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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
How does cystic fibrosis affect the GI system?
Thick secretions cause viscous mucus which can cause bowel obstruction, cholestasis and CF related liver disease
26
How does cystic fibrosis affect the reproductive system?
Congenital absence of vas deferens in men means they are infertile.
27
How might cystic fibrosis present in neonates?
Meconium ileus Failure to thrive Neonatal jaundice
28
How might cystic fibrosis present in infants?
Failure to thrive Recurrent chest infections Steatorrhoea
29
How might cystic fibrosis present in childhood?
Rectal prolapse Nasal polyps Sinusitis
30
How might cystic fibrosis present in adolescence?
``` Diabetes mellitus Chronic lung disease Gallstones Liver cirrhosis Distal intestinal obstruction syndrome ```
31
What signs on examination might be suggestive of CF?
``` Clubbing Nasal polyps Hyperinflation of the chest Faecal mass on abdominal palpation Scars from surgeries Thin- pancreatic insufficiency- cannot process fat ```
32
How is CF diagnosed?
Heel prick testing at birth | Chloride sweat test
33
What tests are done to monitor CF?
``` 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
Who is involved in the Cystic Fibrosis MDT?
Respiratory consultant, Paediatrician, Dietician, CF specialist nurse, physiotherapist
35
How is CF managed?
``` 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
Give 4 potential causes of bronchiectasis
Cystic fibrosis Chronic lung infection--> influenza, measles, adenovirus, strep pneumonia, TB Immunodeficiency Primary ciliary dyskinesia Post-obstructive- foreign body inhalation Congenital
37
Give 5 clinical features of bronchiectasis
``` Productive chronic cough Purulent sputum Chest pain Wheeze Breathless on exertion Haemoptysis Recurrent LRTIs Clubbing Crackles ```
38
How is bronchiectasis managed?
Chest physiotherapy Antibiotics for LRTIs Bronchodilators for wheeze
39
Give 4 risk factors for pneumonia
``` Not vaccinated against influenza Household overcrowding Malnutrition Immunocompromised Parental smoking Indoor pollution eg. wood fires ```
40
What is the main viral cause of pneumonia in children?
RSV
41
What is the main bacterial cause of pneumonia in children?
Strep pneumoniae | H influenzae type B
42
What is the main fungal cause of pneumonia in children?
Pneumocystis jiroveci (HIV patients)
43
Give 5 clinical features of pneumonia
``` Cough Fever SOB Feeding problems Convulsions Fever Tachycardia Hypoxia Agitation Chest wall recessions Wheeze Hypothermia Dehydration ```
44
How is pneumonia managed?
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
What is an episodic viral wheeze?
Wheezing only in response to viral infection and no interval symptoms
46
What is multiple trigger wheeze?
Wheeze in response to viral infection as well as other triggers such as aeroallergens and exercise. Precursor for asthma.
47
How is a viral induced wheeze managed?
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
Give 3 risk factors for Croup
Male Autumn/Spring time 6 months to 3 years old
49
What is the pathophysiology of croup?
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
Describe the clinical features found in mild, moderate and severe croup
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
When should a child be admitted for croup?
``` <6 months old Immunocompromised Poor fluid intake Poor response to treatment Uncertain diagnosis Parental anxiety ```
52
How is croup managed in hospital?
Oral dexamethasone or prednisolone (single dose) Nebulised adrenaline O2 therapy
53
How is croup managed at home?
Will resolve in 48 hours Can use ibuprofen/paracetamol Adequate fluid intake Oral steroid single dose
54
What are the clinical features of epiglottitis?
``` Cough Drool saliva Fever >38.5 Soft stridor Weak/silent voice Dehydrated ```
55
How is epiglottitis managed?
Do not examine child as this can cause them to become distressed and the airway to close Establish airway + give O2
56
Why is epiglottitis rare in the UK?
Caused by H. influenza type B (HiB) which is vaccinated against in the UK
57
What is the pathophysiology of Whooping Cough?
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
Describe the 3 stages of whooping cough
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
How is Pertussis investigated?
Nasopharyngeal aspirate Anti-pertussis toxin IgG serology FBC
60
When should a child with pertussis be admitted?
<6 months and acutely unwell Significant breathing difficulty Feeding difficulties Complications- pneumonia, seizures
61
How is pertussis managed?
<1 month old= Clarithromycin >1 month old= Clarithromycin or Azithromycin Paracetamol/ibuprofen Fluid intake Avoid nursery/school
62
Give 3 risk factors for TB
``` Immunocompromised From high prevalence area Exposure to others with TB <5 years old Malnutrition ```
63
What bacteria causes TB?
Mycobacterium Tuberculosis
64
Give 5 features of TB
``` Persistent cough Haemoptysis Night sweats Losing weight Losing appetite Lymphadenopathy Fever Failure to thrive ```
65
Give 4 investigations for TB
Chest x-ray Mantoux test Interferon gamma release assay Lymph node biopsy
66
How is TB treated?
Isoniazid- 6 months Rifampicin- 6 months Pyrazinamide- 2 months Ethambutol- 2 months
67
Give 2 risk factors for foreign body inhalation
1-3 years old Eating small, crunchy foods Allowed to play with small toys
68
Give 3 clinical features of foreign body inhalation
``` Coughing Choking Wheeze Unilateral breath sounds Increased RR Reduced O2 sats Reduced breath sounds ```
69
How is foreign body inhalation managed?
Most often in right bronchial tree Chest x-ray Direct bronchoscopy- remove foreign body with forceps
70
Give 3 potential complications of foreign body inhalation
``` Pneumonia Pneumothorax Lung abscess Bronchiectasis Death ```
71
Give 4 risk factors for tracheomalacia
``` Congenital Treatment for oesophageal atresia Heart anomalies Mass pushing on trachea Recurrent infections Tracheostomy tubes ```
72
What is the pathophysiology of tracheomalacia?
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
Give 4 clinical features of tracheomalacia
``` High pitched breathing Stridor Exercise intolerance Frequent infections Noisy cough Breath holding Choking during feeding Blue spells ```
74
How is tracheomalacia managed?
Goes away with time Surgery- support trachea
75
Give 3 common causes of pleural effusion
``` Infection Pneumonia Chest surgery Fluid retention Lupus ```
76
Give 3 clinical features of pleural effusion
SOB Fever Increased HR Chest pain
77
How is a pleural effusion investigated?
Chest x-ray Fluid biopsy FBC, CRP, U+Es
78
How is a pleural effusion managed?
Antibiotics (if bacterial infection) Steroids (if autoimmune) Chest drain Video assisted thoracoscopic surgery
79
What is apnoea?
Temporary cessation of breathing, especially during sleep
80
Give 3 causes of apnoea
Obesity Sickle cell Down's syndrome Enlarged tonsils
81
What is the pathophysiology of apnoea?
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
Give 3 clinical features of apnoea
``` 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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