Resp Flashcards
What are some symptoms of Asthma in paeds?
Recurrent cough worse at night/exercise
Expiratory wheeze
SOB
What are some triggers of asthma?
Cold
Allergens
Exercise
Smoke
How can suspected asthma be investigated in children?
Peak Flow if >5y
Clinical Diagnosis if <5y
CXR - Rule out PTX if suspicious
What are symptoms of an acute asthma attack in paeds?
Acute SOB Cough Wheeze Increased work of breathing Frightened
How is a mild asthma attack defined for paeds?
Breathless
Not distressed
PEF >50%
How is a severe asthma attack defined for paeds?
Too breathless to talk/feed
RR>50
Pulse >130
PEF <50%
How is a life-threatening asthma attack defined for paeds?
PEF <33% Silent chest Cyanosis Fatigue Drowsiness Confusion Hypotension
How should Asthma be managed in under 5y?
- SABA - Salbutamol
- Regular LTRA - Montelukast
- Low Dose ICS + LTRA
- Increasing doses of ICS
How should asthma be managed in over 5y?
- SABA - Salbutamol
- Low dose ICS
- Low dose ICS + LABA/LTRA
- Increase ICS dose or add LABA/LTRA
What should be used with an inhaler in under 5y?
Metered dose inhaler with a spacer
How can acute exacerbations of asthma in kids be managed?
Reliever medication Aggressive treatment with: High Flow O2 Beta 2 Agonists Ipratroprium Bromide Systemic Corticosteroids
Which gene is responsible for development of Cystic Fibrosis?
Mutation of CFTR gene on Chromosome 7
What is the pathophysiology behind Cystic Fibrosis?
Excessive thick secretions obstruct small and large airways giving recurrent infections
What are some of the systemic effects of CF?
ENT - Polyps, Sinusitis Liver - Biliary Stasis Poor Growth - Malabsorption GI - Pancreatic insufficiency, DM, Meconium Ileus Congenital absence of Vas Deferens
What are some complications of CF?
Recurrent chest infections Malabsorption due to pancreatic insufficiency DM Salt loss Biliary stasis
How is CF diagnosed?
Newborn - Bloodspot screening
Gene testing
Sweat Test - Measures NaCl
How should confirmed CF be managed?
Nutritional and respiratory support
What is Whooping Cough?
Highly infectious notifiable disease due to Bordella Pertussis, particularly in infants under 3m
When are children vaccinated against Pertussis?
2m, 4m, 3y4m
What are the distinct phases of Whooping cough?
Catarrhal Phase
Paroxysmal Phase
Convalescent Phase
How does the Catarrhal Phase of Whooping Cough present?
Rhinitis Conjunctivits Irritability Sore Throat Low-grade fever Dry cough
How does the Paroxysmal of Whooping Cough present?
Episodes of severe coughing followed by a characteristic inspiratory “Whoop”
How does the Convalescent Phase of Whooping Cough present?
Cough decreases in severity over 3m
What will be found upon examination with Whooping cough?
Normal Low grade fever Conjunctival haemorrhoage Facial petichiae Auscultation - Normal
Which investigations are appropriate for suspected Whooping Cough?
Culture of Nasopharyngeal Aspirate
IgG Serology
FBC
How should confirmed Whooping Cough be managed?
Admit if <6m, significant breathing/feeding problems
Clarithromycin to reduce infectivity
How long should a Whooping Cough patient avoid school for?
Either until:
They’ve had the cough for 21 days
They’ve taken Clarithromycin for 5 days
What is Croup?
A viral URTI leads to mucosal inflammation giving a cough
What are common causative organisms of croup?
Parainfluenza
Adenovirus
Rhinovirus
Influenza A+B
What are some risk factors for Croup?
Male
Autumn/Spring seasons
Genetic variation
What are some symptoms of Croup?
10-14d history of: Non-specific cough Rhinorrhoea Fever Progression to barking cough
What are some clinical signs of Croup?
Stridor Normal chest/reduced air entry Tachypnoea/Tachycardia Recession Cyanosis Lethargy Reduced Consciousness
How does mild Croup present?
Occasional cough
No stridor at rest
No recession
How does moderate Croup present?
Frequent cough
Audible stridor at rest
Suprasternal and Chest Wall retraction at rest
How does severe Croup present?
Frequent cough
Prominent inspiratory stridor at rest
Marked retractiosn
Distressed child at rest
How should Croup be managed?
Mild - Supportive, NSAIDs
Moderate/Severe - IP admission, Oral Steroids, Nebulised Adrenaline
What are some potential complications of Croup?
Lymphadenitis Otitis Media Dehydration Pulmonary Oedema Pneumothorax
What is Bronchiolitis?
A viral infection of bronchioles by Respiratory Syncytial Virus 1 which is common in children under 3y in winter and spring
What happens in Bronchiolitis?
Infection leads to mucus hypersecretion, bronchiolar constriction, hyperinflation, increased airway resistance, atelectasis and VQ mismatch
What are some risk factors for Bronchiolitis?
Breast fed for <2m
Smoke exposure
Has siblings that attend nursery
Prematurity
What are some symptoms of Bronchiolitis?
Increasing severity for 2-5d of: Low grade fever Nasal congestion Rhinorrhoea Cough Feeding Difficulty
What may be found upon examination with Bronchiolitis?
Tachypnoea Grunting Nasal Flaring Recessions Inspiratory crackles Expiratory Wheeze Hyperinflated chest Cyanosis/Pallor
Which investigations are appropriate for suspected Bronchiolitis?
Throat swab for RSV Blood/Urine cultures FBC ABG CXR
How should bronchiolitis be managed?
At home with supportive measures
When should bronchiolitis be admitted?
O2 <92%
Fluids/NGT needed
CPAP
What are some complications of bronchiolitis?
Hypoxia Dehydration Fatigue Respiratory failure Cough/Wheeze Bronchiolitis Obliterans
