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Phase 3A - Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is a wheeze

A

Polyphonic expiratory noise originating from lower airways

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2
Q

what conditions cause a wheeze

A 
Asthma 
CF 
Bronchiolitis 
Pneumonia 
Extrinic allergic allveolitis
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3
Q

what does a focal wheeze indicate

A

focal airway obstruction

  • Inhaled foreign body
  • Tumour
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4
Q

what is a stridor

A

High pitched inspiratory noise originating from turbulent airflow through partially obstructed upper airway

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5
Q

what conditions cause a stridor

A 
Inhaled foreign bodies 
croup 
epiglottitis 
laryngomalacia 
bacterial trachetitis 
anaphalxis
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6
Q

BRONCHIOLOITIS

When is bronchiolitis common and in what age group

A

common in winter

children < 1 year

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7
Q

BRONCHIOLOITIS

what are the causes of bronchiolitis

A

RSV
Parainfluenza
adenovirus

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8
Q

BRONCHIOLOITIS

what are the risk factors from bronchiolitis

A 
passive smoke 
prematurity 
low birth weight 
immunocompromised 
congeital ehart disease 
Downs
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9
Q

BRONCHIOLOITIS

How does bronchiolitis present

A 
Coryzal sx - 1 to 3 days 
- mild fever 
wheeze 
breathlesness 
poor feeding
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10
Q

BRONCHIOLOITIS

What are the clinical signs of bronchiolitis

A 
signs of respiratory distress 
Fine end inspiratory crackles 
Hyperinflation 
wheeze 
stridor 
cyanosis 
tachycardia
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11
Q

BRONCHIOLOITIS

what are the investigations for bronchiolitis

A

Pulse oximetry

PCR analysis of nasal secretions

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12
Q

BRONCHIOLOITIS

What is the management fo bronchiolitis

A

Supportice
Hymidified O2
NG feeds
Fluids

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13
Q

BRONCHIOLOITIS

What is the prevention for nrochiolitis

A

Palvizumab
Monthly vaccinations for patients with: CF / Premature / chronic lung disease / immunocompromised / congenital heart defects

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14
Q

PNEUMONIA

What are the causes of pneumonia

A 
Bacterial - older children 
strep pneumonia 
Group B strep - Neonates 
S. aureus 
Mycoplasma pneumonia

Viruses - common in < 2y/o
RSV
H.Influenzae

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15
Q

PNEUMONIA

Which age group is Group B strep pneumonia more common in

A

Neonates

Pre vaccinated infants

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16
Q

PNEUMONIA

What features indicate pneumonia caused by s.aureus

A

CXR findings of pneumatoceles - round air filled cavities

consolidation of multiple lobes

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17
Q

PNEUMONIA

What features inidcate pneumnia caused by mycoplasma pneumonia - atypical

A

Erythem multiforme - red circular rash

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18
Q

PNEUMONIA

what is the presentation of pneumonia

A 
cough - wet / productuve 
high fever - >38.5 
lethargy 
poor feeding 
pain 
- Localised to chest / abdominal / neck – Pleurel irritation 
- Suggests bacterial infection
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19
Q

PNEUMONIA

what are the clincial signs of a pneumonia infection

A 
tachycardia / tachypnoea 
respiratory distress 
Aucultation 
- bronchial breath sounds 
- End inspiratory coarse crackles 
Dullness to percussion
20
Q

PNEUMONIA

Investigatiosn for pneumonia

A 
sputum cultures / throat swabs 
- bacterial culture and PCR
CBG 
- monitor metabolic acidosis 
- monitor blood lactate 
CXR
21
Q

PNEUMONIA

What is the criteria for admission

A

O2 < 92%

Signs of respiratory distress

22
Q

PNEUMONIA

What is the management of pneumonia

A

Abx
Neonates - Broad spectrum

others
1st line - Amoxicillin
2nd line - Erythromycin

23
Q

PNEUMONIA

what should you suspect if a child gets unwell after a period of improvement following a pneumonia dx

