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Paediatrics > Resp > Flashcards

Resp Flashcards

1
Q

Wheeze V Stridor

A 
Wheeze = polyphonic, expiratory noise, mainly from lower airway.
Stridor = Inspiratory, harsh noise, from larger upper airways.
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2
Q

Signs of acute upper airway obstruction

A

Stridor
Hoarseness
Barking cough
Variable dyspnoea

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3
Q

Differential diagnosis for a child with STRIDOR 🤷‍♀️🤷‍♀️🤷‍♀️

A 
Croup/laryngotracheobronchitis
Pseudomembranous croup/Bacterial tracheitis
Rhinitis
Epiglottitis
Anaphylactic reaction
Inhaled foreign body
Whooping cough/Pertussis
Retropharyngeal abscess
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4
Q

Croup epidemiology and pathogenesis

A

Upper airway obstruction and inflammation
Mostly due to viral infection
Commonly 6months-6years
Mostly due to parainfluenza virus

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5
Q

Classic symptoms of croup

A

Coryzal of several days
Barking cough, strider hoarse voice, respiratory distress.
Low grade fever
Can have respiratory distress with signs such as intercostal and sternal indrawing/recessions.
Symptoms worse at night and on agitation.

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6
Q

Management of croup

A 
Most mild cases can be managed at home with appropriate safety-net advise and basic analgesia.
Oral dexamethasone (0.15mg/kg), oral prednisolone or nebulised steroids can be prescribed to reduce severity and duration.
If severe = nebulised adrenaline with oxygen facemask. but beware of rebound effect.
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7
Q

Pseudomembranous croup

A

Bacterial tracheitis
More acute onset
Bacterial cause (croup mostly viral) S.aureus.
VERY HIGH FEVER, airway obstruction, increased secretions creating mucopurulent exudate.
Loud harsh stridor.
Treat with IV flucloxacillin.

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8
Q

Epiglottitis causative organism

A

H.influenza type B

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9
Q

Clinical features of epiglottis

A 
ACUTE ONSET - EMERGENCY!
Drooling saliva
Very ill child/toxic
Very high temp over 38.5
Soft stridor
Very sore throat preventing child from speech and swallowing.
Difficulty in breathing/resp distress
No cough
No coryza prodrome
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10
Q

Management of epiglottitis

A 
DO NOT EXAMINE THROAT!
SECURE AIRWAY!
IV access
Cefuroxime
Rifampicin for close contact prophylaxis.
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11
Q

Bronchiolitis main causative organism and peak age of onset

A

Respiratory syncytial virus

Affects children less than 12months old.

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12
Q

Clinical features of bronchiolitis

A 
Apnoea in under 4months
Coryza prodrome
Sharp dry cough
Tachypnoea
Low grade temp
Hyperinflation
Pallor and cyanosis
Sub and inter-coastal recessions
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13
Q

Differentials for bronchiolitis

A 
Pneumonia
Infective exacerbation of asthma
Viral induced wheeze
Whooping cough
GORD
Cystic fibrosis
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14
Q

Risk factors for developing bronchiolitis

A 
Preterm (<32weeks)
Cystic fibrosis
Congenital heats defect babies
Very young babies
Neuromuscular disorder babies
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15
Q

Diagnosing bronchiolitis

A

CLINICAL DIAGNOSIS

PCR of nasopharyngeal secretions for causative organisms (msc)

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16
Q

Treating bronchiolitis

A

No cure, supportive care.
High flow O2/CPAP
Isolation treatment/barrier nursing.
Good feeding and fluid intake.

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17
Q

Prophylaxis of bronchiolitis

A

Monoclonal antibody for RSV. Given to high risk babies (e.g.premature) via IM injection in winter months. expensive so limited use!

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18
Q

Types of respiratory infections in children

A

Upper airway = coryza, otitis media, pharyngitis, tonsillitis.
Laryngeal/tracheal = croup, epiglottitis, bacterial tracheitis.
Bronchitis
Bronchiolitis = RSV
Pneumonia

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19
Q

Aetiology of community acquired pneumonia in children

A

Most are viral - respiratory syncytial virus.
Neonate bacterial = group B strep (from mother’s tract), E.coli.
Infant bacteria = Strep pneuoniae, H.influenza, S.aureus.
Children over 5 bacteria = Mycoplasma pneumoniae, S.pneumoniae, Chlamydia pneumoniae.
Always consider mycoplasma tuberculosis.

