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Toni's Paeds > Resp > Flashcards

Resp Flashcards

1
Q

What is pharyngitis

A

Sore throat
Viral: adenovirus, enterovirus, rhinovirus
Sometimes: beta-haemolytic streptococcus in older kids

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2
Q

What is tonsillitis

A

Tonsil inflammation + purulent exudate
Beta-haemolytic strep or EBV
Can’t clinically distinguish

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3
Q

What is acute otitis media

A 
Infection of middle ear
Common at: 6-12months
Short, horizontal eustacian tubes
Earache + pyrexia
Red, bright, bulging tympanic membrane, loss of light reflection
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4
Q

Otitis media treatment

A 
Analgesia: paracetamol + ibuprofen
Resolves spontaneously
Abx don't reduce risk of hearing loss
Decongestants and antihistamines won't help
Complications: mastoiditis, meningitis
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5
Q

What is serous otitis media / glue ear

A

Otitis media with effusion
Dull retracted eardrum with visible fluid level
Flat trace on tympanometry
Evidence of conductive hearing loss
Resolves spontaneously
Common at 2 - 7 yrs
Grommets +- adenoidectomy may help in chronic cases

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6
Q

What is sinusitis

A

Infection of paranasal sinuses
Usually viral
Occasionally secondary bacterial infection:
Pain, swelling and tenderness over cheeks
Analgesia, decongestants, antibiotics

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7
Q

Indications for tonsillectomy

A

Recurrent severe tonsillitis:
Will only reduce episodes by 1/3
Peritonsillar abscess: quinsy

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8
Q

Indications for tonsillectomy and adenoidectomy

A

Recurrent otitis media with effusion and long term hearing loss
Obstructive sleep apnoea

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9
Q

How to recognise acute upper airways obstruction

A

Stridor on inspiration + Hoarseness + Barking cough
Dyspnoea+ Chest retraction
Increased HR + RR
Hypoxaemia: measure oxygen saturations

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10
Q

Managing acute upper airway obstruction

A

Don’t examine throat
? Signs of hypoxia ? Deterioration
Severe -> nebulised epinephrine + anaesthetist
Resp failure req urgent tracheal intubation

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11
Q

What is Laryngotracheobronchitis / Croup

A

Fever + coryza-> barking cough, harsh stridor, hoarseness
Subglottic oedema can -> tracheal narrowing
Parainfluenza
6 months - 6 yrs

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12
Q

Management of mild upper airway obstruction:

Stridor and chest recession disappear at rest

A

Management at home

Analgesia

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13
Q

Moderate upper airway obstruction:

Stridor and recession at rest
Obs normal

A

Oral dexamethasone / prednisolone
Nebulised budesonide
Reduces severity and admission

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14
Q

Bacterial tracheitis / Pseudomembranous croup

A 
Severe viral croup + high fever
Copious thick airway secretions
Harsh stridor
Rapidly progressive airway obstruction
Staph aureas
IV abx +- intubation and ventilation
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15
Q

What is Acute epiglottitis

A 
Life threatening emergency
H.influenzae type B 
Epiglottic swelling -> obstruction in hours 
No preceding coryza
Unable to speak or swallow, dribbling
Soft stridor, sat upright mouth open
Septicaemia 
1-6 yrs
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16
Q

Managing acute epiglottitis

A 
Don't examine throat!
Call anaesthetist, paeds, ENT
Transfer to ICU, intubate under GA
If not possible -> tracheostomy
Blood cultures
IV ceftriaxone: 3-5 days
Prophylactic rifampicin to close contacts
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17
Q

What is acute bronchitis

A

Hx of cough + fever
Mixed wheeze + coarse crackles
Causes incl: pertussis + mycoplasma

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18
Q

What is whooping cough?

