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Sarah Paeds > Resp > Flashcards

Resp Flashcards

1
Q

Signs of respiratory distress

A 
Tachypnoea 
Increased WOB 
Cyanosis 
Recessions 
Nasal flaring 
Tracheal tug 
Grunting 
See-saw abdomen
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2
Q

Commonest cause of child death worldwide

A

Resp

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3
Q

What is stridor

A

Narrowing/obstruction of upper airways

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4
Q

4 causes of stridor

A

Croup
Epiglottitis
Foreign body
Larngomalacia

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5
Q

Commonest causative organism of epiglottitis

A

Hib

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6
Q

Epiglottitis age of presentation

A

1-6 years

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7
Q

Epiglottitis clinical features

A 
Sudden onset 
Quiter/whispering stridor 
High fever 
Sore throat 
Drooling - unable to swallow secretions 
(Absence of a preceding coryza - unlike croup)
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8
Q

What must you not do in a child with epiglottitis?

A

Examine their throat or lie the child down

Allow them to position themselves

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9
Q

Management of epiglottitis

A 
Blood cultures 
Urgent admission (?PICU)
IV ceftriaxone 
Steroids 
\+/- adrenaline nebs 
Prolonged intubation if severe
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10
Q

Recovery of epiglottitis

A

Usually 2-3 days

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11
Q

Clinical features of croup

A 
Onset over days 
Barking stridor (seal)
Preceding coryza 
Hoarseness 
Fever 
(Symptoms worse at night)
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12
Q

Age of presentation croup

A

6mos - 6 yrs

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13
Q

Percentage of croup with viral cause

A

95%

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14
Q

What is croup

A

Laryngotracheal bronchitis with mucosal inflammation and increased secretions

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15
Q

Management of mild croup

A

Single dose oral dex 0.15mg/kg

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16
Q

Three severities of croup and defining features

A

Mild - symptoms disappear at rest
Moderate - symptoms persist at rest
Severe -

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17
Q

Management moderate croup

A

ADMISSION
Oral/nebulised dex/budenoside
+/- nebulised adrenaline

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18
Q

Management severe croup

A

ADMISSION
IV dex, nebulised adrenaline
100% O2
Intubation

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19
Q

Prognosis croup

A

Usually resolves over 48 hours

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20
Q

Where is a foreign body more commonly found

A

R main bronchus

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21
Q

CXR features of foreign body

A

Hyperlucent on one days, mediastinal shift to the other side

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22
Q

Management of foreign body in conscious child

A

Encourage coughing
5 back blows
5 heimlich’s (not on infants/very young children)

Flexible/rigid bronch (w/ conscious sedation/GA)

Surgery/thoracotomy

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23
Q

Management of a foreign body in unconscius child

A

Secure airway (ET tube)

Remove FB from upper airway

Cricothyroidotomy

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24
Q

Inspiratory stridor in otherwise well child

A

Laryngomalacia

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25
Q

What is laryngomalacia

A

Cartilage rings not yet strong enough to hole patent airway

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26
Q

Complications of foreign body

A

Bronchiectasis if diagnosis delayed

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27
Q

Ix for laryngomalacia

A

Flexible laryngoscopy showing omega shaped epiglottis

Monitor SATs

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28
Q

Mx of laryngomalacia (mild/mod/severe)

A

Mild: observation looking for resp distress/FTT. GORD therapy (thickened fluids, baby gaviscon, Nissen fundoplication. Patient fed upright)

Moderate: observation. Surgery - supraglottoplasty relieving obstruction. BiPAP. GORD therapy.

Severe: surgical therapy - supreaglottoplasty. BiPAP. GORD therapy.

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29
Q

Causes of cough in child

A 
Asthma 
URTI/LRTI (viral/bacterial)
Pertussis 
CF 
Smoking parents 
GORD 
Bronchiectasis 
TB
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30
Q

Commonest cause of cough

A

URTI

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31
Q

Age of presentation pertussis

A

3 years

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32
Q

Causative agent pertussis

A

Bordatella pertussis

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33
Q

Pertussis presentation

A

1 week of coryza
Paroxysmal cough with expiratory “whoop” (+/- cyanosis)
Vomiting
Worse at night and after feeding

Epistaxis and conjunctival haemorrhage (from increased pressure)

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34
Q

How long does pertussis persist for?

A

3-6 weeks

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35
Q

Investigations and results for pertussis

A

Nasal swab

Blood film shows marked lympocytosis

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36
Q

Three phases of pertussis

A

Catarrhal
Paroxysmal
Convalescent

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37
Q

Management of pertussis

A

NOTIFY HPU
Admission(isolation) if <6 months old, significant breathing difficulties, complications (e.g. seizure,pneumonia)

Azithromycin if still in catarrhal phase (within 21 days of cough starting)

School exclusion until 48 hours after starting abx

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38
Q

When can Azithromycin be given in pertussis?

A

Within 21 days of cough starting (catarrhal phase)

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39
Q

When can a child with pertussis return to school?