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20
Q

Clinical features of pneumonia

A 
High fever
Cyanosis
Tachypnoea
Cough
Lethargy
Increased work of breathing = chest in-drawing, nasal flaring, grunting.
Poor feeding.
End expiratory coarse, focal crackles in auscultation.
Low Oxygen sats
(No hyperinflation)
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21
Q

Symptoms and signs suggestive of a bacterial pneumonia

A

Localised chest, abdo or neck pain = pleural irritation.
Pleural effusion (absent breathes sounds, dull percussion)
Lobar consolidation
Leukocytosis.

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22
Q

Investigations for pneumonia

A 
SpO2
CXR - localised consolidation
FBC
Sputum and blood cultures
Do not require investigations if child is being treat with CAP at home (safety-net)
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23
Q

Treatment of pneumonia

A

As viral and bacteria can not be easily differentiated, always give ABx -amoxicillin.

24
Q

Signs of a child with pneumonia needing hospital admittance

A

SpO2 less than 92%
Grunting, recessions, resp rate over 60breaths/min
Cyanosis
Signs of pneumonia complicated by effusion.
Unrousable and unresponsive to cues.
Temp over 38 if 3months or less

25
Q

Differentials for wheeze/cough/pneumonia

A

Viral induced wheeze.
Acute exacerbation of asthma - Hx of asthma or atopy, worsened by asthma triggers.
Bronchiolitis - sharp dry cough, prodrome.
CAP - acute, localised consolidation.
Bronchiectasis - copiious sptum, frequent RTI.
CF - productive cough, GI symptoms, failure to thrive, chronic symptoms from birth.
Pertussis - paroxysms coughing followed by inspiratory whoop.

26
Q

Asthma pathophys

A

Triggers e.g. pollen, dust mites cause IgE production via Th2 cells.
Airway oedema, excess mucus production and plugging, white cell infiltration into epithelium.
Bronchial hyper-responsiveness.
Bronchoconstriction.
Airway narrowing and obstruction.
Reversible changes.

INFLAMMATION + AIRWAY HYPERSENSITIVITY

27
Q

Risk factors for asthma

A

Low birth weight
FHx/genetic atopy
Pollution and exposure to tobacco smoke
Hx of lung disease

28
Q

Clinical features of asthma

A

COUGH, WHEEZE, SOB.
Recurrent, episodic polyphonic wheeze - worse at night and in early morning (diurnal variation).
Wheeze is triggered by exercise, mites, emotions, laughter, dust etc
Chest tightness, breathlessness, cough
Symptoms worsened on infection (exacerbation)

29
Q

Details of the wheeze in asthma

A

Polyphonic
Episodic
Triggered by laughter, emotions, dust, pets, cold, allergens.
Worse in early morning and night.

30
Q

Investigations for asthma

A

Fractional exhaled nitric oxide test = +ve if result over 40ppb
Spirometry = FEV1/FVC < 70%
Bronchodilator reversibility = bronchodilator will improve FEV1/FVC by 12%
Variable peak expiratory flow = more than 20% variability in twice daily testing for 2-4weeks.

31
Q

Chronic asthma drug treatment

A

1) Short acting beta-2-agonist as reliever e.g. PRN salbutamol
2) Add inhaled corticosteroid as preventer e.g. OD beclometasone.
3) Add leukotriene receptor antagonist e.g. pd Montelukast.
4) Stop LRTA and add long-acting beta-2-agonist .e.g salmeterol.
5) MART regime = maintenance and deliver therapy e.g. ICS and LABA in 1 inhaler.
6) Increase ICS dose
7) Specialist assessment.

32
Q

How does treatment of asthma change if child under 5

A

If asthma not controlled on ICS and LRRA for to specialist

33
Q

General advise and education for asthma and review topics

A 
Self-management education.
Up to date on routine vaccines.
Advise on avoiding triggers.
Explain how to use inhalers.
In review - ask about days off school, oral steroid use, inhaler technique and adherence.
34
Q

Signs in a moderately severe asthma exacerbation

A

peak expiratory flow rate is between 50-75%. Normal speech. No features of acute or life-threatening asthma

35
Q

Signs in an acute severe asthma exacerbation

A 
PEFR between 33-50%
tachypnoea
tachycardia
inability to complete sentences in a single breath
use of accessory muscles
inability to feed
SpO2 less than 92%
36
Q

Signs of a life-threatening asthma exacerbation

A 
PEFR less than 33%
SpO2 less than 92%
Altered consciousness 
exhaustion or arrhythmia
hypotensive 
cyanosis
silent chest
confused.
Poor resp effort
37
Q

Management of acute asthma exacerbation

A

1) High flow 100% oxygen
2) SABA + ipratropium bromide nebulised
3) Prednisolone or hydrocortisone
4) Consider Magnesium Sulphate
5) Aminophylline
6) Consider CPAP get some more help!

38
Q

Genetics of cystic fibrosis

A

Autosomal recessive.
Chromosome 7 mutation at cystic fibrosis transmembrane conductance regulator gene (CFTR), dysfunctional cyclic AMP-regulated sodium/chloride channel.

39
Q

Diagnosis of cystic fibrosis

A

Guthrie test in postnatal period = raised immunoreactive trypsinogen.
Sweat test = greater than 60mmol/L of chloride.
Genetic counselling.

40
Q

Infancy clinical features of cystic fibrosis

A

Meconium ileus
Prolonged neonatal jaundice
Failure to thrive
Recurrent chest infections with atypical organisms
Steatorrheoa and malabsorption due to pancreatic insufficiency,

41
Q

Clinical features of a child with cystic fibrosis

A 
Recurrent chest infections with atypical organisms (Bronchiectasis)
Rectal prolapse
Nasal polyp
Sinusitis
Distal intestinal obstruction syndrome
42
Q

Clinical features in an adolescent with cystic fibrosis

A 
Diabets mellitus
Cirrhosis and portal HTN
Pneumothorax
Allergic bronchopulomary aspergillosis
Sterility/infertility
43
Q

Atypical organisms seen in cystic fibrosis RTI

A

S.aureus
H.influenza
P.aeruginosa

44
Q

Resp clinical features of cystic fibrosis

A 
Persistent cough which produces purulent sputum.
Hyperinflation of chest.
Expiratory wheeze
Coarse inspiratory creptations.
Clubbing
Haemoptysis
Neutrophilic airway inflammation.
45
Q

Meconium ileus

A

Presents in first days of life.

Thick meconium causes bowel obstruction = vomiting, abdo distension and poor defection.

46
Q

Steatorrhoea

A

Oily, loose, pale fatty stools

47
Q

Pathophys of cystic fibrosis

A 
Low chloride secretion
High sodium reabsorption
More viscous mucus
Worse muco-cilary clearance.
Increased bile concentration.
Stagnation of pancreatic enzymes (DM)
48
Q

MDT for cystic fibrosis

A 
Paediatrician
Nures
Physio
Dietician
Pharmacist
Psychologist
Social worker
49
Q

Annual review of cystic fibrosis

A 
Pulmonary assessment.
Nutrition assessment.
DM testing
Psych
review exercise programme.
50
Q

Treatment for pulmonary symptoms of cystic fibrosis

A

Airway clearance techniques and exercises. Teach percussion and postural drainage. 2-3/day
Immunomodulatory agent e.g. azithromycin or corticosteroid.
Mucoactive agent e.g. rhDNase, hypertonic saline or mannitol dry powder.

51
Q

Treatment for GI symptoms of cystic fibrosis

A

Replace pancreatic enzymes e.g. Pancrex V
High calorie diet
Fat soluble vitamin supplements.

52
Q

Complications of cystic fibrosis

A 
Diabetes mellitus
Cirrhosis
Distal intestinal obstruction syndrome
Low bone density
Pancreatic insufficiency.
53
Q

Type of immune response seen in asthma

A

Hypersensitivity type 1

54
Q

Contents of sputum from asthma

A

Curschmann’s spirals

Charcot-Leyden crystals

55
Q

4 signs on auscultation of pneumonia

A

Crackles
Pleural rub
Increase vocal resonance
Bronchial breathing

Paediatrics (16 decks)

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