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3a Notes AC > Paeds Resp > Flashcards

Paeds Resp Flashcards

1
Q

Winter epidemic

Epidemiology and RF for Bronchiolitis

A

Most common serious respiratory infection in infancy, 90% below 10months old. 2-3% of infected infants end up in hospital.

Typical Disease of U1s

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2
Q

Causes of Bronchiolitis

A

RSV - 90% of cases
Can also get coinfected with other viruses

Other: parainfluenza, rhinovirus, adenovirus, influenza, metapneumovirus

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3
Q

Lumen

Pathophysiology of Bronchiolitis

A

Virus prouduces mucus and swells the already narrow lumen of infant. Air exchange at alveoli affected

Adults=larger lumen of airways = little impact of virus

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4
Q

Signs on Auscultation

Signs and Symptoms of Bronchilolitis

A
  • Coryzal Symptoms
  • Cough and Breathlessnes
    Others
  • Respiratory distress symptoms
  • Mild fever and apnoea can occur

Auscultation=Fine end-inspiratory crackles +prolonged expiration/wheeze

Apnoea (Transeint cessation of respiration)

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5
Q

Complications of Bronchiolitis

A
  • Respiratory Distress
    Feeding difficulty due to dyspnoea (SOB) leads to admission
  • Bronchiolitis obliterans (permanenent damage to airways)
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6
Q

Typical Course of Bronchiolitis

A
  • Starts of as URTI with Coryza
    50% children get better by this stage
  • Chest symptoms after day 1-2
  • Symptoms worst day 3-4
  • Usually last 7-10 days

Full recovery made within 2 weeks

Bronchiolitis in Infancy = Increased Viral induced wheeze during childhood

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7
Q

Bronchilolitis is common in U1s

Protective factor for Bronchiolitis

A

Maternal IgG provides protection to neonates

IgG longterm
IgM short term

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8
Q

Investigations for Bronchiolitis

A

Pulse Oximetry & Routine Investigations
CBG and CXR only when Resp Failure suspected

immunofluorescence of nasopharyngeal secretions may show RSV

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9
Q

Indications that hospital is required for bronchiolitis

A
  • Apnoea
  • O2 Saturations <92%
  • Central Cyanosis
  • RR above 70 (HCP consider @ 60)
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10
Q

Management of Bronchiolitis

A
  • Nasal O2 if saturations below 92%
  • Nasogastric feeding for infants unable to feed

Nasal Suction with saline drops used for infant w/ excessive secretions

Ventilation may be required in extreme cases

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11
Q

MAB

Vaccine for Bronchiolitis

A

Pavlizumab - monthly vaccine given as preventative for high risk babies (premature, Congenital diseases)

Only provides passive protection - therefore require monthly topup

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12
Q

How to determine poor ventilation in bronchiolitis

How to determine if ventialtion is required or not

A

Take Capillary Blood Gas
* Rising pCO2 show airways have collapsed, unable to clear waste CO2
* Falling pH - Respiratory Acidosis, raised CO2. If hypoxic then T2 Resp Failure

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13
Q

What is Viral Induced wheeze

A

Acute wheezy illness caused by viral infections (RSV/Rhinovirus)
narrrow small airways constrict due to increase in inflammation and oedema

Common in children 1-3y

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14
Q

Presentation of Viral Induced Wheeze

A
  • SOB
  • May have signs of Respiratory Distress
  • Expiratory Wheeze throughout chest
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15
Q

Episodic Viral Wheeze Vs Multiple Trigger Wheeze

A
  • Episodic: Wheeze only when viral URTI
  • Multiple: Wheeze triggered by excercise, allergens & Cigarette smoke

Risk of developing Asthma higher in multiple trigger than episodic

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16
Q

Management of Viral Induced Wheeze

A

Symptomatic treatment only
* 1st line: Salbutamol (Short acting beta 2 agnosist) or anticholinergic via spacer
* 2nd line: Montelukast or inhaled coticosteroid
* Oral Predinslone rarely used for childen outside hospital

Multiple trigger wheeze: inhaled corticosteroid or montelukast 4-8/52wk

Encourage parents to stop smoking

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17
Q

Both have low grade fever

Viral Induced Wheeze Vs Bronchiolitis

More complications seen in Bronchiolitis

A
  • Bronchiolitis: ‘Wet lungs’ More secretions
  • Viral Wheeze: Bronchospasm

Bronchiolitis: Days Viral Wheeze: Hours - need bronchodilators

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18
Q

What is Croup

A

URTI seen in infants & toddlers causing oedema in larynx

Common in Autumn

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19
Q

Epidemiology of Croup

Age and Causative viruses

A
  • Commonly seen in children 6mths to 2 years
  • Caused by Parainfluenza
  • Others: Influenza, Adenovirus, RSV
20
Q

