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Finals flashcards > Paeds resp > Flashcards

Paeds resp Flashcards

1
Q

Presentation of whooping cough/pertussis

A

Initial symptoms: low grade fever, mild coryzal sx, mild dry cough.
Develop severe coughing fits after a week with an inspiratory whoop after coughing ends.

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2
Q

Diagnosing pertussis

A

Nasal/nasopharyngeal swab with PCR/bac culture in first few weeks.

If cough for over 2 weeks, can test for anti-pertussis toxin IgG.

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3
Q

Mx and prognosis of pertussis

A
  • Notifiable disease
  • Supportive care, admit if vulnerable/acutely unwell: severe coughing fits, cyanosis, apnoeas.
  • Can use macrolides in first few weeks.
  • Sx resolve in 8 weeks.
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4
Q

Complication of pertussis

A

Bronchiectasis

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5
Q

Who should be vaccinated against pertussis?

A

Young children and pregnant ladies

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6
Q

What does bronchiolitis describe?

A

Infection and inflammation of the bronchioles (small airways). As the bronchioles of infants are so small, even a small amount of inflammation can have a significant effect on breath sounds.

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7
Q

Most common cause of bronchiolitis

A

Usually viral, RSV

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8
Q

Age group affected by bronchiolitis

A

Under 1yrs, particularly under 6 month olds in winter.

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9
Q

How does bronchiolitis present?

A

Mild fever, coryzal sx (sneeze, runny nose, watery eyes, mucus in throat, cough), poor feeding, tachypnoea, dyspnoea, apnoeas (periods of not breathing), signs of respiratory distress.

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10
Q

Signs of respiratory distress

A 
Head bobbing
Nasal flaring
Tracheal tug
Cyanosis
Use of accessory muscles (abdominal, intercostal, sternocleidomastoid)
Intercostal and subcostal recessions
Abnormal airway noises
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11
Q

Abnormal airway sounds

A

Wheeze
Stridor (high pitched inspiratory noise, e.g. croup)
Grunting

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12
Q

Typical RSV course for bronchiolitis

A

Starts as URTI with coryzal sx. Half then get better, half will develop chest sx 1-2 days after onset of coryzal sx.

Sx usually worst on day 3/4. Last 7-10 days. Recover fully in 2-3 weeks.

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13
Q

Mx of bronchiolitis at home

A

Most can be mx at home: ensure adequate feeding and can use saline nasal drops to clear secretions. Safety net- if feeding falls to 50-75%, signs of respiratory distress, feel unable to manage.

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14
Q

When would you admit for bronchiolitis?

A
  • Under 3m, down’s, CF, premature
  • sats below 92%
  • RR above 70
  • Signs of r.distress, apnoeas
  • Dehyrdated, 50-75% of normal feeding
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15
Q

Mx of bronchiolitis in hospital

A
  • Adequate intake (oral, NG, IV). Small, frequent feeds, gradually increase them as tolerated. Too full = restricts breathing.
  • Saline nasal drops/suctioning
  • O2 if <92%
  • Ventilatory support if required- do CBG
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16
Q

Blood gas results for poor ventilation

A

Rising CO2- airways have collapsed and can’t clear CO2

Falling pH- respiratory acidosis

17
Q

What is palivizumab used for?

A

Monthly injections of a monoclonal AB for ex-premature + congenital heart disease children. Provides passive protection.

18
Q

Having bronchiolitis as an infant increases the chances of developing what condition in childhood?

A

Viral wheeze.

19
Q

Features of viral induced wheeze vs. asthma

A
  • Presenting before 3 years
  • No hx of atopy
  • Only occurs during viral infections
20
Q

Symptoms and signs of viral wheeze

A

Preceeding viral illness (fever, cough, coryzal) 1-2 days before signs:

  • SOB
  • Signs of r.distress
  • Expiratory wheeze throughout chest (SHOULD NOT BE FOCAL)
21
Q

Mx of viral wheeze

A

Same as acute asthma in kids.

22
Q

What does epiglottitis describe?

A

Inflammation/swelling of epiglottis caused by infection, usually Haem. infleunza B. Within hours, it can swell to the point of completely obscuring the airway- life threatening emergency.

Included in routine vaccinations but beware in unvaccinated children.

23
Q

How does epiglottitis typically present?

A

Unvaccinated child with fever, sore throat, stridor, drooling, sat forward in tripod position (sat forward with a hand on each knee).

May appear septic, distressed, quiet voice, difficulty swallowing.

24
Q

Investigations for epiglottitis

A

If acutely unwell + suspect epiglottitis, don’t perform inv.

  • Lateral X-ray of neck shows thumbprint sign (oedematous, swollen epiglottis). Excludes foreign body also.
25
Q

Mx of epiglottitis

A

Treat as emergency- risk of sudden airway closure. Don’t distress the child, leave them alone in their comfort zone.

Inform senior paed. and anaesthetist immediately.

1) Ensure airway is secure- must be prepared for potential intubation.
2) IV AB + steroids (cef. and dex)

26
Q

Complication of epiglottitis

A

Epiglottic abscess.

Tx similar to epiglottitis.

27
Q

What does laryngomalacia describe?

A

Tissue of larynx flops over the airway, causing partial obstruction.

1) Shortened aryepiglottic folds pull the epiglottis into an omega shape.
2) Tissue surrounding supraglottic larynx = softer with reduce tone, flops.

28
Q

Presentation of laryngomalacia + demographic

A

Occurs in infants, peaks at 6 months.

Intermittent stridor, more prominent when feeding, upset or on back. Difficulty feeding.

29
Q

Mx/disease course of laryngomalacia

A

As the larynx matures, it grows and is better able to support itself. Grow out of condition with no interventions required usually.

30
Q

Who does chronic lung disease of prematurity affect? (CLDP)

A

Premature babies, typically those born before 28 weeks gestation.

31
Q

How can risk of CLDP be reduced?

A
  • Corticosteroids (betamethasone) to mothers showing signs of premature labour at less than 36 weeks.
  • Once born: use CPAP instead of intubation/vent if possible, use caffeine to stimulate respiratory effort, don’t over oxygenate.
32
Q

Dx of CLDP

A

Formal sleep study to assess sats.
CX
O2 requirements after 36 weeks

33
Q

Signs of CLDP

A

Low sats, increased work of breathing, crackles/wheeze, poor weight gain

34
Q

Sx of CLDP

A

poor feeding + poor weight gain

35
Q

Mx of CLDP

A

O2, can discharge with low dose to wean.

Palivizumab injections monthly- RSV protection.

Finals flashcards (15 decks)

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