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3a > Paeds resp > Flashcards

Paeds resp Flashcards

1
Q

Give 4 symptoms of pneumonia ?

A
  • Cough (wet and productive)
  • High fever (>38.5)
  • Lethargy
  • Delirium
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2
Q

Give 5 signs of pneumonia

A
  • Tachypnoea
  • Tachycardia
  • Increased work of breathing
  • Hypoxia
  • Hypotension
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3
Q

Give 3 investigations for pneumonia

A
  • Sputum cultures and throat swabs for bacterial cultures and viral PCR
  • Blood culture
  • CXR : consolidation
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4
Q

Give 3 chest signs of pneumonia

A
  • Bronchial breath sounds
  • Focal coarse crackles
  • Dullness to percussion
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5
Q

Causes of pneumonia by age

A
  • Newborn : GBS or enterococci
  • Infant + > 5 yrs : strp pneumonia or RSV
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6
Q

Give 3 viral causes of pneumonia

A
  • RSV -> most common
  • Parainfluenza virus
  • Influenzavirus
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7
Q

What is the management for mild pneumonia ?

A

-Oral amoxicillin
- Add macrolide if no response (e.g. erythromycin)
- Co-amoxiclav in pneumonia associated with influenza

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8
Q

What is the management for severe pneumonia?

A

-Iv benzylpenicillin

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9
Q

Define croup

A

-Acute, infective, URTI causing oedema of the larynx

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10
Q

What age group does croup typically affect?

A

-6mnths to 2yrs

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11
Q

What is the most common cause of croup?

A

-Parainfluenzae

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12
Q

Give 5 symptoms of croup

A
  • ‘Barking’ cough
  • Stridor
  • Low grade fever
  • Hoarse voice
  • Increased work of breathing
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13
Q

How is croup managed if more than supportive care is needed ?

A
  • Oral dexamethasone (single dose of 0.15mg/kg)
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14
Q

Explain the different age groups affected by bronchiolitis, viral induced wheeze and asthma

A
  • > Bronchiolitis : 6mns usually (less than <1 yr)
  • > Viral induced wheeze : <3 years
  • > Asthma : >3 years
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15
Q

What is the most common viral cause of bronchiolitis ?

A

-RSV -> respiratory syncytial virus

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16
Q

What can be given to high risk babies to protect against bronchiolitis

A
  • Palivizumab -> monoclonal antibody targeting RSV.

- Given as a monthly IM injection

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17
Q

How does bronchiolitis present ?

A
  • Wheeze and crackles
  • Coryzal symptoms
  • Tachypnoea
  • Dyspnoea
  • Dry cough
  • Poor feeding
  • Mild fever
  • Apnoeas
  • Signs of respiratory distress
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18
Q

Give 8 signs of respiratory distress

A
  • Raised resp rate
  • Use of accessory muscles : sternocleidomastoid, abdominal and intercostal muscles
  • Nasal flaring
  • Heading bobbing
  • Tracheal tug
  • Cyanosis
  • Abnormal airway noises
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19
Q

what would suggest a diagnosis of pneumonia over bronchiolitis ?

A
  • High fever (>39 degrees)
  • Persistently focal crackles
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20
Q

What 6 factors would suggest admission to hospital for bronchiolitis ?

A
  • Oxygen at 92% or below
  • RR >70
  • Moderate to severe resp distress
  • 50-75% less of nomral milk intake
  • Apnoea
  • Clinical dehydration
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21
Q

How is bronchiolitis managed in hospital ?

A

Supportive

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22
Q

What is the stepwise approach to ventilation support in bronchiolitis ?

A
  1. High-flow humidified oxygen via tight nasal cannula
  2. Continuous positive airway pressure
  3. Intubation and ventilation
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23
Q

What 3 factors suggest viral induced wheeze over asthma?

A

<3 yrs

  • No atopic history
  • Only occurs following a viral infection
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24
Q

What is the presentation of a viral induced wheeze?

A
  • Evidence of a viral illness (fever, cough and coryzal symptoms) before onset of :
  • SOB
  • Expiratory wheeze throughout the chest
  • Signs of respiratory distress
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25
Q

What is cystic fibrosis ?

A

-Autosomal recessive condition affecting the mucus glands, most commonly caused by Delta-F508 mutation of CFTR gene on chromosome 7

26
Q

what is the most common mutation in CF?

A
  • Delta-F508 mutation of CFTR gene on chromosome 7
27
Q

How is CF diagnosed ?

A
  • Newborn bloodspot test
  • Sweat test : gold standard
28
Q

What is an early sign of CF

A
  • Meconium ileus
29
Q

Give 6 symptoms of CF

A
  • Chronic cough
  • Thick sputum production
  • Recurrent resp tract infections
  • Steatorrhoea
  • Abdo pain and bloating
  • Salty taste to child
  • Failure to thrive
30
Q

Give 5 signs of CF

A
  • Low weight or height on growth charts
  • Nasal polyps
  • Finger clubbing
  • Crackles and wheeze on auscultation
  • Abdo distention
31
Q

What is the gold standard test for CF?

A
  • Sweat test
  • Pilocarpine is applied to a patch on the skin, electrodes are placed either side and a small current passed between the electrodes.
  • The sweat is absorbed and tested for chloride concentration
32
Q

What chloride concentration is diagnostic for CF on a sweat test

A

> 60mmol/L

33
Q

What are 2 common microbial colonisers in people with CF?

