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3a > Paediatrics: Respiratory > Flashcards

Paediatrics: Respiratory Flashcards

1
Q

What is bronchiolitis? upper or lower resp tract?

A

Inflammation + infection of the bronchioles
- Lower resp tract infection

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2
Q

What is bronchiolitis usually caused by?

A

Usually viral
- RSV (respiratory syncytial virus)

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3
Q

What proportion of children get Bronchiolitis in their first year of life? during what season?

A

1/3
in winter

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4
Q

What age is Bronchiolitis common in?

A

usually in kids <18 months (mostly <6 months)

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5
Q

Describe the pathophysiology of Bronchiolitis

A

viral infection => excess mucus production + oedema + inflam (of tiny bronchioles) => obstruction of airflow in and out of chest

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6
Q

Bronchiolitis presentation?

A

bad feeding and bad breathing
- Coryzal symptoms (snotty nose, sneezing, mucus in throat, watery eyes)
- Syns of resp distress (dyspnoea, tachypnoea, tachycardia, poor feeding, mild fever, apnoea, wheeze)

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7
Q

What is the typical history/course of a child presenting with Bronchiolitis ? describe the days

A

5 month old with URTI Coryzal symptoms => chest symptoms (day 1-2) => symptoms at their worst day 3-4 => symptoms last total 7-10 days

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8
Q

when would a child with bronchiolitis have to be admitted to hospital ? (7)

A
  • <3 months
  • oxy sats <92%
  • reduced feeding
  • moderate-severe resp distress
  • apnoeas
  • RR > 70
  • clinically dehydrated
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9
Q

Bronchiolitis management?

A

supportive
- ensure adequate intake (oral, NG, IV)
- nasal suctioning
- supplementary oxygen
- ventilatory support

(- paracetamol if fever)

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10
Q

what advice should you give about Bronchiolitis and feeding?

A

ensure adequate intake but do not overfeed as it will restrict breathing (full stomach)

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11
Q

How long can the cough from bronchiolitis last?

A

disease course is usually 7-10 days but the cough can last up to 6 weeks

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12
Q

What is viral induced wheeze?

A

Acute wheezy illness caused by viral infection

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13
Q

Describe the pathophysiology of viral induced wheeze?

A

small children so small airway encounter virus => inflam + oedema + trigger smooth muscle constriction => restricts airflow => wheeze and resp distress

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14
Q

why do adults not get viral induced wheeze?

A

the inflam and aimed has little effect on larger child or adult due to the larger airways

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15
Q

Viral induced wheeze presentation ?

A
  • Evidence of viral disease (fever, cough, coryza)
  • Plus: sob, signs, of resp distress, expiratory wheeze
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16
Q

on auscultation of the chest, where will the VIW wheeze be heard? focal or throughout? what other condition causes similar finding?

A

wheeze will be throughout chest
- (neither asthma nor VIW causes focal wheeze)

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17
Q

What is acute asthma exacerbation?

A

rapid deterioration in the symptoms of asthma

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18
Q

name some triggers of acute asthma (7)

A
  • infection
  • exercise
  • cold weather
  • high emotion
  • dust
  • animals
  • fod allergies
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19
Q

Acute asthma presentation?

A
  • sob
  • sings of resp distress
  • expiratory wheeze
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20
Q

on auscultation, what chest finding might you find in acute asthma ? explain (2)

A
  • expiratory wheeze (throughout the chest)
  • silent chest (no noise due to airway so tight => no airflow) life threatening
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21
Q

what might you see in a life threatening acute asthma exacerbation? peak flow? sats? other signs (A-E) ?

A
  • peak flow < 33%
  • sats < 92%
  • exhaustion and poor resp effort
  • hypotension
  • silent chest
  • cyanosis
  • altered consciousness
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22
Q

name some of the classes of drugs used in management of acute asthma ?

A
  • Bronchodilators
  • Steroids
  • Supplementary oxygen
  • Abx
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23
Q

name 3 bronchodilators used in acute asthma management?

