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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is asthma?

A

Airway hyperresponsiveness - various triggers for bronchial smooth muscle contraction
Bronchial inflammation - immune cell infiltration causing oedema, smooth muscle hypertrophy, mucus plugging, epithelial damage
Airflow limitation - reversible

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2
Q

How can asthma present?

A

Symptoms induced by weather, exercise, and ill-health, and nocturnal symptoms
Wheeze - heard by bedside or on auscultation
An absent wheeze can suggest narrowed airways
Expiratory wheeze
Cough
Increased WOB
Atopy

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3
Q

What signs might suggest increased WOB?

A 
Head bobbing
Tripoding
Nasal flaring
Tracheal tug
Use of abdominal muscles, sternocleidomastoid
IC recession
Grunting or gasping
Chest expansion
Cyanosis
RR
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4
Q

What is the long term management of asthma?

A 
Step 1 - SABA PRN
Step 2 - regular low dose ICS
Step 3
- < 5 leukotriene receptor antagonist
- > 5 LABA
Step 4 - increase ICS dose, add in LRA
Step 5 - regular oral steroids
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5
Q

What suggests acute asthma?

A

33 92 CHEST

  • < 33% PEFR
  • < 92% sats
  • Cyanosis
  • Hypotension
  • Exhaustion
  • Silent chest
  • Tachycardia
  • Respiratory acidosis on ABG
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6
Q

How is acute asthma treated?

A

OH SHIT Me!

  • Oxygen
  • Hydrocortisone
  • Salbutamol nebs or 10 puffs via INH or IV
  • Ipratropium bromide
  • Theophylline
  • Magnesium sulphate
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7
Q

How does VIW tend to present?

A 
Pre-school children
Symptoms associated with chest infection
Symptom free between infections
Not worse at night
Inhalers useful during symptoms
No benefit for oral steroids during exacerbation
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8
Q

What is bronchiolitis?

A

Inflamed and mucus plugging of bronchioles

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9
Q

What is the most common cause of bronchiolitis?

A

RSV
Adenovirus
Rhinovirus

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10
Q

How does bronchiolitis present?

A 
Dry cough followed by vomiting
Increased WOB
Low grade pyrexia
Poor feeding 
Apnoea when sleeping
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11
Q

How is bronchiolitis investigated?

A

NPA - nasopharyngeal aspirate
Blood gas
CXR - if lung examination asymmetrical then might want to rule out superimposed pneumonia or pneumothorax or lobar collapse
U&E to look at hydration status

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12
Q

When should you use a SABA in bronchiolitis?

A

FHx or atopy
Co-existing eczema
Over 6 months - babies don’t have beta-2 receptors

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13
Q

What bacteria can cause pneumonia in children?

A

Strep pneumonia
Staph aureus
HiB
Mycoplasma

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14
Q

What viruses can cause pneumonia in children?

A

Adenovirus
Rhino virus
RSV

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15
Q

How does pneumonia present?

A 
Cough
Increased WOB
Pyrexia
Poor feeding and dehydration
Auscultation - crepitations, reduced AE
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16
Q

What investigations should you do for pneumonia?

A

CXR - focal consolidations
Raised WCC and CRP
Sputum cultures
Blood cultures

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17
Q

How is pneumonia managed?

A

Oral antibiotics unless expecting sepsis
First line amoxicillin
Add macrolide if suspecting atypical infection or mycoplasma - clarithromycin

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18
Q

What are the complications of pneumonia?

A 
Sepsis
Parapneumonic effusions
Lung abscess
Empyema
Dehydration
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19
Q

What bacteria can cause tonsilitis?

A

Group A strep

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20
Q

When might you suspect bacterial tonsilitis?

A

Fever
Tender swollen anterior cervical lymphadenopathy
Tonsillar exudate
Absent of cough

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21
Q

How do you manage bacterial tonsilitis?

A

10 days pen V

If stertor and dysphagia then IV antibitoics, IVI and corticosteroids

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22
Q

What is quinsy and how does it present?

A 
Peritonsillar abscess
Trismus
Hot potato voice
Drooling
Odynophagia
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23
Q

How is quinsy managed?