Bordetella Pertussis

A

Epidemics every 3-4yrs
Week coryza
Spasmodic cough 3-6 wks
Inspiratory whoop: red/blue face, streaming mucus
Coughing-> vomiting, epistaxis, subconjunctival haemorrhage
Symptoms can persist months

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19
Q

Management of pertussis

A

Admission and isolation with sever spasms/cyanosis
Erythromycin only improves sx if started in coryzal phase
Prophylactic erythromycin for close contacts
Immunisation reduces risk but doesn’t protect entirely
Identified on nasal swab culture/PCR

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20
Q

What is Bronchiolitis

A

1-9 months
Respiratory Syncytial Virus
Co infection with metapneumovirus= severe bronchiolitis
Coryza, dry cough, SOB, crackles, wheeze
Feeding difficulty -> admission
Incr risk if premature, underlying lung pathology

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21
Q

What is Pneumonia

A 
Viral or bacterial
Preceding URTI
Fever, lethargy
Difficulty breathing, cough
Tachypnoeic, incr work of breathing
Local chest pain = bacterial pleural irritation
End insp. coarse crackles
Decr oxygen saturations -> admission
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22
Q

What is coryza

A

Common cold
Viral: rhinovirus, corona virus, RSV
Self-limiting
Paracetamol/ ibuprofen for pain + fever

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23
Q

What is Viral induced wheeze/ transient early wheezing

A

Small airways more likely to narrow + obstruct with infection
RF: maternal smoking, not atopy
More common in males
Resolves by age 5

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24
Q

What is Atopic Asthma

A

Persistent recurrent wheezing beyond preschool age
House dust mite, pollen or pet allergy
Assoc with eczema and food allergy
Worse: at night, early am, cold, pets, dust
Interval symptoms
Skin-prick test or serum IgE, CXR, PEFR

25
Q

Atopic asthma pathology

A

Genetics + triggers:
Bronchial inflammation: oedema, mucus, infiltration ->
Bronchial hyperresponsiveness: twitchiness ->
Airway narrowing: reversible obstruction->
Symptoms: cough, wheeze, SOB, chest tightness

26
Q

Examining a young child with suspected asthma, what are you looking for?

A

Current: generalised polyphonic wheeze, prolonged exp phase
Harrison sulci: chronic obstructive airways disease
Eczema
Allergic rhinitis in nasal mucosa
Plot growth
Clubbing, wet cough, sputum= chronic infection not asthma

27
Q

Managing atopic asthma

A

Response to treatment: PEFR before + after bronchodilator

Should increase by > 10-15%

28
Q

Short-acting beta2-agonists

A 
Relievers:
Salbutamol + Terbutaline
Bronchodilator
Rapid onset of action, last 2-4hrs
As req
High doses for acute asthma attacks
29
Q

Long-acting beta-2-agonists

A 
Salmeterol + Formoterol
Bronchodilators
Effective for 12 hrs
Used in conjunction with inhaled steroid
Useful in exercise-induced asthma
30
Q

Ipratropium bromide

A

Anticholinergic bronchodilator
Young infants
Severe acute asthma

31
Q

Inhaled corticosteroids

A

Prophylactic therapy, must be taken regularly ‘preventers’
Reduce airway inflammation
Reduce symptoms, exacerbations + bronchial hyperactivity
Used in conjunction with LABAs
Systemic side effects at v high doses: impaired growth, adrenal suppression, altered bone metabolism

32
Q

Add on asthma therapy

A

5yrs LABA = 1st line

Slow-release oral theophylline is an alternative but has common SE incl: vomiting, insomnia, headaches. Not often used

33
Q

Therapies for severe persistent asthma

A

Specialist management required!
Oral prednisolone:
Omalizumab: anti IgE mab

34
Q

Stepwise asthma therapy

A
  1. Mild intermittent: reliever as req
  2. Req beta-2-agonist 3 or more times/wk: add inhaled steroid
  3. Poor control on normal doses steroid: ‘add on’ therapy
  4. Persistent poor control: max inhaled steroid dose
  5. Oral steroid use
35
Q

Assessment of acute asthma attack

A
  • wheeze + tachypnoea + pulsus paradoxus = unhelpful
  • tachycardia + SOB preventing talking = severe
  • chest recession +use of accessory muscles = severe
    Oxygen saturations
    PEFR
  • cyanosis, fatigue and drowsiness: late signs, imminent arrest
36
Q

Criteria for admission with asthma

A

Persisting SOB + tachypnoea
Exhaustion
Marked reduction in PEFR

37
Q

Severe persistent cough following acute infection

A 
If wet sounding
CXR 
Cystic fibrosis
Unresolved lobar collapse
TB
38
Q

Persistent cough & wheeze

A

? Asthma
? Aspiration of feed
? Inhaled foreign body
? Smoker in household

39
Q

What is bronchiectasis

A

Permanent dilatation of bronchi due to chronic lung infection
Best identified by CT, CXR may identify gross changes
Generalised: CF, primary ciliary dyskinesia, immunodeficiency, chronic aspiration
Focal: prev severe pneumonia, congenital abnormality, obstruction by foreign body

