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Paediatrics > Paeds Resp > Flashcards

Paeds Resp Flashcards

1
Q

Common benign cause of inspiratory stridor (noisy breathing) in otherwise well infants?

A

laryngomalacia

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2
Q

Who are the only girls who can develop X-linked conditions?

A

Those with Turner’s syndrome!
no Y chromosome!
45,X

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3
Q

What is the posh name for croup?

A

viral laryngotracheobronchitis

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4
Q

What is the commonest cause of stridor?

A

croup

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5
Q

Which virus causes croup?

A

parainfluenza

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6
Q

Which age group does croup affect?

A

6 months - 6 years

esp 2 yr olds

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7
Q

What time of year do kids get croup?

A

autumn

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8
Q

2 yr old with barking cough, stridor, hoarse cry, fever, preceding coryza. Suspect?

A

Croup

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9
Q

“barking cough”. What FLASHES across your mind?

A

croup

ruff ruff ruff

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10
Q

What kind of noisy breathing does croup cause?

A

stridor

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11
Q

Is stridor when you breathe out or when you breathe in?

A

stridor is INSPIRATORY

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12
Q

A child has croup. What will their cry be like?

A

hoarse

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13
Q

What is the treatment for croup?

A

ORAL DEXAMETHASONE 0.15MG/KG

if severe - high flow O2 + nebulised adrenaline

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14
Q

When do you give oral dexamethosone 0.15mg/kg?

A

CROUP

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15
Q

What is the emergency treatment for SEVERE croup?

A

high flow O2, nebulised adrenaline

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16
Q

What colour is the epiglottis in epiglottitis?

A

cherry red.

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17
Q

What infective agent causes epiglottitis?

A

HiB

Haemophilus influenza B

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18
Q

What don’t you do when a child has epiglottitis?

A

examine the throat

could cause complete obstruction

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19
Q

The fever in croup tends to be <38.5. True or false.

A

True

croup = low-grade fever

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20
Q

The fever in epiglottitis tends to be >38.5. True or false.

A

True

epiglottitis = high-grade fever

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21
Q

A 5 yr old presents with soft stridor, fever of 39.5, minimal cough, sitting immobile with her mouth open drooling saliva. What do you do??

A

epiglottitis. Don’t examine the throat.

Call ENT and anaesthetists … INTUBATE under GA

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22
Q

After you’ve intubated a child with epiglottitis to save their airway, what do you do next to treat it?

A

blood cultures … IV Abx

rifampicin to contacts

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23
Q

My child has had epiglottitis. What should I be taking?

A

rifampicin

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24
Q

What is a disease similar to acute epiglottitis, caused by Staph aureus?

A 
Bacterial tracheitis 
(needs tracheal intubation under GA + IV Abx)
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25
Q

What infective agent causes bacterial tracheitis? (high fever and ill)

A

Staph aureus

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26
Q

Stridor is obstruction of which airways?

A

trachea / larynx

extrathoracic airways

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27
Q

Wheeze is partial obstruction of which airways?

A

intrathoracic airways

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28
Q

Is wheeze breathing out or breathing in?

A

EXPIRATORY

in exp, the intrathoracic airways are collapsed, so turbulent flow - wheeze

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29
Q

How many airways obstructed in monophonic wheeze?

A

one (e.g. foreign bod, carcinoma)

mainly polyphonic

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30
Q

Kate. Give me 6 causes of ACUTE WHEEZE in kids.

A 
bronchiolitis
viral episodic wheeze
asthma
anaphylaxis
foreign bod
atypical pneumonia
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31
Q

What season do kids usually get bronchiolitis?

A

winter

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32
Q

Give me 4 symptoms of croup.

A

barking cough
stridor
hoarse cry
low grade fever

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33
Q

Give me 4 symptoms of bronchiolitis.

A

dry wheezy cough
coryza
breathlessness
feeding difficulties

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34
Q

On examination of a child with bronchiolitis, what might you see? What might you hear?