A
  • salbutamol
  • ipratropium
  • Mg sulphate
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24
Q

describe the stepwise management of acute asthma? (7)

A

1) salbutamol inhalers via spacer device (10 puffs every 2 hrs)
2) nebuliser salbutamol/ipratropium bromide
3) Oral prednisolone
4) IV hydrocortisone
5) IV Magnesium sulphate
6) IV salbutamol
7) IV aminophylline

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25
Q

what electrolyte might you want to monitor during acute asthma management?

A

check serum K while on high dose salbutamol as can cause hypokalaemia

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26
Q

name 2 (3) side effects of salbutamol

A

tachycardia + tremor
(does also cause hypokalaemia)

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27
Q

What is the commonest chronic condition in children?

A

Asthma

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28
Q

what is + Describe the pathophysiology of chronic asthma

A

chronic inflammatory airway disease leading to variable airway obstruction
- hypersensitive + slightly inflamed airway responds to stimuli => constrict => airway obstruction

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29
Q

What type of airway obstruction is there in asthma?

A

reversbile airway obstruction

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30
Q

Describe the symptoms and variability of chronic asthma

A

dry cough, wheeze, sob
- episodic symtoms with intermittent exacerbations, diurnal variability, triggers + FHx of atopy

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31
Q

what factors would move you away form a diagnosis of asthma?

A
  • wheeze only related to coughs and cold (viral induced wheeze)
  • productive cough
  • no response to bronchodilators
  • unilateral wheeze
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32
Q

what could a unilateral/focal wheeze indicate? (2)

A
  • inhaled foreign body
  • infection
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33
Q

How is asthma diagnosed?

A

often made clinically
- spirometry with reversibility testing, peak flow variabilty
- kinda confirmed if the treatment is successful

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34
Q

Describe the long term management of asthma? (5)

A

stepwise approach
1) inhaled salbutwmal as prequired
2) los dose corticosteroid inhlaer
3) LABA inhaler
4) leukotriene agonist
5) titrate up ICS

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35
Q

What is pneumonia ?

A

infection of the lung tissues causing inflammation of lung tissues and sputum filling airway + alveoli

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36
Q

Pneumonia presentation (7)

A
  • cough
  • high fever (>38.5)
  • tachypnoea
  • tachycardia
  • increased work of breathing
  • lethargy
  • Delirium
    (resp distress)
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37
Q

what is the cough typically like in pneumonia?

A

wet + productive

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38
Q

what chests sounds might you find in pneumonia ?

A
  • bronchial breath sounds
  • focal corase crakcles
  • Dullness to percussion
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39
Q

what is the most common bacterial cause of pneumonia ? plus other bacteria (4 other)

A
  • Strep pneumonia (most common)
  • GAS
  • GBS
  • S. aureus
  • H. Influenza
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40
Q

what is the most common viral cause of pneumonia ? plus 2 others?

A
  • RSV (most common)
  • parainfluenza
  • influenza
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41
Q

What investigations might you do for suspected pneumonia ?

A

CXR: not routinely required but useful if in doubt
- Sepsis screen

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42
Q

Pneumonia manament ?

A

Abx: amoxicillin (IV if sepsis)
- Oxygen as required (maintain above 92%)

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43
Q

what is another term for croup?

A

Acute larygotracheobronchitis

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44
Q

What is croup ? who does it affect?

A

acute viral URT infection affecting children aged 6 months - 3years

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45
Q

when is the peak age for children affected by croup ?

A

2 years

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46
Q

what is the most common cause of croup? plus other?

A

para influenza virus
- influenza, adenovirus, RSV

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47
Q

describe the physiology that causes stridor?

A

caused by obstruction in upper airway

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48
Q

Describe the presentation of croup?

A
  • increased work of breathing
  • Barking cough
  • hoarse voice
  • stridor
  • low grade fever
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49
Q

describe the management of croup?

