Brainscape's Knowledge GenomeTM

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


See full index

Finals > Paeds: Resp > Flashcards

Paeds: Resp Flashcards

1
Q

Cystic Fibrosis

what is it

A

an autosomal recessive genetic condition affecting mucus glands

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

Cystic Fibrosis

what is it caused by
​

A

a genetic mutation of the cystic fibrosis transmembrane conductance regulatory gene

on Ch7

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

Cystic Fibrosis

what is the most common variant of the cystic fibrosis transmembrane conductance regulatory gene

A

the delta-F508 mutation: codes for cellular channels, particularly a type of chloride channel

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

Cystic Fibrosis

what causes a lack of lipase in the digestive tract

A

thick pancreatic and biliary secretions that cause a blockage of the ducts

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

Cystic Fibrosis

what causes the susceptibility to airway infections and bacterial colonisation

A

low volume thick airway secretions that reduce airway clearance

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

Cystic Fibrosis

what causes male infertility

A

congenital bilateral absence of the vas deferens

the sperm have no way of getting from the testes to the ejaculate

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

Cystic Fibrosis

what is the mode of inheritence

A

autosomal recessive

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

Cystic Fibrosis

both parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?

A

2 in 3

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

Cystic Fibrosis

when is it screened

A

at birth with the newborn bloodspot test

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

Cystic Fibrosis

what is often the first sign

A

meconium ileus (not passing meconium within 24h)

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

Cystic Fibrosis

sx

A
  • chronic cough
  • thick sputum production
  • recurrent resp tract infections
  • steatorrhoea
  • abdo pain and bloating
  • salty kisses
  • failure to thrive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cystic Fibrosis

why does steatorrhoea occur

A

due to the lack of fat digesting lipase enzymes

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

Cystic Fibrosis

signs

A
  • low weight or height
  • nasal polyps
  • finger clubbing
  • crackle + wheezes on auscultation
  • abdo distention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are causes of clubbing in children

A
  • hereditary clubbing
  • cyanotic heart disease
  • infective endocarditis
  • cystic fibrosis
  • TB
  • IBD
  • liver cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cystic Fibrosis

what are the 3 key methods for establishing a diagnosis

A
  • newborn blood spot testing
  • sweat test
  • genetic testing for CFTR gene during pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cystic Fibrosis

what is the gold standard for diagnosis

A

sweat test

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

Cystic Fibrosis

what happens during a sweat test

A
  • pilocarpine applied to skin patch
  • electrodes places on either side and current is passed between electrodes
  • this causes skin to sweat
  • sweat absorbed by filter paper
  • sent to lab for Chloride conc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cystic Fibrosis

what is the diagnostic concentration in the sweat test

A

> 60mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cystic Fibrosis

why does bacteria colonate in these pts easily

A

they struggle to clear secretions in the airway

perfect environment with moisture and oxygen to colonise

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

Cystic Fibrosis

what are key microbial colonisers

A

Staph aureus

pseudomonas

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

Cystic Fibrosis

how do pts prevent staph aureus infection

A

take long term prophylactic flucloxacillin

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

Cystic Fibrosis

why should CF patients stay away from each other

A

risk of spreading pseudomonas

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

Cystic Fibrosis

why are pseudomonas difficult

A

resistant to multiple antibiotics

significant increase in morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cystic Fibrosis

trx for Pseudomonas colonisation

A

long term nebulised abx: tobramycin

PO ciprofloaxin alternatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cystic Fibrosis

mnx

A
  • chest physio
  • exercise
  • high calorie diet
  • CREON tablets
  • prophylactic flucloxacillin
  • treat chest infections
  • salbutamol
  • neb DNase (dornase alfa)
  • neb hypertonic saline
  • vaccinations: pneumococcal, influenza, varicella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cystic Fibrosis

what is Nebulised DNase (dornase alfa)

