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resp Flashcards

1
Q

increased risk of severe resp illness: risk factors

A

parental smoking, poor nutrition, underlying lung disease (CF, asthma, chronic lung disease), cyanotic heart disease, immunodeficiency infants

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2
Q

URTI presentation

A

coryza, nasal discharge/ blockage fever painful throat earache cough Screen in all: feeding difficulties, breathing difficulties, drinking enough? urine output (dehydration) apnoea/ blue

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3
Q

congenital softening of cartilage of larynx, collapse during inspiration

A

laryngomalacia

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4
Q

laryngomalacia features

A

can present at birth, usually worsens in first few wks of life. otherwise well infant w stridor noisy breathing can be severe- w reps distress signs + FTT (need surgery)

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5
Q

most common cause of tonsillitis

A

group A B-haemolytic strep and EBV (viral)

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6
Q

viral vs bacterial tonsillitis

A

both have fever, throat pain, pain on swallowing. but white tonsillar exudate and cervical lymphadenopathy more common w bacterial

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7
Q

Bacterial tonsillitis Mx

A

10 days Penicillin (erythromycin if penicillin allergy) Analgesia (NSAIDs, paracetamol)

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8
Q

Recurrent tonsillitis

A

Indicated for tonsillectomy

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9
Q

Complications of Group A strep

A

Rheumatic fever, erythema nodosum, post strep glomerulonephritis

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10
Q

Tonsillitis Ix

A

Look in mouth at tonsils. Feel for cervical LN General obs- temp etc If severely unwell, FBC, WCC, CRP, Blood cultures. Culture of throat swab

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11
Q

Acute Otitis Media risk factors

A

if eustachian tubes are short, horizontal or function poorly assoc w Downs, cleft palate, primary ciliary dyskinesia, allergic rhinitis. Freq URTI household smoking

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12
Q

acute otitis media

A

pain in ear + fever

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13
Q

Acute otitis media Ix

A

Examine tympanic membrane - bright red and bulging with loss of normal light reflection occasionally - perforation of eardrum w pus visible in ear canal

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14
Q

Acute otitis media complications

A

mastoiditis meningitis

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15
Q

Acute otitis media mx

A

analgesia (paracetamol or ibuprofen) antibiotics if still unwell after 2-3 days. Amoxicillin

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16
Q

Otitis media with effusion

A

children asymptomatic apart from decreased hearing. most common cause of conductive hearing loss in children -> can lead to interference w normal speech development and learning difficulties in sch

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17
Q

otitis media with effusion ix

A

examine tympanic membrane- ear drum dull and retracted, often w fluid level visible Tympanometry: flat trace Audiometry: evidence of conductive loss Distraction hearing test in younger children: reduced hearing

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18
Q

Otitis media w effusion Mx

A

usually resolves spontaneously. if severe interference, grommet insertion

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19
Q

pain swelling and tenderness over the cheek

A

sinusitis

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20
Q

sinusitis mx

A

antibiotics if bacterial infection (symptoms >10 days) [1st line Phenoxymethylpenicillin] analgesia (paracetamol, ibuprofen) topical decongestants Admit if severe systemic infection, or serious complication involving orbital region (periorbital oedema, double vision, ophthalmoplegia) or intracranial region (severe frontal headache, swelling over frontal bone, meningitis, focal neuro signs) If recurrent (req >3 abx per yr) -> routine referral to ENT specialist

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21
Q

Croup aka laryngotracheobronchitis what is it?

A

viral infection cause inflammation and oedema of the upper airways + increased secretions *oedema of the subglottic area potentially dangerous as it may cause critical narrowing of the trachea

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22
Q

What is contraindicated in croup?

A

throat exam

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23
Q

Croup features

A

barking cough harsh stridor (ask about noisy breathing) hoarseness preceded by fever and coryza symptoms often worse at night

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24
Q

Croup mx

A

if mild- manage at home low threshold of admission for <12 yo due to narrow airway calibre. *** Oral dexamethasone to all nebulised steroids (budesonide) if severe: nebulised adrenaline w oxygen If still not improving: tracheal intubation w anaethetist

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25
Q

Croup mx for all severities

A

Oral dexamethasone

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26
Q

Croup mx for severe

A

oral dexamethasone nebulised steroids nebulised adrenaline w oxygen admit!!