A

most cases managed at home (guide + rest), conforms + calm the child
- Single dose oral dexamethosone
- Oxygen as required (>92%)
- nebuliser Ad (provide relief of symptoms)
- Intubation + ventilation

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50
Q

What scale categorises croup presentation into mild/moderate/severe croup?

A

Westley Croup Score

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51
Q

describe the time course of croup vs epiglottis ?

A
  • Croup: days
  • Epiglottitis: hours
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52
Q

Describe the features prior in croup vs epiglottis ?

A
  • Croup: coryza
  • Epiglottitis: none
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53
Q

Describe the cough in croup vs epiglottis ?

A
  • Croup: Barking
  • Epiglottitis: slight if any
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54
Q

Describe the mouth in croup vs epiglotittis ?

A
  • Croup: closed
  • Epiglottitis: drooling saliva
55
Q

describe the fever in croup vs epiglottis ?

A
  • Croup: <38.5 degrees
  • Epiglottitis:>38.5 degrees
56
Q

describe the voice in croup vs epiglotittis?

A
  • Croup: hoarse
  • Epiglottitis: potato
57
Q

What is Epiglottitis ?

A

life threatening inflam + swelling of the epiglottis by usually infection => airway obstruction

58
Q

What is the most common cause of Epiglottitis ?

A

HiB

59
Q

why are the rates of Epiglottitis a lot lower now?

A

a lot rarer now due to HiB vaccination (most common cause)

60
Q

what non-infectious causes of epiglottis are there? (2)

A
  • thermal: steam
  • direct trauma: blind sweep to remove foreign body
61
Q

4 Ds: dyspnoea, psyyhagia, drooling and dysphonia is the common presentation for what condition?

A

epiglotittis

62
Q

describe the presentation of Epiglottitis ?

A
  • sore throat + stridor
  • drooling
  • tripod position
  • high fever
  • difficulty or painful swallowing
  • hot potato voice
63
Q

What investigations do you do in suspected epiglottis ?

A

if suspected + patient unwell then no not perform any investigations
- do not examine!
- xray

64
Q

what might X-ray of patient with Epiglottitis show? why useful?

A

lateral Xray of neck shows thumb sign + thickened aryepiglottic folds
- useful to exclude IFB

65
Q

What is the management of epiglottis ?

A

Medical emergency (risk of airway closing), do not distress the child (can prompt airway closure)
1) secure the airway: May need intubation
2) oxygen: can be held by the parent
3) nebuliser Ad: buys time while awaits definitive management
4) IV Abx
5) IV steroids (dexamethasone - reduce oedema + swelling)

66
Q

what Abx would you consider for Epiglottitis

A

IV ceftriaxone - covers HiB

67
Q

What is larygomalacia? affects who?

A

condition affecting infants when immature larynx (above vocal cords) is abnormally structured => airway obstruction

68
Q

Describe the structural changes in larygomalacia? pathophysiology

A
  • shortened aryeppiglottic folds => characteristic omega shape
  • Immature supraglottic fold has less tone => more floppy on inspiration => partial obstruction
69
Q

Laryngomalacia presentation? what makes it worse?

A

chronic inspiratory stridor, intermittent
- worse when feeding/ lying on back/upset

70
Q

what investigations might you do for suspected Laryngomalacia?

A

laryngoscopy (flexible endoscopy)

71
Q

Laryngomalacia management

A

no intervention required, child is left to grow out of it
- severe cases (rare): can be life threatening: ABCDE, consider surgical intervention

72
Q

what percentage of Laryngomalacia cases self-resolve?

A

99%

73
Q

What is whooping cough?

A

highly infectious bacterial upper respiratory tract infection that causes coughing fits

74
Q

Describe the coughing fits in whooping cough?

A

coughing fits are sos ever such that child is unable to take breaths between + then Mae whooping noise as they forcefully suck in air

75
Q

Name the pathogen that causes whooping cough?

