Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4C - Paediatrics > Paediatric Respiratory Conditions > Flashcards

Paediatric Respiratory Conditions Flashcards

1
Q

What is the medical term for croup?

A

Laryngotracheobronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the typical presentation and clinical course of croup?

A

1 - 2 days of coryza. On the 2nd or 3rd night / early morning, awake with a barking cough. Stridor might develop after that. Barking cough / stridor only lasts 2-3 days. Viral symptoms last 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the typical microorganism which causes croup?

A

Parainfluenza virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the management of croup?

A
  1. Basics - minimal handling. Supplemental oxygen or respiratory support if required in severe cases. 2. Place and person - admit to hospital if worried about increased WOB or hypoxia. 3. Investigations and definitive diagnosis - clinical diagnosis 4. Management - oral prednisolone (1mg/kg), oral dexamethasone (0.15 - 0.6 mg/kg), IV dexamethasone (0.2mg/kg), nebulised adrenaline (1:1000), ETT 5. Long term
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two main types of croup?

A

Acute viral croup or recurrent spasmodic croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of epiglottis?

A

The four Ds Dysphagia Dyphonia Drooling Dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common microorganism which causes epiglottis?

A

H. influenzae B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common microorganism which causes bacterial tracheitis?

A

Staphylococcus aureus (now more common than epilglottitis due to Hib vaccine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the dosage of ipatropium bromide given in moderate / severe acute exacerbations of asthma?

A

6 yo give 8 puffs with salbutamol burst therapy (every 20 minutes for one hour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs of respiratory distress in a child?

(Hint there are 7)

A

7 SIGNS OF INCREASED WOB IN KIDS

(general inspection -> obs -> hands -> face -> neck -> chest)

—Cyanosis
—Tachypnoea
—Head bobbing (younger kids)
—Grunting
—Nasal flare
—Tracheal tug
—Intercostal and subcostal recession

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the pathophysiology of bronciolitis?

A

Inflammation of the bronchioles

Often caused by infections with RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the usual causative microorganism of brinchiolitis?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In what age group is bronchiolitis most common?

A

<12-24 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does RSV tend to cause?

A

Bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does parainfluenza virus usually cause?

A

croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the typical presentation of Bronchiolitis?

A

Child < 18 months old

URTI + asthma like symptoms [cough, dyspnoea, wheeze]

(remember, can’t diagnose asthma <2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you consider for “Place and Person” in a child with bronchiolitis, when deciding whether or not to admit them?

A
  • Oxygen requirement - if requiring oxygen to maintain SpO2 > 93% admit
  • Apnoeic episodes - marker of severity
  • Behaviour - poor feeding, lethargy and irritability are signs of severity
  • Work of breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the management of bronchiolitis?

A

Basics

  • DRABC
  • Vital Signs

Place and Person

  • Assess severity
  • If increased WOB, requiring O2 to maintain SpO2 > 93%, apnoeas or lethargy/poor feeding/irritabilty –> ADMIT [if RURAL - if parents are anxious / nervous / “irresponsible” or if live far away]

Ix and confirm diagnosis

  • Usually aclinical diagnosis
  • If diagnostic uncertainty, can do CXR

Definitive Management

  • Supportive management
    • Minimal handling and frequent feeds’
  • Oxygen via NP / HFNP
  • NGT / IV fluids if poor feeding
  • Can be discharged once maintaining adequate oxygenation and adequate feeding
  • Can triabl salbutamol if 2 years old to see if salbutamol responsive

Follow Up

  • Follow up with GP
  • Educate RE signs to return (apnoeic, lethargic, poor feeding, wheeze, increased WOB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Braking cough = ?

A

Croup

Laryngotracheobronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the causative microorganisms of croup?

A

95% is Parainfluenza

Can be bacterial (H. influenzae, S. aureus) = bacterial tracheitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

BONUS WOMENS QUESTION

What are the causes of menorrhagia?

A

Bleeding disorder

Iatrogenic (IUDs and drugs)
Thyroid dysfunction (especially hypo)
Cancer (Endometrial, cervical)
Hyperplasia of the endometrium
Fibroids (leiomyomata) and polyps
Adenomyosis and endometriosis
Chlamydia, gonorrhea and STIs
Ectopics, miscarriage, pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

At what age do you get croup?

A

6 months - 6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the typical symptoms/ signs of croup?

What is added to make this bacterial tracheitis?

A

URTI followed by barking cough, hoarse voice, wheeze [even though LRTI], increased WOB

If there is also high fever + toxic looking child –> consider BACTERIAL TRACHEITIS [OR EPIGLOTTITIS FOR THAT MATTER?!]