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27
Q

most common pathogen cause of croup

A

parainfluenza virus

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28
Q

Pseudomembranous croup

A

bacterial tracheitis similar to severe viral croup but child has HIGH fever, appears toxic and has rapidly progressive airway obstruction w thick airway secretions (loud, harsh stridor)

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29
Q

Psuedomembranous croup pathogen

A

Staph Aureus -> tx w IV Abx and intubation and ventilation if required

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30
Q

Acute epiglottitis cause

A

Haemophilus influenza type B

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31
Q

Acute epiglottitis what is it

A

life-threatening EMERGENCY Intense swelling of epiglottis and surrounding tissues, assoc w septicaemia

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32
Q

Acute epiglottitis features

A

acute onset (over hours compared to croup- days) High fever unwell toxic looking child no preceding coryza intensely painful throat drooling soft inspiratory stridor w rapidly increasing resp difficulty Child sitting immobile, upright, w open mouth to optimise airway

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33
Q

What is contraindicated in acute epiglottitis

A

Throat exam

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34
Q

Acute epiglottitis mx

A

urgent hospital admission and tx senior anaesthetist, paediatrician and ENT surgeon. ITU, intubation w GA otherwise, urgent tracheostomy after securing airway, blood cultures and IV ABx (cefuroxime) started

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35
Q

Acute epiglottitis abx

A

cefuroxime IV

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36
Q

acute epiglottitis prophylaxis to close contacts

A

rifampicin

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37
Q

whooping cough aka Pertussis pathogen

A

Bordatella pertussis

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38
Q

Pertussis presentation

A

Preceding coryza characteristic paroxysmal cough followed by inspiratory whoop (due to airway obstruction from airway swelling and increased mucus) Violent bouts of coughing may lead to vomiting, child going blue

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39
Q

Pertussis complications of vigorous coughing

A

vomiting cyanosis apnoea epistaxis subconjunctival haemorrhage broken ribs seizures

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40
Q

How long do symptoms of pertussis last

A

may persist for months due to damage by bacteria

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41
Q

Pertussis Ix

A

Always examine child, full obs, assess dehydration, resp exam for resp distress Pernasal swab for PCR/ culture (diagnostic) Antibody serology FBC - WCC/CRP - shows marked lymphocytosis

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42
Q

Pertussis Mx

A

Erythromycin/ Azithromycin within 21 days of onset of illness close contacts esp immunocomp given prophylaxis erythromycin School exclusion until ABX/ after d21

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43
Q

When are immunisations for pertussis?

A

2, 3, 4 months, preschool booster

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44
Q

bronchiolitis most common cause

A

RSV

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45
Q

severe bronchiolitis dual infection

A

RSV and Humanmetapneumovirus

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46
Q

Bronchiolitis features

A

Coryza feeding difficulty dry cough Resp difficulty - subcostal/ intercostal recessions, fine end inspiratory crackles

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47
Q

Severe bronchiolitis risk factors

A

Chronic lung disease, congenital heart disease, CF

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48
Q

bronchiolitis ix

A

NPA PCR O2 sats Blood venous gas in severe when considering additional ventilatory support

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49
Q

Bronchiolitis Mx

A

Supportive. Admit if <50% normal feeding, parental concern, resp difficulties (esp if blue, apnoeic) Optiflow (humidified oxygen via nasal cannulae) NG feeding if necessary Fluids via NG tube or IV Suction of excessive upper airway secretions Assisted ventilation (CPAP) may be required

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50
Q

Bronchiolitis complications

A

permanent damage to airways - bronchiolitis obliterans

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51
Q

bronchiolitis prevention

A

Pavilizumab (monoclonal Ab to RSV) for high risk premies

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52
Q

bronchiolitis what is it?