A

Bordatella pertussis

76
Q

describe the gram staining and shape of the pathogen causing whooping cough?

A

gram negative bacillus

77
Q

when vaccinations against pertussis?

A
  • children (2,3,4 months and 3 yrs + 4 months)
  • pregnant women
78
Q

after how many years does pertussis immunity wane in children?

A

5-10years

79
Q

describe the presentation of whooping cough? course

A
  • starts with mild Coryzal symptoms, low grade fever + dry cough
  • Then more sever coughing fits (paroxysmal cough)
80
Q

what can severe coughing fits in whooping cough cause ?

A
  • fainting
  • vomiting
  • pneumothorax
81
Q

instead of a cough, how may infants with whooping cough present?

A

apnoeas

82
Q

How is whooping cough diagnosed?

A
  • nasopharyngeal or nasal swab with PCR testing or bacterial cultures
  • > 2 weeks: anti-pertussis toxin IgG serology
83
Q

Whooping cough management?

A
  • Notifiable disease: notify public health
  • supportive care
  • Abx
84
Q

what Abx for whooping cough?

A

Clarythromycin (macrolide) for pertussis

85
Q

when would a child get admitted for whooping cough? (5)

A
  • If acutely unwell
  • < 6 moths
  • apnoeas
  • cyanosis
  • severe coughing fits
86
Q

how long can the cough in whooping cough last for?

A

Symptoms typically resolve within 8 weeks

87
Q

Whats another term for chronic lung disease of prematurity?

A

bronchopulmonary dysplasia

88
Q

What is CLDP?

A

chronic lung disease of prematurity
- occurs in premature babies (<28 weeks): suffer with RDS + require oxygen therapy or intubation+ventilation

89
Q

How is CLDP diagnosed?

A
  • Based on CXR changes
  • When abby requires oxygen therapy after 26 weeks gestational age
90
Q

Features of CLDP?

A
  • Low oxygen sats
  • increased work of breathing
  • Poor feeding + weight gain
  • Increased susceptibility to chest infection
91
Q

what might be heard on auscultation of infant with CLDP?

A

crackles and wheeze

92
Q

What is done to prevent CLDP? antenatal? neonatal? (3)

A
  • Antenatal: Corticosteroids (betamethosone) to mother showing sings of premature labour

Neonatal:
- CPAP (rather than intubation + ventilation)
- using caffeine to stimulate resp effort
- not over oxygenating

93
Q

what type of inheritance is cf?

A

autosomal recessive

94
Q

1 in how many people are cf carriers?

A

1 in 25

95
Q

cf is caused by a genetic mutation to which gene? on which chromosome ?

A

CFTR gene on chromosome 7 (delta-F508)

96
Q

which 4 systems does cf affect?

A
  • Resp tract
  • Pancreas
  • GI tract
  • Reproductive tract
97
Q

how does cf affect the pancreas? pathophysiology?

A

Thick pancreatic + biliary secretions => blockage of ducts + lack of digestive enzymes in the digestive tract

98
Q

in cf, which enzyme is especially low?

A

Pancreatic lipase

99
Q

how does cf affect the airways? pathophysiology?

A

Low vol thick secretions => reduced airway clearance => bacterial colonisation => susceptibly to airway infections

100
Q

how does cf affect the reproductive tract?

A

Congenital bilateral absence of vas deferent in males (=> male infertility)

101
Q

meconium ilues in path-pneumonic with what condition?

A

Cystic fibrosis

102
Q

when is cf usually picked up? normal presentation?

A

Usually picked spat new born screening (newborn blood spot test)

103
Q

what are the main symptoms of cf?

A
  • Chronic cough
  • Thick sputum production
  • Recurrent resp tract infection
  • Abdo pain + bloating
  • Failure to thrive
  • Steatorrhoea
104
Q

how might cf affect stool? why?

A

Loose greasy tools (steatorrhoea)
- Due to low lipase enzymes

105
Q

child presents with nasal polyps. what is your top differential?