A

I+D of abscess

IV antibiotics

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24
Q

What causes croup?

A

Most commonly influenza and parainfluenza virus in < 2

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25
Q

How does croup present?

A

Coryzal prodrome followed by barking cough

Mucosal inflammation of airway can result in inspiratory stridor, increased WOB, reduced AE, cyanosis, and LOC

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26
Q

How is croup managed?

A

Adrenaline nebs

Steroids

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27
Q

What does stridor sound like?

A

High-pitched, single tone
Caused by blockage in throat/larynx - upper airway obstruction
Often heard on inspiration

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28
Q

What does wheeze sound like?

A

Continuous, coarse, whistling sound produced in respiratory airways during breathing, musical
Caused by small airway narrowing
Often heard on expiration

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29
Q

What are the differentials for a child with stridor?

A 
Croup
Foreign body inhalation
Epiglottitis
Laryngitis
Anaphylaxis
Bacterial tracheitis
Trauma to the throat
Diphtheria
Laryngomalacia
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30
Q

How might epiglottitis present?

A

Severe sore throat, pain when swallowing, drooling, looks very unwell, tripoding, acute onset

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31
Q

How might croup present?

A

Low-grade fever
Barking cough
Stridor

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32
Q

Why might you not examine a child with stridor?

A

May precipitate complete airway obstruction

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33
Q

What are the main causes of croup?

A

Parainfluenza virus
RSV
Other respiratory viruses

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34
Q

What time of year is croup most common?

A

Autumn

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35
Q

What age is croup most common?

A

3 months - 6 years

Peak at 2 years

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36
Q

What is the first line treatment of croup?

A

Oral dexamethasone 150mg/kg

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37
Q

What could be some differential diagnoses of bronchiolitis?

A 
Asthma (depends on age)
Pneumonia
Croup
Whooping cough
Viral induced wheeze
Covid
Heart failure
CF
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38
Q

What question can you ask to find out a child’s risk of whooping cough?

A

Did mother have whooping cough vaccine during pregnancy?

Child up to date with imms?

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39
Q

What can cause bronchiolitis?

A

RSV - most common
Adenovirus
Influenza virus
Parainfluenza virus

40
Q

What factors can increase risk of bronchiolitis?

A 
Premature
Underlying heart/lung conditions
Suppressed immune system
Exposure to tobacco smoke
Infant < 3 years
Winter months
Bronchopulmonary dysplasia
Attending nursery
Older sibling with infections
41
Q

How is bronchiolitis treated?

A 
Supportive treatment
Fluids if dehydrated
Anti-pyrexials if feverish
O2 if low sats
NG tube
Nasal suction
Don't give nebulisers - often doesn't help
42
Q

How can bronchiolitis be prevented?

A

Vaccination

Antibody injection monthly for children with chronic lung disease/congenital heart disease/congenital muscular dystrophy

43
Q

What investigations would you order to help confirm your diagnosis?

A 
Throat swab and viral PCR
Pulse oximetry
Mucus sample test
Blood gas
CXR but only if suspect bacterial infection
44
Q

Why would you do a throat swab for bronchiolitis?

A

Helps stop passing on different viruses, cohort areas of ward

45
Q

What is the guthrie test?

A

Heel prick neonatal screening test

46
Q

What conditions are picked up on the guthrie test?

A 
CF
Sickle cell disease
Congenital hypothyroidism
Galactosaemia
Inherited metabolic diseases
- Phenyloketonuria
- Medium chain acyl-CoA dehydrogenase deficiency
- Maple syrup urine disease
- Isovaleric acidaemia
- Glutaric aciduria type 1
- Homocystinuria
47
Q

How is CF inherited?

A

Autosomal recessive

48
Q

What is the pathophysiology of CF?

A

Mutation in CFTR gene (CF transmembrane conductance regulator) protein produced by gene regulates movement of chloride and sodium ions across epithelial membranes

49
Q

What happens in the respiratory system due to CF?

