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Finals Systems > Paeds respiratory > Flashcards

Paeds respiratory Flashcards

1
Q

gene and chromosome cystic fibrosis

A

CFTR - codes a cAMP-regulated chloride channel

F508 on the long arm of chromosome 7

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2
Q

Organisms which may colonise CF patients?

A

Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus

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3
Q

Diagnostic test cystic fibrosis

A

sweat test - high sweat chloride
normal value < 40 mEq/l,
CF indicated by > 60 mEq/l

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4
Q

Cystic fibrosis drug

A

Lumacaftor/Ivacaftor (Orkambi)

Fluclox to prevent s.aureus

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5
Q

Investigation bronchiolitis

A

immunoflurescence of nasal secretions may show RSV

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6
Q

A 3-year-old boy is brought into the emergency department with cough and noisy breathing following a 3-day history of coryzal symptoms. On examination, he is afebrile but has harsh vibrating noise on inspiration, intercostal recession and a cough. He is systemically well

A

croup

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7
Q

A 5 month old baby, fever 38.2, coroyzal, struggling to feed< 75% of normal, RR of 70,

A

bronchiolitis

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8
Q

Pathogen croup

A

Parainfluenza virus

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9
Q

Pathogen bronchiolitis

A

RSV

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10
Q

Pathogen pneumonia

A

Streptococcus pneumoniae

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11
Q

Pathogen whooping cough

A

Bordetella pertussis

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12
Q

Investigation pneumonia

A

CXR

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13
Q

Management pneumonia in children

A

Amoxicillin

Macrolides may be added if there is no response to first line therapy

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14
Q

Mangement pneumonia ?chlamydia or ?mycoplasma

A

Macrolides eg erythromycin

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15
Q

Management pneumonia associated with influenza

A

co-amoxiclav

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16
Q

Presentation bronciolitis

A

coryzal
mild fever
feeding difficulties
wet cough
wheeze
breathlessness

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17
Q

when should children be admitted immediately with bronchiolitis 999

A

apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

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18
Q

when should you consider hospital admission with bronchiolitis

A

a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration.

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19
Q

Management bronchiolitis

A

humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%

nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth

suction is sometimes used for excessive upper airway secretions

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20
Q

Prevention of bronchiolitis

A

Palivizumab is a monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease eg premature.

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21
Q

what time of year is croup most common

A

autumn

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22
Q

peak incidence croup

A

6mo-3years

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23
Q

features croup

A

stridor
barking cough (worse at night)
fever
coryzal symptoms

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24
Q

Indications for admission croup

A

< 6 mo age
known upper airway abnormality eg laryngomalacia, downs

anyone with mod/severe:
- frequent barking cough
- stridor
- wall recession

severe = distress

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25
Q

Xray sign croup

A

a posterior-anterior view will show subglottic narrowing, commonly called the ‘steeple sign’

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26
Q

Xray sign epiglottitis

A

a lateral view in acute epiglottitis will show swelling of the epiglottis - the ‘thumb sign’

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27
Q

Management croup - routine and emergency

A
  • oral dex (0.15mg/kg) to everyone

emergency:
- high flow O2
- nebulised adrenaline

  1. neb budesonide
  2. ENT
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28
Q

features epiglottitis

A

rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

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29
Q

diagnosis epiglottitis

A

direct visualisation (only by senior/airway trained staff)

30
Q

Management epiglottitis

A
  • ENT and anesthetics - endotracheal intubation
  • O2
  • IV abx
31
Q

Pathogen epiglottitis

A

HiB

32
Q

Which of EV wheeze and MT wheeze are associated with asthma

A

Episodic viral wheeze is not associated with an increased risk of asthma in later life although a proportion of children with multiple trigger wheeze will develop asthma

33
Q

Management multiple trigger wheeze

A
  1. If > 4 significant episodes per year consider a 3 month trial of inhaled corticosteroid
  2. LRTA
34
Q

When should whooping cough be suspected

A

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:

Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

35
Q

Investigations whooping cough

A

nasopharyngeal swab PCR
anti-pertussis toxin immunoglobulin G (oral if <5, blood if >5)

36
Q

Management whooping cough

A

Macrolide antibiotics such as azithromycin, erythromycin and clarithromycin can be beneficial in the early stages (within the first 21 days) or vulnerable patients. Co-trimoxazole is an alternative to macrolides.

