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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
Atopic asthma pathology
Genetics + triggers: Bronchial inflammation: oedema, mucus, infiltration -> Bronchial hyperresponsiveness: twitchiness -> Airway narrowing: reversible obstruction-> Symptoms: cough, wheeze, SOB, chest tightness
26
Examining a young child with suspected asthma, what are you looking for?
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
Managing atopic asthma
Response to treatment: PEFR before + after bronchodilator | Should increase by > 10-15%
28
Short-acting beta2-agonists
``` Relievers: Salbutamol + Terbutaline Bronchodilator Rapid onset of action, last 2-4hrs As req High doses for acute asthma attacks ```
29
Long-acting beta-2-agonists
``` Salmeterol + Formoterol Bronchodilators Effective for 12 hrs Used in conjunction with inhaled steroid Useful in exercise-induced asthma ```
30
Ipratropium bromide
Anticholinergic bronchodilator Young infants Severe acute asthma
31
Inhaled corticosteroids
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
Add on asthma therapy
5yrs LABA = 1st line Slow-release oral theophylline is an alternative but has common SE incl: vomiting, insomnia, headaches. Not often used
33
Therapies for severe persistent asthma
Specialist management required! Oral prednisolone: Omalizumab: anti IgE mab
34
Stepwise asthma therapy
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
Assessment of acute asthma attack
- 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
Criteria for admission with asthma
Persisting SOB + tachypnoea Exhaustion Marked reduction in PEFR
37
Severe persistent cough following acute infection
``` If wet sounding CXR Cystic fibrosis Unresolved lobar collapse TB ```
38
Persistent cough & wheeze
? Asthma ? Aspiration of feed ? Inhaled foreign body ? Smoker in household
39
What is bronchiectasis
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
What is primary ciliary dyskinesia
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
Chronic aspiration
Seen in children with neuro disability: Oropharyngeal incoordination Gastro-oesophageal reflux
42
Cystic fibrosis
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
Consequences of CF in the lungs
Reduced airway surface liquid layer = impaired mucociliary clearance = retained mucopurulent secretions Chronic infection, incl: staph aureas, haemophilus influenzae, pseudomonas aeruginosa, burkholderia -> bronchiectasis
44
Consequences of CF in the GI and endocrine systems
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
Signs of CF
Chest hyperinflation Coarse insp creps, exp wheezp Clubbing Short stature
46
Diagnosing CF
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
Managing CF
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
Later complications of CF
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
Chronic lung disease
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
Which lobe will an inhaled foreign body most likely end up in?
Right middle lobe Terminal branch of right main bronchus Right main bronchus: widest, shortest, most vertical
51
What respiratory profile will children with muscular dystrophy have?
Restrictive respiratory disease Reduced FVC Normal FEV1/FVC ratio
52
Near fatal asthma
Raised PaCO2 And /or Requiring mechanical ventilation with raised inflation pressures
53
Life threatening asthma
Severe asthma + one of: | PEF
54
Severe asthma
``` Any of: PEF 33-50% best/predicted Tachypnoea Tachycardia Inability to complete sentences in one breath ```
55
Moderate asthma
Increasing symptoms PEF 50-75% of best/predicted No features of acute severe asthma
56
Sx of carbon monoxide poisoning
``` Hypoxia: headache, dizziness, nausea No cyanosis Syncope + seizures Coma + death CO has 250x oxygen affinity for binding Hb ```
57
How to diagnose CO poisoning
Carboxyhaemoglobin levels >5% in non-smoker is diagnostic Smokers can have COHb of up to 9%
58
Management of CO poisoning
100% O2 with tight fitting mask May req fluids and anticonvulsants If COHb >40% or severe sx, may req hyperbaric oxygen
59
How to manage bronchiolitis
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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