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year 3 > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

Differential diagnosis of a wheeze

A
  1. Lung parenchyma: pneumonia, pulmonary oedema, enlarged left atrium compressing maintsem bronchi, enlarged hilar lymph node, scoliosis

Asthma
Bronchiolitis
CF
Bronchitis

Aspiration, foreign body inhalation

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2
Q

Causes of inspiratory stridor

A

Nose and Nasopharynx:
Congenital obstruction
Inflammation: rhinitis, sinusitis

Mouth, oropharynx and hypo pharynx:
1. Tonsillar hypertrophy, masses, foreign body

Larynx:
1. Gastroosesophageal refulx (inflammation
Infection: epiglottis, laryngotracheobronchitis
Masses: haemangiomas, abscess
Trauma: subglottic stenosis, foreign body inhalation

Trachea:
1. Infection: Bacterial Tracheitis

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3
Q

Upper airway diseases that can cause an acute cough

A
  1. Common cold: rhinovirus

Parainfluenza, sinusitis, tonsilliti, laryngitis, allergy, vocal cord dysfunction

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4
Q

Lower airway diseases that can cause acute cough

A
  1. Asthma
  2. Infection: Bronchitis due to adenovirus, influenza and parainfluenza

Lung parenchyma disease: empyema, viral and bacterial pneumonia

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5
Q

Upper airway causes of chronic cough

A

Infection: Chronic sinusitis, tonsilitis, bordatella pertussis
Inflammation: Reflux

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6
Q

Lower airway causes of chronic cough

A
  1. Asthma
  2. Infection
    Foreign body
  3. Bronchiectasis
  4. CF

Psychogenic
Tourette

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7
Q

Abnormal lung mechanics that can cause breathlessness

A
  1. Restrictive lung disease: chest wall (obesity), chest deformity, kyphoscoliosis
  2. Parenchymal lung disease: pneumonia, pulmonary hypertension
  3. Muscle weakness: Duchenne muscular dystrophy, diaphragmatic paralysis
  4. Hypoxia: V/Q mismatch in lung disease, pneumonia and pneumothorax
    Heart disease: pericarditis and myocarditis
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8
Q

Name three types of lung function testings

A

Achieved after 5 years old

  1. FEV1/FVC
  2. Exercise testing
  3. Bronchodilator responsiveness
  4. Pulse oximetry
  5. ABG
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9
Q

What is the level of Na seen in sweat test to diagnose CF

A
  1. Diagnostic: >60 mol/L (suspicious if >40)
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10
Q

What three findings would I find in a person with asthma

A
  1. Barrel-shaped chest
  2. Hyperinflation
  3. Wheeze and prolongs expiration
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11
Q

What would CXR show for asthma

A
  1. Hyperinflation
  2. Flattened hemi-diapgrams
  3. Atelectasis (collapse of lung)
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12
Q

Spirometry results for asthma

A
  1. PEFR <80% predicted for height
  2. FEV1/FVC < 80%
  3. Concave scooped shape in flow volume
  4. 15% increase in FEV1 when given bronchodilator
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13
Q

Treatment of Inflammation and hyperactivity in asthma

A
  1. Beclometasone (inhaled steroid)
  2. Prednisolone
  3. Methylxanthines: theophylline
  4. Leukotriene inhibitor: montelukast
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14
Q

Side effects of steroid treatment in asthma

A
  1. Impaired growth
  2. Oral candidiasis
  3. Altered bone metabolism
  4. Adrenal suppression
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15
Q

Side effects of theophylline

A
  1. Vomiting
  2. Headaches
  3. Arrythmias
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16
Q

How are acute infrequent asthmatic episodes managed

A

EITHER B2 bronchodilators or short-douse red and nebuliser bronchodilator in more severe episodes

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17
Q

How are frequent asthmatic episodes treated

A
  1. B2 and low dose inhaled steroid
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18
Q

What defines frequent episodic asthma

A
  1. Every 2-4 weeks
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19
Q

What defines persistent asthma

A
  1. > 3 episodes/week, with cough at night and morning
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20
Q

Management of persistent asthma

A
  1. Long acting b2
  2. Oral steroids
  3. Oral montelukast
  4. Use prophylactically inhaled steroids
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21
Q

Management of exercise induced asthma

A
  1. Use b2 bronchodilator before excercise
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22
Q

