Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

paediatrics > resp > Flashcards

resp Flashcards

1
Q

why is prompt recognition and treatment of acute epiglottitis important?

A

airway obstruction can develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is acute epiglottitis caused by?

A

Haemophilus influenzae type B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the features of acute epiglottitis?

A
  1. rapid onset
  2. high temperature, generally unwell
  3. stridor
  4. drooling of saliva
  5. ‘tripod’ position: pt finds it easier to breathe if leaning forward and extending neck in seated position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how is the diagnosis of acute epiglottitis made?

A

direct visualisation via laryngoscopy

X-rays can be done, especially if there is concern about a foreign body

(lateral view: ‘thumb sign’ swelling of epiglottis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is acute epiglottitis managed?

A
  1. immediate senior involvement + anaesthetics, ENT (emergency airway support): ET may be necessary to protect airway
  2. if suspected, DO NOT examine the throat due to risk of acute airway obstruction
  3. oxygen
  4. IV abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what should you NOT do if you suspect acute epiglottitis and why?

A

examine the throat as this can cause acute airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is croup and what is it characterised by?

A

an URTI seen in infants and toddlers

characterised by stridor caused by a combination of laryngeal oedema and secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is croup caused by?

A

parainfluenza viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the peak incidence for croup?

A

6 months to 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the features of croup?

A
  1. stridor
  2. barking cough (worse at night)
  3. fever
  4. coryzal symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the different severity of croup?

A
  1. mild
  2. moderate
  3. severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what defines mild croup?

A
  • occasional barking cough
  • no audible stridor at rest
  • no / mild suprasternal +/- intercostal recession
  • child is happy, prepared to eat, drink and play
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what defines moderate croup?

A
  • frequent barking cough
  • easily audible stridor at rest
  • suprasternal and sternal wall retraction at rest
  • no / little distress or agitation
  • child can be placated and is interested in its surroundings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what defines severe croup?

A
  • frequent barking cough
  • prominent inspiratory (and occasionally, expiratory) stridor at rest
  • marked sternal wall retractions
  • significant distress and agitation / lethargy / restlessness (a sign of hypoxaemia)
  • tachycardia occurs with more severe obstructive symptoms and hypoxaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when do you admit a child with croup?

A

moderate / severe croup

other features:

  • <6 months age
  • known upper airway abnormalities (e.g. Laryngomalacia, Down’s)
  • uncertainty about dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are other important differentials to consider for croup?

A
  1. acute epiglottitis
  2. bacterial tracheitis
  3. peritonsillar abscess
  4. FB inhalation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the management for croup?

A

single dose of oral dexamethasone (0.15 mg/kg) to all children regardless of severity

[prednisolone is an alternative]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what should be given in an emergency for croup?

A
  1. high-flow oxygen
  2. nebulised adrenaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when do you start low dose inhaled corticosteroid (ICS) in chidren > 5 years old?

A

Not controlled on previous step (with SABA only)
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is bronchiolitis and what is the pathogen responsible?

A

a condition characterised by acute bronchiolar inflammation.

Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months, with a peak incidence of 3-6 months). Maternal IgG provides protection to newborns against the pathogen
  • higher incidence in winter
A

bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the other causative organisms for bronchiolitis?

A

other causes: mycoplasma, adenoviruses

may be secondary bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what comorbidities could a child have that makes bronchiolitis more serious?

A
  • bronchopulmonary dysplasia (e.g. Premature)
  • congenital heart disease
  • cystic fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are features of bronchiolitis?

A
  • coryzal symptoms (including mild fever) precede
  • dry cough
  • increasing breathlessness
  • wheezing, fine inspiratory crackles (not always present)
  • feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when should you consider referring a child with bronchiolitis to hospital?

A
  • 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.
26
Q

how do you investigate for bronchiolitis?

A

immunofluorescence of nasopharyngeal secretions may show RSV

27
Q

how is bronchiolitis managed?

A

largely supportive!

  • humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
  • nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
  • suction is sometimes used for excessive upper airway secretions
28
Q

In a child aged < 5 years with asthma not controlled by a SABA + paediatric low-dose ICS, what is the next step in Mx?

A

add a leukotriene receptor antagonist

29
Q

in children > 5 years old with asthma, what is the next step in management if SABA + paediatric low dose ICS + LTRA does not work?

A

(stop LTRA)

SABA + paediatric low dose ICS + LABA

30
Q

what does a normal pCO2 indicate in acute asthma attack?

normal pCO2 is 4.8-6kPa

A

indicates reduced respiratory effort

is therefore a life-threatening sign

31
Q

what are the criteria for a severe asthma attack?

A
  • spO2 < 92%
  • PEF 33-50% best or predicted
  • too breathless to talk or feed
  • HR >125 (>5years), >140 (1-5 years)
  • RR >30 bpm (>5 years), >40 (1-5 years)
  • use of accessory neck muscles
32
Q

what are the features of a life-threatening asthma attack?

