Paeds Resp Flashcards

Question

How dose acute asthma present ?

Answer 1

- Progressive worsening SOB - Signs of respiratory distress - Tachypnoea - Expiratory wheeze on auscultation heard through the chest - Chest can sound ‘’tight’’ on auscultation with reduced air entry

Answer 2

- Silent chest - This means that the airways are so tight that it is impossible for the child to move enough air through the airways to wheeze - Might be associated with reduced respiratory effort due to fatigue and is life threatening

Answer 3

- Peak flow > 50% predicted - Normal speech - No accessory muscle involvement

Answer 4

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

Answer 5

- Peak flow < 33% predicted - Sats < 92% - Exhaustion and poor respiratory effort - Hypotension - Silent chest - Cyanosis - Altered GCS/confusion

Answer 6

- Oxygen if <94% or working hard - Bronchodilators e.g. salbutamol, ipratropium and magnesium sulphate - (ABs – only if bacterial cause suspected e.g. amoxicillin or erythromycin)

Answer 7

- Inhaled or nebulised salbutamol (SABA) - Inhaled or nebulised ipratropium bromide (anti-muscarinic) - IV magnesium sulphate - IV aminophylline

Answer 8

- Manage as outpatient with regular salbutamol inhalers via spacer (e.g. 4-6 puffs every 4 hours)

Answer 9

- Salbutamol inhalers via a spacer device starting with 10 puffs every 2 hours - Nebulisers with salbutamol/ipratropium bromide - Oral prednisolone (1mg per kg of body weight once a day for 3 days) - IV hydrocortisone - IV magnesium sulphate - IV salbutamol - IV aminophylline - Intubate and ventilate - (Step up)

Answer 10

- Episodic symptoms with intermittent exacerbations - Diurnal variability – typically worse at night and early morning - Dry cough, wheeze and SOB - Typical triggers - A Hx of other atrophic conditions - FHx of atopy - Bilateral widespread ‘’polyphonic’’ wheeze heard by a HCP - Symptoms improve with bronchodilators

Answer 11

- Wheeze only related to coughs and colds are more suggestive of viral induced wheeze - Isolated or productive cough - Normal investigations - No response to treatment - Unliteral wheeze – suggest a focal lesion, inhaled foreign body or infection

Answer 12

- Dust - Animals - Cold air - Exercise - Smoko - Food allergens

Answer 13

- No gold standard - Usually based on Hx and exam

Answer 14

- Spirometry with reversible testing - Direct bronchial challenge test with histamine or methacholine - Fractional exhaled nitric oxide - Peak flow variability – peak flow diary – several times a day for 2-4 weeks

Answer 15

- SABA e.g. salbutamol - Low dose corticosteroids or leukotriene antagonists i.e. oral montelukast - Add the other option from step 2 - Refer to specialist

Answer 16

- SABA e.g. salbutamol - Add regular or low dose CS inhaler - Add LABA e.g. salmeterol - Titrate up CS inhaler to medium dose – consider adding oral leukotriene receptor antagonist e.g. montelukast or oral theophylline - Increase CS to high dose - Refer to specialist – may require daily oral steroids

Answer 17

- SABA e.g. salbutamol - Add regular low dose CS inhaler - Add LABA inhaler e.g. salmeterol - Titrate up CS inhaler to medium - Consider trial of montelukast, oral theophylline or an inhaled LAMA i.e. titropium - Titrate CS inhaler to high dose - Combine additional treatments form step 4, including the option of an SABA - Refer to specialist - Add oral steroids at the lowest dose possible to achieve good control under specialist guidance

Answer 18

- Steroids can lead to growth retardation - However so can poor asthma control - Also poor inhaler technique can lead to oral thrush

Answer 19

- Assemble the spacer - Shake the inhaler (depending on the type) - Attach the inhaler to the correct end - Sit or stand up straight - Lift the chin slightly - Make a seal around the spacer mouthpiece or place the mask over the face - Spray the dose into the spacer - Take steady breaths in and out 5 times until the mist is fully inhaled - (Clean spacer once a month)

Answer 20

- RSV or rhinovirus

Answer 21

- Children <3 - Airways are small so a small amount of inflammation and oedema can restrict airflow - Inflammation also triggers the smooth muscle of the airways to constrict further narrowing of the space in the airway

Answer 22

- Poiseuille’s law states that flow rate is proportional to radius of the tube to the power of 4 - Therefore halving the diameter of the tube decreases the flow rate by 16 - Air flowing through the narrow airways causes a wheeze, and restricted ventilation leads to respiratory distress

Answer 23

- Presenting before the age of 3 - No atopic history - Only occurs during viral infections

Answer 24

- Fever, cough and Cozyal symptoms for 1-2 days preceding onset of - SOB, signs of respiratory distress, expiratory wheeze throughout the chest

Answer 25

- Same as acute asthma - Oxygen if <94% or working hard - Bronchodilators e.g. salbutamol, ipratropium and magnesium sulphate - (ABs – only if bacterial cause suspected e.g. amoxicillin or erythromycin)

Answer 26

- Inflammation and infection of the bronchioles (small airways of the lungs) - MCC is respiratory syncytial virus (RSV) - Very common in winter - Generally considered to occur in children under 1 year, MC in children under 6 months - Particularly present in ex-premature babies with chronic lung disease

