Brainscape's Knowledge GenomeTM

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


See full index

Year 4 - Paediatrics > Paeds - Difficulty breathing > Flashcards

Paeds - Difficulty breathing Flashcards

1
Q

In children what behaviour is a marker of severe breathlessness?

A

Difficulty talking or stopping talking

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

What PEWS score indicates that a child may need immediate intervention (urgent medical review), close observation and the doctor on call should be informed?

A

4 or more

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

What are the features of asthma?

A
  • Wheeze (often expiratory)
  • Cough (worse at night)
  • SoB
  • Chest tightness
  • Reduced PEFR
  • FHx or personal history of Atopy

N.B. above symptoms often exhibit diurnal variation and can be ‘triggered’ / worsened by allergens:

  • Dust mites
  • Pets
  • Tobacco smoke
  • Pollen)
  • Cold air
  • Occupation / parent occupation if exposed (bakers, farmers, carpenters, plastics, foams or glues)
  • Emotions e.g. anxiety, stress, laughter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the step-wise escalation of management for asthma in children aged 5-16?

A
  1. Newly diagnosed asthma –> SABA
  2. SABA + peadiatric low-dose ICS
    1. ​if not controlled on previous step OR newly diagnosed asthma /w symptoms ≥ 3 times per week or night-time waking
  3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  4. SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
  5. SABA + switch ICS/LABA for a maintenance and reliever therapy (MART)
    • MART = combined ICS and fast acting LABA in a single inhaler, used for daily maintanance and PRN relief
  6. SABA + paediatric moderate-dose ICS MART
  7. SABA + one of the following:
    • Paediatric high-dose ICS
    • Trial of theophylline
    • Expert opinion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the step-wise escalation of management for asthma in children aged under 5?

A
  1. Newly diagnosed asthma –> SABA
  2. SABA + peadiatric low-dose ICS
    • ​if not controlled on previous step OR newly diagnosed asthma /w symptoms ≥ 3 times per week or night-time waking
  3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  4. Stop the LTRA and refer to an paediatric asthma specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What dose of ICS represents the following:

  1. Low peadiatric dose
  2. Moderate peadiatric dose
  3. High peadiatric dose
A
  1. Low peadiatric dose = ≤ 200 μg budesonide or other
  2. Moderate peadiatric dose = 200-400 μg budesonide or other
  3. High peadiatric dose = > 400 μg budesonide or other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What areas of history always relavent in paediatric history? (BIG)

A
  1. Birth history e.g. prematurity, delivery process
  2. Immunisation history - risk of specific infections
  3. Growth and wellbeing (development) - hitting developmental milestones, feeding etc.

Also:

  • Mother’s pregnancy history - medications, conditions, trauma etc.
  • Family History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Harrison’s Groove?

A

A horizontal groove along the lower border of the ribcage seen in children/infants, corresponding to the costal insertion of the diaphragm

Caused by:

  1. Chronic asthma or obstructive respiratory disease
  2. Rickets (due to lack of mineralisation of ribs resulting in softer bone that can be pulled inward by tension of diaphragm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does serum lactate levels reflect and thus what problems can it indicate?

A

Serum lactate reflect peripheral circulation as when circulation worsens, tissues / organs respire anaerobically - producing lactic acid

Raised lactate (hyperlactemia = > 2 mmol/L)

  • Lactic acidosis type A (inadequate O2 delivery):
    • Sepsis
    • Shock
    • Hypoxia
    • Cardiac arrest
    • Regional hypoperfusion e.g. mesenteric ischaemia
  • Lactic acidosis type B (no evidence of inadequate O2 delivery):
    • Malignancy
    • Alcoholism
    • Pancreatitis
    • DKA
    • Hepatic failure
    • Medications: salbutamol, adrenaline, methanol, beta-agonist etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When advising parents on the average duration of illness length, how long should you state for each of the following?

  • Acute otitis media
  • Common cold
  • Acute sore throat / acute pharngitis / acute tonsillitis
  • Acute thinosinusitis
  • Acute cough / acute bronchitis
A
  • Acute otitis media - 4 days
  • Common cold - 1/2 weeks
  • Acute sore throat / acute pharngitis / acute tonsillitis - 1 week
  • Acute thinosinusitis - 2.5 weeks
  • Acute cough / acute bronchitis 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is bronchiectasis?

A

Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.

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

What can cause bronchiectasis?