A

tachycardia + tachpnoea
intercostal recession
hyperinflated chest

fine end inspiratory crackles
expiratory wheeze

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35
Q

You suspect a child has bronchiolitis. You listen to the chest. What are you expecting Doc?

A

fine end inspiratory crackles

expiratory wheeze

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36
Q

What age group does bronchiolitis affect?

A

<1yr old

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37
Q

What infective agent causes bronchiolitis?

A

RSV

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38
Q

Name three groups of kids at increased risk of severe bronchiolitis.

A

ex prems with bronchopulm dysplasia
cystic fibrosis
congenital heart disease

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39
Q

What is the investigation for bronchiolitis?

A

nasopharyngeal aspirate (NPA)

check sats.
if severe - CXR, ABG .. exclude pneumonia

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40
Q

If bronchiolitis is severe, what do you need to exclude?

A

pneumonia

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41
Q

What is the treatment for bronchiolitis?

A

O2 aim >94%
IV fluids

if bad - CPAP

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42
Q

If bronchiolitis is severe, what treatment?

A

CPAP

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43
Q

How do you prevent bronchiolitis in prems?

A

IM monthly injections of PALIVIZUMAB

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44
Q

What is prevalence of CF?

A

1 in 2,500

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45
Q

What is prevalence of CF carriers?

A

1 in 25

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46
Q

CF is autosomal recessive. Which chromosome is affected?

A

chromosome 7

delta F508

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47
Q

Which is the defective protein in CF?

A

CFTR
transmembrane conductance regulator
= abnormal Cl- ion transport across epi = THICK SECRETIONS

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48
Q

What effects can CF have on the resp system? (x3)

A

pneumonia (pseudomonas)
allergic bronchopulmonary aspergillosis
bronchiectasis

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49
Q

What effects can CF have on the intestines? (x3)

A

meconium ileus
rectal prolapse
malabsorption

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50
Q

What effects can CF have on the pancreas? (x2)

A

DIABETES MELLITUS

steathorroea (malabsorption)

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51
Q

What effects can CF have on the reproductive system (esp men)?

A

INFERTILITY

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52
Q

What test is diagnostic for CF?

A

sweat test

shows high chloride in sweat

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53
Q

Describe some aspects of the management of CF?

A

chest physio; postural drainage
pancreatic enzymes with meals - high fat, high kCal
may need heart + lung transplant

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54
Q

What age should viral episodic wheeze have improved by?

A

5yrs

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55
Q

What usually triggers viral episodic wheeze?

A

URTI

small airways more likely to narrow when inflamed

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56
Q

Name a key risk factor for viral episodic wheeze.

A

Maternal smoking.

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57
Q

What is a multiple trigger wheeze?

A

wheeze in pre-school age triggered by not just viral but lots of different precipitants
including cold air, exercise, dust, animal dander

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58
Q

Kate. Give me 6 causes of RECURRENT WHEEZE in kids.

A 
viral episodic wheeze
multiple trigger wheeze
asthma
cystic fibrosis
bronchopulm dysplasia
GORD
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59
Q

What proportion of UK children have asthma?

A

1 in 11

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60
Q

Give me three features of asthma pathophysiology.

A

bronchial infl. - mucus + swelling
bronchial hyper-responsiveness
reversible airway obstruction

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61
Q

THE BIG ASTHMA FOUR symptoms

A

wheeze
cough
breathlessness
chest tightness

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62
Q

When are asthma symptoms worse?

A

in morn / at night

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63
Q

Give me some pointers that point the finger towards asthma.

A 
in morn / at night
non viral triggers
symptoms between attacks
FHx atopy 
response to asthma therapy!
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64
Q

What are the investigations for asthma?

A

Peak flow diary (PEFR)

spirometry

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65
Q

What would peak expiratory flow rate diary show to suggest asthma?

A

diurnal variation

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66
Q

What would expect from asthma spirometry?

