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Paeds > Resp Conditions/Exams > Flashcards

Resp Conditions/Exams Flashcards

1
Q

Signs of increased work of breathing

A

→ Tachypnoea
→ Grunting
→ Alar flaring
→ Intercostal recession
→ Subcostal recession / Hoover’s sign, i.e. lower chest wall indrawing
→ Suprasternal recession / tracheal tug
→ Use of accessory muscles
→ Head bobbing

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2
Q

DISTINGUISH PLEURAL EFFUSION FROM DENSE CONSOLIDATION

A

Consolidation: decreased air entry, bronchial breathing, decreased chest movement, collapse, displaced
trachea, dull note on percussion, increased vocal resonance.
Pleural effusion: decreased chest movement, displaced trachea, stony dull note on percussion, decreased
vocal resonance, and decreased air entry.

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3
Q

Causes of large air trapping and small airway trapping

A
  1. Large airway:
    Foreign body
    TB
    Congenital abnormalities
  2. Large airway
    Acute or viral bronchiolitis
    Asthma
    Pneumonia
    Cardiac failure
    CF bronchiectasis
    Non CF bronchiectasis
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4
Q

Most common cause of viral pneumonia in SA (in paeds)

A

Respiratory synctytial virus
RSV

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5
Q

Which organisms commonly cause pneumonia in HIV/immunocompromised infants

A

P.Jirovecci
CMV

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6
Q

Drug tx for pneumonia in >2y/o

A

Amoxicillin 45mg/kg PO 12hourky 5days
Poor response: amoxicillin-clavulanate same dose (also add azythromycin 10mg/kg if atypical org suspected

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7
Q

Drug tx for severe pneumonia

A

Ampicillin IV 50mg/kg 6hourky ash Gentamycin Iv 6mg/kg 5-10days

Or
Amoxi-clav 30mg/kg IV 8hourly

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8
Q

Dry tx for p.jirovecci

A

Co-trimaxazole 5/25mg/kg IV 6hourky 21days

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9
Q

Tx for CMV caused pneumonia

A

Gamcivlovir 5mg/kg IV 12hourly

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10
Q

Reasons for failure of antibiotics

A

Non adherence
Incorrect dose
Incorrect diagnosis
Organism resistant
Organism not covered
A complication has developed

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11
Q

Grading system for stridor

A

Grade 1: Inspiratory stridor
observe, support
Grade 2: Insp and Exp stridor
Nebulised Adrenalin
Grade 3: Insp+Exp stridor +pulsus paradox
Continuous nebulised adrenalin, if poor imprv intubate
Grade 4: Impending apnoea
Intubate

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12
Q

Clinical signs seen in bronchiolitis (3)

A

Air trapping
Hyperinflation (barrel chest)
Widespread wheezing on auscultation
Tachypnoea

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13
Q

Common causative organism for bronchiolitis

A

Respiratory Syncitial virus

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14
Q

Tx for bronchiolitis

A

There’s no curative tx, tx is supportive
-O2 via NPO2, high flow nasal cannula or CPAP
-Oral feeding except is tachypnoea or distress
-Trial of nebulised beta2agonist (salbutamol). Nebulised Adrenalin
-Ab if secondary bacterial infection is suspected
-Ventilation if Resp failure

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15
Q

Complications of bronchiolitis

A
  1. Recurrent wheezing
  2. Bronchiolitis Obliterans (due to severe adenovirus bronchiolitis, tx with High dose steroids)
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16
Q

How would you diagnose TB lymph node compression of the large airways

A

-Doesn’t respond to bronchodilator
-On CXR: Trachea displaced from midline, and compression of left main bronchus intermedium’s on good Inspiratory CXR.

17
Q

Triad of foreign body aspiration on clin exam

A

Unilateral wheezing
Decreased ventilation
Lung collapse

18
Q

What is Loffers syndrome

A

Eosinophilia pneumonia.
Clin features: wheezing with alveolar consolidation
Dx: raised eosinophils with parasites in stool
Tx: steroids, doesn’t respond to Ab
Deworming with a germicide- Albendazole or Mebendazole

Children with intestinal parasites can develop an exaggerated eosinophilic response to it, characterised by alveolar consolidation and accompanying wheeze
Doesn’t respond to Ab

19
Q

What can cause pneumonia to recur in the same area

A

TB involvement of the airway
Foreign body inhalation
Localised bronchiectasis
Anatomical abnormality of the lung

20
Q

Mechanism of development of bronchiectasis

A

-Bronchial lumen obstruction ie by TB glandular obstruction or foreign body aspiration
-Lung parenchyma destruction due to necrotising pneumonia ie by staph aureus, S.pneumonia, S.pyogenes, H.influenza
-Repeated LRTI including pneumonia.

21
Q

Signs of air trapping

A

Barrel chest
Displaced liver
Decreased cardiac dullness

22
Q

Approach to a patient with bronchiectasis

A

-Determine the cause, commonly Cystic Fibrosis, complicated HIV or TB.
-Determine extent by CT, spirometer. As affects CVS if extensive, determine transcutaneous sats post exercise.

23
Q

Complications of bronchiectasis

A

Bacterial superinfection
TB
Cor pulmonale

(Most common organism for LRTI is non typable H. influenza

24
Q

Management of bronchiectasis

A

Medical
-Treat exacerbations of infections, broad spectrum amoxicillin-clavulanic acid, sputum before Ab
-Optimise nutrition
-Ensure immunisation (esp Influenza)
-Physio
-Bronchodilator response (see if relief with beta2agonists
-Immunomodulation of the airway inflammation. Usually with azithromycin.

Sugucal
-remove bronchiectasis lobe or lung, usually only if unilateral and medical has failed
Contra: pulmonary HPT and bilateral bronchiectasis

25
Q

Cystic fibrosis presentation

A

Neonates: meconium ileus causing bowel obstruction, meconium peritonitis and prolonged neonatal cholestatic jaundice
During 1st year of life: recurrent Resp tract infections, prolonged and recurrent wheezing, failure to thrive.
Malabsorption if nutrients during to pancreas insufficient with peripheral odema often misdiagnosed as protein malnutrition
Clue to dx: Early onset malabsorption and large foul smelling bulky stool with fat globules
Can also present with:
Chronic liver failure, Hyponatremia dehydration (salt lost in sweat) and DM

26
Q

How to dx cystic fibrosis

A

Genetic test
Sweat test (>60mmol/l of Cl concentration)
Pancreatic insufficiency(stool chemotrypsin and stool elastase

27
Q

Tx of cystic fibrosis

A

Tx in tertiary care units
Physio
Manage exacerbations with Ab
Tx of pancreatic insufficiency with enzyme supplements and nutritional support
Manage GIT disease

28
Q

Clinical presentation of croup

A

Barking cough
Stridor

29
Q

Tx of croup (laryngo-tracheo-bronchitis)

A

-Nebulised Adrenalin in 1ml saline.
-Oral corticosteroids- oral prednisone or -Dexamethasone as alternative.
-Endotracheal Intubation
-Herpes Simplex LTB tx with acyclovir for 14 days

30
Q

What is primary cilia dyskinesia

A

Dysfunctional cilia in resulting in mucociliary blanket not clearing secretions
Results in recurrent upper and lower airway infections esp Otitis media, sinusitis and recurrent pneumonia

31
Q

Kartagener syndrome triad

A

Dextrocardia
Chronic sinusitis
Bronchiectasis

Paeds (24 decks)

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