24
Q

What is the management of croup?

A

Basics

  • DRABC
  • Vitals

Place and Person

  • Do they need to be admitted?
    • Stridor at rest
    • Requiring O2 - VERY LATE SIGN
    • Increased lethargy/irritability
    • Poor feeding
    • Live far away [rural]
    • Parents don’t seem “sensible” [rural]

Ix and Confirm Diagnosis

  • Want to avoid over-investigating because can worsen
  • CXR if uncertainty: steeple sign if severe

Definitive management

  • Mild: D/C home and supportive care. Freqeunt small feeds and minimal handling
  • Moderate:
    • Oral corticosteroids:
      • 1mg/kg prednisolone
      • 0.15mg/kg dexamethasone
  • Severe:
    • Nebulised adrenaline
    • plus oral steroids as above

Follow Up

  • DC once no stridor at rest
  • Follow up with GP a few days later
  • Educate RE signs to come back in
25
Q

What are the markers of severity for croup?

A

Stridor at rest

Poor feeding

Lethargy / irritability

Increased WOB

Reduced SpO2 is a very late sign

26
Q

What is the aetiology of epiglottitis?

A

Haemophillus infleunzae

Or, if immunised, more likelt to be

Beta haemolytic strep

Moraxella catarrhalis

Strep pneumoniae

27
Q

What are the causes of epiglottitis in an immunised child?

A

Group A Strep

Moraxella Catarrhalis

Streptococcus Pneumoniae

28
Q

How do you differentiate between croup and epiglottitis?

A

Croup

  • sickness comes on over a few days
  • Preceeding URTI symptoms
  • Not usually with high fever
  • Miserable
  • Loud, barking, brassy cough
  • Loud, harsh stridor
  • Hoarse voice
  • Able to drink, not drooling

Epiglottitis

  • Comes on suddenly
  • No preceeding URTI symptoms
  • High fever
  • Flat / flopppy
  • Soft, muffled cough
  • Soft stridor
  • Quiet voice, reluctant to speak / dysarthria
  • Dysphagia and drooling
29
Q

What is the management of epiglottits!

A

Straight to ED

Secure the airway (be prepared to perform a crycothyroidectomy)

Take bloods once intubated

Empiral antibiotics (Ceftriaxone)

Treat contacts with Rifampicin prophylactically

30
Q

What is the aetiology of cystic fibrosis?

A

autosomal recessive mutation on chromosome 7

inteferes with CFTR gene which cuases altered ion transportation across epithelial cells

31
Q

What are the clinical features of CF?

A

Respiratory

  • Thickened secretions
    • Recurrent infections
    • Bronchiectasis
    • Recurrent pneumothroacies
    • ABPA
  • Nasal polyps
  • Chronic sinusitis

Pancreas

  • Exocrine insufficiency (which then blocks the endocrine ducts)
  • Malabsorption
  • Steatorrhea
  • Failure to thrive
  • Recurrent pancreatitis
  • T1DM

Hepatobiliary System

  • Prolonged neonatal jaundice
  • Hepatic cirrhosis
  • Portal HT
  • Fat soluble vitamin deficiency (vitamin ADEK)
  • Recurrent cholecystitis

GIT

  • Meconium ileus
  • DIOS

Reproductive system

  • Absence of vas deferens
  • Delayed puberty due to malnutrition
  • Infertility
32
Q

What is involved in testing for CF using the Gutehrie Test?

A
  1. First Test for IRT (immunorecative trypsinogen level)
  2. If this is high - then test for CFTR
33
Q

What is the screening test for CF?

What is the diagnostic test?

A

Screening test = Gutherie Heel Prick (IRT & CFTR)

Diagnostic Test = Sweat Test

34
Q

If you had a child with symptoms of CF, what FIRST investigation would you order?

A

Sweat Test

(Sweat chloride levels >60mmol/L = diagnostic of CF)

NOT the heel prick test, this is a screening test

35
Q

What is the overall management of CF?

A

Basics

  • Explain there is NO CURE - only manage potential complications

Place and Person

  • Referral to paediatrician, respiratory physician, allied health including physiotherapists and dieticians

Ix and CD

  • Sweat Test if not already done

Definitive Management:

Think of each system

  • Respiratory
    • physiotherapy
    • aerolysed mucolytics
    • ABx if infection, also given resuce antibiotics
    • Lung transplant (last line)
  • GIT & Pancreas
    • High calorie diet
    • Pancreatic enzyme replacement (Creon)
    • Fat solumble vitamin replacement (A,D,E,K)
    • Salt replacement occasionally
    • Insulin later in life

Prevntative / Ongoing

  • Flu vaccine
  • Pneumococcal vaccine
  • NO SMOKING
  • Avoid sick people
  • Regular follow up
    • Yearly mucous cultures taken (and at every exacerbation). Eventually get infected with pseudomonas.
  • DEXA scan at puberty
    *
36
Q

How do you classify asthma in cenhildr?