A

low FEV 1
low FEV1/FVC

= OBSTRUCTIVE picture

WITH BRONCHODILATOR REVERSIBILITY!!!

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67
Q

Give me some examples of asthma triggers.

A 
URTI
allergens
smoking
cold air
exercise
emotion
chemical irritants
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68
Q

Give me 2 examples of SABAs (short acting beta2 agonists)

A

salbutamol

terbutaline

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69
Q

Give me an example of an anti-cholinergic bronchodilator

A

ipratropium bromide

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70
Q

Give me 3 examples of inhaled corticosteroids.

A

beclometasone
budenoside
fluticasone

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71
Q

Give me 3 examples of LABAs (long acting beta2 agonists)

A

salmeterol

formeterol

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72
Q

What kind of drug is Montelukast (oral)?

A

leukotriene receptor antagonist

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73
Q

A child presents to A+E having an asthma attack. She can talk, her O2 sats are >92%. Some intercostal recession. Is this moderate, severe of life-threatening?

A

moderate

74
Q

A child presents to A+E having an asthma attack. She is too short of breath to talk..her sats are <92%. HR >140/min. RR >40/min. She is using accesssory neck muscles to breathe. Is this moderate, severe, or life-threatening?

A

severe

75
Q

A child presents to A+E having an asthma attack. She has a silent chest, cyanosis and altered consciousness. This is life-threatening. What might you find about her:

  • heart
  • breathing
  • BP
A

arrythmias
poor resp effort
hypotension

76
Q

What is the treatment of chronic asthma for <5yr old child?

A

SABA
+ ICS
+ leukotriene
+ refer to resp paediatrician

77
Q

What is the treatment of chronic asthma for >5yr old child?

A 
SABA
\+ ICS
\+ leukotriene
\+ increase ICS dose / add theophylline
\+ oral pred
\+ refer to resp paediatrician
78
Q

What is the treatment of a MODERATE asthma attack?
1,
2,

A

salbutamol via spacer (max 10 puffs)

oral pred

79
Q 
What is the treatment of a SEVERE asthma attack?
1, 
2, 
3, 
4,

+/- …. / …… /……

A
  1. high flow O2
  2. salbutamol via spacer/ neb
  3. oral pred / IV hydrocortisone
  4. inhaled ipratropium bromide

+/- IV salbutamol / aminophylline / Mg

80
Q

In severe asthma, what would you expect from the HR and RR?

A

HR >140

RR >40

81
Q

In a moderate asthma attack, what is their peak flow like?

A

> 50% of their best

82
Q

In a severe asthma attack, what is their peak flow like?

A

<50% of their best

83
Q

In a life-threatening asthma attack, what is their peak flow like?

A

<33% of their best

84
Q 
What is the treatment for a LIFE-THREATENING asthma attack?
1, 
2, 
3, 
4,

+/- ….. / ….. / …..

A
  1. high flow O2
  2. salbutamol nebs
  3. oral pred / IV hydrocortisone
  4. nebulised ipratropium bromide

+/- IV salbutamol / aminophylline / Mg

85
Q

If the treatment for life-threatening asthma attack is not working………

A

PICU
senior review
CXR, ABG

…. mech vent :/

86
Q

The child has responded to treatment for her asthma attack and is doing much better :) What now?

A

continue bronchodilators PRN
discharge when stable on 4hrs treatment
continue oral pred for 3-7ds

87
Q

You’ve discharged a child after her asthma attack, with PRN bronchodilators and a supply of oral pred for 3-7ds. What else does she need?

A

follow up arranged for…
personalised asthma action plan
review meds and inhaler technique

88
Q

What dose of oral pred should you discharge a child on after an asthma attack?

A

1-2mg/kg OD

89
Q

In severe asthma attack, you’ve given high flow O2, salbutamol neb, IV hydrocortisone. What else?