A

infection, most often viral, of the small airways

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53
Q

Pneumonia most common pathogens in newborn

A

GBS E coli Listeria

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54
Q

Pneumonia most common in children > 5

A

mycoplasma pneumoniae strep pneumonia chlamydia pneumoniae

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55
Q

pneumonia most common in infants

A

strep pneumoniae or h influenzae

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56
Q

CF chronic endobronchial infection

A

Pseudomonas aeruginosa

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57
Q

CF signs in newborn

A

meconium ileus prolonged jaundice

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58
Q

CF in infant features

A

FTT recurrent chest infections malabsorption steatorrhoea

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59
Q

CF complications in young child

A

bronchiectasis due to chronic infection nasal polyp sinusitis rectal prolapse

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60
Q

CF future complications

A

DM infertility (99% have congenital bilateral absence of vas deferens) cirrhosis

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61
Q

CF signs on examination

A

chest hyperinflation coarse inspiratory creps and or expiratory wheeze finger clubbing

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62
Q

CF Ix

A

faecal elastase test (pancreatic insufficiency) sweat test diagnostic (Cl is 60-120 mmol/L) Genetic testing: CFTR mutation CXR to monitor disease progression

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63
Q

CF MX

A

MDT Approach- Paediatrician, GP, physiotherapist, dietician, specialist nurse, teachers rv annually at specialist centre Aim is to prevent progression, maintian adequate nutrition and growth Resp- physio incl chest percussion and postural drainage to clear mucus Hypertonic saline may help decrease sputum viscosity Prophylactic ABx and vaccinations Pancreas: oral pancreatic replacement therapy w all meals High calorie intake + high fat intake essential Vitamin supplements

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64
Q

CF end stage treatment

A

Lung transplant

65
Q

Guthrie screening test for CF

A

Immune reactive trypsin increased

66
Q

examination findings in bronchiolitis? (resp)

A

signs of resp distress e.g. intercostal, subcostal recessions, tachypnoea, tracheal tug, nasal flaring, grunting widespread fine inspiratory crackles wheeze

67
Q

When to refer to emergency hospital care?

A

if apnoea, looks seriously unwell, central cyanosis severe resp distress e.g. grunting, marked chest recession, RR > 70, persistent SaO2 <92% on RA

68
Q

apnoea + central cyanosis - emergency?

A

yes

69
Q

RR>70 or RR>60 - emergency?

A

70

70
Q

emergency signs of resp distress?

A

grunting marked chest recession

71
Q

risk factors for more severe bronchiolitis?

A

immunodeficiency Chronic lung disease congenital heart disease age <3 mth premie

72
Q

red flags of bronchiolitis?

A

fluid intake 50-75% of normal no wet nappy for 12 h apnoea cyanosis exhaustion worsening work of breathing

73
Q

life threatening asthma attack - PEFR?

A

PEFR <33%

74
Q

life threatening asthma features?

A

PEFR<33% silent chest too breathless to speak altered consciousness cyanosis confusion

75
Q

Viral induced wheeze Mx?

A

give oxygen via face mask/ nasal cannula treat w SABA with spacer (salbutamol) Puff every 30-60 s up to 10 puffs.

76
Q

Asthma acute exacerbation MX?

A

O2 SABA via spacer (salbutamol) or if severe/life threatening - nebulised salbutamol oral prednisolone

77
Q

Pneumonia features?

A

high fever >39 cyanosis increased work of breathing focal crackles low saO2 dull percussion note haemoptysis

78
Q

Pneumonia Ix?

A

obs- temp, RR, HR, SaO2, BP, clinical hydration status (CRT, skin turgor, mucous membranes, UO) examination of resp system- chest

79
Q

pneumonia Mx?

A

rAntibiotics. amoxicillin 1st line if no response add Macrolide to cover mycoplasma pneumoniae. for 7-14 d

80
Q

Ix for suspected inhaled foreign body?

A

bronchoscopy

81
Q

barking cough

A

croup

82
Q

examination findings of chronic resp disorder?