A

Infreuent intermittent

  • Attacks less often than every 6 weekly
  • No interval symptoms

Frequent intermittent

  • Attacks more often than every 6 weekly
  • No interval symptoms

Persistent

  • Attacks more often than every 6 weekly
  • Mild: Interval symptoms fewer than 1 x per week
  • Moderate: interval symptoms 1 x per week
  • Severe: interval symptoms >1 x per week
37
Q

How do you classify infrequent intermittent asthma?

A

Attacks less often than every 6 weeks

No interval symptoms

38
Q

How do you classify frequent intermittent asthma?

A

Attacks more often than every 6 weeks

No interval symptoms

39
Q

How do you classify mild persistent asthma?

A

attacks more frequent than every 6 weeks

interval symptoms less than once per week

40
Q

How do you classify severe persistent asthma?

A

Attacks more frequently than every 6 weeks

Interval symptoms more than once per week

41
Q

How do you classify moderate persistent asthma?

A

Attacks more frequently than every six weeks

Interval symptoms 1 x per week

42
Q

What are interval symptoms?

What else can you ask to grade the severity of asthma?

A

Interval Symptoms

Night cough / wheeze
Morning cough / wheeze
Exercise tolerance
Days of school missed?

Youcan also ask

  • When was the last time / has he ever / how often does he require steroids for his asthma?
  • Has he been to ED / wards / ICU with his asthma?
43
Q

What is the defnitive management of infrequent intermittent asthma?

A

SABA prn

44
Q

What is the defitive management of frequent intermittent asthma?

A

SABA prn

+

low dose/higher dose ICS

AND/OR

LTRA

AND/OR

cromone

45
Q

What is the definitive management of persistent asthma?

A

SABA prn

+

low dose/higher dose ICS

AND/OR

LTRA

AND/OR

cromone

+

LABA

oral CS

46
Q

Name two generic types of SABA and some brand name?

A

Salbutamol (Vontolin)

Terbutaline (Bricanyl)

47
Q

Name two different types of ICS and their brand names?

A

Fluticasone (Flixotide)

Budenoside (Pulicort)

48
Q

Name two different types of combined ICS / LABA?

A

Fluticasone + Salmetorol = Seretide

Budenoside + efometerol = Symbicort

49
Q

Name two types of LABA and their brand names?

A

Efometerol = Foradile

Salmeterol = Serevent

(usually see this combined with an ICS)

50
Q

Name one generic type of LTRA and it’s brand name

A

Monteleukast (Singulair)

51
Q

Name one type of cromone and their brand name

A

Cromoglycate (intal)

52
Q

How do you diagnose asthma in a child?

A

Trial of salbutamol

(not with lung function tests or PEF until over 7-8)

53
Q

In what age group would you use LABAs?

A

No evidence for children <5

54
Q
A
55
Q

What is the emergency management of asthma, to instruct parents of a child >6 years old, to do at home?

A

> 6 y.o. = maximum 12 puffs of ventolin

‘4,4,4’ rule

  • 4 puffs (4 breaths per puff)
    • wait 4 minutes
  • 4 puffs (4 breaths per puff)
    • wait 4 minutes
  • 4 puffs (4 breaths per puff)
    • wait 4 minutes

Then if not better, call an ambulance

/ bring in to hospital.

Can bring straight in to hospital if:

  1. If you are worried – call an ambulance straight away even before administering ventolin
  2. If are requiring ventolin more frequently than every 3-4h
  3. If wheezing lasts >24h and is not getting better
  4. If you get little or no relief from ventolin
56
Q

What is the home emergency management of asthma of a child <6 years old?

A

< 6 y.o. = maximum 6 puffs of ventolin

‘2,2,2 rule’

2 puffs (3-4 breaths)

  • wait two minutes

puffs (3-4 breaths)

  • wait two minutes

2 puffs (3-4 breaths)

  • wait two minutes

if not better call ambulance / bring in to hospital

other reasons to call an ambulance / seek medical attention

  1. If you are worried – call an ambulance straight away even before administering ventolin
  2. If are requiring ventolin more frequently than every 3-4h
  3. If wheezing lasts >24h and is not getting better
  4. If you get little or no relief from ventolin

Year 4C - Paediatrics (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions