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Child Health > Paediatric Respiratory Medicine - Distress, cough, apnoea and CF > Flashcards

Paediatric Respiratory Medicine - Distress, cough, apnoea and CF Flashcards

1
Q

What are the signs of respiratory distress seen in a child?

A 
Accessory muscles
Tachypnoea
Grunting 
Nasal flaring
Recession 
Head bobbing
Tripoding - optimise use of accessory muscles
Cyanosis
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2
Q

What is grunting caused by?

A

Exhaling against a partially closed glottis to keep airway open

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3
Q

What is the difference between a wheeze and stridor?

A

Wheeze is an expiratory sound caused by lower airway obstruction. Intrathoracic airway collapse

Stridor is a high pitched inspiratory sound caused by upper airway obstruction. Extra thoracic airways collapse

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4
Q

Name some causes of wheeze

A

Asthma
Bronchiolitis
Viral wheeze
Foreign body

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5
Q

Name some causes of stridor

A 
Croup
Foreign body
Epiglottitis
Laryngomalacia
Vocal cord dysfunction
Abscess - peritonsillar or retropharyngeal
Anaphylaxis
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6
Q

What causes of respiratory distress should you consider? (broadly speaking)

A

Cardiac problems?
Structural issues?
Infective cause?
Gas exchange problem?

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7
Q

What duration of cough corresponds to being acute, subacute and chronic respectively?

A

Acute <3 weeks
Subacute 3-8 weeks
Chronic >8 weeks

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8
Q

What generally causes acute coughs?

A

Infection

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9
Q

What generally causes subacute coughs?

A

Post viral cough

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10
Q

What about a cough could indicate it is due to asthma?

A

Night time
Wheeze
Has a trigger

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11
Q

What features of a cough could indicate it is due to a recurrent infection?

A

Start with additional respiratory signs

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12
Q

What feature of a cough would indicate a post nasal drip or GORD

A

Worse on lying down

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13
Q

What would suggest a cough is one of habit?

A

Won’t cough at night

Otherwise well

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14
Q

What would suggest a cough has an environmental cause?

A

History of smoking/parental smoking

Live in polluted area

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15
Q

How would a cough present in a child with Cystic Fibrosis?

A

Begin at young age

Systemically unwell

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16
Q

What is a classical Tuberculosis cough?

A

Systemically unwell

Cough progress

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17
Q

What features of a cough would suggest a child has inhaled a foreign body?

A

Acute onset

Haemoptysis?

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18
Q

What are the red flag signs for a cough?

A 
Sudden onset
Haemoptysis
Dysphagia
Moist productive cough
Night sweats
Weight loss
Worsening cough
Failure to thrive
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19
Q

What investigations would you consider if a child had a chronic cough?

A

CXR
Lung function
Skin prick
Sputum sample for culture and microscopy

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20
Q

A 12 year old obese boy comes in with feeling tired at school. His mum says he is always grumpy in the morning and has missed school because of headaches. She often hears him snoring loudly at night. Upon examination his tonsils appear swollen. What is the likely diagnosis?

A

Obstructive sleep apnoea

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21
Q

What is obstructive sleep apnoea?

A

Intermittent airway obstruction during sleep

22
Q

How does obstructive sleep apnoea present?

A

Sleep disturbance
Snoring
Waking grumpy - headache, refuse breakfast
Dry mouth and cracked lips - mouth breathing
Repeated Ent infections - adenoidal hypertrophy

23
Q

What are the causes of obstructive sleep apnoea?

A

Adenotonsillar hypertrophy
Obesity
Craniofacial abnormalities
Achondroplasia

24
Q

How is a diagnosis of obstructive sleep apnoea made?