A

an enzyme that can break down DNA material in respiratory secretions, making secretions less viscous and easier to clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cystic Fibrosis

why do they need follow up every 6m

A
  • sputum culture for pseudomonas

- screening for diabetes, osteoporosis, vitamin D deficiency and liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bronchiolitis

what is it

A

inflammation and infection in the bronchioles, the small airways of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bronchiolitis

what is it caused by

A

Respiratory syncytial virus (RSV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Bronchiolitis

what age is it most common in

A

<6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Bronchiolitis

what is heard on auscultation

A

wheeze and crackles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bronchiolitis

why does it have a significant effect on infants and not adults

A

the airways of infants are very small to begin with

so even the smallest amount of inflammation and mucus in the airway has a significant effect on the infant’s abaility to circulate air to the alveoli and back out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Bronchiolitis

presentation

A
  • Coryzal sx
  • resp distress signs
  • dyspnoea
  • tachypnoea
  • poor feeding
  • mild fever
  • apnoeas
  • wheeze and crackles on auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Bronchiolitis

what are coryzal sx

A
  • snotty nose
  • sneezing
  • mucus in throat
  • watery eyes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Bronchiolitis

signs of respiratory distress (9)

A
  1. raised RR
  2. use of accessory muscles
  3. intercostal recessions
  4. subcostal recessions
  5. nasal flaring
  6. head bobbing
  7. tracheal tugging
  8. cyanosis
  9. abnormal airway noises
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Bronchiolitis

what is wheezing

A

whistling sound caused by narrowed airways, typically heard during expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is grunting

A

caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is stridor

A

a high pitched inspiratory noise caused by obstruction of the upper airway, for example, in croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Bronchiolitis

what is the typical RSV course

A
  • starts with URTI: coryzal sx
  • half get better, half develop chest sx over the next 1-2d
  • sx last 7-10d
  • fully recover in 2-3w
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Bronchiolitis

what day are sx generally worst on

A

day 3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Bronchiolitis

what are infants more likely to have during childhood if they have had bronchiolitis as an infant

A

viral induced wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Bronchiolitis

reasons for admission

A
  • <3m
  • preexisting condition: prem, Down’s, CF
  • 50-75% less of their normal intake of milk
  • clinical deyhdration
  • RR>70
  • O2 sats <92%
  • mod-sev resp distress
  • apnoeas
  • parents not confident
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Bronchiolitis

mnx

A

supportive:

  • adequate intake,
  • saline nasal drops and suctioning
  • O2 if <92%
  • ventilatory support if required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Bronchiolitis

mnx: why is it important to avoid overfeeding

A

a full stomach will restrict breathing

start with small frequent feeds and gradually increase as tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Bronchiolitis

what are the steps in order of severity for ventilatory support

A
  1. high flow humidified O2
  2. CPAP
  3. intubation + ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Bronchiolitis

what is high flow humidified O2

A

via tight nasal cannula

delivers air + O2 continuously with some added pressure

it adds positive end-expiratory pressure to maintain the airway at the end of expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Bronchiolitis

what is CPAP

A

sealed nasal cannular performs similarly to high flow (Airvo ot Optiflow)

but can deliver much higher and more controlled pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Bronchiolitis

what does intubation and ventilation involve

A

inserting an endotracheal tube into the trachea to fully control ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bronchiolitis

what inx is useful in severe resp distress and in monitoring children who are having ventilatory support

A

capillary blood gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Bronchiolitis

what are the most helpful signs of poor ventilation

A
  • rising pCo2

- falling pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Bronchiolitis

what does rising pCO2 show

A

the airways have collapsed and can’t clear waste CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Bronchiolitis

what does a falling pH show

A

CO2 is building up and not able to buffer the acidosis this creates

this is resp acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Bronchiolitis

which babies are high risk

A

ex-premature

congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Bronchiolitis

what is given to high risk babies

A

Palivizumab

55
Q

Bronchiolitis

what is Palivizumab

A

a monoclonal antibody that targets RSV

monthly injection is given as prevention against RSV

56
Q

Bronchiolitis

why is Palivizumab not a true vaccine

A

it does not stimualte the infant’s immune response

it provided passive protection

57
Q

Viral-Induced Wheeze

what is it

A

an acute wheezy illness caused by a viral inection

58
Q

Viral-Induced Wheeze

pathophysiology

A

virus

inflammation and oedema, swelling the walls of the airways

smooth muscle constricts

wheeze due to air flowing through these narrow airways

59
Q

Viral-Induced Wheeze

what is Poiseuille’s law

A

flow rate is proportional to the radius of the tube to the power of 4

slight narrowing of an infant’s airway leads to a proportionally larger restriction in airflow.