A
  • Cystic fibrosis
  • Post-infective (recurring) e.g. tuberculosis, measles, pertussis, pneumonia
  • Bronchial obstruction e.g. lung cancer/foreign body
  • Immunodeficiency e.g. selective IgA, hypogammaglobulinaemia
  • Allergic bronchopulmonary aspergillosis (ABPA)
  • Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
  • Yellow nail syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of Bronchiectasis?

A
  • Sputum production (purulent during infective exacerbations)
  • Persistant cough
  • Fever
  • Wheeze can be present (25%)
  • Recurrent ‘chest infections’
  • Clubbing
  • Course inspiratory crackles
  • CXR - ‘tram tracks’ opacities of bronchi and bronchioles (see image)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What investigations would you do in suspected Bronchiectasis?

A

Bedside:

  • Smoking Hx or exposure
  • Respiratory examination

Other:

  • Sputum culture - identify pathogens
  • CXR - exclude other pathology + look for ‘tram tracks’
  • Post-bronchodilator spirometry - assess severity of airflow obstruction
  • Chloride sweat test - test for CF
  • Screen for gross antibody deficiency
  • Bronchoscopy - if foreign body or malignant obstruction is suspected
  • Aspergillus screen - if Allergic bronchopulmonary aspergillosis (ABPA) is suspected
  • GI investigations - if bronchiectasis 2ndary to GORD + aspiration is suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms / signs of acute exacerbation of cystic fibrosis?

A
  • Cough
  • Mucus production
  • SoB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the airway of a pt with cystic fibrosis look like?

A
  • Airway is dilated
  • Thick, sticky mucous obstructing airway
  • Blood in mucus
17
Q

Use the mneumonic O-SHIT-ME

to recall the treatment of acute asthma

A
  • O - Oxygen - 15 L non-rebreath if needed, aim for SpO2 > 94%
  • S - Salbutamol - 2.5mg - 5mg nebulised or IV
  • H - Hydrocortisone - 100mg IV or Prednisolone 40mg PO
  • I - Ipratropium bromide - 500μg nebulised (SAMA)

Give the above 4 immediately!!

  • T - Theophylline (acutally Aminophylline IV)
  • M - Magnesium IV
  • E - Escalate care (senior + consider intubation and ventilation)
18
Q

What are the features of an acute exacerbation of asthma in children?

A
  • Wheeze (chest may become silent = severe)
  • SoB
  • Tachypnoea & Tachycardia
  • Chest tightness
  • Cough
  • Inability to speak
  • Intercostal, sub-costal retraction
  • Nasal flaring
  • Tracheal tug
  • Presence of infection (viral or bacterial)
  • Recent exposure to allergens / exercise
19
Q

In addition to the O-SHIT-ME mneumonic for managing varying severities of acute exacerbations of asthma, an Abx may be prescribed … which and why?

A

Macrolide Abx

e.g. Clarithromycin, erythromycin or azithromycin

Reason: this is only done for exacerbations triggered by bacterial URTI - the most common causative organism for this is …

Mycoplasma pneumoniae (sensitive to macrolides)

20
Q

What vaccinations are reccomended in asthma?

A

Influenza

&

Pneumococcal

  • Asthma pts aren’t more likely to get flu, but are more likely to get serious complication as it exacerbates their symptoms due to increased inflammation
  • Flu can also lead to pneumonia
  • Flu/coryzal symptoms: fever, cough, sore throat, rhinorrhoea, body aches, headache, chills, fatigue
21
Q

How is flu treated in asthma patients?

A

Anti-virals

e.g. Peramivir or Oseltamivir

  • Start treatment ASAP!!
  • Works best when started within 48hrs of symptoms starting
22
Q

What factors influence a patients PEFR (Peaky Expiratory Flow rate)?

A
  1. Age
  2. Height
  3. Ethnicity
23
Q

How long does a patient record their PEFR and how often when diagnosing asthma?

How is this different in occupational asthma?

A

Diagnosis:

  • Record PEFR twice daily (morning + bedtime) - for 2-4 weeks

Occupational asthma diagnosis:

  • Record PEFR every 2-4 hrs over several weeks
24
Q

Describe how FEV1 , FVC and FEV1 / FVC change in Obstructive and Restrictive Lung disease?