A

Cystic fibrosis - strongly suspect cf in a child with nasal polyps

106
Q

what 3 tests could be done to investigate for cf? which gold standard?

A
  • Newborn blood spot testing
  • Sweat test (gold standard)
  • Genetic testing (CFTR gene)
107
Q

when could genetic testing for cf be done? (2)

A
  • Antenatally (amniocentesis, CVS)
  • Newborn blood test
108
Q

describe the chloride sweat test. testing for what? over what value indicates disease?

A

Gold standard test for CF
- Check chloride conc of sweat (induced with electrodes)
- >60ml/L => CF

109
Q

Describe the management of CF?

A
  • Chest physiotherapy several times per day to clear mucus
  • Exercise and high cal diet
  • CREON tablets (to replace lipase enzymes)
  • Prophylactic flucloxacillin to reduce infection risk
110
Q

Which bacteria’s chronic infection is associated with worsening lung function + must be treat aggressively in cf patients?

A

Pseudmona Aeruginosa

(used to have peer cf groups but now not anymore because of the risk of spreading it among cf patients - it is advised for cf patient to avoid other cf patients because of the risk of this infection)

111
Q

What is the life expectancy of patient with cf?

A

47 years

112
Q

cf prognosis: how many patients develop pancreatic insufficiency?

A

90%

113
Q

cf prognosis: what proportion of patients develop CF related diabetes

A

50%

114
Q

What is another name for primary ciliary dyskinesia?

A

Kartagener’s syndrome

115
Q

what genetic inheritance is primary ciliary dyskinesia ? (PCD)

A

autosomal recessive condition

116
Q

what does PCD affect?

A

motile cilia of various different cells of body

117
Q

Kartageners syndrome airway pathophysiology?

A

PCD
caused by dysfuction of motile cilia (resp tract) => build up of mucus in lungs => infection risk (just like in cf)

118
Q

other than the airways where can karageners affect?

A

Dysfunction of cilia in fallopian tube and sperm flagellum dysfunction => decreased/abscent fertility

119
Q

PCD has a strong association with what other condition

A

situs inversus

120
Q

what karagener’s triad presentation?

A

PCD
- Paranasal sinusitis
- bronchiectasis
- situs inversus

121
Q

what might a patient with PCD complain of?

A

recurrent RTI

122
Q

what investigation would you do for PCD?

A

sample of ciliated epithelium

123
Q

PCD management ?

A

similar to cf
- Daily physio
- High cal diet
- Abx

124
Q

what is bronchiectasis?

A

abnormal dilation of the airways with associated description of bronchial tissue

125
Q

Bronchiectasis commonly occurs as a result of what condition?

A

CF

126
Q

describe the pathophysiology of bronchiectasis as a result of infection?

A

infection => inflam => structural damage within bronchial walls => dilation + reduced number of cilia => increased infection risk

127
Q

What are the causes of bronchiectasis ? (3)

A
  • Post infectious (sever LRTI - strep pneumonia)
  • Primary ciliary dyskinesia
  • Post obstructive (foreign body aspiration)
128
Q

what 4 changes to the bronchi does Bronchiectasis cause?

A
  • Dilation of bronchi
  • Scarring of bronchi
  • Brachial wall thickening
  • Destruction of cilia
129
Q

common clinical feature of bronchiectasis ? (6)

A

Hx of chronic productive cough
- chest pain, wheeze, breathlessness on exertion, recurrent LRT infections

130
Q

what investigations would you do for bronchiectasis? gold standard?

A
  • CXR
  • High resolution CT (HRCT) - gold standard
  • Underlying pathology (sweat test for cf)
131
Q

what would you see on CXR of Px with bronchiectasis? (2)

A
  • Bronchial wall thickening
  • Airway dilation
132
Q

management of bronchiectasis?

A
  • treat underlying cause
  • chest phsyiotherapy
  • Abx
133
Q
A

3a (43 decks)

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