A

Cells absorb too much Na and water so thick secretions
Reduced muco-ciliary clearance
Frequent infections
Scarring of lungs

50
Q

What happens in the digestive system due to CF?

A

Sticky mucus blocks pancreatic ducts preventing pancreatic enzymes digesting food
Rectal prolapse
Meconium ileus (babies)
Diabetes

51
Q

How does CF affect the reproductive system?

A

Vas deferens doesn’t develop, male infertility

52
Q

How does CF present in newborns?

A

Bowel obstruction - failure to pass meconium

53
Q

What is the definition of wheeze?

A

Wheezing/whistling sounds
Breathlessness
Persistent troublesome cough
Severely affecting the well-being of infant or child

54
Q

Why might you get recurrently wheezing children?

A 
Persistent infantile wheeze - small airways/smoking/viruses
Viral episodic wheeze - no infantile symptoms/URI triggered
Asthma - persistent symptoms/FH/atopy
Other causes
- CF
- Chronic lung disease
- Tracheo-bronchomalacia
- Ciliary dykinesia
- GORD
- Chronic aspiration (potentially due to neurodisability)
- Immune deficiency
- Persistent bacterial bronchitis
55
Q

What can cause transient early wheeze in children?

A

Small airways
Mother smoking
Early viruses
Preterm

56
Q

What can cause viral episodic wheeze?

A

RSV/other LRTI

Airway hyper-reactivity

57
Q

What can cause IgE associated asthma?

A

Atopy

Airway hyper-reactivity

58
Q

What might the course of viral episodic wheeze look like?

A 
No interval symptoms
No excess of atopy
Likely to improve with age
No benefit from regular inhaled steroids
Use bronchodilators
May use oral steroids in severe exacerbations
59
Q

How do you manage an acute asthma exacerbation?

A

ABC
O2 if needed
Beta agonist
Prednisolone 1mg/kg oral (or IV hydrocortisone)
IV salbutamol bolus
Aminophylline +/- MgSO4 +/- salbutamol infusion

60
Q

What are the primary medications for asthma?

A

Preventers
Relievers
Add on therapies

61
Q

What preventers are there for asthma?

A 
Inhaled steroids
- Beclomethasone
- Budesonide
- Fluticasone
(Inhaled cromones)
- Sodium cromoglycate
- Nedocromil sodium
62
Q

What relievers are there for asthma?

A

Beta agonists
- Salbutamol
- Terbutaline
Ipratropium bromide (muscarinic antagonist, atrovent)

63
Q

What add on therapies are there for asthma?

A 
Long acting beta-agonists
- Salmeterol
- Formeterol
Leukotriene receptor antagonists - montelukast
Theophyllines
Omalizumab (anti-IgE)
Protexo (high IgE)
64
Q

What is important to consider when prescribing inhaled steroids?

A

Lowest effective dose
Minimise oral deposition
Minimise GI absorption

65
Q

What is important to consider when prescribing relievers?

A

Age-appropriate device
Easy to use
Portable
Dosage not critical

66
Q

What is step 1 of asthma management in children aged 5-12?

A

Mild intermittent asthma

- Inhaled short acting beta-agonist PRN

67
Q

What is step 2 of asthma management in children aged 5-12?

A

Regular preventer therapy

- Add inhaled steroid 200-400mcg/day

68
Q

What is step 3 of asthma management in children aged 5-12?

A

Add on therapy

  • Add inhaled long-acting beta-agonist
  • Assess asthma control
    • Good response from LABA
    • Benefit from LABA but control still inadequate so increase steroid
    • No response to LABA - stop LABA and increase steroid dose
69
Q

What is step 4 of asthma management in children aged 5-12?

A

Persistent poor control

- Increase inhaled steroid up to 800mcg/day

70
Q

What is step 5 of asthma management in children aged 5-12?

A

Continuous or frequent use of oral steroids

  • Refer to resp paediatrician
  • Use daily steroid tablet to lower dose providing adequate control
  • Maintain high dose inhaled steroid at 800mcg/day
71
Q

What could be causes of failure to respond to medication in asthma?

