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Y4 medicine > Paeds Resp > Flashcards

Paeds Resp Flashcards

1
Q

clinical features of asthma?

A

dry cough with wheeze and SOB
symptoms worse at night and early morn
personal or family Hx of atopic disease
+ve response to asthma therapy
episodic symptoms with itnermittent exacerbations
bilateral widespread polyphonic expiratory wheeze on auscultation
non viral triggers

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2
Q

Ix to diagnose asthma

A

typical Hx and examination
if high probability then trial tx to see if symptoms improve
if diagnostic doubt then:
- spirometry (needs to be <80%) with reversibility testing
- peak flow variability

children not usually diagnosed until 2/3 yo

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3
Q

Tx of asthma is under 5 yo

A
  1. SABA: salbutamol as required
  2. low dose corticosteroid (e.g. beclometasone) or leukotriene antagonist (montelukast)
  3. add other option from step 2
  4. refer to specialist
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4
Q

Tx for asthma is age 5-12yrs?

A
  1. SABA: salbutamol as required
  2. low dose corticosteroid e.g. beclometasone
  3. add LRTA (montelukast)
  4. swap LRTA for SABA (salmeterol)
  5. increase dose of inhaled corticosteroid to medium dose.
  6. refer to specialist (might need oral steroids)
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5
Q

Tx of asthma for >12yo?

A

(same as adults)

  1. SABA: salbutamol as required
  2. low dose corticosteroid e.g. beclometasone
  3. add LABA (salmetarol)
  4. titrate corticosteroid inhaler to medium dose + consider adding leukotriene receptor antagonist (montelukast) or oral theophylline or LAMA
  5. increase dose of inhaled corticosteroid to high dose. + option of oral salbutamol.
  6. refer to specialist (might need oral steroids)
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6
Q

what is the step wise control of acute asthma attack in children?

A
  1. salbutamol inhalers via inhaler (10 puffs every 2 hrs)
  2. nebs with salbutamol/ipatropium bromide
  3. oral prednisolone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline
  • if not got control call aneasthetist + ITU (may need intubation and ventilation)
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7
Q

sign of moderate asthma attack?

A

peak flow >50% predicted
normal speech
no features of severe of life threatening attack

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8
Q

clinicl features of a severe asthma attack?

A

peak flow <50% predicted
sats <92%
unable to complete sentences in one breath
signs of resp distress
RR>40 (1-5yrs)
RR>30 (>5yo)
HR>140 (1-5yrs)
HR>125 (>5yo)

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9
Q

clinical features of life threatening asthma

A

peak flow <33% predicted
sats <92%
exhaustion and poor resp effort
hypotension
silent chest
cyanosis
altered consiousness/confusion

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10
Q

what is stridor?

A

harsh high pitched inspiratory sound due to partial obstruction of lower portion of upper airway (upper trachea and larynx)

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11
Q

causes of stridor

A

croup (viral laryngotracheobronchitis) - most common!!
epiglottitis
bacterial tracheitis
laryngeal or oesophageal foreign body
retropharyngeal abscess
allergic laryngeal oedema
diphtheria

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12
Q

common cuases fro croup?

A

parainfluenza - most common!!
influenza
adenovirus
resp syncytial virus (RSV)

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13
Q

clinical features of croup?

A
  • increased work of breathing
  • barking cough
  • hoarse voice
  • stridor
  • low grade fever

(oedema and inflammation of trachea, larynx and bronchi)

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14
Q

Mx of croup ?

A

most cases = supportive Tx (fluids and rest)

sit the child up and comfort them
oral dexamethasone single dose (repeated after 12hrs)
O2
if doesnt work then nebs budesonide then adrenaline
last resort - intubation and ventilation

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15
Q

what is epiglottitis?

A

inflammation and swelling of epiglottitis cuased by infection typically heamophilus influenza type B

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16
Q

clincial features of epiglottitis?

A
  • sore throat
  • stridor
  • drooling
  • tripod position (sat forward with hands on knees)
  • high fever
  • difficulty or painful swallowing
  • muffles voice
  • scared adn quiet
  • septic and unwell apperance
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17
Q

Ix for epiglottitis?