Stepwise treatment of astjma

A
  1. Short acting B2
  2. Short acting B2 + Low dose steroid inhaled
  3. Short acting B2 + high dose inhaled steroids
    or
    Low dose inhaled steroids + long acting bronchodilator
  4. Short acting B2 + High dose steroid + Theophylline
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23
Q

Advice to people with asthma

A
  1. Allergen avoidance
  2. Passive smoking
  3. Education on inhaler technique
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24
Q

What transmembrane receptor is defected in CF

A

CFTR

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25
Q

Clinical signs of CF

A
  1. Cough and wheeze
  2. SOB
  3. Sputum production
  4. Haemoptysis
  5. Fatty, pale stools and diarrhoea
  6. Weight loss or poor weight gain
  7. Failure to thrive
  8. Chest infections
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26
Q

Investigations for CF

A
  1. Sweat test: cl > 60
  2. CXR: hyperinfation, increased anteroom-posterior diameter, bronchial dilatation, cysts
  3. LF: Obstructive pattern with decreased FVC and increased lung volumes
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27
Q

Problems of CF found at infancy

A
  1. Meconium ileus
  2. Neonatal jaundice
  3. Hypoproteinaemia/oedema
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28
Q

Problems of CF found in childhood

A
  1. Recurrent LRTI
  2. Bronchiectasis
  3. Poor appetite
  4. Rectal prolapse
  5. Sinusistis
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29
Q

Problems of CF found in adolescence

A
  1. Bronchiectasis
  2. DM
  3. Cirrhosis and portal hypertension
  4. Pneumothorax
  5. Male infertility
30
Q

Name three types of physiotherapy in CF

A
  1. Postural drainage
  2. Slef percussion
  3. Deep breathing excercises
31
Q

Antimicrobial therapy in CF

A
  1. PROTECT against Staph aureus, haemophilia influenza

Mucolytics
Bronchodilators
Oral Azithromycin

32
Q

GI management of CF

A
  1. Laculose

2. Oral acetylcysteine

33
Q

How is pancreatic insufficiency treated in CF

A
  1. Supplements (VIT E,K, Multivitamins)
  2. Omeprazole

High calorie diet

Salt supplements

34
Q

What is sleep apnoea

A
  1. Lack of breathing

Obstructive apnoea: lack of air in the face to allow rep support - tonsillar hypertropj, macroglossia

35
Q

Clinical features of sleep apnoea

A
  1. Snoring and sleep disturbance
  2. Enuresis
  3. Daytime sleepiness or inattention
36
Q

Investigations of sleep apnoea

A
  1. Sleep study overnight pulse oximetry

Polusomnography
2. CXR and ECG to check hear consequences

37
Q

Indications of tonsillectomy

A
  1. Airway obstruction
  2. History of recurrent tonsillitis
  3. History of two episodes of peritonsillar abscess
38
Q

Indications of adenoidectomy

A
  1. Recurrent middle ear infection
  2. Chornic nasopharyngitis
  3. Chornic mouth breathing
39
Q

Clinical features of allergic rhinitis

A
  1. Nasal congestion
  2. Itching
  3. Sneezing
  4. Postnasal drip
  5. Nose rubbing
  6. Watery red eyes

HISTORY OF ATOPY

40
Q

Investigations of allergic rhinitis

A
  1. Skin tests for specific antigens

2. Specific serum IgE

41
Q

Treatment of allergic rhinitis

A
  1. Antihistamines
  2. Montelukast
  3. INtransal steroids
42
Q

Causes of URTI

A
  1. Common cold
  2. Sore throat (pharyngitis and tonsillitis)
  3. Ear infection (acute otitis media)
  4. Sinusitis
43
Q

Clinical features of URTI

A
  1. Painful throat
  2. Fever
  3. Blocked nose
  4. Nasal discharged
  5. Earache
  6. Wheeze
44
Q

Treatment of URTI

A

Symptoms: Paracetamol
antibiotics: Tonsilitis and pharyngitis - penicillin or erythromycin

Avoid amoxicillin as it causes maculopapular rash in cases of EBV

OTITIS MEDIA: Co-amoxiclav

45
Q

Management of acute epiglottis

A
  1. ENDOTRACHEAL intubation
  2. IV Cefuroxime
  3. Rifampicin prophylaxis to close contacts
46
Q

