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CP2 PAEDS > Paeds - Respiratory > Flashcards

Paeds - Respiratory Flashcards

1
Q

How do URT disorders present?

A

Coryza, sore throat, earache, sinusitis, stridor

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2
Q

How do LRT disorders present?

A

Cough, wheeze, resp distress

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3
Q

What % children after affected by asthma?

A

1/10

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4
Q

What is asthma?

A

Chronic airway inflammation + bronchial hyperactivity, reversible airway obstruction

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5
Q

What are the 2 patterns of wheezing in asthma?

A

Viral induced wheezing

Multiple trigger wheeze

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6
Q

What are the risk factors for viral induced wheezing?

A

Maternal smoking

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7
Q

What is not a risk factor fr viral induced wheezing?

A

FHx of asthma

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8
Q

At what age does viral induced wheezing resolve by?

A

Aged 5

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9
Q

What conditions is multiple trigger wheeze associated with?

A

Eczema

Rhinosinusitis

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10
Q

What is the pathological triad in asthma?

A

B inflamm
Hyper-response
Airway narrow

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11
Q

What is the clinical triad in asthma?

A

Cough
Wheeze
SOB

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12
Q

O/E - Asthma (5)

A 
Normal between attacks 
Hyperinflation of chest 
Barrel-shaped chest 
Polyphonic expiratory wheeze 
Harrison sulci
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13
Q

Ix in asthma

A

Allergies - skin prick/IgE
CXR - rule out pathology
Spirometry - PEFR

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14
Q

E.g. of SABA?

A

Salbutamol

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15
Q

Is Salbutamol a reliever or preventer?

A

Preventer

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16
Q

How long does salbutamol work for?

A

2-4hrs

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17
Q

SE salbutamol?

A

Tremor

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18
Q

E.g. of LABA

A

Salmeterol

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19
Q

Is salmeterol a reliever or preventer?

A

Reliever

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20
Q

How long does salmeterol work for?

A

12hrs

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21
Q

In what conjunction must salmeterol be used?

A

W/ an ICS

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22
Q

What specific type of asthma is salmeterol useful in?

A

Exercise induced asthma

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23
Q

When is Ipratropium used?

A

In infants
When others = found to be effective
or
Severe acute asthma

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24
Q

E.g.s of ICS

A

Beclomethasone

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25
Q

Is Beclomethasone a preventer or reliever?

A

Preventer

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26
Q

How must you take beclomethasone for it to work?

A

Take daily

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27
Q

SE beclomethasone

A

Oral candidiasis

High doses - impaired growth, adrenal suppression, altered bone pets

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28
Q

Add on therapies in asthma

A

LTRA - Montelukast
Theophylline
PO steriods
Omaluzinab

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29
Q

Step by step approach - Asthma, <5 y/o

A

1) SABA as required
2) + LTRA or ICS (200-400mcg)
3) If on LTRA + ICS, if on ICS + LTRA
4) Rx to consultant

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30
Q

Step by step approach -Asthma >5y/o

A

1) SABA
2) + ICS (200-400Mcg)
3) + LABA
4) incr dose ICS to 800mcg
5) + PO steroid @ lowest dose + Rx to consultant

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31
Q

What age is a pressurised meter dose inhaler for?

A

All ages
<2 need face mask + spacer
>2 - spacer alone

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32
Q

What age is a breath inhaler for?

A

6+

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33
Q

What age is a dry powder inhaler for?

A

4+

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34
Q

Features of a severe acute asthma attack(6)

A 
Tachypnoea 
O2 sats <92% 
PEFR 33-50
Can't talk in full sentences 
TachyC 
Signs of resp distress
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35
Q

Features of a life threatening acute asthma attack (5)

A 
Silent chest 
Decr RR 
PEFR <33
Decr consciousness/agitation 
Cyanosis - O2 < 85
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36
Q

When should you admit an asthmatic child to hospital? (3)

A

Won’t respond to high dose bronchodilator
Marked reduction PEFR
O2 in air <92%

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37
Q

Mx moderate asthma attack (2)

A

SABA + spacer 2-4 puffs every 2 mins

PO Prednisolone 1-2mg/kg

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38
Q

Mx severe asthma attack (4)

A

High flow O2
SABA - 10 puffs via spacer
PO Pred/IV Hydrocortisone
Consider - Ipratropium/IV SABA/Mg

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39
Q

Mx life threatening asthma attack (5)

A 
15L High flow O2 
SABA 
PO Prednisolone/IV HC
Ipratropium 
IV SABA or Mg
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40
Q

If child is responding to Tx in an acute asthma attack, what should be done?

A

Continue bronchodilators every 1-4hrs prn

PO pred for 3 days

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41
Q

If child is not responding to Tx in an acute asthma attack, what should be done?

A

Transfer to HDU/PICU

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42
Q

Wheeze differentials (8)

A 
Transient early wheeze 
Non-atopy wheeze (post-viral) 
Cardiac failure 
Bronchiolitis 
Pneumonia 
CF
GOR
Croup
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43
Q

What is the most common respiratory infection in infancy?

A

Bronchiolitis

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44
Q

Which season is Bronchiolitis more common in?

A

Winter

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45
Q

What is the peak age for bronchiolitis?

A

3-6months

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46
Q

Which organism causes >80% bronchiolitis?

A

RSV

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47
Q

Other causative pathogens bronchiolitis (3)

A

Parainfluenza
Rhinovirus
Adenovirus

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48
Q

RF Bronchiolitis (5)

A

Older siblings
Nursery
Passive smoke
Pre-term or LBW

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49
Q

Sx Bronchiolitis

A

Coryzal Sx –> Dry cough + Incr SOB

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50
Q

Inspection findings - Bronchiolitis

A

Recession
TachyC
Pallor

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51
Q

Percussion findings Bronchiolitis

A

Hyper-inflated chest

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52
Q

Auscultation findings - Bronchiolitis

A

Fine end insp crackles

Wheeze - Exp > Insp

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53
Q

Ix bronchiolitis (3)

A

PCR secretions
O2 sats
Blood gas

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54
Q

Mx bronchiolitis (4)

A

Supportive
Humidified O2
IV Fl
Highly infective - stop spread

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55
Q

Prognosis bronchiolitis

A

Most recover 2 w

1/2 have recurrent cough/wheeze

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56
Q

What prevention can be given for bronchiolitis?

A

Palibuzimab

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57
Q

When should someone with bronchiolitis be admitted to hospital?

A

If feeding <50% usual

Or Increasing dyspnoea

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58
Q

Causes - newborn pneumonia (2)

A

GBS

Gram -ve bacilli

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59
Q

Causes - infant pneumonia (4)

A

RSV
Strep P
H influ
Staph A (serious)

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60
Q

Causes - > 5y/o pneumonia (3)

A

Mycoplasmum P
Strep P
Chlamydia

61
Q

Which vaccine has markedly reduced pneumonia incidence?

A

HiB vaccine

62
Q

Clinical features pneumonia (6)

A 
URTI followed by: 
Fever
Cough
Rapid breathing - most sensitive sign 
Lethargy 
Poor feeding 
Localised chest/neck/pain
63
Q

Inspection - child w/ pneumonia (4)

A

Tachpnoea
Nasal flaring
Chest recession
O2 sats

64
Q

Percussion - child w/ pneumonia

65
Q

Auscultation - pneumonia

A

End insp coarse crackles
Decr sounds
Bronch breathing

66
Q

Ix - pneumonia (3)

A

Chest x-ray

N-P aspirate can determine viral/bacterial cultures

67
Q

Mx - pneumonia - when to admit (5)

A 
O2 <92%
Severe tachypnoea
Difficulty breathiing 
Apnoea 
No feeding
68
Q

Mx pneumonia in hospital (4)

A

O2
Analgesia
IV Fl
ABx - neonate/broad spec, infants - amox

69
Q

What is pertussis

A

Whooping cough

70
Q

Causative organism Pertussis

A

Bordetella pertussis

71
Q

How often do Pertussis epidemics occur?