60
Q

Viral-Induced Wheeze

what are they more at risk of developing in later life

A

asthma

61
Q

Viral-Induced Wheeze

what is the difference between asthma and viral induced wheeze

A

viral induced wheeze:

  • presenting before 3y
  • no atopic hx
  • only occurs during viral infections

asthma:

  • other triggers: cold, dust, emotions
  • reversible airflow obstruction
62
Q

Viral-Induced Wheeze

presentation

A
  • initially viral illness
  • SOB
  • signs of resp distress
  • expiratory wheeze throughout the chest
63
Q

what could a focal wheeze show

A

focal airway obstruction such as an inhaled foreign body or tumour

64
Q

Viral-Induced Wheeze

mnx

A

same as acute asthma in children

65
Q

what is the most common side effect of salbutamol

A

tachycardia

66
Q

Acute asthma

signs of moderate severity

A
  • Peak flow > 50 % predicted

- Normal speech

67
Q

Acute asthma

signs of severe severity

A
  • Peak flow < 50% predicted
  • Saturations < 92%
  • Unable to complete sentences in one breath
  • Signs of respiratory distress
  • RR:
    > 40 in 1-5 years
    > 30 in > 5 years
  • HR
    > 140 in 1-5 years
    > 125 in > 5 years
68
Q

Acute asthma

signs of life threatening severity

A
  • Peak flow < 33% predicted
  • Saturations < 92%
  • Exhaustion and poor respiratory effort
  • Hypotension
  • Silent chest
  • cyanosis
  • altered consciousness/confusion
69
Q

Acute asthma

stepwise approach in mnx

A
  1. salbutamol inhaler via spacer (10 puffs/2hr)
  2. nebulisers: salbutamol/ipratropium bromide
  3. PO prednisolone (1mg/kg OD for 3d)
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline
70
Q

Acute asthma

why Consider monitoring the serum potassium when on high doses of salbutamol

A

salbutamol causes potassium to be absorbed from the blood into the cells.

71
Q

Croup

what age does it affect

A

6m - 2y

72
Q

Croup

what is it

A

URTI causing oedema in the larynx

73
Q

Croup

classic cause

A

parainfluenza virus

also:
influenza
adenovirus

74
Q

Croup

croup caused by diphtheria leads to what

A

epiglottitis

75
Q

Croup

presentation

A
  • ‘barking’ cough occurring in clusters
  • low grade fever
  • increased work of breathing
  • hoarse voice
  • stridor
76
Q

Croup

conservative mnx

A

most cases can be managed at home:

  • fluids + rest
  • sit child up + comfort them
  • hand wash
  • stay off school
77
Q

Croup

medical mnx

A

DEXAMETHASONE
single dose 150mcg/kg
repeated after 12h if required

78
Q

Croup

medical mnx where dexamethasone trx is not available (in GP)

A

prednisolone

79
Q

Croup

Stepwise options in severe croup

A
  • PO dexamethasone
  • Oxygen
  • neb budesonide
  • neb adrenaline
  • intubation + ventilation
80
Q

Whooping Cough

cause

A

Bordetella pertussis (a gram negative bacteria)

81
Q

Whooping Cough

presentation

A
  • starts with mild coryzal sx, low grade fever, dry cough
  • 1w later, paroxysmal cough + coughing fits until out of breath
  • loud inspiratory whoop when the coughing ends
  • apnoea
82
Q