Features of Croup

Hint: No Wheeze

A
  • Stridor
  • Barking cough - worse at night (tracheal oedema)
  • Fever - Low Grade
  • Coryzal Symptoms
  • Increase work of Breathing

X rays show: Steple Sign and/or Thumb sign

21
Q

Management Croup

A
  • Manage at home with rest and hydration
  • Oral dexamathasone (0.15mg/kg) given every 12hrs
  • Alternative: prednislone

Emergency: high flow Oxygen & Nebulised Adrenaline

22
Q

Complications of Croup

A

Central cyanosis, reduced level of consciousness suggest impending complete airway obstruction -> intubation

23
Q

Causes of Stridor in children

Stridor: externally audible, high-pitched sound caused by turbulent

airflow due to obstruction of the upper respiratory tract

A
  • Croup
  • Acute epiglottitis
  • Inhaled Foreign Body
  • Laryngomalacia (congenital abnormality presents at week 4)
24
Q

Parainfluenza virus

Mild, Moderate & Severe Croup

URTI seen in infants & toddlers causing oedema in larynx

A

Mild: Occasional barking cough
Moderate: frequent barking cough, audible stridor at rest
Severe: frequent barking cough, prominent stridor (inspiratory, sometimes expiratory) significant distress and RDS signs

25
Q

What is is Acute Epiglottitis

A

Inflammation & Swelling of epiglottis due to infection. Life threatening.

Typically caused by Haemophilus influenza type B - Hib Vaccine Protectiv

Caution when unvaccinated child when they present with croup as it can be Epiglottitis

26
Q

Presentation of Acute Epiglottitis

A
  • Rapid Onset
  • High Temperature
  • Stridor
  • Drooling
  • Sore throat
  • Tripod Position: Pt finds it easier to sit fwd with elbows on knees
27
Q

Diagnosing Acute Epiglottitis

A
  • Made by direct visualisation only by senior/airway trained staff
  • X rays: Thumb sign & Steeple Sign
  • X rays can also rule out foreign bodies

Must not start investigating too invasively risk of aspiration.

28
Q

Management Acute Epiglottitis

A

Do not distress patient and inform seniors
* Endotracheal intubation to secure airway (not in all cases)
* IV antibiotics
* Oxygen

29
Q

Complications of Epiglottitis

A

Common complication is the development of epiglottic abscess which is a collection of pus around the epiglottis.
Death can be caused if airway not secured

30
Q

Pneumonia in Children

A

Infection of the lung tissue causing inflammation and sputum filling airways and alveoli.
* Bacterial oft caused by: Strep Pneumoniae (others Group A and B Strep, Staph Aureus etc)
* Viral: RSV, Parainfluenza, Influenza

Seen as consolidation on X ray

31
Q

Signs and Symptoms of Pneumonia

in Children

A
  • Wet cough
  • Fever
  • Tachypnea, Tachycardia
  • Hypoxia
  • Confusion
  • Bronchial breath sounds: harsh breath sounds that are equally loud on inspiration and expiration

- Focal coarse crackles

  • Dullness to percussion due to tissue collapse or consolidation
32
Q

Investigation of Pneumonia

in Children

A

CXR
Throat swabs for causative organism

33
Q

Complications of Pneumonia

in Children

A

Can be associated with a **pleural effusion ** this can become infected where it is then termed an empyema. Can lead to sepsis

34
Q

Management Pneumonia

in Children

A
  • Amoxicillin is first-line for all children with pneumonia
  • Macrolides may be added if there is no response to first line therapy erythromycin, clarithromycin or azithromycin

Macrolides should be used if mycoplasma or chlamydia is suspected

In pneumonia associated with influenza, co-amoxiclav is recommended

35
Q

What is Cystic Fibrosis?