A

FTT finger clubbing hyperinflated chest

83
Q

fever, progressive cough, Haemoptysis, weight loss

A

TB

84
Q

chronic cough >8 wks DDx

A

asthma post nasal drip/ allergic rhinitis chronic lung infection: CF, primary ciliary dyskinesia interstitial lung disease TB habitual pertussis

85
Q

whooping cough

A

pertussis

86
Q

wet productive cough

A

CF bronchiectasis infection

87
Q

Viral induced wheeze 2nd line mx if SABA not effective?

A

oral montelukast/ ICS

88
Q

asthma history?

A

wheeze, cough, SOB, any daily/ seasonal variation? any triggers? FH/Hx of atopy?

89
Q

asthma features on examination?

A

expiratory polyphonic wheeze

90
Q

asthma investigations?

A
  1. spirometry 2. bronchodilator reversibility test (offer if obstructive spirometry) 3. peak flow variability
91
Q

findings of an asthmatic with spirometry?

A

FEV1/FVC ratio <70%

92
Q

findings of an asthmatic with bronchodilator reversibility test?

A

improvement of FEV1 of 12% or more

93
Q

findings of an asthmatic with fractional exhaled nitric oxide?

A

> 35 ppb

94
Q

findings of an asthmatic with peak flow variability?

A

>20%

95
Q

what can you do to identify triggers after diagnosis of asthma made?

A

skin prick tests to aeroallergens or specific IgE tests

96
Q

mx of asthma if not controlled on SABA + low dose ICS?

A

add leukotriene receptor antagonist Montelukast so reliever: SABA Maintenance tx: low dose ICS + LTRA

97
Q

mx of asthma if not controlled on SABA + low dose ICS + not responsive to LTRA?

A

start LABA, stop LTRA so reliever: SABA Maintenance tx: low dose ICS + LABA

98
Q

mx of asthma if not controlled on SABA + low dose ICS + LABA?

A

change ICS + LABA maintenance therapy to MART regimen w paediatric low maintenance ICS dose MART e.g. formoterol. 2 in 1 inhaler used daily

99
Q

mx of asthma if not controlled on MART with low maintenance ICS dose?

A

Increase ICS to a paediatric moderate maintenance dose

100
Q

mx of asthma if not controlled on MART w moderate maintenance ICS dose?

A

seek advice from healthcare professional w expertise in asthma increase ICS dose to high maintenance or trial of additional drug e.g. theophylline

101
Q

mx of asthma if <5 yo?

A

SABA then add low dose ICS then add LTRA then refer to paediatric asthma specialist

102
Q

e.g. of LABA?

A

salmeterol

103
Q

e.g. of MART?

A

formoterol

104
Q

What is low dose ICS?

A

<200 micrograms budesonide

105
Q

what is moderate dose ICS?

A

200-400 micrograms budesonide

106
Q

what is high dose ICS?

A

>400 micrograms budesonide

107
Q

Bronchiolitis NICE recommends immediate referral usually by 999 ambulance if any of the following:

A

apnoea (observed or reported) child looks seriously unwell to a healthcare professional severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute central cyanosis persistent oxygen saturation of less than 92% when breathing air.

108
Q

Bronchiolitis consider referring to hospital if?

A

respiratory rate of over 60 breaths/minute difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’) clinical dehydration.

109
Q

what is the most common cause of stridor in neonates?

A

laryngomalacia.

congenital abnormality of the larynx infants typically present at 4 wks of age with stridor.

laryngomalacia can be exacerbated by intercurrent respiratory infections.

110
Q

laryngomalacia - what is it?

A

laryngeal cartilage is soft and floppy. causing it to collapse and narrow during inspiration, resulting in inspiratory stridor. It is usually a benign condition with noisy breathing but no major problems w feeding or significant respiratory distress. Most cases resolve spontaneously within a year as the larynx grows and the cartilagninous rings stiffen.

111
Q

when you see a strawberry haemangioma on the skin, what do you have to consider?

A

a haemangioma is a collection of small blood vessels that form a lump under the skin. most children only have one, but occasionally a child has multiple haemangiomas in various parts of the body. Haemangiomas can occur in various parts of the body. e.g. liver, airway, heart and brain. potentially life threatening e.g. in the upper airway -> assessment by ENT

112
Q

DDx of stridor in infant

A

laryngomalacia laryngeal cyst/ haemangioma laryngeal stenosis

113
Q

Dx of laryngomalacia?

A

visualization of the larynx using flexible laryngoscopy. Can be done by ENT surgeon as an outpatient procedure. This demonstrates prolapes over the airway of an omega-shaped epiglottis or arytenoid cartilages.

114
Q

O/E with inhaled foreign body

A

unilateral wheeze and decreased air entry on one side

115
Q

DDx of sudden/ acute onset stridor in child

A

Croup: usually URTI followed by barking cough, hoarse voice, stridor and low grade fever

Foreign body: sudden coughing and or choking, accompanying cyanosis

Anaphylaxis: exposure to allergen and usually w associated urticarial rash, facial swelling, vomiting, wheeze or hypotension

Epiglottitis: unimmunized child? drooling

Severe tonsilitis w v large tonsils

Bacterial tracheitis

116
Q

Mx of Croup/ acute stridor

A

ABC

Oral dexamethasone

(nebulised budesonide)

If 2-3 h later and child has improved, SaO2>95% on air, child can be discharged.

If not, further dose of steroids can be administered 12-24 h later.

If the child deteriorates, then nebulized adrenaline can be administered. If adrenaline is requied then senior help and an anaesthetist should be summoned urgently.

If further deterioration, then intubation and ventilation to secure airway. If intubation unsuccessful, an ENT surgeon will be required to perform an emergency tracheostomy.

117
Q

Dx for RSV

A

Nasopharyngeal aspirate for viral immunofluorescence and Polymerase chain reaction or culture.

Largely for infection control and epidemiology and does not affect acute management.

118
Q

Prevention of RSV bronchiolitis?

A

Pavilizimub

monoclonal RSV Ig

reserved for high risk infants, e.g. premies, CHD, CLD

119
Q

Indications for hospital referral with bronchiolitis

A

apnoeic episodes

intake <50% of normal in last 24h

cyanosis

severe resp distress- grunting, nasal falring, severe recession, RR>70/min

Congenital heart disease, pre-existing lung disease or immunodeficiency.

Significant hypotonia e.g. trisomy 21 - less likely to cope with resp compromise

survivor of extreme prematurity

social factors

v low threshold for admitting any baby <2 months of age on day 1 -2 of their illness as they may deteriorate and become exhausted and apnoeic.

120
Q

If infant in hospital with bronchiolitis and deteriorating?

A

capillary blood gas checked

CXR IF clinical course unusual

Blood tests if diagnostic uncertainty e.g. if temp>39 or a superadded bacterial infection is suspected.

Small proportion of infants need high dependency or intensive care- most respond well to continous positive airways pressure (CPAP)

*exposure to tobacco smoke must be avoided.

121
Q

DDX of recurrent or persistent cough in childhood

A

recurrent viral URTIs

ashtma - usually w wheeze / SOB

allergic rhinitis- often nocturnal due to post nasal drip

chronic non specific cough- probably post viral w increased cough receptor sensitivity

pertussis - can continue for months

recurrent aspiration- GOR

envt - smoking,

suppurative lung disease- CF/ primary ciliary dyskinesia

TB
Habit

122
Q

erythema multiforme with resp symptoms- crackles, fever, coryza etc

A

suggestive of mycoplasma pneumoniae

123
Q

presentations of CF in neonate

A

meconium ileus

intestinal atresia

hepatitis/ prolonged jaundice

124
Q

presentation of CF in an infant

A

FTT

Malabsorption and Vit A, D, E, K deficiciency-> steatorrhoea

rectal prolapse

125
Q

presentation of CF in older child

A

recurrent chest infections

haemoptysis

nasal polyps

diabetes mellitus (exocrine pancreatic insufficiency)

liver disease

distal intestinal obstruction syndrome

126
Q

National newborn screening of CF: what does it look for?