37
Q

when are pregnant women offered whooping cough vaccine

A

16-32 weeks

38
Q

school exclusion whooping cough

A

48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

39
Q

complications whooping cough

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

40
Q

inheritance primary ciliary dyskinesia

A

autosomal recessive

41
Q

risk factor primary ciliary dyskinesia

A

consanguinity

42
Q

Kartagner’s triad

A

the three key features of PCD:

Paranasal sinusitis
Bronchiectasis
Situs Inversus

43
Q

Diagnostic investigation PCD

A

nasal brushing or bronchoscopy (sample)

44
Q

risk factors laryngomalacia

A

Invasive ventilation
Prematurity

45
Q

Children severe acute asthma heart rate

A

> 140/min in children 1-5 years
125/min in children > 5 years

46
Q

Children severe acute asthma respiratory rate

A

> 40 in children 1-5 years
30 in children > 5 years

47
Q

SpO2 severe/LT

A

< 92%

48
Q

PEF for severe acute asthma

A

33-50% best/predicted

49
Q

PEF for life threatening

A

<33

50
Q

Signs of life threatening

A

A CHEST

Agitated/altered conscioussness
Cyanosis
Hypotension
Exhaustion
Silent chest
Threatening peak flow < 33%

51
Q

what is can’t complete sentences a sign of

A

severe acute asthma

52
Q

PEF in moderate acute asthma

A

> 50% best or predicted

53
Q

Management acute asthma in children

A
  1. SpO2 <94% or LT : highflow oxygen via a tight-fitting face mask or nasal cannula to achieve saturations 94–98%
  2. Inhaled B2 agonist (salbutamol) (100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.
  3. If not controlled or LT→ hospital
  4. Nebulised salbutamol (2.5mg if <5 years. 5mg if >5 years)
  5. Nebulised ipratropium bromide (250 micrograms)
  6. Oral prednisolone (20 mg if aged 2–5 years and 40 mg for children >5 years )
  7. IV hydrocortisone (4 mg/kg repeated four hourly) if can’t oral
  8. Nebulised magnesium sulphate (in the first hour in children with a short duration of acute severe asthma symptoms presenting with an SpO2 <92%)
  9. IV salbutamol
  10. IV aminophylline
  11. IV magnesium sulphate
  12. Anaesthetics and ICU
54
Q

GP management asthma attack

A
  1. high flow O2 if SpO2 < 94
  2. salbutamol via a spacer 100 micrograms - 1 puff every 30-60 seconds up to a maximum of 10 puffs.
  3. Oral prednisolone
  4. Urgent rf to hospital if uncontrolled
55
Q

Dosage for spacer salbutamol @ GP

A

(100 micrograms via a pMDI + spacer) 1 puff every 30-60 seconds up to a maximum of 10 puffs.

56
Q

Dosage nebulised salbutamol

A

2.5mg if <5 years

5mg if >5 years

57
Q

Dosage nebulised ipatropium bromide

A

250 micrograms

58
Q

Dosage oral prednisolone

A

20 mg if aged 2–5 years

40 mg for children >5 years

treatment should be given for 3-5 days

59
Q

When can a child be discharged after asthma attack

A

child well on 6 puffs 4 hourly of salbutamol.

They can be prescribed a reducing regime of salbutamol to continue at home, for example 6 puffs 4 hourly for 48 hours then 4 puffs 6 hourly for 48 hours then 2-4 puffs as required.

60
Q

Investigations asthma

A
  1. spirometry with a bronchodilator reversibility (BDR) test
  2. a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test
61
Q

Positive spirometry result

A

FEV1/FVC ratio less than 70% (or below the lower limit of normal if this value is available) is considered obstructive

62
Q

Positive result reversibility testing

A

in children, a positive test is indicated by an improvement in FEV1 of 12% or more

63
Q

Positive result FeNO

A

in children a level of >= 35 parts per billion (ppb) is considered positive

64
Q

Name the short acting asthma drugs

A

Beta 2 agonist: Salbutamol, terbutaline

Muscarinic antagonist: Ipratropium bromide

65
Q

Name the long acting asthma drugs

A

Beta 2 agonist: Femeterol, salmeterol

Muscarinic antagonist: Tiotropium bromide

66
Q

Management of asthma aged 5-16

A
  1. SABA
  2. SABA + low-dose ICS
  3. SABA + low-dose ICS + LTRA
  4. SABA + low-dose ICS + LABA
  5. SABA + MART (low-dose ICS + LABA)
  6. SABA + MART (mod-dose ICS + LABA)
  7. SABA + one of: high dose ICS, add drug eg theophylline, seek help)
67
Q

Management of asthma aged < 5

A
  1. SABA
  2. SABA + 8 weeks mod-dose ICS
    - if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely
  • if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy
  • if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS
  1. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  2. Stop the LTRA and refer to an paediatric asthma specialist
68
Q

normal pco2

A

4.7 to 6.0 kPa

69
Q

what is low dose ICS

A

< 200mcg budesonide

70
Q

If moderate asthma how do you give the salbutamol? vs severe

A

spacer if moderate

nebulised if sev/LT

Finals Systems (27 decks)

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