Answer 27

- Respiratory syncytial virus

Answer 28

- Coryzal symptoms - Signs of respiratory distress - Dyspnoea - Tachypnoea - Poor feeding - Mild fever - Apnoeas - Wheeze and crackles on auscultation

Answer 29

- Starts as URTI with coryzal symptoms - Develop chest symptoms 1-2 days following onset - Symptoms worsening on days 3-4 - Usually last 7-10 days and most recover by 2-3 weeks - More likely to develop viral induced wheeze during childhood

Answer 30

- Under 3 months - Pre-existing conditions such as prematurity, Downs or CF - 50-75% of their normal intake of milk - Clinical dehydration - RR over 70 - Oxygen sats below 92% - Moderate to severe respiratory distress such as deep recessions or head bobbing - Apnoeas - Parents not confident in their ability to manage at home or difficulty accessing medical help from home

Answer 31

- Typically only supportive - Ensuring adequate intake (oral, NG or IV) depending on severity - Saline nasal drops and nasal suctioning - Supplementary oxygen if sats below 92% - Ventilatory support - (little evidence that nebulised saline, bronchodilators, steroids and ABs have an impact)

Answer 32

- High-flow humidified oxygen via a tight nasal cannula – adds positive end-expiratory pressure (PEEP) to maintain the airway at the end of expiration - Continuous positive airway pressure (CPAP) - Intubation and ventilation

Answer 33

- Oxygen sats - Capillary blood gases

Answer 34

- Rising pCO2 – airways cannot clear CO2 - Failing pH – showing the CO2 building up and they are not able to buffer the acidosis this creates

Answer 35

- Palivizumab - MCAB that targets respiratory syncytial virus - Monthly infection given to prevent bronchiolitis caused by RSV in high risk babies e.g. congenital heart disease or ex-premature - Not true vaccine, provides passive protection

Answer 36

- Autosomal recessive genetic condition affect the mucus glands - Mutation in cystic fibrosis transmembrane conductance regulatory gene on chromosome 7 - The genes codes for cellular channels, particularly a type of chloride channel

Answer 37

- Thick pancreatic and biliary secretions cause blockage of the ducts resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract - Low volume thick airway secretions that reduce airway clearance, resulting in bacterialla colonisation and susceptibility to airway infections - Congenital bilateral absence of the vas deferens in males – infertility

Answer 38

- Meconium ileus is often the first sign of CF - In CF meconium is thick and sticky causing it to get obstructed (20% of cases) - Heel-prick test at birth - If not at birth then diagnosed with LRTIs, failure to thrive or pancreatitis

Answer 39

- Chronic cough - Thick sputum - Recurrent resp infections - Loose, greasy stools - Abdominal pain and bloating - Parents may report the child tastes salty - Poor weight and height gain

Answer 40

- Lowe weight or heigh - Nasal polyps - Finger clubbing - Crackles and wheezes on auscultation

Answer 41

- Hereditary clubbing - Cyanotic heart disease - Infective endocarditis - CF, TB, IBD - Liver cirrhosis

Answer 42

- Newborn blood spot testing - The sweat test – gold standard - Genetic testing – transmembrane conductance regulatory gene

Answer 43

- Staph aureus - Haemophilus influenza - Klebsiella pneumonia - E.coli - Burkhodheria cepacian - Pseudomonas aeruginosa (partially difficult to get rid of, linked to increased morbidity and mortality)

Answer 44

- Limit contact with others with CF - Can be treated with long term nebulised ABs such as tobramycin or oral ciprofloxacin

Answer 45

- Chest physiotherapy several times a day to clear mucus and reduce infection/colonisation - Exercise - High calorie diet - CREON tables to digest fats (if pancreatic insufficiency) - Prophylactic flucloxacillin - Bronchodilators e.g. salbutamol - Nebulised DNase (secretions less viscous and easier to clear) - Nebulised hypertonic saline - Vaccinations – pneumococcal, influenza and varicella

Answer 46

- Lung transplant (end stage resp failure) - Liver transplant - Fertility treatment - Genetic counselling

Answer 47

- DM - Osteoporosis - Vit D deficiency - Liver failure

Answer 48

- Median life expectancy is 47 years - 90% develop pancreatic insufficiency - Burkhodheria cepacian and Pseudomonas aeruginosa linked to worse prognosis

Answer 49

- Inflammation and swelling of the epiglottis caused by infection - Typically haemophilus influenza type B - Epiglottis can swell to the point that it completely occludes the airway - Now a rare condition due to haemophilus influenza type B being part of the 6 in 1 vaccine given at 2,3 and 4 months

Answer 50

- Sore throat and stridor - Drooling - Tripod position (sat forward with a hand on each knee) - High fever - Difficulty or painful swallowing - Muffled voice - Scared and quite child - Septic and unwell appearance

Answer 51

- Do not distress the patient as this could prompt closure of the airway - Alert a senior paediatrician and anaesthetist - Be prepared to intubate at any time - Tracheostomy may need to be done - Once airway secure – IV ABs (ceftriaxone) and steroids (dexamethasone)