Whooping Cough

patients can cough so hard they ___

A

faint, vomit or even develop a pneumothorax

83
Q

Whooping Cough

inx to confirm dx

A

nasopharyngeal or nasal swab with PCR testing or bacterial culture

within 2-3w of onset of sx

84
Q

Whooping Cough

inx if cough has been present >2w and aged 5-16y

A

anti-pertussis toxin immunoglobulin G

in the oral fluid

85
Q

Whooping Cough

inx if cough has been present >2w and aged over 17y

A

anti-pertussis toxin immunoglobulin G

in the blood

86
Q

Whooping Cough

is it notifiable

A

yes

87
Q

Whooping Cough

mnx

A

supportive

88
Q

Whooping Cough

mnx for vulnerable or acutely unwell patients, those <6m and patients with apnoeas, cyanosis or patients with severe coughing fits

A
  • may need to admit
  • ## azithromycin /erythromycin/clarithromycin within first 21d
89
Q

Whooping Cough

which close contacts are given prophylactic abx

A

close contacts in a vulnerable group e.g. pregnant, unvaccinated infants, healthcare workers with close contact with children or pregnant women

90
Q

Whooping Cough

prognosis

A

‘100 day cough’

sx typically resolve within 8w

91
Q

Whooping Cough

key complication

A

bronchiectasis

92
Q

Ddx for stridor

A
  • croup
  • epiglottitis
  • foreign body
93
Q

Epiglottitis

cause

A

haemophilus influenza type B

94
Q

unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling

what is it

A

epiglottitis - a emergency

95
Q

Epiglottitis

presentation

A
  • sore throat
  • stridor
  • drooling
  • tripod position (sat forward with hand on each knee)
  • high fever
  • difficulty or painful swallowing
  • muffled voice
  • scared + quiet child
  • septic + unwell appearance
96
Q

Epiglottitis

should you examine the throat

A

no

97
Q

Epiglottitis

inx

A

lateral xray of the neck

98
Q

Epiglottitis

what will the lateral xray of the neck show

A

thumb sign” or “thumbprint sign”.

soft tissue shadow that looks like a thumb pressed into the trachea

caused by the oedematous + swollen epiglottis

99
Q

Epiglottitis

immediate mnx

A
  • do not distress child
  • alert most senior paediatrician + anaesthetist
  • ensure airway is secure:
    may need intubation or tracheostomy
100
Q

Epiglottitis

additional trx once airway is secure

A
  • IV ceftriaxone

- dexamethasone

101
Q

Epiglottitis

common complication

A

epiglottic abscess

collection of pus around the epiglottis.

102
Q

Epiglottitis

trx of an epiglottic abscess

A

similar to epiglottitis

103
Q

Chronic Asthma

Children are usually not diagnosed with asthma until they are at least ___

A

2-3y

104
Q

Chronic Asthma

inx where there is intermediate probability of asthma or diagnostic doubt

A
  • spirometry w/ reversibility testing (>5y)
  • direct bronchial challenge test w/ histamine or methacholine
  • fractional exhaled NO (FeNO)
  • peak flow diary
105
Q

Chronic Asthma

medical therapy <5y

A

1) SABA
2) + low does ICS or LTRA (montelukast)
3) + other option from step 2
4) refer

106
Q

Chronic Asthma

medical therapy aged 5-12y

A

1) SABA
2) + low does ICS
3) + LABA (salmeterol) only if good response
4) switch to medium dose ICS + consider adding PO LTRA, PO theophylline
5) switch to high dose ICS
6) refer. may need PO steroids

107
Q

Chronic Asthma

medical therapy aged >12y (same as adults)

A

1) SABA
2) + low dose ICS
3) + LABA (salmeterol)
4) switch to medium dose ICS + consider trial of PO LTRA, theophylline or inh LAMA (tiotropium)
5) switch to high dose ICS + combine trx from step 4 + PO SABA. Refer
6) + PO steroids

108
Q

Chronic Asthma

mum worried that ICS slows growth. What do you say?