A

lateral xray of neck shows ‘thumb sign’ (cuased by oedematous and swollen epiglottis)
neck xray can also exclude foreign body

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18
Q

Mx of epiglottitis?

A

keep the child calm
ensure airway is secure
most dont need intubation

once airway secure: IV abx (ceftriaxone) and steroids (dexamethasone)

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19
Q

common complication of epiglottitis?

A

epiglottic abscess

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20
Q

what is bronchiolitis?

A

inflammation of the bronchioles usually by a virus (respiratory syncytial virus is most common cause)

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21
Q

clinical featuers of a child with bronchiolitis?

A
  • coryzal zymptoms: rhinorrhea, sneezing, mucus in throat, watery eyes
  • signs of resp distress (raised RR, use of accessory muscles, intercostal recessions, nasal flaring, head bobby, cyanosis)
  • dyspnoea
  • tachypnoea
  • poor feeding
  • mild fever
  • wheeze and crackles on auscultation

** no active bronchoconstriction

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22
Q

what is wheezing?

A

whistling sound caused by narrowed airways typically heard during expiration

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23
Q

what are the indications for admission of a child with bronchiolitis?

A
  • age under 3 months
  • pre existing condition e.g. downs or cystic fibrosis
  • 50-75% or less of normal intake of milk
  • clinical dehydration
  • resp rate > 70
  • o2 sats below 92%
  • moderate to severe resp distress
  • apnoeas
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24
Q

Mx of bronchiolitis?

A

supportive Mx!!

  • ensure adequate intake (NG tube or IV fluids)
  • saline nasal drops + nasal suctioning
  • supplementary o2 if sats are <92%
  • ventilatory support if required (high flow humidified o2, CPAP, intubation and ventilation)

** asthma tx is useless as there is no bronchoconstriction in bronchiolitis

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25
Q

whats the best way of assessing ventilation in a child with resp distress?

A

capillary blood gases taken from the heel to see rising pCO2 and falling pH

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26
Q

what is the role of palivizumab in bronchiolitis?

A

it is a monoclonal antibody that targtes syncytial virus -> monthyl injection given as a prevention against bronchiolitis caused by RSV.
given to high risk babies (e.g. congenital heart disease)

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27
Q

what is viral induced wheeze?

A

children who have a viral chest infection get a wheeze (rhinovirus type C is most common)

** occurs commonly around one year of age

28
Q

differentials of a child with a wheeze?

A
  • neonatal resp distress
  • allergy
  • asthma / preschool wheeze
  • viral induced wheeze
  • foreign body aspiration
  • bronchomalacia
29
Q

why is it important to use spacers in children

A

better deposition of medicine
reduces chance of oral thrush and hoarse voice

30
Q

how to administer medication via inhaler to <4yo

A

use a volumatic spacer + meter dose inhaler + MASK to help

shake the inhaler, seal mask onto baby’s face,
need to tilt the space upwards to open valve, puff the inhaler, hold on for 10 secs

31
Q

how to clean a spacer

A

pull apart
wash with soap and warm water
AIR DRY!!!

*change every 6 months

32
Q

defintion of acute and chronic cough

A

acute: < 4wks
chronic: > 4 wks

33
Q

Ix in a child with a chronic cough?

A
  • cxr
  • bloods: immune screen, allergy markers
  • lung function test (if old enough)
34
Q

tx of rhinitis?

A

steroid nasal spray
antihistmines

35
Q

clinical signs of rhinitis?

A

throat clearing, snoring, blocked nose, bad breath, worse in morning but clears throughout day

36
Q

tx of GORD?

A

trial of PPI, gaviscon

37
Q

2 main purposed of bronchoscopy?

A
  1. Microbial samples: Stubborn/resistant infections
  2. Assess Airways
38
Q

what is tracheobronchomalacia?

A

floppy airways - flaccidity of supporting cartilage

39
Q

tx for tracheobronchomalacia?

A
  • nothing rlly (symptomatic mx)

prophylactic abx/physio
CPAP
surgery - if rlly severe - to stent airwasy

40
Q

what is bronchiectasis?

A

abnormla dilatation and distortion of the bronchial tree

41
Q

gold standard ix for bronchiectasis?

A

high resolution ct

42
Q

key findings of bronchiectasis on ct

A

signet ring sing

43
Q

gold standard ix for bronchiectasis?

A

ct scan with contrast

44
Q

tx for bronchiectasis?

A
  • prophylactic abx
  • physio
  • aggressive tx of LRTI
  • nutrition
  • regular monitoring incl. lung function
45
Q

clinical features of community acquried pneumonia

A

tachypnoea
pyrexia
cough
increased work of breathing

46
Q

tx for cap

A

non severe - oral abx for 5-7 days (amoxicillin)
severe - iv (amoxicillin or cefuroxine) abx

47
Q

ix for cap

A

cxr / bloods not needed! can just diagnose from hx and examination

48
Q

what is the usual presentation of cystic fibrosis?

A
  • found in newborn bloodspot test screening
  • meconium ileus presentation
  • later in childhood - recurrent LRTI, failure to thrive or pancreatitis
49
Q

what is meconium ileus?

A

not passing meconium in the first 24hrs of life due to the meconium being thick and sticky and getting caught in the bowel
also presents with abdo distention + vomiting

50
Q

symptoms of cystic fibrosis if not picked up by screenign or meconium ileus?

A
  • chronic cough
  • thick sputum production
  • recurrent LRTIs
  • loose, greasy stools (steatorrhea)
  • abdo pain and bloating
  • salty skin
  • poor weight and height gain (failure to thrive)
51
Q

diagnosis of cystic fibrosis?

A

screening (heel prick tesT)
sweat chloride test (gold standard) - chloride >60mmol/L
genotyping

52
Q

Mx of cystic fibrosis?

A
  • chest physio
  • exercise
  • high calorie diet
  • CREON tablets to digest fats (due to pancreatic insufficiency)
  • prophylactic flucloxacillin
  • salbutamol inhalers
  • vaccinations
53
Q

which bacteria has a high rate of mortality in cystic fibrosis patients?

A

pseudomonas aeruginosa

54
Q

name some complications that need to be screened for in cystic fibrosis?

A
  • diabetes,
  • osteoporosis
  • vitamin D deficiency
  • liver failure
55
Q

preventer inhalers used in children?

A
  • corticosteroids e.g. beclometasone, budesonide
  • LAMA e.g. salmeterol, formoterol
  • combo of the two
56
Q

SE of inhaled corticosteroids?

A

hoarse voice and oral thrush
can have systemic SE, but usually dose not high enough

57
Q

SE of LAMAs

A

tachy and tremor

58
Q

what is stridor?

A

abnormal resp sound characterised by high pitched (predominantly inspiratory) noise
causes by upper airway obstruction e.g. laryngomalacia, croup

59
Q

what is wheeze?

A

abnormal resp sound characterised by high pitched (expiratory)
causes by lower airway obstruction e.g. asthma, COPD

60
Q

what is whooping cough

A

also known as pertussis
it is an URTI caused by a gram -ve bacteria

61
Q

what bacteria causes pertussis?

A

bordetella pertussis

62
Q

presentation of pertussis?

A

mild coryzal symptoms (low grade fever and dry cough)

followed by coughing fits -> loud inspiratory whoop when coughing ends
pts can faint or vomit w coughing fits

63
Q

how do you diagnose pertussis?

A

nasopharyngeal or nasal swab with PCR testing or culture (to identify bordetella pertussis)

64
Q

Mx for whooping cough?

A
  • notify public health england
  • supportive care usually
  • may need admitting (<6 months, apnoeas, cyanosis)
  • abx: azithromycin/erythromycin
  • if in contact and vulnerable (e.g. pregnant) then prophylactic abx
65
Q

how long does it take for whooping cough to resolve

A

typically within 8 wks

can take longer - ‘called the 100 day cough’

Y4 medicine (17 decks)

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