreign body inhalation

A

1-3 years old
Eating small, crunchy foods
Allowed to play with small toys

68
Q

Give 3 clinical features of foreign body inhalation

A 
Coughing 
Choking 
Wheeze
Unilateral breath sounds
Increased RR
Reduced O2 sats 
Reduced breath sounds
69
Q

How is foreign body inhalation managed?

A

Most often in right bronchial tree

Chest x-ray
Direct bronchoscopy- remove foreign body with forceps

70
Q

Give 3 potential complications of foreign body inhalation

A 
Pneumonia
Pneumothorax
Lung abscess
Bronchiectasis
Death
71
Q

Give 4 risk factors for tracheomalacia

A 
Congenital 
Treatment for oesophageal atresia
Heart anomalies
Mass pushing on trachea
Recurrent infections 
Tracheostomy tubes
72
Q

What is the pathophysiology of tracheomalacia?

A

C-shaped cartilage rings around the trachea are wider and more U-shaped causing the posterior membrane to restrict airflow and interfere with breathing.
OR
A cyst or mass can press on the trachea, restricting airflow

Airway will collapse when breathing

73
Q

Give 4 clinical features of tracheomalacia

A 
High pitched breathing 
Stridor 
Exercise intolerance
Frequent infections 
Noisy cough 
Breath holding 
Choking during feeding 
Blue spells
74
Q

How is tracheomalacia managed?

A

Goes away with time

Surgery- support trachea

75
Q

Give 3 common causes of pleural effusion

A 
Infection 
Pneumonia 
Chest surgery 
Fluid retention
Lupus
76
Q

Give 3 clinical features of pleural effusion

A

SOB
Fever
Increased HR
Chest pain

77
Q

How is a pleural effusion investigated?

A

Chest x-ray
Fluid biopsy
FBC, CRP, U+Es

78
Q

How is a pleural effusion managed?

A

Antibiotics (if bacterial infection)
Steroids (if autoimmune)
Chest drain
Video assisted thoracoscopic surgery

79
Q

What is apnoea?

A

Temporary cessation of breathing, especially during sleep

80
Q

Give 3 causes of apnoea

A

Obesity
Sickle cell
Down’s syndrome
Enlarged tonsils

81
Q

What is the pathophysiology of apnoea?

A

Muscles around the airway relax and weaken. The muscles cause the airway to collapse in on itself which restricts breathing. If the person is asleep, they will jerk awake due to hypoxia.

82
Q

Give 3 clinical features of apnoea

A 
Snoring 
Sleeping in unusual positions
Tired in the daytime 
Aggressive/hyperactive
Headache
Poor concentration

2. Senior Block- Child Health (14 decks)

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