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Paeds > Resp > Flashcards

Resp Flashcards

1
Q

Organisms which cause bronchiolitis

A

RSV (80%)
Mycoplasma, adenovirus

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2
Q

How does bronchiolitis present

A

a coryzal phase preceding respiratory symptoms such as dry cough, increased work of breathing, wheezing, feeding difficulties due to dyspnoea

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3
Q

If patient with bronchiolitis presents to GP with bronchiolitis when should call 999 or refer to hospital

A

999
- RR over 70
- seriously unwell
- severe rep distress (chest recession etc)
- cyanosis
- sats less than 92

Hospital
- RR over 60
- clinical dehydration (50-75% of normal volume)
- difficulty feeding

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4
Q

Management of bronchiolitis

A

Largely supportive
Humidified oxygen via head box if sats less than 92
CPAP if impending resp failure

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5
Q

Examination finding of bronchiolitis

A

Wheeze
Fine inspiratory crackles

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6
Q

What causes croup

A

Parainfluenza viruses

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7
Q

Presentation of croup

A

Stridor
Barking cough worse at night
Fever
Corzyal symptoms

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8
Q

Management of croup

A

Give all patients 0.15mg/kg of dexamethasone
If too unwell/vomiting give inhaled budenoside or IM dexamethasone
Determine if mild, moderate or severe- admit if moderate or severe
Also admit if
- immunocompromised
- under 3 months
- chronic lung disease
- congenital heart disease
- dehydrated

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9
Q

Categorising croup

A

Mild- seal like barking but no stridor or recession at rest
Moderate- seal like barking cough with stridor and sternal recession with no agitation or lethargy
Severe- seal like barking, stridor, recession, agitation

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10
Q

What to do if reduced barking cough in croup

A

Suggests impending resp distress- call ambulance

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11
Q

How is croup diagnosed

A

Normally clinically but can do CXR
PA or lateral

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12
Q

PA versus lateral CXR finding in croup

A

PA- shows subglottic narrowing (steeple sign)
Lateral- acute epiglottis (thumb sign)

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13
Q

When can those with whooping cough return to school

A

2 days after commencing antibiotics

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14
Q

How does congenital diaphragmatic hernia present

A

Respiratory distress as bronchopulmonary hypoplasia
Hypertension
Bowel sounds on ausculation of lungs

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15
Q

What would cause tinking bowel sounds on auscultation

A

Diaphragmatic hernia

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16
Q

Initial management of congenital diaphragmatic hernia

A

NG to keep air out of the gut
If patient cyanosed intubate

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17
Q

Cause of stridor in a child

A

Foreign object
Croup
Acute epiglottitis
Laryngomalacia

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18
Q

What is laryngomalacia

A

Congenital abnormality of the larynx which presents around 4 weeks of age

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19
Q

Causes of snoring in a child

A

obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism

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20
Q

Management of acute epiglottitis

A

DO NOT lie patient down or examine their mouth
Imeediate referral to ENT, paediatrics and anaesthetics
Secure airway with endotracheal intubation
Blood cultures
Cephalosporin and dexamethasone

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21
Q

How to treat severe croup

A

Oxygen
Nebulised adrenaline

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22
Q

Best way to diagnose pertussis

A

Per nasal swab
PCR the most specific

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23
Q

Pneumonia management of children

A

First line - amoxicillin
Second line- add macrolide if fail to respond
Chlamydia or mycoplasma use macrolide
If influenza suspected use co-amoxiclav

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24
Q

Influenza pneumonia management

A

Co-amoxiclav

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25
Q

2 prognostic factors of CDH

A

Lung in thorax
Lungs to head ratio

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26
Q

What is antenatal finding of TOF or oesophageal atresia

A

Polyhydramnios as never swallowed amniotic fluid

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27
Q

How can allergic rhinitis present

A

Nasal discharge
Postnasal drip causes nocturnal cough
Cough can be so severe get vomiting and noisy breathing