A

48h after starting abx

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40
Q

Causes of bronchiectasis

A 
CF 
Kartagener's (ciliary dyskinesia)
Delayed foreign body 
Chronic aspiration 
Immunodeficiency
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41
Q

Presentation of bronchiectasis

A 
Recurrent URTI/LRTI infections 
Purulent cough (green sputum)

Chronically dilated bronchi

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42
Q

Investigations and results bronchiectasis

A

CT - permanent dilatation of bronchi

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43
Q

Management of bronchiectasis

A

Improved nutrition
Exercise

Airway clearance therapy (physiotherapists)

Inhaled SABA/hypertonic saline

Tobramycin if common P.aeuroginosa infections

Long term macrolide PO (e.g. azithro)

Surgical lung resection/transplantation

44
Q

Which abx is appropriate in a patient with recurrent P.aeuruginosa infections?

A

Tobramycin

45
Q

Which patients often get P.aeuruginosa infections?

A

CF
Bronchiectasis
Kartagener’s

46
Q

Pathophysiology of GORD

A

Inappropriate relaxation of LES

47
Q

Management of GORD

A

Physical - position during feeding, winding
Feed - smaller, more frequent feeds. Consider thickener.

Baby gaviscon
PPI

48
Q

Complications of GORD

A

Oesophagitis

FTT

49
Q

What must be considered (feeding) in patients with resp illness?

A

Ensuring they have enough feed.

Also cutting down feed to 2/3 because thorax working hard, more likely to precipitate GORD/vomit

50
Q

Causes of wheeze in child

A 
Asthma (acute/chronic)
Viral episodic wheeze 
Bronchiolitis 
Pneumonia 
Allergy 
CF
51
Q

Age of presentation viral episodic wheeze

A

<3 years

52
Q

Presentation of viral wheeze

A

Resp distress
Wheeze
Coryzal symptoms (+preceding)
Reduced feeding

53
Q

Risk factors for viral wheeze

A 
Smokers in household 
Mother smoking during pregnancy
Pets 
Damp/mould 
Other ill contacts
54
Q

Management viral wheeze

A 
Burst therapy (3x salbutamol nebs, ? 1x ipratroprium).
If inhaled -- SPACER

Inhaled glucocorticoids

“Stretching” - once they can last 4 hours without symptoms, can be discharged.

(At home can be given 10 puffs every 4 hours (via space))

55
Q

Viral episodic wheeze (parent explanation)

A

Narrowing of airways due to viral chest infection causes whistling sound

56
Q

Paent information on discharge: viral wheeze

A

Salbutamol - 10 puffs every 4 hours via spacer.

If requiring more than every 4 hours, or requiring more than 10 puffs, come back.
Any other resp distress, come back - recessions, nasal flaring, tracheal tug, etc.

57
Q

Two types of asthma

A

Atopic/non-atopic

58
Q

Features of asthma

A 
Child > 3 years 
Wheeze on more than one occasion 
Worse at night/morning 
Worse in cold/on exercise 
Interval symptoms 
(Response to SABA)
DRY COUGH
59
Q

Asthma signs

A

Prolonged expiratory phase
Polyphonic widespread wheeze
Hyperinflated chest

Harrison Sulci - COPD of childhood

60
Q

Investigations in suspected asthma

A

Examination

CXR - hyperinflated chest, Harrison sulci

PEFR

Skin prick to gauge atopy

61
Q

Features of moderate asthma attack

A

PEFR >50%

SPO2 >92

62
Q

Features of severe asthma attack

A 
PEFR 33-50% 
SPO2 <92 
Difficulty talking 
Tachycardia/pnoea 
Use of accessory muscles
63
Q

Features of life threatening asthma attach

A 
PEFR <33% 
SPO2 <92 
Silent chest 
Reduced consciosness 
"Normal" CO2 
Reduced BP
64
Q

Acute asthma attack treatment (escalation ladder)

A

ABCDE

O2 if hypoxic
Burst therapy (3x back to back SABA nebs)
Ipratroprium nebs
Oral pred
IV bronchodilators - aminophylline, theophylline, MgSO4
IM adrenaline

TRANSFER TO ICU

65
Q

Appropriate salbutamol dose in <5 yr child

A

2.5mg

66
Q

Appropriate salbutamol dose in >5 yr child

A

5mg

67
Q

What factors does chronic asthma management depend on? And what is it trying to achieve?

A 
Frequency of attacks 
Severity of attacks 
Interference with school 
Sleep disturbance 
Exercise tolerance 
Growth/nutrition
68
Q

Chronic asthma management in child <5 years

A 
Inhaled SABA (10 puffs 4x/day)
\+ low dose ICS/LTRA
\+ med dose ICS 
\+ high dose ICS and specialisr r/f 
\+ PO steroids
69
Q

Chronic asthma management in child >5 years

A 
Inhaled SABA (10 puffs 4x/day)
\+ low dose ICS/LTRA
\+ med dose ICS + LABA  
\+ high dose ICS and specialisr r/f and omalizumab
\+ PO steroids
70
Q

What is omalizumab?

A

Monoclonal antibody used in asthma therapy (>5 years). Used in allergy therapy

71
Q

What is asthma?