Name there three stage son whooping cough

A
  1. Catarrhal (mild symptoms, fever, cough and coryza)
  2. Paroxysmal (severe paroxysmal cough and inspiratory wheeze)
  3. Convalescent (lessening symptoms that take a whole month
47
Q

Investigations of whooping cough

A
  1. Eyes: Subconjunctival haemorrhages
  2. CXR
  3. Blood count: leucocytsosis and lymphocytosis
  4. Perusal swab
48
Q

Complications of whooping cough

A
  1. Seizures

2. Encephalopathy

49
Q

Treatment of whooping cough

A

BCG

2. ERYTHROMYCIN for 14 days

50
Q

What causes bronchiolitis

A

Respiratory Syncytial Virus

51
Q

Clinical features of bronchiolitis

A
  1. Wheeze
  2. Feeding difficulty
  3. Episodes of apnoea
  4. Cyanosis
  5. Dry cough
  6. Tachpnoea
  7. Intercostal recession
  8. Chest hyperinflation
  9. Wheeze and crackles
    Encephalopathy with seizures due to hyponatraemia
52
Q

Investigations of bronchiolitis

A
  1. Pulse oximetry
  2. CXRL hyperinflation , atelectasis and consolidation
  3. Nasopharyngeal swab : immunofluorescent antibody testing
53
Q

Hospital treatment of bronchiolitis

A
  1. Oxygen
  2. NGT if tachypnoea
  3. nebuliser salbutamol for wheeze
  4. Mechanical ventilation
54
Q

Prophylaxis for RSV

A

Palivizumab

55
Q

Four species that cause pneumonia in neonates

A
  1. Group B strep
  2. E coli
  3. Klebsiella
  4. Stap aureus
56
Q

Two species that causes pneumonia in infant s

A
  1. Strep. pneumonia, chlamydia
57
Q

Risk factors for children - pneumonia

A
  1. CF
  2. Sickle cell
  3. Tracheostomy
  4. Immunodeficiency
58
Q

CF of pneumonia

A
  1. Fever
  2. SOB
  3. Cough with sputum in older children
  4. Tachypnoea
  5. Grunting
  6. Intercostal recession
  7. Cyanosis
  8. Lethargy
59
Q

Auscultation signs of lobar pneumonia

A
  1. Dullness to percussion
  2. Crackles
  3. Decreased breath sounds
  4. Increased tactile remits
  5. Bronchial breathing
60
Q

Investigations of lobar pneumonia

A
  1. Sputum culture
  2. Nasopharyngeal aspirate for viral immunofluorescence
  3. Blood culture
  4. CXR
  5. Pleural fluid aspirate sample
  6. Viral titres
    Blood tests
    Resp test
61
Q

X-ray signs for pneumonia

A
  1. Consolidation
  2. Pleural effusions
  3. Calcifications
62
Q

Treatment of pneumonia

A

Under 5: Amoxicillin or co=amoxiclave/erythromycin

Over 5: Amoxicillin, staph aureus alternative

IV FLuids
Nasal canullae oxygen, chest drain

63
Q

Severe treatment of pneumonia

A
  1. Co-amoxiclav, cefotazime or cefuroxime IV
64
Q

What is done to effusion fluid sample collection

A
  1. Microbiology: culuture and sensitivity - acidfast bacilli
    Cytology
65
Q

Diagnosis of empyema

A
  1. pH <7.2, glucose <3.3 mol/L, protein > 3g/L, pus cells
66
Q

Treatment of empyema

A
  1. 40,000U urokinase via chest drain
    Instil chest drain, clamp drain and encourage patient to roll over the next 4hr
  2. Suction device and supply bupicacaine
67
Q

Management of TB

A
  1. 2 months: isoniazid, rifampicin, pyrazinamide and ethambutol
    4months: isoniazid, rifampicin
68
Q

Management of Miliary spread

A

3 months: isoniazid, rifampicin, ethambutol, pyrazinamide

12-18months: isoniazid, rifampicin

69
Q

What commonly causes epiglottis

A

H. influenza type b

70
Q

Vaccination of epiglottitis

A

Hib vaccine

71
Q

Signs of epiglottis

A
  1. Fever
  2. Throat pain
  3. Difficulty swallowing
  4. Stridor
  5. Voice hoarseness
  6. people lean forward to open the airway

year 3 (25 decks)

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