A
  • Staph aureus : long term prophylactic flucloxacillin taken
  • Psuedomonas aeruginosa : treated with nebulised tobramycin
34
Q

What is epiglottitis ?

A

-Inflammation and swelling of the epiglottis caused by infection

35
Q

What is the cause of epiglottitis ?

A

-Haemophilus influenzae type B

36
Q

Give 5 presenting symptoms of epiglottitis

A

Rapid onset :

  • High fever
  • Sore throat
  • Drooling
  • Difficulty or painful swallowing
  • Muffled voice
37
Q

Give 4 signs of epiglottitis

A
  • Tripod position
  • Scared and quiet child
  • Septic and unwell appearance
  • Soft, whispering stridor
38
Q

How is epiglottitis diagnosed?

A
  • Lateral X-ray of the neck -> ‘thumb’ or ‘thumbprint’ sign
  • However if child is acutely unwell, don’t waste time with Ix
39
Q

How is epiglottitis managed ?

A

1) Don’t examine throat
2) Call ENT and anaestehtics
3) Intubate and IV 3rd gen cephalosporin (cefuroxime)

40
Q

What is a complication of epiglottitis ?

A

-Epiglottic abscess

41
Q

What is whopping cough and what causes it ?

A
  • URTI
  • Bordetella pertussis (gram neg)
42
Q

How does whooping cough present ?

A
  • 1 wk Preceding coryza
  • 3- 6 wks severe paroxysmal coughing fits with large inspiratory whoop.
  • Possible apnoea presentation
43
Q

How is pertussis diagnosed ?

A
  • Nasal swab with PCR testing or bacterial culture within 2 to 3 wks of symptoms
  • If cough present for >2 wks : anti-pertussis toxin immunoglobulin G on oral fluid aged 5-16 and blood if >17
44
Q

How is whooping cough managed ?

A
  • <6 mnths. = admit
  • Oral macrolide if within 21 days of cough (erythromycin)
  • Household prophylaxis
  • School exlusion : 48 hrs after starting Abx
45
Q

What is a key complication of whooping cough ?

A

-Bronchiectasis

46
Q

How does a moderate acute exaccerbation of asthma present ?

A
  • Peak flow >50% predicated
  • Normal speech
47
Q

How does a severe asthma exacerbation present ?

A
  • Peak flow <50% predicated
  • Saturations <92%
  • Unable to complete sentances in one breath
  • Signs of resp distress
  • Resp rate : >40 in 1-5 or >30 in over 5’s
  • HR : >140 in 1-5 yrs or >125 in over 5’s.
48
Q

How does a life threatening asthma exacerbation present ? (8)

A
  • Peak flow <33%
  • Saturations <92%
  • Exhaustion and poor resp effort
  • Hypotension
  • Silent chest
  • Cyanosis
  • Altered consciousness / confusion
49
Q

What are the stepwise medications used in viral induced wheeze / acute asthma

A
  • Oxygen (if <94%)
  • Bronchodilators
  • Steroids
  • Antibiotics
50
Q

What is the discharge plan in acute asthma?

A

-Can be discharged once on 6 puffs 4 hrly of salbutamol

51
Q

What is determined as mild croup

A
  • Occasional barking cough
  • No audible stridor at rest
  • No or mild suprasternal or intercostal recession
  • Child is happy and prepared to eat, drink and play
52
Q

What is defined as moderate croup

A
  • Frequent barking cough
  • Easily audible stridor at rest
  • Suprasternal and sternal wall retraction at rest
  • No or little distress and agitation
  • Child can be placated and is interest in its surroundings
53
Q

What is defined as severe croup

A
  • Frequent barking cough
  • Prominent inspiratory stridor
  • Marked sternal wall retractions
  • Significant distress and agitation, or lethargy or restlessness
  • Tachycardia and hypoxaemia
54
Q

When is a child admitted with croup

A
  • Moderate or severe
  • <6 mnths
  • Known upper airway abnormalities
  • Uncertainty about diagnosis
55
Q

what can be seen on bloods in whooping cough

A

Marked lymphocytosis

56
Q

How is asthma diagnosed in >5

A

-> Peak flow (2/3 times daily for 2 wks)
-> Spirometry with reversibility
-> FeNO can support

57
Q

What would be seen on spirometry with asthma

A
  • FEV1/FVC : <70%
  • Reversibility : Improvement of 12% or more
58
Q

what is a common finding in CF in a male

A

Bilateral absence of vas deferens

59
Q

Give the stepwise management of croup

A
  • Oral dex
  • Oxygen
  • Nebulised budenoside
  • Nebulised adrenaline
  • Intubation and ventilation
60
Q

What is the step up of bronchodilators

A
  1. Inhaled or nebulised salbutamol
  2. Inhaled or nebulised ipratropium bromide
  3. IV mag sulph
  4. IV aminophylline
61
Q

How is a mild asthma attack managed ?

A
  • Salbutamol inhalers via spacer
62
Q

How is a moderate to severe asthma attack managed ?

A
  1. Salbutamol via spacer
  2. Nebulised salbutamol / ipratropium bromide
  3. Oral pred
  4. IV hydrocortisone
  5. IV mag sulph
  6. IV salbutamol
  7. IV aminophylline

3a (45 decks)

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