40
Q

What is primary ciliary dyskinesia

A

Congenital abnormality in structure or function of cilia
Impaired mucociliary clearance
Recurrent U+L RTIs -> bronchiectasis
Chronic ear infections
Sinusitis
50% dextrocardia + situs inversus (kartagener’s)
Daily physio, proactive abx therapy, ENT
Infertility

41
Q

Chronic aspiration

A

Seen in children with neuro disability:
Oropharyngeal incoordination
Gastro-oesophageal reflux

42
Q

Cystic fibrosis

A

AR, Caucasians, 1/2500 affected, 1/25 carrier
CFTR gene Chr 7 (deltaF508)
Defect in cyclic AMP dep Cl channel
Screened for in Guthrie test

43
Q

Consequences of CF in the lungs

A

Reduced airway surface liquid layer
= impaired mucociliary clearance
= retained mucopurulent secretions

Chronic infection, incl: staph aureas, haemophilus influenzae, pseudomonas aeruginosa, burkholderia -> bronchiectasis

44
Q

Consequences of CF in the GI and endocrine systems

A

Thick viscous meconium= meconium ileus in 10-20%

Pancreatic ducts blocked by thick secretions = pancreatic enzyme deficiency = malabsorption
Steatorrhoea, low elastase in faeces
Excessive Na + Cl concentrations in sweat

45
Q

Signs of CF

A

Chest hyperinflation
Coarse insp creps, exp wheezp
Clubbing
Short stature

46
Q

Diagnosing CF

A

Sweat test
CF Cl= 60-125 mmol/L (normal = 10-40)

Sweating stimulated by pilocarpine iontophoresis ->capillary tube -> weighted filter paper,
Confirmed by testing for CFTR abnormalities

47
Q

Managing CF

A

MDT
Regular spirometry
Twice daily physio, prophylactic oral abx (fluclox), rescue abx, IV abx
Enteric coated pancreatic replacement therapy with all food
Fat soluble vitamin supplements
Bilateral sequential lung transplant

48
Q

Later complications of CF

A

DM
Liver disease (req reg ursodeoxycholic acid) rarely -> failure
Distal intestinal obstruction syndrome (cleared with gastrografin)
Pneumothorax
Virulent strains of pseudomonas and burkholderia betw patients
Male infertility
Psych

49
Q

Chronic lung disease

A

Oxygen requirement at 36wks corrected gestation/28 days post term
Premature babies due to barotrauma/volutrauma, surfactant deficiency or oxygen therapy
Increased risk resp tract infections
Paluvizumab given as prophylaxis against RSV

50
Q

Which lobe will an inhaled foreign body most likely end up in?

A

Right middle lobe
Terminal branch of right main bronchus
Right main bronchus: widest, shortest, most vertical

51
Q

What respiratory profile will children with muscular dystrophy have?

A

Restrictive respiratory disease
Reduced FVC
Normal FEV1/FVC ratio

52
Q

Near fatal asthma

A

Raised PaCO2
And /or
Requiring mechanical ventilation with raised inflation pressures

53
Q

Life threatening asthma

A

Severe asthma + one of:

PEF

54
Q

Severe asthma

A 
Any of:
PEF 33-50% best/predicted
Tachypnoea
Tachycardia
Inability to complete sentences in one breath
55
Q

Moderate asthma

A

Increasing symptoms
PEF 50-75% of best/predicted
No features of acute severe asthma

56
Q

Sx of carbon monoxide poisoning

A 
Hypoxia: headache, dizziness, nausea
No cyanosis
Syncope + seizures
Coma + death
CO has 250x oxygen affinity for binding Hb
57
Q

How to diagnose CO poisoning

A

Carboxyhaemoglobin levels
>5% in non-smoker is diagnostic
Smokers can have COHb of up to 9%

58
Q

Management of CO poisoning

A

100% O2 with tight fitting mask
May req fluids and anticonvulsants

If COHb >40% or severe sx, may req hyperbaric oxygen

59
Q

How to manage bronchiolitis

A

Hx
Exam
Nasopharyngeal swabs to confirm RSV
May req admission for supportive fluids + oxygen
Abx, steroids, bronchodilators not effective

Toni's Paeds (16 decks)

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