A

inhaled ipratropium bromide

+/- IV salbutamol / aminophylline / Mg

90
Q

What are the 3 Ts of asthma counselling

A

adherence to Treatment
inhaler Technique
avoid Triggers

91
Q

what IV Abx for acute epiglottitis?

A

iv cefuroxime

92
Q

Give me 4 types of upper respiratory tract infection (URTI)

A
  • common cold
  • pharyngitis, inc tonsillitis
  • sinusitis
  • acute otitis media
93
Q

Sore throat, coryza and asthma exacerbation can by symptoms of URTI. What else?

A 
febrile seizures 
feeding difficulties (blocked nose, can't breathe)
94
Q

Common virus culprit of the common cold (coryza)?

A

rhinovirus

self limiting, paracetamol + ibuprofen

95
Q

infectious mononucleosis a.k.a.

A

glandular fever

96
Q

Give me two common bugs causing pharyngitis (sore throat)

A

Group A strep throat

adenovirus

97
Q

Give me two common bugs causing tonsillitis (sore throat, type of pharyngitis)

A

Group A strep throat

EBV (glandular fever)

98
Q

What criteria are used to estimate the probability that pharyngitis / tonsillitis is bacterial (strep).

A

Centor criteria

99
Q

Centor criteria are used to estimate probability that pharyngitis/tonsillitis is bacterial (strep) rather than viral. What are the 5 criteria which score points?

A
  1. age (3-14)
  2. exudate
  3. cervical lymphadenopathy
  4. fever >38
  5. absent cough
100
Q

What is treatment for tonsillitis?

A

Pen V 10 days

or erythromycin
(if unable to swallow may need IV fluids + analgesia)

101
Q

inflammation of paranasal sinuses may occur with URTI. occasionally there is secondary bac infection (pain + sweeling of cheek, maxillary sinus). if so, what Rx

A

Abx + analgesia

102
Q

when is acute otitis media most common and why?

A

6-12 months

short Eustachian tubes

103
Q

Where in particular would you examine if you suspected acute otitis media, and what would you expect to see?

A

tympanic membrane

red, bulging, loss of light reflection

104
Q

Give me three potential complications of acute otitis media

A

mastoiditits
meningitis

glue ear if recurrent

105
Q

Give me 5? bacterial causes of acute otitis media.

A

rhinovirus, RSV

penumococcus, Hib, moraxella

106
Q

What is the treatment for acute otitis media

A

ANALGESIA

NOT ANTIBIOTICS
only if >3days

107
Q

When would you give antibiotics for an ear infection?

A

if lasts longer than 3 days
amoxicillin

(Abx marginally shorten pain but dont decrease the risk of hearing loss)

108
Q

otitis media with effusion =

A

glue ear

109
Q

What kind of hearing loss does glue ear cause?

A

conductive hearing loss

110
Q

What is the treatment for glue earm if persistent?

A

grommets

ventilation tubes. only last 12 months

111
Q

If your child has got bad glue ear, and grommets have not worked, what might be considered?

A

adenoidectomy

112
Q

Give me two indications for adenoidectomy.

A
  1. bad glue ear

2. obstructive sleep apnoea

113
Q

Give me two indications for tonsillectomy.

A
  1. recurrent severe tonsillitis

2. peritonsillar abscess (quinsy)

114
Q

Quinsy a.k.a

A

peritonsillar abscess

115
Q

Do children usually get hypoxic / tachypnoeic with URTI?

A

no - infeciton of conducting airways, as opposed to respiratory, so doesnt usually affect gas exchange.

116
Q

URTI is an infection of which airways.

A

conducting airways

so doesnt usually affect gas exchange

117
Q

What three infections in kids does pneumococcus tend to cause?

A

otitis
bronchitis / pneum
meningitis

118
Q

What four infections in kids does Hib tend to cause?

A

otitis
epiglottitis
pneumonia
meningitis

119
Q

what counts as a persistent cough?