A
  • spO2 <92%
  • PEF <33% best or predicted
  • silent chest
  • poor respiratory effort
  • agitation
  • altered consciousness
  • cyanosis
33
Q

what are the causes of snoring in children?

A
  • obesity
  • nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
  • recurrent tonsillitis
  • Down’s syndrome
  • hypothyroidism
34
Q

what are amber signs in paediatric patients with a fever?

A
  • Nasal flaring
  • Lung crackles on auscultation
  • Not responding normally to social cues
  • Reduced nappy wetting
  • Dry mucous membranes
  • Pallor reported by parent or carer
35
Q

what are red signs in paediatric patients with a fever?

A
  • Moderate or severe chest wall recession
  • Does not wake if roused
  • Reduced skin turgor
  • Mottled or blue appearance
  • Grunting
36
Q

what are your dDx for stridor in children?

A
  1. croup
  2. acute epiglottitis
  3. inhaled foreign body
  4. laryngomalacia
37
Q

what are the sx of foreign body inhalation?

A

depends on site of impaction

sudden onset:

  • coughing
  • choking
  • vomiting
  • stridor
38
Q

what is laryngomalacia and how does it present?

A

congenital abnormalitiy of the larynx

infants present at 4 weeks of age with stridor

39
Q

what is surfactant deficient lung disease (SDLD) also known as?

A

respiratory distress syndrome

40
Q

in whom is SDLD seen in?

A

premature infants

41
Q

what is SDLD caused by?

A

insufficient surfactant production and structural immaturity of the lungs

42
Q

what does the risk of SDLD decrease with?

A

gestation

43
Q

what are the other risk factors for SDLD?

A
  1. male
  2. diabetic mothers
  3. C-section
  4. 2nd born of premature twins
44
Q

what are the clinical features of SDLD?

A

respiratory distress in the newborn

tachypnoea, intercostal recession, expiratory grunting, cyanosis

45
Q

what are the CXR findings for SDLD?

A

‘ground-glass’ appearance

indistinct heart border

46
Q

what is the mx for SDLD?

A
  1. prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
  2. oxygen
  3. assisted ventilation
  4. exogenous surfactant given via endotracheal tube
47
Q

what is cystic fibrosis (CF)?

A

autosomal recessive disorder

causing increased viscosity of secretions (e.g. lungs and pancreas)

due to defect in CF transmembrane conductance regulator gene (CFTR)

which codes a cAMP-regulated chloride channel

48
Q

what are 80% of CF cases due to in the UK?

A

delta F508 on long arm of chromosome 7

49
Q

how many births does CF affect and what is the carrier rate?

A

affects 1 per 2500 births

carrier rate 1 in 25

50
Q

what are some organisms which may colonise CF pts?

A
  1. staph aureus
  2. pseudomonas aeruginosa
  3. bukholderia cepacia
  4. aspergillus
51
Q

what are the presenting features of CF in the neonatal period?

A

around 20%

  • meconium ileus
  • less commonly prolonged jaundice
52
Q

what are other presenting features of CF

A
  • recurrent chest infections (40%)
  • malabsoption (30%): steatorrhoea, faltering growth
  • other features (10%): liver disease
53
Q

when are most cases of CF picked up?

A

during newborn screening programmes or early childhood

but 5% of pts are dx-ed after 18 years old

54
Q

what are other features of CF?

A
  • short stature
  • DM
  • delayed puberty
  • rectal prolapse (due to bulky stools)
  • nasal polyps
  • male infertility, female subfertility
55
Q

how is CF diagnosed?

A

sweat test

  • pts with CF have abnormally high sweat chloride
  • normal value <40 mEq/l, CF >60 mEq/l
56
Q

what are some causes of false +ve sweat test?

A
  • malnutrition
  • adrenal insufficiency
  • glycogen storage diseases
  • nephrogenic diabetes insipidus
  • hypothyroidism, hypoparathyroidism
  • G6PD
  • ectodermal dysplasia
57
Q

what is the most common reason for false -ve sweat test?

A

skin oedema

due to hypoalbuminaemia/hypoproteinaemia 2˚ to pancreatic exocrine insufficiency

58
Q

how is CF managed?

A
  • multidisciplinary approach
  • regular chest physiotherapy and postural drainage (at least 2x/day)
  • high calorie diet, high fat intake
  • vitamin supplementation
  • pancreatic enzyme supplements
  • minimise contact with other CF pts to prevent cross infection
  • lung transplantation
  • Lumacaftor / Ivacaftor (Orkambi) for pts homozygous for delta F508 mutation
59
Q

what does Lumacaftor do?

A

increases the number of CFTR proteins that are transported to the cell surface

60
Q

what does Ivacaftor do?

A

a potentiator of CFTR that is already at the cell surface, increasing the probability that the defective channel will be open and allow chloride ions to pass through channel pore

61
Q

what is an important CF-specific contraindication to lung transplantation?

A

chronic infection with Burkholderia cepacia

paediatrics (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions