Paediatrics - Respiratory Flashcards

1
Q

What is it?

2 year old, barking cough, stridor, coryza, temperature

A

Croup - laryngotracheal infection

Differential - epiglottitis

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2
Q

What are the symptoms and treatment of bronchiolitis?

A

Cough, wheeze, viral symptoms, tachypnoea, tachycardia, recession, flared nostrils, poor feeding, crackles
Treatment - supportive

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3
Q

What are the risk factors for developing bronchiolitis?

A

Family smokers, chronic respirtory or cardiac conditions, born premature, immunocompromised

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4
Q

What is bronchiolitis?

A

Infection of the bronchioles - become swollen and full of mucus
Very common in children - 1/3 have it before a year of age

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5
Q

What is the most common causative pathogen of bronchiolitis?

A

RSV (respiratory synctial virus) - 80% of time

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6
Q

What is it?
Child comes in, hyperextended, drooling, increased cappilary refill, stridor, muffled voice
How would you treat this?

A

Epiglottitis
Be very careful with child, do not agitate!
IV antibiotics

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7
Q

What is the main pathogen causing epiglotitis?

A

Hib (haemophilis influenza type B, aerobic diplococci) - decreased since vaccine

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8
Q

What are the treatment steps of chronic childhood asthma?

A
  1. Environment
  2. SABA and ICS
  3. Monteleukast
  4. LABA
  5. Increase ICS
  6. Oral steroids
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9
Q

How do you treat croup?

A

Self-limiting
Steroids - prednisilone, dexamethasone, nebulised budesonide
Occasionally o2, nebulised adrenaline and intubation

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10
Q

What are signs of CF?

A

Neonate - meconium ileus

Older - recurrent chest infections, recurrent wheeze, failure to thrive

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11
Q

How would you treat CF?

A

O2, antibiotics, steroids,
Blocking Na reabsorption - amiloride
Stimulate Cl secretion - adenoside
transplant

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12
Q

What type of inheritance is CF? How common is it?

A

autosomal recessive

1/25 in general public

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13
Q

What is the chronic lung disease of prematurity?

A

needing o2 at 36 weeks or 28 days after birth, decreased lung volume diffusion, decreased alveolar SA defect, increased mortality, recurrent admission

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14
Q

What are some respiratory complications of being born prematurely?

A

lack of surfactant = respiratory distress syndrome surfactant decreased surface tension to prevent alveolar collapse
alveoli absent at 24 weeks
lung damage is worsened by O2, sepsis, ventilation

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15
Q

Name 3 antibiotics used in pneumonia

A

amoxicillin
cefurotxime
cefatamine
beta-lactam

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16
Q

How would you manage epiglottitis?

A

call paediatrician, anaesthetics and ENT surgeon
transfer to ITU - intubate
bloods - culture
IV antibiotics e.g. cefuroxime

17
Q

Name some symptoms of epiglottitis

A
rapid onset - hours 
no coryza, absent/slight cough 
can't drink 
drool saliva 
> 38.5 temp 
muffled voice 
soft stridor 
appears toxic
18
Q

What is respiratory distress syndrome?

A

lack of surfactant from Type 2 penumocytes results in increased surface tension and alveolar collapse

19
Q

When is it asthma and when is it viral induced wheeze?

A

VIW <5

Asthma >5

20
Q

Name 2 bronchodilators

A

Salbutamol and ipratropium

21
Q

Name 2 steroids to treat acute asthma

A

oral prednisione

IV hydrocortisone

22
Q

What alternative medicines would you use to treat acute asthma?

A

magnesium, aminophylline, salbutamol

23
Q

What would you see on a blood gas in Type 1 respiratory failure?
Name 3 causes

A

low O2 and normal/low CO2

damage to lung tissue (acute hypoxaemic) - pulmonary oedema, pneumonia, ARDS

24
Q

What would you see on a blood gas in Type 2 respiratory failure?
Name 3 causes

A

low O2 and high CO2

failure to ventilate - COPD, GBS, Duchenne’s, opiods, chronic bronchitis

25
What are the symptoms of hypercapnia?
CRAB - confusion, reduced consiousness, asterixis, bounding pulse
26
What is the definition of stridor?
harsh vibrating noise when breathing, caused by obstruction of windpipe or larynx
27
What is the definition of wheeze?
Breathe with a whistling or rattling sound in chest as result of obstruction in air passages
28
What are the main causes of wheeze?
Asthma, bronchiolitis, viral induced wheeze, pnuemonia
29
What are the main causes of stridor?
Croup, epiglottitis, bacterial tracheitis, diptheria, inhaled foreign body, anaphylaxis
30
What are the signs of respiratory distress?
cyanosis, tracheal tug, subcostal/intercostal recession, hypoxia, tachycardia, wheeze, stridor, head bobbing
31
What is palivizumab?
monoclonal antibody against RSV - vaccine given once a month during winter to CF, premature, chronic lung disease, immunodeficient
32
What causes pertussis?
upper respiratory tract infection - bordetella pertussis - gram negative cocobacilli
33
What causes CF?
autosomal recessive gene that alters the cystic fibrosis transmembrane conductance regulatory gene on chromosome 7 - codes for chlorine channels
34
What does ground glass appearance of lungs on a CXR mean?
surfactant deficiency - especially common | Surfactant production begins between 24-28 weeks
35
What is bronchiectasis?
dilation of bronchioles and poor mucociliary clearance
36
What are the commonest causative organisms of pneumonia in children?
steptococcus pneumonia | haemophilis influenza
37
What is an empyema and how would you trest for it?
it is a pleural effusion with pus | - pH <7.2, glucose < 3.3
38
What are the levels of acute asthma attack severity and some symptoms?
Moderate - o2>92%, RR <30 children >5, can talk normally Acute severe - o2 <92%, PEF 33-50%, HR >140 in <5s, >125 >5s Life-threatening - exhaustion, hypotension, cyanosis, silent chest, confusion, PEF <33%, o2 <92%
39
How would you manage an acute asthma attack?
``` 02 salbutamol, terbutaline ipratropium bromide steroids - prednisilone, hydrocortisone antibiotics LTRA nebulised magnesium sulphate IV salbutamol, aminophylline, magnesium sulphate ```