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28
Q

Causes of bronchiectasis in kids

A

CF
Post infection like pertussis
Foreign body

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29
Q

Different presentations of CF

A

Neonates- meconeum ileus
Childhood- chronic cough, recurrent chest infections, malabsorption and pancreatic insufficiency, nasal polyps, short stature, rectal prolapse from being ill all the time

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30
Q

Later presentation of CF

A

DM
Bronchiectasis
Sterility
Cirrhosis

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31
Q

Management of chronic cough and recurrent infection in CF

A

Physio twice a day
Nubulised hypertonic saline or DNAase
ABx prophylaxis- flucloxacillin and azithromycin
Annual spirometry

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32
Q

Management of pancreatic insufficiency in CF

A

Vitamin supplementation
Creon after meals

33
Q

Management of infection susceptibility in CF

A

Vaccination
Abx prophylaxis- flucloxacillin and azihromycin

34
Q

Moderate asthma/viral induced wheeze features

A

PEFR at least 50% of best
Normal speech
No severe/life threatening features

35
Q

Severe asthma/viral induced wheeze features

A

O2 sats must be greater than 91!
PEFR- 33-50% best
Inability to complete sentences
Accessory muscle use
Inability to feed
RR
- over 25 if over 12
- over 30 if 5-15
- over 40 if 2-5
HR
- over 110 if over 12
- over 125 if 5-12
- over 140 if 2-5

36
Q

Life threatening asthma/viral induced wheeze features

A

PEFR under 33%
O2 sats less than 92%
Altered consciousness/confusion
Arrythmia
Hyotension
Cyanosis
Poor resp effort
Silent chest
Exhaustion

37
Q

When to admit someone with acute asthma/viral induced attack

A

Life threatening
Fail to respond to bronchodilator if severe
Moderate- getting worse or has been near fatal attack previously
Factors which would lower threshold for admitting
- premature
- congenital issue
- CF
- immune deficiency
- assess cares ability

38
Q

Management of acute asthma/viral induced wheeze waiting for admission

A

Life threatening
- maintain O2 over 94
- nebulised salbutamol
Severe
- nebulised salbutamol
Moderate
- MDI salbutamol with spacer
NOTE- if nebulsier not available use MDI

39
Q

Management of asthmatic child at GP without needing hospital admission

A

SABA every 30-60 seconds do 10 times
If responds well to these can prescribe SABA for at home PRN
If history of atopy or confirmed asthma give oral pred course

40
Q

Management of infective excacerbation of asthma

A

Amoxicillin
If contraindicated
- 12 and over doxycycline
- under 12 macrolide or cefaclor

41
Q

Management of infective excacerbation of asthma

A

Amoxicillin
If contraindicated
- 12 and over doxycycline
- under 12 macrolide or cefaclor

42
Q

Asthma guidelines under 5

A

Under 5
1. SABA
2. Paediatric moderate dose ICS for 8 weeks and monitor
- if no resolvement consider different diagnosis
- sx reoccurred within 4 weeks of stopping ICS restart low dose ICS as maintenance
- sx reoccurred beyond 4 weeks restart moderate dose ICS
3. SABA, low dose ICS, LTRA
4. Stop LTRA and refer to paediatric asthma specialist

43
Q

Asthma guidelines 5-16

A
  1. SABA
  2. SABA+paediatric low dose ICS
  3. SABA+paediatric low dose ICS+LTRA
  4. SABA+paediatric low dose ICS+LABA (stop LTRA)
  5. SABA +MART combining LABA and low dose ICS
  6. SABA + moderate dose ICS MART
  7. SABA + one of;
    - increase ICS mart to high dose
    - add theophylline
    - refer to expert
44
Q

What factors are associated with worse prognosis in CF

A

Burkholderia or pseudomonas infection chronically

45
Q

Diagnosing CF

A

Sweat test
CFTR gene karyotyping- can determine management

46
Q

Why is genetic testing significant in CF

A

If suffer from delta F508 deletion mutation then can give Kaftrio- combination of ivacaftor, tezacaftor and elexacaftor

47
Q

What causes whooping cough

A

Bordatella pertussis

48
Q

What are the stages to whooping cough

A

Cattarheal- prodromal malaise, dry cough, sore throat
Paroxysmal- expiratory burst then subsequent gasp on inspiration giving whoop
Convalescent- improval in cough severity and frequency

49
Q

What factors can trigger whooping

A

Cold
Exercise
Worse at night

50
Q

When to suspect pertussis

A

If cough for over 14 days with 1 of following
- paroxysmal
- post coughing vomiting
- whoop
- apnoeic episodes in infants

51
Q

Management of whooping cough

A

Admit if necessary
Offer antiobiotic if cough has lasted less than 21 days
- clarithomycin if less than 1 month
- clarithomycin or azithromycin if over 1 month
If contraindicated use co-trimoxazole (not licensed if under 6 weeks)
Management of contacts if been in same room over night in first 21 days
- pregnant
- unimmunised children
- working with children
Give macrolide and co trimoxazole if contraindicated

52
Q

When can go back to school with pertussis

A

48 hours of antibiotics
21 days after cough started

53
Q

Who admit for pertussis

A

Is 6 months of age or younger and acutely unwell.
Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis).
Has a significant complication (for example seizures or pneumonia)
Must inform hospital before to ensure adequate isolation

54
Q

Recommended diet for CF

A

High calories
High fat
Pancreatic enzyme replacement with every meal

55
Q

What drugs are contraindicated in asthma

A

Beta blockers
NSAIDS
Adenosine
ACEi

56
Q

Long term asthma examination findings

A

Hyperinflated chest
Harrison sulci- under costal margin

57
Q

Why do children wheeze more when get viral infections under 5

A

Airways narrower

58
Q

What does short stature suggest with a rectal prolapse

A

CF

59
Q

Pathophysiology of CF

A

Autosomal recessive disease caused by a mutation in the CFTR (chloride channel)
Leads to reduced movement of chloride out of cells, leading to thick mucus

60
Q

Which infections are common in CF people

A

Staphylococcus aureus
Pseudomonas aeruginosa
Haemophilus influenzae
Aspergillus fumigatus
Non-tuberculous mycobacteria

61
Q

When is only do a CXR in bronchiolitis

A

Being transferred to ITU
May see peribronchial thickening

62
Q

Management of laryngomalacia

A

Typically with resolve within a few months
If apnoeic episodes, cyanosis or poor feeding and development then can consider surgery- supraglottoplasty

63
Q

When consider pneumonia over bronchiolitis

A

Fever over 39
Persistant localised crackles

64
Q

What lobe are foreign objects typically seen in

A

Right middle lobe

65
Q

Features of kartageners syndrome

A

Sinusitis
Bronchiectasis
Infertility
Dextrocardia

66
Q

What is most common cause of pneumonia in children

A

Under 4s- strep pneumoniae
over 4- mycoplasma

67
Q

What is dose of dexamethasone used for croup

A

0.15ml/kg

68
Q

What is best test for diagnosing asthma

A

FEV1 on a spirometer
12% improvement with bronchodilator positive

69
Q

Management guidelines for pneumothorax

A

Breathless or over 2 cm= needle aspiration -> if fails chest drain
Any intervention needs followup in 2 weeks in OPD
Under 2cm= discharge and see in OPD in 2 weeks

70
Q

Pneumonia in a neonate

A

GBS
Gram neg enterococcus

71
Q

Pneumonia in an infant and young kids

A

Strep p
Haemophilus influenza

72
Q

Cough that worsens when cry

A

Croup

73
Q

If spirometry fails to identify asthma what do

A

FeNO

74
Q

If someone with desaturates quickly with meconium aspiration syndrome, what is diagnosis

A

Pneumothorax

75
Q

What is severe complication of bronchiolitis

A

Bronchiolitis obliterans

76
Q

What is bronchiolitis obliterans and what causes it

A

Repair of lung tissues is in overdrive leading to scar tissue formation
Adenovirus

77
Q

How does bacterial tracheitis present

A

Croup like
Very high fever
Copious airway secretions

78
Q

What is most common cause of bacterial tracheitis

A

Staph aureus

Paeds (17 decks)

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