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Resp Flashcards

1
Q

What are the common viruses found in childhood respiratory infections?

A

Viruses account for 80-90 percent of childhood respiratory infections

  1. Respiratory Syncytial Virus
  2. Rhinovirus
  3. Parainfluenza
  4. Adenoviruses
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2
Q

What are the common bacteria found in childhood respiratory infections?

A
  1. Streptococcus Pneumoniae
  2. Haemophilus Influenza
  3. Bordetella Pertussis
  4. Mycobacterium Tuberculosis
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3
Q

Risk factors for respiratory infection?

A
  1. Parental smoking, especially maternal
  2. Poor socio-economic status
  3. Poor Nutrition
  4. Underlying lung disease (bronchopulmonary dysplasia prems, CF or Asthma
  5. Male
  6. Congenital Heart Disease
  7. Immunodeficiency
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4
Q

Common presentation of URTI?

A

Nasal Discharge and blockage, fever, painful throat and earache, cough.

Could cause –> difficulty in feeding, febrile convulsions, acute exacerbations of asthma

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5
Q

What organisms normally found in pharyngitis (sore throat)?

A

adenovirus, enterovirus and rhinovirus

In older children, group A beta haemolytic streptococcus is a common pathogen

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6
Q

What organisms normally cause tonsillitis?

A

group A beta-hemolytic strep and Epstein Barr virus

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7
Q

How to differentiate viral or bacterial tonsillitis?

A

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

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8
Q

At what age is Acute Otitis Media most commonly seen?

A

6-12 months

Eustachian tubes are short, horizontal and function poorly
Tympanic membrane commonly will appear bright red and bulging, occasionally with pus visible

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9
Q

What are the indications for a Tonsilliectomy and Adenoidectomy?

A

Tonsillectomy - recurrent severe tonsillitis, peritonsillar abscess, obstructive sleep apnoea

Adenoidectomy - recurrent otitis media with effusion with hearing loss

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10
Q

Treatment option in severe Otitis Media?

A

insertions of grommet, which are ventilation tubes

or

adenoidectomy

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11
Q

What are the characteristics of Laryngeal or Tracheal infections?

A
  1. Stridor
  2. Hoarseness (inflammation of vocal cords)
  3. Barking of a Sea Lion
  4. Dyspnoea
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12
Q

2 ways to assess severity of Laryngeal and Tracheal Infections?

A
  1. Chest Retraction (none, only on crying, at rest)

2. Stridor (none, only on crying, at rest or biphasic)

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13
Q

What is the medical term for Croup?

A

Laryngotracheobronchitis

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14
Q

What are common indicators of Croup?

A

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

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15
Q

Treatment of Croup?

A

Oral Dexamethasone
Oral Prednisolone

adrenaline
oxygen

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16
Q

How is bacterial tracheitis (pseudomembranous croup) different from Viral Croup?

A

Higher fever, appears toxic, copious airway obstruction

caused by Staph Aureus

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17
Q

What organism is responsible for Acute Epiglottis?

A

H. Influenza

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18
Q

Characteristics of Acute Epiglottitis?

A

High-fever, painful throat ( can’t speak or swallow = drools), soft insp stridor, rapidly increasing resp difficulty

Child is immobile, upright with open mouth

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19
Q

What organism causes whooping cough?

A

Bordetella Pertussis

20
Q

How does whooping cough present?

A

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

21
Q

What antibiotic is used as treatment for whooping cough?

A

Azithromycin

22
Q

What are signs of Respiratory Distress?

A

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.

23
Q

What organism is most commonly seen in bronchiolitis?

A

Respiratory Syncytial Virus 80%

dual infection with RSV and Human Metapneumovirus is associated with severe bronchiolitis

24
Q

What age group are most affected by bronchiolitis?

A

90% in 1-9 months

25
Q

What are the clinical features of bronchiolitis?

A

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
26
Q

What group of children are most at risk for bronchiolitis?

A

premature babies with bronchopulmonary dysplasia, CF and congenital heart disease

27
Q

What organism most commonly found in newborn Pneumonia?

A

Organisms from mother’s genital tract

  • group B strep
  • gram -ve enterococci
28
Q

What organism most commonly found in Infants and young children Pneumonia?

A

RSV

Strep Pneumoniae or H. Influenza
Bordetella Pertuss

29
Q

What organism most commonly found in >5 years oldPneumonia?

A

Mycoplasma Pneumoniae, Strep Pneumonia

30
Q

What vaccines have reduced the incidence of Pneumonia?

A 
Conjugate Vaccine (Prenevar) - strep. penumoniae
Hib - H. Influenza
31
Q

What is transient-early wheezing? What is it triggered by?

A

episodic viral wheeze/wheezy bronchitis

triggered by viruses/common cold

32
Q

What is a risk for transient-early wheeze?

A

Maternal smoking

Children that have decreased lung function from birth

33
Q

What findings would be consistent with Persistent recurrent wheeze/asthma?

A

Child with wheeze >1 y/o

Symptoms worse at night and in early morning

Symptoms have triggers

Positive response to asthma treatment

34
Q

What investigations would you do to confirm diagnosis of asthma?

A

Hx and Exam

Skin prick testing for common allergens

CXR to rule out other conditions

Peak flow increases 10-15% with treatment

35
Q

In terms of HR and RR what would you qualify as an acute asthma attack ?

A

2-5 y/o - RR >50, HR >130bpm

>/5 y/o - RR >30, HR >120 bpm

36
Q

What physical signs would you see in an acute asthma attack?

A

Use of accessory muscles

Breathlessness

Cyanosis

Fatigue

Drowsiness

37
Q

What is long term management of asthma?

A

salbutamol

beclamethasone

38
Q

What is management of mild intermittent asthma?

A

inhaled SABA

can consider inhaled ipratropium bromide in infants and young children

39
Q

What would regular preventer therapy be for chronic asthma?

A

3+ SABA inhalations per week

Add inhaled steroid

40
Q

If asthma is poorly controlled on conventional doses of inhaled steroids, what would you be the next step?

A

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

41
Q

How would you manage a child suffering an acute asthma attack?

A

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

42
Q

What would you seen on examination of an individual with CF?

A

hyperinflation of chest

coarse inspiratory crepitations

expiratory wheeze

clubbing

43
Q

How does CF present in infants?

A

meconium ileus

prolonged neonatal jaundice

failure thrive

recurrent chest infections

malabsorption

steatorrhoea

44
Q

How would CF present in children?

A

bronchiectasis

rectal prolapse

sinusitis

diabetes

cirrhosis

portal hypertension

sterility in males

45
Q

What would be management for a child with CF?

A

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

46
Q

How would you manage asthma in a child <5?

A

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

47
Q

What would you see on CXR of someone with TB?

A

bihilar lymphadenopathy

consolidation

pleural effusion

Paeds (13 decks)

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