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Paediatrics > Resp Exam > Flashcards

Resp Exam Flashcards

1
Q

How long should a cough not lost for?

A
  • it should not be more than 14 days
    -if it is >21 days it is a chronic cough caused by:
    Undiagnosed TB
    Whooping cough
    Bronchiectasis
    Poorly controlled asthma
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2
Q

Describe wheezing

A

It is a high pitched polyophonic (continuous) musical sound caused by narrowing of the small airways
-usually in the expiratory phase

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3
Q

Describe stridor

A
  • High pitched inspiratory sound from the narrowing extrathoracic airways after a viral subglottic infection
  • usually auscultated in the apices of the lungs
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4
Q

Describe crackles

A
  1. There are fine crackles And course crackles (both known as rales)
    - they are caused by sudden opening of the airways
    - usually heard at the base of the lungs
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5
Q

What are fine crackles indicative of?

A
  1. Pneumonia
  2. Bronchiolitis
  3. Left sidded heart failure
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6
Q

What are coarse crackles indicative of?

A
  1. Bronchiectasis

2. Bronchitis

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7
Q

What does air trapping present with?

A
  • flattening of the diaphragm and indrawing of the subcostal ribs along the sheet margins causing Hoover’s sign
  • if prolonged it leads to Harrison’s sulcus which is also seen in rickets
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8
Q

What are the causes of clubbing?

A
  1. Cyanotic lung disease
  2. Bronchiectasis
  3. HIV
  4. Infective endocarditis
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9
Q

How do we diagnose respiratory failure in babies?

A

We diagnose on blood gas and not clinically

‘-we notice hypoxia or hypercapnea

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10
Q

What organisms can we expect in pneumonia in children with HIV?

A
  1. Pneumocystis jirovecii penumonia

2. Cytomegalovirus

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11
Q

What is the presentation of pneumonia in children less than 2 months?

A
  1. Lethargy
  2. Failure to feed
  3. Hypothermia
  4. Apnea
  5. Convulsions
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12
Q

On physical exam in infants what can we expect?

A
  1. Tachypnoea
  2. Fever
  3. Widespread crackles
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13
Q

What type of pneumonia do infants usually get?

A

-bronchopneumonia

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14
Q

What kind of pneumonia do older children usually get?

A

-lobar pneumonia

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15
Q

What organisms contribute to causing peumonia?

A
  1. Viral organism
    - RSV, Adenovirus, parainfluenza, influenza
  2. Bacterial organism
    - streptococcus pneumoniae,staphylococcus aureus, previously haemophillus before vaccines were available
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16
Q

What organisms do immune compromised children get-due to HIV, malnutrition or after malnutrition

A
  1. CMV
  2. Pneumocystis jirovecci
  3. Klebsiella pneumonia
  4. Mycobacterium TB
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17
Q

What are the danger signs of admitting a child into hospital as a result of pneumonia?

A
  1. Stridor
  2. Altered level of consciousness
  3. Severe malnutrition
  4. HIV positive not on treatment
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18
Q

What organisms can we expect in neonatal penumonia?

A

1, streptococcus B

2. Chlamydia trachomatis

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19
Q

What organisms can we expect babies under 3 months in CAP?

A
  1. Gram negative organisms
  2. Group B streptococcus
  3. Staphylococcus aureus
  4. Haemophillus influenzae
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20
Q

When should we admit a neonate or infant?

A
  1. Cyanosis
  2. Chest indrawing
  3. SATS<92%
  4. Neonates and infants<2 months
  5. Congenital heart disease
  6. Chronic lung disease
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21
Q

How does viral penumonia show up on X-Ray?

A
  1. Hyperinflation
  2. Perihilar streaking
  3. Interstitial changes
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22
Q

What is a pneumatocoele?

A
  • thin walled air filled cystic lesions followed after pneumonia infection and they resolve spontaneously
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23
Q

What special investigations can we do fo patients with pneumonia?

A
  1. Bacterial cultures by taking a blood culture or aspirating if pleural effusion is present
  2. Nasopharyngeal aspirate if it is viral
  3. Sputum or pharyngeal aspirate
  4. FBC with white cell count(not very specific in determining difference between viral and bacterial)
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24
Q

What are the key features of bronchopneumonia?

A
  1. Patchy consolidation either bilaterally or involving multiple lobes
  2. Diffuse crackles heard in affected areas
  3. Percussion: dull to percussion
  4. Mostly young children
  5. Centered in the bronchioles and bronchi
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25
Q

What is the differential diagnosis of pneumonia in a child?

A
  1. Bronchiolitis
  2. Asthma
  3. TB
  4. Cystic fibrosis
  5. Underlying cardiac lesion
26
Q

What is community acquired pneumonia?

A

It is an acute infection of les than 14 days acquired in the community and causing dyspnea, tachypnea, coughing and chest wall indrawing due to lower respiratory tract infection

27
Q

What is the most common VIRUS causing community acquired pneumonia in children?

A

RSV

28
Q

What is simple pneumonia?

A

It is bronchopneumonia involving only the airways and possibly the surrounding interstitium or if lobar pneumonia affecting only a single lobe

29
Q

What is complicated pneumonia?

A

It is pneumonia affecting more than one lobe, causing parapneumonic effusions, abscesses or cavity, empyema, pneumothorax or bronchopleural fistula

30
Q

What are the VIRUSES that cause community acquired pneumonia?

A
  1. Respiratory syncytial pneumoniae
  2. adenovirus
  3. Influenza A or B
  4. Parainfluenza type 1 and 2
31
Q

What are the common BACTERIAL causes of community acquired pneumonia?

A
  1. Streptococcus pneumoniae
  2. Staphylococcus aureus
  3. Mycobacterium TB
  4. Haemophillus influenzae
32
Q

What bacteria can we expect between 3 months and 5 years in CAP?

A
  1. Staphylococcus aureus
  2. Haemophillus influenza
  3. Streptococcus pneumoniae
33
Q

What bacteria can we expect in children older 5 years?

A
  1. Streptococcus pneumoniae
  2. Mycoplasma pneumoniae
  3. Staphylococcus aureus
34
Q

How does mycoplasma pneumoniae present?

A
  • usually children >5 years

- presents with malaise, sore throat, fever, cough over 3-5 days

35
Q

What organisms can we expect to develop in HIV positive patients?

A
  1. PJP
  2. CMV
  3. Candida species
36
Q

What are the signs of severe pneumonia according to WHO?

A
  1. Cough or difficulty breathing in addition to signs of respiratory distress
    - nasal flaring
    - chest indrawing
    - expiratory grunting
37
Q

What is VERY severe pneumonia characterised by?

A
  • cough and difficulty breathing with
  • cyanosis
  • severe respiratory distress
  • decreased level of conscious, lethargy, convulsions
38
Q

How do we diagnose pneumonia?

A
  1. Blood culture

2. Chest X-ray

39
Q

When should we admit a child in hospital for pneumonia?

A
  1. If the child has respiratory distress-nasal flaring, grunting, chest indrawing
  2. Stridor
  3. Decreased level of conscious
  4. Severe acute malnutrition
  5. Cyanosis
40
Q

At what age can we expect PJP infection in HIV positive patients?

A

Between 6 months and 6 years

41
Q

Which extremely virulent pathogen can cause hospitalization in children?

A

-CA-MRSA

Community associated methicillin resistant staphylococcus aureus

42
Q

What is the antibiotics we can give to children?

A

-we usually give oral amoxicillin 90mg/kg/day because it provides appropriate coverage for streptococcus pneumoniae

43
Q

What do we give in immune compromised children?

A
  1. IV ampicillin
  2. An aminoglycoside (gentamycin)
  3. 3rd generation cephalosporin (ceftriaxone)
44
Q

What supportive treatment can we give children with pneumonia?

A
  1. Supplemental oxygen via nasal prongs with Fi02 of 28-35%

2. Oxygen mask at a flow rate of 6-10l/min

45
Q

What supportive treatment can we give children with pneumonia?

A
  1. Supplemental oxygen via nasal prongs with Fi02 of 28-35%
  2. Oxygen mask at a flow rate of 6-10l/min
  3. Supplemental zinc (20mg per day) is found to decrease the duration of hypoxia
46
Q

Which organism usually causes empyema?

A
  1. Streptococcus penumonia
47
Q

What is empyema?

A

-it is a complication of penumonia where pus collects in the thoracic cage

48
Q

What is the criteria of RW light in empyema?

A

-parapneumotic effusions are exudates and so at least one of the following criteria must be fulfilled:

  1. Pleural fluid LDH/Plasma LDH>0,6 of pleural >200 IU/L
  2. Pleural fluid protein/plasma protein >0,5
  3. Glucose levels <60 mg/d
49
Q

What is necrotising pneumonia?

A
  • it is pneumonia with cavitations or cavitatory necrosis

- on chest X-ray you see dense lobar consolidation and pleural effusion

50
Q

How do we definitively diagnose necrotising pneumonia?

A

On chest CT

51
Q

What is the pathophysiology of of necrotising penumonia?

A

-massive pulmonary gangrene, tissue liquefaction and necrosis

52
Q

What organisms are known to cause necrotising pneumonia?

A
  1. Streptococcus pneumonia
  2. Staphylococcus aureus
  3. Mycoplasma pneumoniae
53
Q

When should we consider that a child is not responding to treatment?

A

1.after 48-72 hours

54
Q

What could be reasons for a child not responding to treatment effectively?

A
  1. The bug
    - the organism could be resistant to the AB
    - there could be an unusual organism like TB
    - there could be other additional organism
  2. The drug
    - Wong AB
    - Wrong dose of AB
  3. The host
    - immunodeficiency
    - complicated pneumonia
    - foreign body aspiration
55
Q

When should we consider transfer of the child to ICU?

A
  1. Failure to obtain SATS of >90% on Fi02 >70%
  2. If the child is apneac
  3. Exhaustion
  4. Hypercarbic patient leading the acidaemia (Ph<7,25)
56
Q

What can we do to prevent to pneumonia in chilsdren?

A
  1. Influenza vaccine

2. Pneumococcal vaccine

57
Q

What is the treatment for a child less than 3 months?

A
  1. Ampicillin
  2. Gentamycin
  3. Cloxacillin
58
Q

How long do we usually treat complicated PJP and CMV pneumonia?

A

21 days

59
Q

How long do we treat children with who are HIV positive or neonates?

A

7-10 days

60
Q

What antibiotics do we use to treat children with atypical bacteria?

A
  1. Azithromyin or erythromycin
61
Q

When does hospital acquired/nosocomial pneumonia usually occur?

A

72 hours after admission into hospital

Paediatrics (40 decks)

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