A

immunoreactive trypsinogen

(a pancreatic enzyme precursor found in the blood that is raised in most of those w CF at birth)

IRT raised since pancreatic ducts are partially blocked leading to abnormal enzyme drainage.

127
Q

most common cause of finger clubbing in children

A

Cystic fibrosis

128
Q

in Asthma, signs of impending resp failure

A

exhaustion

unable to speak/ complete sentences

colour - pallor/ cyanosis

hypoxia despite high flow humidified oxygen

restless and agitation are signs of hypoxia, esp in small children

silent chest

tachycardia

drowsiness

PEFR persistently <30%

129
Q

mx of acute asthma attack

A

acute mx goals are to correct hypoxia, reverse airway obstruction and prevent progression.

Give high flow oxygen via mask and monitor saturations.

Start regular inhaled B agonist (salbutamol) via a nebulizer. B agonists can be given continuously- but cardiac monitoring is needed.

Inhaled Ipratropium Bromide.

Give oral prednisolone or IV hydrocortisone.

Capillary or venous blood gas and a CXR may be required.

if child continues to deteriorate,

IV salbutamol, IV MgSo4 (Smooth muscle relaxant) and IV aminophylline

130
Q

Review in a child whose asthma is not well controlled

A
  • review compliance

is there parental supervision?

  • review technique

Children rarely use MDIs effectively and need a spacer, esp during acute episodes.

  • consider stepping up tx
  • smoking in the household? education about allergen avoidance e.g. daily vacuuming to reduce house dust mites.
  • all asthmatics should have a written home mx plan.
  • asthma symptom diary
131
Q

In SIADH, what is the urine and serum osmolality?

A

serum osmolality is low

urine osmolality is high

normally, a fall in serum osmolality would suppress ADH secretion to allow excretion of excess water as dilute urine. In SIADH, urine osmolality is inappropriately high (>320) and urine sodium is usually high (>40mmol/L) unlike in hypovolaemic states where it is <20mmol/L

132
Q

pneumonia in a child + hypoNa

A

SIADH

diarrhoea/ excessive vomiting -> hypovolaemic hypoNa

133
Q

Mx of pneumonia

A

oxygen to maintain SaO2 >92%

adequate pain relief for pleuritic pain (may be tummy pain esp if lower lobe pneumonia)

IV Abx according to local guidelines e.g. co-amoxiclav

Fluid balance, U&Es monitoring- adjust fluids accordingly.

Physiotherapy e.g. bubble blowing, encourage mobility

Monitor for development of a pleural effusion. if present- longer course of abx needed. or even a chest drain

Ensure adequate nutrition - low threshold for supplementary feeds via ng tube

arrange for follow up CXR in 6-8 wks in those w lobar collapse and/ or effusion.

134
Q

What are the side effects of continuous B agonist e.g. salbutamol?

A

irritability, tremor, tachycardia, hypokalaemia

so must have cardiac monitoring

135
Q

DDx of chest pain in children

w lack of any resp/ chest signs

A

Idiopathic/ psychological chest pain - due to stresses e.g. family death, bullying, anxiety

Costochondritis - tenderness on palpation of cartilage in the anterior chest wall and pain may be worse on movement or coughing.

trauma e.g. fractured rib

exercise e.g. overuse injury

reflux oesophagitis

sickle cell disease with chest crisis

w resp signs:

pneumonia w pleural involvement

asthma

severe cough

pneumothorax

chest signs:

pericarditis, angina eg from severe aortic stenosis

136
Q

what is costochondritis?

A

inflammation of the cartilage that connects the inner end of each rib to the sternum

tenderness on palpation and pain may be worse on movement or coughing.

usually self limiting. consider NSAIDs for pain relief.

