Resp Flashcards
What are the common viruses found in childhood respiratory infections?
Viruses account for 80-90 percent of childhood respiratory infections
- Respiratory Syncytial Virus
- Rhinovirus
- Parainfluenza
- Adenoviruses
What are the common bacteria found in childhood respiratory infections?
- Streptococcus Pneumoniae
- Haemophilus Influenza
- Bordetella Pertussis
- Mycobacterium Tuberculosis
Risk factors for respiratory infection?
- Parental smoking, especially maternal
- Poor socio-economic status
- Poor Nutrition
- Underlying lung disease (bronchopulmonary dysplasia prems, CF or Asthma
- Male
- Congenital Heart Disease
- Immunodeficiency
Common presentation of URTI?
Nasal Discharge and blockage, fever, painful throat and earache, cough.
Could cause –> difficulty in feeding, febrile convulsions, acute exacerbations of asthma
What organisms normally found in pharyngitis (sore throat)?
adenovirus, enterovirus and rhinovirus
In older children, group A beta haemolytic streptococcus is a common pathogen
What organisms normally cause tonsillitis?
group A beta-hemolytic strep and Epstein Barr virus
How to differentiate viral or bacterial tonsillitis?
Not clinically possible to distinguish
However constitutional disturbances such as headcahe, apathy and abdominal pain, white tonsillar exudate and cervical lymphadenopathy, is more common with bacterial infection
At what age is Acute Otitis Media most commonly seen?
6-12 months
Eustachian tubes are short, horizontal and function poorly
Tympanic membrane commonly will appear bright red and bulging, occasionally with pus visible
What are the indications for a Tonsilliectomy and Adenoidectomy?
Tonsillectomy - recurrent severe tonsillitis, peritonsillar abscess, obstructive sleep apnoea
Adenoidectomy - recurrent otitis media with effusion with hearing loss
Treatment option in severe Otitis Media?
insertions of grommet, which are ventilation tubes
or
adenoidectomy
What are the characteristics of Laryngeal or Tracheal infections?
- Stridor
- Hoarseness (inflammation of vocal cords)
- Barking of a Sea Lion
- Dyspnoea
2 ways to assess severity of Laryngeal and Tracheal Infections?
- Chest Retraction (none, only on crying, at rest)
2. Stridor (none, only on crying, at rest or biphasic)
What is the medical term for Croup?
Laryngotracheobronchitis
What are common indicators of Croup?
Occurs commonly between 6 months and 6 years old ( peak incidence at 2 years)
often preceded by fever and coryza
symptoms starts and are worse at night
95% of time it is Viral
Treatment of Croup?
Oral Dexamethasone
Oral Prednisolone
adrenaline
oxygen
How is bacterial tracheitis (pseudomembranous croup) different from Viral Croup?
Higher fever, appears toxic, copious airway obstruction
caused by Staph Aureus
What organism is responsible for Acute Epiglottis?
H. Influenza
Characteristics of Acute Epiglottitis?
High-fever, painful throat ( can’t speak or swallow = drools), soft insp stridor, rapidly increasing resp difficulty
Child is immobile, upright with open mouth
What organism causes whooping cough?
Bordetella Pertussis
How does whooping cough present?
starts with a week of coryza
followed by a paroxysmal cough and then a inspiratory wheeze
epistaxis and subconjuctival hemorrhage can occur
Complications include - penumonia, convulsions and bronchiectasis
What antibiotic is used as treatment for whooping cough?
Azithromycin
What are signs of Respiratory Distress?
Increased breathing rate - If your child’s breathing rate increases, this may indicate that she is having trouble breathing or not getting enough oxygen.
Color changes - A bluish color around your child’s mouth, on the inside of her lips or on her fingernails may occur when she is not getting enough oxygen. Her skin may also appear pale or gray.
Grunting - You may hear a grunting sound each time your child exhales. The grunting is her body’s way of trying to keep air in the lungs so they will stay open.
Noseflaring - If your child’s nostrils spread open while she breathes, she may be having to work harder to breathe.
Retractions - our child’s chest will appear to sink in just below the neck or under his breastbone with each breath. This is another way of trying to bring more air into her lungs.
Sweating - There may be an increase of sweat on your child’s head, but without his skin feeling warm to the touch. More often, his skin will feel cool or clammy. This may happen when his breathing rate is very fast.
Wheezing - If you hear a tight, whistling or musical sound each time your child breathes, this may indicate that the air passages are smaller, which makes it harder to breathe.
What organism is most commonly seen in bronchiolitis?