A

Ever 3-4years

72
Q

Transmission pertussis

A

droplet spread

73
Q

Incubation period pertussis

74
Q

What is the most infectious phase pertussis?

A

Catarrhal phase

75
Q

For how long should someone with pertussis stay away from school?

A

21 days after Sx

5 days from starting ABx

76
Q

Catarrhal phase pertussis

A

1-2 w coryza/runninig nose

77
Q

paroxysmal phase - up to 3 months (6)

A 
Dry hacking cough
Prolonged eps 
Then whooping cough
Worse @ night --> vomiting
During child goes red/blue
Apnoea
78
Q

O/E pertussis (2)

A

Cough

Tired child

79
Q

Ix pertussis (5)

A 
NOTIFITABLE
N-p swabs 
PO fl testing (>5 y/o)
Serology if cough >2w
PCR
80
Q

Mx pertussis (3)

A

Admit
Abx - infected pt + contacts (clarithromycin)
Prophylaxis

81
Q

Abx pregnant woman ABx for pertussis

A

Erythromycin

82
Q

Sx of 1’ infection TB (3)

A

Fever
Decr Wt
Cough

83
Q

Xray appearance 1’ TB

A

Hilar lymphadenopathy

Collapse/consolidation

84
Q

Diagnosis TB (4)

A

Sputum sample
Check urine. LN + CXR
Mantoux
IFN gamma

85
Q

Tx TB

A

RIPE

Decreased to R+I - 2 months

86
Q

Carrier rate CF

87
Q

Life expectancy CF

A

+/- 40years

88
Q

Which gene is defective in CF?

89
Q

What does the severity of CF depend on?

A

Gene mutation
Microbial pathogens
Passive smoking
Social deprivation

90
Q

CF - affect on airways (4)

A

Decr airway liquid layer
Decr ciliary fct
Incr mucopurulent secretion
Dysregulation of inflammation = incr infection rate

91
Q

CF - affect on abdomen

A

Thick meconium in intestines –> meconium ileus

Pancreatic ducts blocked –> malabsorption

92
Q

CF - affect on sweat glands

A

Incr NaCl in sweat

93
Q

Clinical features CF (4)

A

Recurrent chest infections
Poor growth
Malabsorption
Failure to thrive

94
Q

O/E - CF (4)

A

Hyper-inflated chest
Coarse inspiratory creps
Expiratory wheeze
Clubbing

95
Q

Ix CF (3)

A

Guthrie
Sweat test
Genetic screening

96
Q

Mx (7)

A 
Measure FEV1 regularly 
PT b.d
Exercise - deep breathing
Continuous proph ABx - fluclox
IV Abx if Sx
Lung transplant
Nutritional - ADEK vits, incr kcal
97
Q

Fertility CF

A

F - norm

M - almost always infertile

98
Q

What is epiglottitis

A

Inflammation epiglottis

99
Q

Cause epiglottitis

100
Q

Age epiglottitis

A

1-6 years old

101
Q

S+S epiglottitis (6)

A 
High fever
Painful throat
Saliva drools
Soft insp stridor
Minimal cough
Swollen epiglottis
102
Q

Mx epiglottitis (6)

A 
Admit 
Transfer --> ITU
Intubate under controlled conditions 
Bloods - culture
IV Abx
Prophylactic Hib - contacts
103
Q

Recovery time epiglottitis

104
Q

Why are children prone to OM?

A

B/c have short, horizontal eustachian tubes

105
Q

RF AOM (6)

A 
FH
Cleft palate
ET abnormalities
Downs
Immunocompromised
Smoke exposure
106
Q

S+S AOM (3)

A

Otalgia
Fever
TM - bright red + bulging

107
Q

Common pathogens AOM (5)

A 
RSV
Rhinovirus
Pneumococcus
H.influenza
Morazella catarrhalis
108
Q

Tx AOM

A

Analgesia

Most resolve spontaneously

109
Q

Which Abx should you give for AOM if it is not resolving?