A

not improved after 4 wks

120
Q

what does a ‘habit cough’ sound like?

A

dry barking

121
Q

give me some causes of PERSISTENT cough in a child

A 
smoking
asthma
recurrent URTIs
TB
bac bronchitis
persistent lobar collapse after pneum
aspiration + GORD
habit cough
whooping cough!
122
Q

What bug causes whooping cough?

A

bordetella pertussis

123
Q

how contagious is whooping cough?

A

highly, mainly in catarrhal phase

NOTIFIABLE

124
Q

tell me the three phases of whooping cough.

A

catarrhal
paroxysmal
convalescent

125
Q

What happens in the catarrhal phase of whooping cough?

A

week of coryza

126
Q

What happens in the paroxysmal phase of whooping cough?

A

spasmodic cough + inspiratory whoop

red / blue in face, mucussy

127
Q

In paroxysmal phase of whooping cough, get spasmodic cough + inspiratory whoop. Go red / blue in face and mucus flows from nose / mouth. How long does this phase tend to last?

A

~3 months

sometimes called 100 day cough

128
Q

Paroxysmal phase of whooping cough can be really bad. As well as spasmodic cough, if it’s severe what else might happpen?

A

epistaxis!
subconjunctival haemorrhage!
break ribs, hernia!
vom

129
Q

does pertussis vacccination guarantee protection?

A

no but decreases risk and severity

130
Q

In paroxysmal phase of whooping cough can have epistaxis, subconjunctival haemorrhage, break ribs, hernia and vom. Give me three longer term complications of whooping cough.

A

pneumonia
seizures
bronchiectasis

131
Q

A child presents with spasmodic cough and inspiratory whoop. What investigations?

A

per nasal swab (for culture / PCR if severe)

FBC

132
Q

What would FBC show in whooping cough?

A

lymphocytosis

133
Q

You have done per nasal swab and culture which confirmed whooping cough. What is the treatment?

A

Macrolide Abx within 3 wks of onset

CLARITHROMYCIN
(erythromycin if preg)

(fluids, para + ibuprofen)
close contacts - clarithromycin prophylaxis

134
Q

What age group does whooping cough particularly affect?

A

infants <3 months

135
Q

Is whooping cough a notifiable disease?

A

yes

136
Q

The child chokes, gasps and flails the extremities, with eyes bulging and watering and face reddened. There is frequently post-cough vomiting. What is the likely diagnosis?

A

whooping cough

137
Q

When do you admit a child with whooping cough

A

<6months acutely unwell

or any age if resp difficulties

138
Q

When should clarithromycin be started in whooping cough?

A

within 3 wks

139
Q

Does clarithromycin do anything to alter the clinical course of whooping cough?

A

NO it just decreases the length of INFECTIVITY

140
Q

Why has the whooping cough vaccination been extended to pregnant women ?

A

to give neonates protection for the time before they get vaccine

141
Q

What is the incubation period for whooping cough?

A

7-21 days

142
Q

A 2 yr old is being treated for whooping cough with clarithromycin. What should you give his dad who is his main carer?

A

clarithromycin

143
Q

Persistent WET cough. Give me two key differentials.

A

bac bronchitis

bronchiectasis

144
Q

Infection — inflammation — airway damage — bad mucociliary escalator — infection etc. What’s this?

A

bronchiectasis

145
Q

What happens in bronchiectasis (persistent wet cough)?

A

infection — inflammation — airway damage — bad mucociliary esclator – infection etc.

146
Q

Do you get tachypnoea / hypoxia in bac bronchitis (persistent wet cough)?

A

no its conducting airways not resp airways so gas exchange not usually affected

147
Q

Give me two bac that cause bac bronchitis (persistent wet cough).

A

moraxella catrrhalis

Hib

148
Q

What investigations for bac bronchitis (tends to be Hib and moraxella).

A

sputum culture

bronchial lavage

149
Q

Child has persistent wet cough. You’ve confirmed bac bronchitis with sputum culture which shows moraxella. How do you treat?