Respiratory Syncytial Virus 80%
dual infection with RSV and Human Metapneumovirus is associated with severe bronchiolitis
What age group are most affected by bronchiolitis?
90% in 1-9 months
What are the clinical features of bronchiolitis?
Coryzal symptoms precede a dry cough and increasing breathlessness which leads to feeding difficulty, which is normally the reason for admission
sharp, dry cough tacypnoea sub/intercostal recession hyperinflation of chest fine-end insp crackles high-pitched wheezes tachycardia cyanosis
What group of children are most at risk for bronchiolitis?
premature babies with bronchopulmonary dysplasia, CF and congenital heart disease
What organism most commonly found in newborn Pneumonia?
Organisms from mother’s genital tract
- group B strep
- gram -ve enterococci
What organism most commonly found in Infants and young children Pneumonia?
RSV
Strep Pneumoniae or H. Influenza
Bordetella Pertuss
What organism most commonly found in >5 years oldPneumonia?
Mycoplasma Pneumoniae, Strep Pneumonia
What vaccines have reduced the incidence of Pneumonia?
Conjugate Vaccine (Prenevar) - strep. penumoniae Hib - H. Influenza
What is transient-early wheezing? What is it triggered by?
episodic viral wheeze/wheezy bronchitis
triggered by viruses/common cold
What is a risk for transient-early wheeze?
Maternal smoking
Children that have decreased lung function from birth
What findings would be consistent with Persistent recurrent wheeze/asthma?
Child with wheeze >1 y/o
Symptoms worse at night and in early morning
Symptoms have triggers
Positive response to asthma treatment
What investigations would you do to confirm diagnosis of asthma?
Hx and Exam
Skin prick testing for common allergens
CXR to rule out other conditions
Peak flow increases 10-15% with treatment
In terms of HR and RR what would you qualify as an acute asthma attack ?
2-5 y/o - RR >50, HR >130bpm
>/5 y/o - RR >30, HR >120 bpm
What physical signs would you see in an acute asthma attack?
Use of accessory muscles
Breathlessness
Cyanosis
Fatigue
Drowsiness
What is long term management of asthma?
salbutamol
beclamethasone
What is management of mild intermittent asthma?
inhaled SABA
can consider inhaled ipratropium bromide in infants and young children
What would regular preventer therapy be for chronic asthma?
3+ SABA inhalations per week
Add inhaled steroid
If asthma is poorly controlled on conventional doses of inhaled steroids, what would you be the next step?
1
Newly-diagnosed asthma
Short-acting beta agonist (SABA)
2
Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
SABA + paediatric low-dose inhaled corticosteroid (ICS)
3
SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
4
SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
In contrast to the adult guidance, NICE recommend stopping the LTRA at this point if it hasn’t helped
5
SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS
6
SABA + paediatric moderate-dose ICS MART
OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA
7
SABA + one of the following options:
increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
a trial of an additional drug (for example theophylline)
seeking advice from a healthcare professional with expertise in asthma
How would you manage a child suffering an acute asthma attack?
moderate -SABA spacer 2-4 puffs up to 10 puffs every 2minutes
consider oral prednisolone
severe - SABA 10 puffs via spacer or nebulised
oral prednisolone/IV hydrocortisone
repeat bronchodilators every 20-30mins
life-threathening - nebulised SABA plus ipratropium bromide
IV hydrocortisone
What would you seen on examination of an individual with CF?
hyperinflation of chest
coarse inspiratory crepitations
expiratory wheeze
clubbing
How does CF present in infants?
meconium ileus
prolonged neonatal jaundice
failure thrive
recurrent chest infections
malabsorption
steatorrhoea
How would CF present in children?
bronchiectasis
rectal prolapse
sinusitis
diabetes
cirrhosis
portal hypertension
sterility in males
What would be management for a child with CF?
from diag - physio atleast twice a day
chest percussion and postural drainage
physical exercise
prophylactic abx (flucloxacillin)
nebuslised DNAse or hypertonic saline for sputum
CREON
high calorie diet (150% of normal)
fat-soluble vitamin tablets
How would you manage asthma in a child <5?
1
Newly-diagnosed asthma
Short-acting beta agonist (SABA)
2
Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)
After 8-weeks stop the ICS and monitor the child’s symptoms:
if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely
if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy
if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS
3
SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
4
Stop the LTRA and refer to an paediatric asthma specialist
What would you see on CXR of someone with TB?
bihilar lymphadenopathy
consolidation
pleural effusion