A

Empeyema - check via CXR

24
Q

VIRAL INDUCED WHEEZE

What are children who present with a VIW at higher risk of developing

A

Asthma

25
Q

VIRAL INDUCED WHEEZE

What are the risk factor for VIW

A

Maternal smoking

prematurity

26
Q

VIRAL INDUCED WHEEZE

How does a VIW present

A

Evidence of viral illness

  • fever
  • cough
  • coryzal sx

S.O.B
Signs of respiratory distress
Expiratory wheeze

27
Q

VIRAL INDUCED WHEEZE

What factors differentiate VIW from asthma

A

VIW:
Present before 3 y/o
No atopic hx
only occurs during viral infections

28
Q

CYSTIC FIBROSIS

what is the pathophysiology of CF

A

Mutation in CFTR in chromosome 7

Cl- increased secretions
Increased Na+ absorption

Leads to H20 absorption into cells, thickened secretions and mucus stasis
chnaces in mucus prediposes to infection

29
Q

CYSTIC FIBROSIS

What is the most common mutation in CF

A

Delta-F508

30
Q

CYSTIC FIBROSIS

What is the presentation of CF - Respiratory

A 
chronic cough 
osinusitis 
nasal polyps
breathlesness 
haemoptysis
31
Q

CYSTIC FIBROSIS

What is the presentation of CF - GI

A 
Cholesterol gallstones 
Meconium ileus 
- Abdo distension 
- Vomiting 
Steatorrhoea 
Pancreatitis 
failure to thrive
32
Q

CYSTIC FIBROSIS

What is the presentation of CF - Other

A 
salty taste to child
pubertal delay 
secondary amenorrhoea 
infertilty 
failure to thrive 
recurrent resp infections 
pancreatitis
33
Q

CYSTIC FIBROSIS

What are the signs of CF

A 
Low weight or height on growth charts 
Hyperinflations of chest – air trapping 
Nasal polyps 
Clubbing 
Crackles and wheeze – auscultation 
Abdominal distension
34
Q

CYSTIC FIBROSIS

A
  • Blood spot testing - Gutherie card
  • Sweat test (GOLD STANDARD)
    >60mmol/L
  • Genetic testing
    CVS / Amniocentesis

Faecal elastase

CXR

Lung fucntion

35
Q

CYSTIC FIBROSIS

Describe the gutherie card test

A

Newborn blood spot

  • Looks for immunoreactive trypsinogen
  • conducted between days 5 - 9
36
Q

CYSTIC FIBROSIS

Describe the sweat test

A

DIANGNSOTIC TEST

> 60mmol/L

Pitfalls
- false positive rates common

37
Q

CYSTIC FIBROSIS

Describe the faecal elastase test

A

evidence of abnormal pancreatic exocrine fucntion

38
Q

CYSTIC FIBROSIS

what are the charecteristics of a CF patient on CXR

A

Hyperinflation
Increased anterior-posterior diameter
Bronchial dilation
Cysts / linear shadows / infiltrates

39
Q

CYSTIC FIBROSIS

What is the symptomatic management of CF?

A 
Stop smoking 
vaccinations 
- pneumococcal 
- flu 
- varicella

Symptomatic relief

  • Beta 2 agonists
  • ICS
40
Q

CYSTIC FIBROSIS

What is the pulmonary management of CF

A 
chest physiotherpay 
excercise 
mucoactive agents 
- rhDNase alpha 
- Hypertonic saline 
Amiloride 
Lung trasnplant
41
Q

CYSTIC FIBROSIS

WHat is the MOA of rhDNase alpha

A

breaks down DNA to reduce viscocity of mucus and promotes sputum clerance

42
Q

CYSTIC FIBROSIS

What is the MOA of hypertonic saline

A

osmotic action that hydrates airway secretions and promotes clerance

43
Q

CYSTIC FIBROSIS

What is the MOA of amiloride

A

Inhibits Na+ transport

44
Q

CYSTIC FIBROSIS

What is the management of infection

A

Prophylactic flucloxacillin
- Protects against s.aureus from ages 3 - 6

Vaccinations

45
Q 
CYSTIC FIBROSIS 
What if the extra pulmonary management of CF 
- Nutrition 
- Fertility 
- Heaptobiliary
A 
Nutrition 
- Increase portion size 
- High calorie diet 
- Supplements 
- PERT (CREON tablets) 
  replace lipase

Fertility
- testicualr sperm extraction

Hepatobiliary
- Liver transplant

46
Q

CYSTIC FIBROSIS

What is the impact of bacterial colonisers of a CF patient

A

damage of bronchial walls
bronchiectasis
abscess formation

47
Q

CYSTIC FIBROSIS

What are the common microbial colonisers

A 
S.Aurues 
Haemophilius influnzae 
Klebsiells penumonia 
E.Coli 
Psydomonas aeruginosa

Phase 3A - Paediatrics (1 decks)

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