A

Obstructive:

  • FEV1 : ↓↓ (to <80% of predicted)
  • FVC : ↓ (can be normal but if decreased is to lesser extent that FEV1)
  • FEV1 / FVC : < 70%

N.B. Severity of obstruction is determined by degree of ↓ in FEV1 (as % of predicted)

Restrictive:

  • FEV1 : ↓ (to <80% of predicted)
  • FVC : ↓ (to <80% of predicted)
  • FEV1 / FVC : ≥ 70% (normal or increased)
25
Q

In an assessment of pts response to bronchodilators, what % increase in FEV1 post-bronchodilators in considered significant? (indivative of Asthma)

A

> 12% increase in FEV1 ~ 20 mins after bronchodilator therapy (often 400μg salbutamol)

(among patients with obstructive lung disease not restrictive)

26
Q

What is Cystic Fibrosis?

A

An autosomal recessive disorder which causes increased viscosity of secretions from exocrine glands e.g. lung & pancreas​

27
Q

What causes cystic fibrosis?

A

Defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR)

This gene codes a cAMP-regulated chloride Cl - channel

28
Q

What is the most common mutation that causes cystic fibrosis?

A

Delta F508 on the long arm of chromosome 7

29
Q

What is the carrier rate for a mutation affecting CFTR (causing cystic fibrosis)?

A

1 in 25

30
Q

Which organisms are likely to colonise in cystic fibrosis patients?

A
  1. Staphylococcus aureus
  2. Pseudomonas aeruginosa
  3. Aspergillus
  4. Burkholderia cepacia
31
Q

How is cystic fibrosis diagnosed?

A

Chloride sweat test

Pts with CF have high sweat [chloride] i.e. > 60 mEq/l

Causes of false-positives on chloride sweat test include:

  • most common reason = skin oedema due to hypoalbuminaemia/ hypoproteinaemia secondary to pancreatic exocrine insufficiency
  • malnutrition
  • adrenal insufficiency
  • glycogen storage diseases (GSDs - inherited genetic disorders)
  • nephrogenic diabetes insipidus
  • hypothyroidism
  • hypoparathyroidism
  • G6PD deficiency
32
Q

What are the features of cystic fibrosis?

A
  • Recurrent chest infections (most common presentation)
    • Prolonged ‘wet’ cough
  • Chronic sinusitis
  • Neonatal period:
    • Meconium ileus (bowel obstruction due to thicker meconium than norm) - in 10% of cases this can cause bowel perforation and meconium peritonitis
    • Prolonged jaundice (less common)
  • Failure to thrive
  • Liver - blocked biliary duct –> steatorrhoea (fatty stool due to reduced fat absorption by intestine)
  • Salty sweat
  • Male / female infertility
  • Short stature
  • Clubbing
  • Nasal polyps
  • Voracious appetite - due to malabsorption so body desires more food for nutrients
  • Diabetes mellitus
  • Osteoporosis
  • Delayed puberty
  • Rectal prolapse (due to bulky stools)
33
Q

How is cystic fibrosis managed?

A
  • Daily chest physiotherapy & postural drainage (parents educated on how to do this)
  • High calorie & high fat diet
  • Minimise / avoid contact with other CF patients - to prevent cross infection
  • Vitamin supplementation - A, D, E and K (these are the fat-soluable vitamins that often aren’t absored in CF)
  • Pancreatin - pancreatic enzyme supplements /w meals
    • PPI e.g lansoprazole - used to provide a more alkaline environment which favours pancreatic enzyme function
  • Oral Abx e.g. amoxicillin for acute respiratory infections
  • Inhaled mucolytic e.g. dornase alfa
  • Lactulose (laxative, non-absorabable sugar) - used to treat meconium ileus
  • Heart & Lung transplants
34
Q

What medication can be used to treat CF patients who are homozygous for delta F508 mutation?

How does this medication work?

A

Ivacaftor with or without Lumacaftor

  • Ivacaftor = a potentiator of CFTR that already exists at the cell surface, increasing the probability that the defective channel will open and allow chloride ions through
  • Lumacaftor = ​increases the no. of CFTR proteins that are transported to the cell surface
35
Q

When is most CF diagnosed?

A

During newborn screening programmes

e.g. newborn bloodspot test

  • 90-95% of of children with CF are diagnosed shortly after birth via this test
  • ~ 5% of pts are diagnosed after the age of 18
36
Q

Which medication used in the management of Asthma in 5-16 yrs and adults isn’t used in under 5’s?

A

LABA’s

e.g. salmeterol, formoterol

Year 4 - Paediatrics (16 decks)

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