A

Amoxicillin

110
Q

Complications AOM (2)

A

Mastoiditis

Meningitis

111
Q

S+S Glue ear (3)

A

CHL
Otherwise asymp
TM dull + retracted + fl level

112
Q

What is the most common cause of Conductive hearing loss in children

113
Q

Adenoidectomy indications

A

Recurrent OME + hearing loss

OSA

114
Q

Tx tonsillitis (3)

A

Pen/erythro 10 days
iif severe - admit + IV fl + analgesia
Tonsillectomy

115
Q

Indications tonsillectomy (3)

A

Recurrent - 1/7, 2/5, 3/3
Quinsy
OSA

116
Q

What is a Coryza

A

Common cold

117
Q

Causes coryza (2)

A

RSV

Rhinovirus

118
Q

PS Coryza (3)

A

Clear/mucopurulent rhinorrhoea
Nasal obstruction
Cough - up to 4 w after

119
Q

Tx Coryza

A

Ibu + paracetamol

120
Q

Why is frontal sinusitis unlikely in a child?

A

Because frontal sinus doesn’t develop until >10 years old

121
Q

Tx sinusitis (3)

A

ABx
Analgesia
TO decongestants

122
Q

Define fever

123
Q

Measuring temperature in a child <4 months

A

Electronic thermometer axilla

124
Q

Measuring temperature in a child >4 months

A

Axilla or infra=red tympanic thermometer

125
Q

Infective causes of fever (7)

A 
Localised infection - meningitis/pneumonia/UTI
Bacterial infection
Deep abscess 
Infective endocarditis 
TB
Viral infection 
Parasitic infection
126
Q

Non-infective causes of fever

A 
Systemic juvenile idiopathic arthritis 
SLE
Vasculitis 
IBD
Malignancy 
Sarcoidosis
127
Q

A fever is more significant if: (6)

A 
>41' 
Bacterial sepsis 
SCA
Suppressed immunity
Congen heart disease 
Severe head injury
128
Q

Signs of a fever indicating serious illness (7)

A 
Low level consciousness 
Weak/high-pitched/continuous cry 
Pale/mottled/blue skin
Reduced skin turgor
Signs resp distress 
Bulging fontanelle
129
Q

Mx fever (6)

A 
Tx underlying cause
Antipyretics - P +I
Place in cool room 
Open window/use fan
Reduce amount clothing/bedding 
Keep infants head uncovered
130
Q

At what age do feibrile convulsions send to occur?

131
Q

How long do febrile convulsions occur for?

132
Q

Features of a simple febrile convulsion (3)

A

Isolate
Generalised
T-C seizures

133
Q

Features complex febrile consulsion

A 
One or more of: 
Focal onset
>15mins
Recurs within 24hrs/w/ same febrile illness 
Incomplete recovery within 1hr
134
Q

Febrile status epilepticus

A

Lasts >30mins

135
Q

If a seizure lasts > 5mins, what should be done?

A

Rectal Diazepam
or
Buccal midazolam

136
Q

Peak age Croup

137
Q

Which season is Croup most common in?

138
Q

Causes of Croup (2)

A

Parainfluenza

RSV

139
Q

Sx Croup (7)

A 
Coryza
Fever
Hoarseness 
BARKING cough
Harsh stridor 
SOB 
(worse @ night)
140
Q

Mx Croup - mild

A

Mx at home

Watch closely for worsening signs

141
Q

Mx Croup - mod

A

Inhal moist air

PO Dex/pred/neb steroids

142
Q

Mx Croup - severe

A

Neb’ adrenaline + O2

143
Q

Sx bacterial tracheitis

A 
Croup + 
Fever
Toxic
Rapidly progressive airway obstruction 
Thick secretions
144
Q

Cause bacterial tracheitis

145
Q

Mx Bacterial Tracheitis

A

IV ABx + intubate/vent

146
Q

What is hoarseness

A

Inflamed vocal cords

147
Q

What is more fatal, smoke inhalation or burns?

A

Smoke inhalation

148
Q

Mx smoke inhalation

A 
Remove from smoke ASAP
Airway patency 
100% O2 via non-rebreathe
Intubate 
Fl replacement if burns

CP2 PAEDS (18 decks)

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