A

co-amoxiclav

CHEST PHYSIO

150
Q

co-amoxiclav to treat..

A

bac bronchitis

151
Q

clarithrommycin to treat..

A

whooping cough

152
Q

Pen V to treat..

A

tonsillitis

153
Q

amoxicillin to treat..

A

otitis media if >3ds

154
Q

CF is a cause of generalised bronchiectasis. Give me one another thing.

A

primary ciliary dyskinesia.

155
Q

Post- severe pneumonia is a cause of focal bronchiectasis. Give me one other thing.

A

inhaled foreign body.

as per

156
Q

inflammation of lung parenchyma
(exlcuding bronchi)
What’s this ?

A

pneumonia

157
Q

Define pneumonia.

A

inflammation of lung parenchyma

excluding bronchi

158
Q

What bugs tend to cause pneumonia in neonates?

A

Group B strep

Hib

159
Q

What bugs tend to cause pneumonia in <5yrs?

A

RSV + VIRUSES mainly

160
Q

What kind of pneumonia should you make sure to consider in all ages?

A

TB!

161
Q

What bugs tend to cause pneumonia in >5yrs?

A

strep pneum
mycoplasma pneum
chlamydia pneum

the pneumoniae bacteria!

162
Q

Strep pneum, mycoplasma pneum, chlamydia pneum

tend to cause pneumonia in what age group?

A

> 5yrs

163
Q

What 2 bugs causes pneumonia in imm supp?

A

pneumocystis jiroveccii

toxoplasma gondii

164
Q

What bug causes pneumonia in CF?

A

pseudomonas

165
Q

What bug causes aspiration pneumonia?

A

E.coli

166
Q

What pneumonia can chickenpox cause?

A

varicella pneumonitis

167
Q

Give me 6 symptoms of pneumonia from the history.

A

fever cough
lethargy poor feeding
chest/abdo/neck pain
preceding URTI

168
Q

On examination, give me 6 signs you might get in pneumonia.

A 
TACHYPNOEA
Tachycardia
low sats
nasal flaring
chest indrawing
coarse end-inspiratory crackles
169
Q

What might you hear on the chest of a child with pneumonia?

A

coarse end-inspiratory crackles

170
Q

coarse end-inspiratory crackles. What FLASHES across your mind?

A

pneumonia

171
Q

7 yr old child presents with fever, cough, chest pain and lethargy. On examination, she has tachypnoea, tachycardia, and nasal flaring. What bugs might be the likely culprit?

A

strep pneum
chlamydia pneum
mycoplasma pneum

172
Q

3 yr old child presents with fever, cough, and poor feeding. On examination she has chest in-drawing, low stats and coarse end-inspiratory crackles. What bugs might be the likely culprit?

A

RSV + VIRUSES! (<5yrs)

173
Q

What might you expect to see on CXR for lobar pneumonia?

A

CONSOLIDATION

174
Q

What are the four stages of lobar pneumonia?

A

congestion — red hepatization — grey hepatization – resolution

175
Q

Investigations for suspected pneumonia?

A

?nasopharyngeal aspirate (can distinguish bac/viral)

?CXR (not routine)

176
Q

What is the treatment of pneumonia for a neonate?

A

broad spec IV Abx (BenPen)

supportive - O2 + analgesia + IV fluids

177
Q

The majority of bacterial pneumonia are..

A

strep pneumoniae

178
Q

What is the treatment of pneumonia for a <5yr old?

A

oral amoxicllin

supportive - O2 + analgesia + IV fluids

179
Q

What is the treatment of pneumonia for a > 5 yr old?

A

oral amoxicillin OR erythromycin

supportive - O2 + analgesia + IV fluids

180
Q

i want four complications of pneumonia.

A

parapneumonic effusion
empyema
bronchiectasis
persistent lobar collapse

Paediatrics (14 decks)

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