137
Q

assessment of a child w multiple congenital abnormalities

A

characteristic pattern of abnormalities?

karyotyping/ other specific genetic tests

clinical geneticist should assess child

making a diagnosis allows future problems to be anticipated and allows genetic counselling about recurrence risk in future pregnancies

138
Q

what is apnoea

A

cessation of breathing >20s

or shorter if there is color change/ bradycardia

139
Q

causes of apnoea in newborn

A

apnoea of prematurity

lung disease

congenital heart disease

sepsis

hypoglycaemia

hypothermia

sedative drugs

neuro insults

gastro-oesophageal reflux

140
Q

sudden desaturation in ventilated neonate?

chest movement decreased/ asymmetrical

A

pneumothorax

worsening resp disease

141
Q

sudden desaturation in ventilated neonate

no chest movement

A

ventilator not working/ disconnected

endotracheal tube blocked/ dislocated

142
Q

sudden desaturation in ventilated neonate

chest movement normal

A

right to left shunt e.g. PDA

large periventricular haemorrhage

severe sepsis

143
Q

mx of pneumothorax

A

chest drain

  • should be inserted into the 3/4/5th intercostal space in the mid axillary line

then CXR should be done to ensure that the lung has re-inflated and to check the position of the drain

144
Q

diagnosis of pneumothorax

A

cold light transillumination (one side lights up)

and/or CXR

145
Q

duodenal atresia is also assoc w?

A

Downs

malrotation

oesophageal atresia

congenital heart disease

146
Q

what is the concerning complication with eyelid swelling/ orbital cellulitis?

A

meningitis

as infection spreads to the CSF around the optic nerve

147
Q

neonatal jaundice in first 24h of life

mother is O+ baby is A+

A

ABO incompatibility

it can occur w first pregnancy and does not get worse w successive pregnancies.

anti-A and anti-B is naturally found

148
Q

causes of a floppy infant

central vs peripheral causes

A

central causes more common.

central- deep tendon reflexes are present

peripheral (neuromuscular cause)- absent

149
Q

causes of floppy infant

peripheral (neuromuscular) causes

A

infantile spinal muscular atrophy

congenital myasthenia

congenital myotonic dystrophy

congenital muscular dystrophy

150
Q

causes of floppy infant

central causes

A

chromosomal disorder e.g. Downs, Prader-Willi

Brain injury e.g. HIE

brain infection/ sepsis

metabolic disturbance e.g. hypoglycemia

drug exposure e.g. pethidine

151
Q

what would a baby whose delivery was complicated by shoulder dystocia look like?

A

apnoeic

bradycardia

asystolic

pale

floppy

-> acute asphyxial insult as a result of cord compression

152
Q

resuscitation of newborn

A

baby dried, covered and assessed for color, tone, breathing, heart rate

if the baby is not breathing, airway should be opened by placing head in neutral position

+ five inflation breaths

effectiveness of inflation breaths should be assessed by checking for increase in HR

chest compressions may be required

baby may also require adrenaline/ sodium bicarb to be administered

transfer to neonatal unit immediately for supportive and neuroprotective care

153
Q

Causes of congenital malformations

A

congenital:

  • chromosomal abnormalities

= gene defects

environmental:

  • maternal factors e.g. diabetes
  • prescribed drugs e.g. phenytoin
  • recreational drugs e.g. alcohol

envt toxins

  • infections e.g. CMV/ rubella

sporadic

154
Q

CHARGE syndrome

A

coloboma, heart defects, atresia (choanal), retardation of growth and development, genital and ear abnormalities

155
Q

Microdeletions e.g. Digeorges

Diagnosis via?

A

FISH

156
Q

a severe resp infection in early children may lead to?

A

bronchiectasis

caused by dilatation and poor mucociliary clearance, predisposing to further infection.

157
Q

primary ciliary dyskinesia

affects?

A

resp tract and reproductive organs - which are lined by cilia.

+ assoc w dextrocardia/ situs inversus

158
Q

what lobe is a foreign body most likely to end up in

A

right middle lobe

paeds (12 decks)

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