CFTR GENE

A

Autosomal recessive disorder, causing increased viscosity of mucuos secretions, due to defective CFTR gene which codes Cl channel

1 in 2500 affected

Carrier rate is 1:25 so 25% chance

36
Q

Consequence of Cystic Fibrosis

Pancreas, Airway & Testes

A
  • Thick billiary and pancreatic secretions: blocked ducts = low digestive enzymes
  • Thick airway secretions: reduce airway clearance and easy for bacteria to colonise
  • Absence of Vas Deferens: Infertility

Common bacteria: Staph Aureus, P. Aeruginosa, Aspergillius

37
Q

Presentation of Cystic Fibrosis

Include ssome adults

A
  • Chronic Cough with thick sputum
  • Steatorrohea with abdo pain
  • Recurrent infections
  • Failure to thrive - Short stature
  • Nasal Polyps
  • Finger Clubbing
  • Rectal Prolapse - due to bulky stools

Delayed Puberty
Diabetes Mellitus
Infertility in Males
Subfertility in Females (takes longer to get pregnant)

38
Q

Diagnosis of Cystic Fibrosis

A
  • Newborn screening Day 5: blood spot test & Meconium ileus
  • Sweat Test: Test sweat for Chloride levels (high) GOLD STANDARD
  • Genetic Testing: CFTR mutation check during pregnancy

Meconium ileus is when meconium is sticky and thick which gets stuck in the gut and obstructs the bowel.
Cause of False +ve Sweat test: Malnutrition, Adrenal Insufficiency, Glycogen storage disease, diabetes insipidus.
Cause of Flase -ve Sweat test: Skin Oedema due to Hypoalbuanemia 2ndry to pancreatic exocrine insuffiency

39
Q

Cystic Fibrosis Management

what are some of the risky bacteria?

A

Need Specialist MDT
* Regular physiotherapy and postural drainage
* High calorie/high fat diet
* Minimise contact with other CF patients
* Vit & pancreatic ennzyme supplementation
* Chronic infection with Burkholderia cepacia contraindication to lung transplantation (can’t have it)

Lumacaftor for Pts with delta F508 mutation, increases CFTR proteins

Pseudomonas Aeruginosa bacteria may become resistant to Abx, PA can lead to morbidity and mortality

40
Q

Prognosis of Cystic Fibrosis

A
  • Life expectancy: 47y
  • Pancreatic insufficiency
  • CF related diabetes requiring insulin
  • Development of Liver disease

Absent Vas Deferes in most males rendering them infertile

41
Q

Acute Asthma Presentation

in Children

Moderate Vs Severe Vs Life threatening

A

Moderate: Able to talk, SpO2 above 92%
Severe: Inability to complete sentences SpO2 below 92% PEF: 33-50% use of accessory muscles Raised HR and RRR
Life threatening: SpO2 below 92%, PEF below 33% Silent Chest, Very unresponsive, Cyanosis, Poor respiratory effort

42
Q

Asthma RFs

A
  • Atopy: Eczema, hayfever & Allergies
  • FH
  • Triggers include Cold air, excercise, emotions, smoking and certain drugs, dust mites.
43
Q

Asthma Pathophysiology

A
  • Bronchial inflammation leading to Oedema, excess mucus production, cellular infiltration (WBC)
  • Bronchial hyperresponsiveness - exaggerrated muscle contractions to inhaled and physical stimuli leading to narrowing of airways.

Smooth muscle is always hypersensitive

44
Q

Asthma Investigations

There’s no Gold Standard

A
  • Diagnosis usually made with response to treatment
  • Spirometry with reversibility testing (in children aged over 5 years)
  • Direct bronchial challenge test with histamine or methacholine
  • Fractional exhaled nitric oxide (FeNO)
  • Peak flow variability measured by keeping a diary of peak flow measurements several times a day for 2 to 4 weeks

FEV1 is reduced FVC remains normal resulting in an FEV1:FVC ratio <80%

U5 based on history and examination, response to treatment, skin prick test can help identify sensitisation to certain allergens.

45
Q

Acute Asthma Management

in Children

A

Mild To Moderate Bronchodilator therapy: Beta 2 agonist via spacer (can use close fitting mask), One puff every 30-60s 10 times

Steroid Therapy: 3-5 days, 2-5Y 20mg OD >5Y 40mg OD

46
Q

Chronic Asthma Management

Children 5
Children 5-12

A

Children 5-16: SABA -> ICS -> LTRA -> LABA
Children 5: SABA -> Moderate ICS -> LTRA

If neither work consult specialist Daily Steroids may be required

47
Q

General Asthma Symptoms in children

A
  • Wheeze, cough and breathlessness typically worse at night (diurnal variation)
  • Wheeze and breathlessness with non-viral triggers
  • FH of atopic disease
  • Interval symptoms (nocturnal cough, morning SOB)

Asthma should be suspected in any child with wheezing on more than one ocassion.

3a Notes AC (20 decks)

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