A
  • can cause a small reduction in final adult height of up to 1cm when using long term (>12m)
  • ICS is used to prevent poorly controlled asthma and asthma attacks that could lead to higher doses of PO steroids
  • poorly controlled asthma can lead to more significant impact on growth + development
  • regular asthma reviews to ensure they are growing well and on the minimal dose required to effectively control symptoms.
109
Q

Pneumonia

characteristic chest signs of pneumonia

A
  • bronchial breath sounds
  • focal coarse crackles
  • dullness to percussion
110
Q

Laryngomalacia

what is it

A

the larynx above the vocal cords (the supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction.

‘floppy airway’

111
Q

Laryngomalacia

what is stridor

A

a harsh whistling sound caused by air being forced through an obstruction of the upper airway

112
Q

Laryngomalacia

what is the structural change

A

the aryepiglottic folds are shortened, which pulls on the epiglottis and changes it shape to a characteristic “omega” shape.

The tissue surrounding the supraglottic larynx is softer and has less tone in laryngomalacia, meaning it can flop across the airway

113
Q

Laryngomalacia

at what age does it peak

A

6m

114
Q

Laryngomalacia

presentation

A
  • inspiratory stridor
  • more prominent when feeding, upset, lying on back or URTI
  • difficulties feeding
  • not usually associated with resp distress
115
Q

Laryngomalacia

mnx

A

no interventions are required and the child is left to grow out of the condition.

Rarely tracheostomy may be necessary

116
Q

Chronic Lung Disease of Prematurity

what is it aka

A

bronchopulmonary dysplasia

117
Q

Chronic Lung Disease of Prematurity

features

A
  • resp distress syndrome
  • low O2
  • increased work of breathin g
  • poor feeding + weight gain
  • crackles + wheezes on chest auscultation
  • increased susceptibility to infection
118
Q

Chronic Lung Disease of Prematurity

prevention before birth

A
  • corticosteroid to mother that show signs of premature labour at <36w gestation
119
Q

Chronic Lung Disease of Prematurity

once the neonate is born, the risk can be reduced by?

A
  • CPAP rather than intubation + ventilation when possible
  • caffeine to stimulate resp effort
  • not over- oxygenating
120
Q

Chronic Lung Disease of Prematurity

how is dx made

A
  • CXR changes
  • require O2 after 36w gestational age
  • sleep study to assess their oxygen saturations
121
Q

Chronic Lung Disease of Prematurity

mnx

A
  • may be discharged from the neonatal unit on a low dose of O2 to continue at home
  • followed up to wean the oxygen level over the first year of life.
122
Q

Chronic Lung Disease of Prematurity

what do babies with CLDP every month

A

palivizumab injections to protect against RSV to reduce risk of bronchiolitis

123
Q

Primary Ciliary Dyskinesia

aka

A

Kartagner’s syndrome

124
Q

Primary Ciliary Dyskinesia

what is it

A

an autosomal recessive condition affecting the cilia of various cells in the body

125
Q

Primary Ciliary Dyskinesia

whom is it more common in

A

consanguinity

126
Q

Primary Ciliary Dyskinesia

pathophysiology

A
  • dysfunction of motile cilia
  • build up mucus in lungs
  • good site for infection
  • similar to CF with frequent chest infections
127
Q

Primary Ciliary Dyskinesia

where is there reduced fertility

A

It also affects the cilia in the fallopian tubes of women and the tails (flagella) of the sperm in men

128
Q

Primary Ciliary Dyskinesia

what is Kartagner’s triad

A

3 key features of PCD:

  1. paranasal sinusitis
  2. bronchiectasis
  3. situs inversus
129
Q

Primary Ciliary Dyskinesia

what is situs inversus

A

where all the internal (visceral) organs are mirrored inside the body

130
Q

Primary Ciliary Dyskinesia

what is dextrocardia

A

when only the heart is reversed

131
Q

Primary Ciliary Dyskinesia

which condition is it strongly associated with

A

situs inversus

132
Q

Primary Ciliary Dyskinesia

diagnostic inx

A
  • nasal brushing or bronchoscopy to obtain sample of ciliated epithelium of the upper airway
133
Q

Primary Ciliary Dyskinesia

mnx

A

similar to CF + bronchiectasis:

  • daily physio
  • high calorie diet
  • abx

Finals (47 decks)

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