A

Generally clinical

Can do overnight polysomnography

25
How is obstructive sleep apnoea managed?
Remove tonsils/adenoids CPAP Weight loss Orthodontic/maxillary surgery
26
What should you not give to help treat obstructive sleep apnoea and why?
DONT GIVE CODEINE Causes respiratory depression
27
What is cystic fibrosis?
Autosomal recessive disease leading to mutation in CFTR gene which leads to defective Cl- secretion and increased Na+ absorption
28
What systems can cystic fibrosis affect?
``` Respiratory system Pancreas Sweat Liver Intestines Bones Male fertility ```
29
How does Cystic Fibrosis present in a newborn?
Meconium ileus Failure to thrive Prolonged jaundice
30
How does meconium ileum happen in a newborn with Cystic Fibrosis?
Bowel blocked by sticky secretions leading to signs of intestinal blockage: Bilious vomit Abdo distention Delay in passing meconium
31
Why do children with Cystic Fibrosis fail to thrive?
Malnutrition due to poor gut absorption
32
What is the pathophysiology behind Distal Intestinal Obstruction Syndrome in children with Cystic Fibrosis?
Insufficient pancreatic enzymes and thick mucus --> thick dehydrated contents --> Faecal obstruction in ileocaecum
33
What signs of Distal Intestinal Obstruction Syndrome would you find on examination/imaging?
Palpable RIF mass | AXR show faecal loading and junction between small and large bowel
34
How does Cystic Fibrosis affect the respiratory system?
Abnormal ion transport leads to thickening of mucus Inadequate mucociliary clearance Chronic bacterial colonization Lung injury
35
What respiratory problems can be seen in Cystic Fibrosis?
Recurrent chest infections Chronic sinusitis Nasal polyps Bronchiectasis
36
What pattern of breathing would you see on a lung function test in cystic fibrosis ?
Obstructive pattern
37
What changes would you see on CXR in children with Cystic Fibrosis?
``` Hyperinflation - flat diaphragm Bronchial dilation Bronchiectasis Pulmonary artery dilation RV hypertrophy ```
38
How is Cystic Fibrosis diagnosed?
Postive history in sibling OR positive newborn screen result AND >60mmol/L Cl- on sweat test OR 2 CF genetic mutations OR abnormal nasal epithelium ion transport 2 positive sweat tests confirm diagnosis
39
What bacteria are children with Cystic Fibrosis particularly susceptible to?
``` Staph Aureus H Influenzae Pseudomonas aeruginosa Burkholderia cepacia Aspergillus ```
40
What signs would you see on examination of a child with Cystic Fibrosis?
Hyperinflation Wheeze Crackles Clubbing
41
Why do children with Cystic Fibrosis get steatorrhea?
Deficiency in pancreatic enzymes --> pale greasy offensive stools
42
How are the chest symptoms of Cystic Fibrosis managed?
Physio - postural drainage and airway clearance 2x per day Prophylactic antibiotics Mucolytics - DNase or hypertonic saline
43
What physiotherapy devices are used in Cystic Fibrosis?
PEP masks Flutter devices Acapella device
44
How are gastro symptoms managed in Cystic Fibrosis?
Creon - pancreatic enzyme replacement High calorie diet Fat soluble vitamines - ADEK
45
What do you screen for in children with Cystic Fibrosis?
Diabetes - annually | Osteoporosis
46
What lifestyle changes are suggested for children with Cystic Fibrosis?
``` No smoking Avoid other patients with CF Avoid people with colds No Jacuzzi (pseudomonas) Annual flu vaccine Clean and dry nebulisers fully NaCl tablets in hot weather Exercise! ```
47
What is the prognosis for Cystic Fibrosis?
50% live beyond 40yo
48
What screening methods are used to find if children have Cystic Fibrosis?
IRT - immunoreactive trypsin Sweat test CFTR gene
49
What are nasal polyps in a child indicative of?
Cystic Fibrosis or Primary ciliary dyskinesia
50
When do chest problems start to affect children with CF?
Generally seen once they get a little bit older
51
What can cause false positive and false negative sweat tests
False positive Malnutrition, G6PD, hypothyroidism, adrenal insufficiency False negative Skin oedema due to hypoalbuminaemia due to pancreatic exocrine insufficiency

Child Health (30 decks)

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