A 
Adherence
Bad disease
Choice of drugs/devices
Diagnosis
Environment - parent still smoking, sensitised to animal that child won't keep away from
72
Q

What are the possible risks of inhaled corticosteroids?

A

Adrenal suppression

Growth suppression - brief

73
Q

How can you minimise risk of inhaled corticosteroids?

A

Discuss issues with parent/patient
Minimise dose and maximise targeting
Monitor growth in children

74
Q

Name 3 types of URTI

A 
Rhinitis
Otitis media
Pharyngitis
Tonsilitis
Laryngitis
75
Q

Name 3 types of LRTI

A 
Bronchitis
Croup
Epiglottitis
Tracheitis
Bronchiolitis
Pneumonia
76
Q

What respiratory tract infections are generally caused by viral infection?

A 
Rhinitis
Pharyngitis
Laryngitis
Croup
Bronchiolitis
77
Q

What respiratory tract infection are generally caused by bacterial infection?

A

Epiglottitis

78
Q

How common is RSV?

A 
Annual epidemics
60%+ of infants
20-30% LRTI
0.5-2% infants hospitalised
Mean admission 3 days UK
Mortality v low
Long term morbidity
79
Q

What acute URTI can RSV cause?

A

Rhinitis
Otitis media
Pharyngitis

80
Q

What acute LRTI can RSV cause?

A 
Bronchitis
Acute bronchiolitis
Pneumonia
Viral associated wheeze
Exacerbation of asthma
Croup
81
Q

What is the difference between URTI and LRTI caused by RSV?

A

Increased viral load

82
Q

What are the two main causes of acute stridor?

A

Croup

Acute epiglottitis

83
Q

What are the S&S of croup?

A 
Viral - usually parainfluenza
More common in spring/autumn
Self-limiting
Worse at night
Barking seal-like cough
Stridor
Recessions
Steroids
84
Q

What causes acute epiglottitis?

A

HiB

Severe acute illness

85
Q

What RTI can pneumococcus cause?

A

Otitis media - acute/chronic
Sinusitis
Bacterial bronchitis
Pneumonia - acute/chronic

86
Q

What is pneumonia?

A

Respiratory disease characterised by inflammation of the lung parenchyma (excluding bronchi) with congestion caused by viruses or bacteria or irritants
WHO - history of cough and/or difficulty breathing < 14 days with increased RR

87
Q

What do the cells look like in pneumonia?

A

Congestion
Red hepatisiation
Grey hepatisation
Resolution

88
Q

What is an increased RR for children aged under 2 months?

A

> 60/min

89
Q

What is an increased RR for children aged 2-11 months?

A

> 50/min

90
Q

What is an increased RR for children aged over 11 months?

A

> 40/min

91
Q

What does a pneumonia CXR look like?

A

Dense/fluffy opacity that occupies portion or whole of a lobe or lung that may or may not contain an air bronchgram
Consolidation

92
Q

How is pneumonia diagnosed?

A

Consider in children aged up to 3 years when fever > 38.5 together with chest recession and RR > 50/min
For older children history of difficulty in breathing more helpful than clinical signs
Chest radiography not performed routinely in children with mild and uncomplicated acute LRTI
Radiographic findings poor indicators of aetiology

93
Q

What bacteria can cause pneumonia?

A 
Pneumococcus 30-50%
HiB 10-30%
S aureus
K pneumoniae
TB
94
Q

What viruses can cause pneumonia?

A 
RSV 15-40%
Influenza A and B
Parainfluenza
Human metapneumovirus
Adenovirus
95
Q

What can cause pneumonia in immunosuppression eg HIV?

A

Bacterial infection
Pneumocysitis jiroveci
TB

96
Q

What other organisms can cause pneumonia?

A 
Mycoplasma pneumoniae
Chlamydia spp
Pseudomonas spp
E coli
Measles
Varicella
Histoplasmosis
Toxoplasmosis
97
Q

What is the difference between bacterial bronchitis and pneumonia?

A

Pneumonia affects lung parenchyma and alveoli

Bronchitis 3 specific organisms, form biofilms, chronic cough

Paediatrics (21 decks)

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