A

Bronchial hyperresponsiveness and airway narrowing

72
Q

Commonest serious resp condition in <2 years

A

Bronchiolitis

73
Q

Commonest causative organism in bronchiolitis

A

RSV

74
Q

What % of patients with bronchiolitis are admitted?

A

2-3

75
Q

Presentation of bronchiolitis

A

Preceding coryzal features, then dry distinctive cough, increased SOB/WOB

  • Feeding difficulty
  • Recurrent apnoea
  • Fever
  • Pallor
  • Tachy
76
Q

Bronchiolitis signs

A
  • Fine end inspiratory crackles
  • Prolonged expiration
  • Hyperinflation
77
Q

Ix bronchiolitis

A

NPA (viral PCR)
Monitor O2 SATs
CXR
Blood gas

78
Q

Mx bronchiolitis

A

Humidified O2 if SATs <92% (optiflow/airvo)

CPAP

Suction

IVI (maintenance/recovery fluids - consider 2/3 if breathing affecting feeding)

Pavulizumab - monoclonal antibody against RSV

79
Q

What is pavulizumab?

A

Monoclonal antibody against RSV

Reduced incidence of bronchiolitis when given to preterm infants

80
Q

What causative organism is commonly associated with lobar consolidation?

A

S.pneumoniae

81
Q

Features of pneumonia

A 
Preceding URTI 
Fever 
DIB 
Poor feeding 
Generally unwell
82
Q

Mx penumonia

A 
Admission if:
SATs <92 on air
Resps >60/min 
T > 38 (if <3 mos)
Cyanosis 
Clinically dehydrated

Amoxicillin 7-14/7

Controlled O2

83
Q

Commonest life long AR conditions in caucasians

A

CF

84
Q

Common presentation of CF

A 
Persistent purulent cough after acute infection 
Meconium ileus 
Pale, greasy stools 
(Clubbing)
POOR GROWTH
85
Q

Pathophysiology of CF

A

Mutation in Cl- ion transporters. Blocks flow of H2O - thick, viscous secretions

86
Q

Three commonly affected organs in CF

A

Lungs
Bowel
Pancreas

87
Q

Resp effects of CF

A

Thick, viscous secretions

Recurrent endobronchial chest infections (P.aeruginosa)

88
Q

Bowel effects of CF

A

Thick, viscid meconium

Meconium ileus in 10-20% patients

89
Q

When is CF detected?

A

Guthrie

90
Q

Pancreatic effects of CF

A

Thick, viscid pancreatic secretions = reduced enzymes into bowel.
Reduced elastae
Enzyme deficiency
Malabsorption

91
Q

Resp treatment for CF

A

Chest physio (with SABA first to help open up airways)
Mucolytics (rhDnase and inhaled hypertonic saline)
Inhaled tobramycin
Ibuprofen/steroids (anti-inflammatories)

CFTR modulators (e.g. ivacaftor)

92
Q

How often should CF patients be reviewed?

A

Annual review of their condition AND at least one other review per year by specialist CF MDT

93
Q

What is ivacaftor?

A

CFTR modulator used in CF management - helps thin the thickened mucous

94
Q

Which conditions are classes as “URTI”?

A

Common cold
Sinusitis
Pharyngitis/tonsilitis
Acute otitis media

95
Q

Why does frontal sinusitis rarely present in children under 10 years?

A

Frontal sinuses only develop in late childhood

96
Q

Sinusitis presentation

A

Coryza/cough
Bad breath
General feeling unwell
Painful cheeks/eyes

Yellow-green nasal/post-nasal drip

97
Q

Commonest cause of sinusitis <10 days

A

Viral

98
Q

When should pt with sinusitis be admitted?

A

If severe systemic infection
Intracranial symptoms - meningitis
Intra-periorbital symptoms

99
Q

Treatment for sinusitis lasting <10 days

A

NO abx
Consider nasal decongestant/nasal steroid spray
Paracetamol/ibuprofen for fever
Return if lasts longer than 3/52

100
Q

Commonest cause of sinusitis >10 days <4 weeks

A

Bacterial

101
Q

Treatment for sinusitis lasting >10 days

A

Abx (delayed - if persists beyond 10 days) AMOXICILLIN
Paracetamol/ibuprofen for fever

High dose nasal steroids if >12 years (mometasone)

Seek advice if symptoms worse

102
Q

Persistent cough after acute infection

A

CF

Unresolved lobar collapse

103
Q

Persistent cough

A 
CF 
TB 
Unresolved lobar collapse 
(Asthma)
GORD
104
Q

Kartagener’s syndrome

A

Primary ciliary dyskinesia
Situs inversus
Dextrocardia

105
Q

Predisposing factors for sleep disordered breathing

A 
Hypotonia
Obesity 
Muscle weakness 
Anatomical problems 
Enlarged tonsils/adenoids
106
Q

Ix sleep disordered breathing

A

Overnight O2 saturations: frequency/severity of periods of desaturation

107
Q

Mx sleep disordered breathing

A

Adenotonsillectomy (if hypertrophy)
CPAP/BiPAP to maintain upper airway

Montelukast +/- intranasal budesonide if surgical intervention does not help

Sarah Paeds (20 decks)

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