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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is croup also known as?

A

Acute laryngeotracheobronchitis

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2
Q

What is the usual age range for croup?

A

6 months to 3 years

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3
Q

What age is the peak incidence for croup?

A

2 years of age

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4
Q

What organisms can cause croup?

A

Parainfluenza virus, respiratory syncytial virus, adenovirus, rhinovirus

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5
Q

What counts as a high respiratory rate for a neonate?

A

> 60

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6
Q

What counts as a high respiratory rate for an infant?

A

> 50

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7
Q

What counts as a high respiratory rate for a young child?

A

> 40

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8
Q

What counts as a high respiratory rate for an older child?

A

> 30

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9
Q

What are some signs of respiratory distress in a paediatric patient?

A 
Nasal flaring 
Grunting 
Head bobbing 
Tachypnoea 
Tracheal tug
Inter- and subcostal recession
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10
Q

What are some acute causes of upper airway obstruction and stridor?

A

Infectious: croup, epiglottitis, tracheitis, measles

Non-infectious: foreign body, anaphylaxis, trauma, hypocalcaemia

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11
Q

What are some chronic causes of upper airway obstruction and stridor?

A

Congenital: laryngomalacia, laryngeal web, vascular ring, cystic hygroma

Acquired: stenosis, papilloma, mediastinal mass, damage to vocal cords/spinal cord

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12
Q

What are the clinical features of croup?

A
  • Short history of cough, rhinorrhoea and fever progressing to a barking cough and hoarseness
  • Stridor
  • Tachypnoea, recessions
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13
Q

What are the features of mild croup?

A

Occasional barking cough, no audible stridor at rest, no suprasternal or intercostal recessions, child will eat, drink and play

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14
Q

What are the features of moderate croup?

A

Frequent barking cough, audible stridor at rest, suprasternal and sternal wall retraction, not too distressed or agitated

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15
Q

What are the features of severe croup?

A

Frequent barking cough, prominent stridor at rest, marked recessions, agitation or lethargic or restless

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16
Q

What are the differentials of croup?

A

Epiglottitis, inhaled foreign body, acute anaphylaxis, tracheitis, Laryngomalacia, peritonsillar abscess

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17
Q

How can croup be differentiated from epiglottitis?

A
  • Croup comes on over days, epiglottitis over hours
  • Croup has a coryza prodrome, epiglottitis does not
  • Croup has a barking cough, epiglottitis only a slight cough if any
  • Epiglottitis has a higher grade fever
  • Stridor in croup is rasping, epiglottitis is soft
  • Hoarse voice in croup, weak voice or silent in epiglottitis
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18
Q

When should a child be admitted with mild croup?

A
  • Previous history of severe airway obstruction
  • Less than 6 months old
  • Inadequate fluid intake
  • Poor response to initial treatment
  • Significant parental anxiety
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19
Q

How is croup treated?

A

Single dose of oral dexamethasone (0.15mg/kg) or oral prednisolone (1-2mg/kg)

Nebulised adrenaline

Oxygen as required

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20
Q

What organism causes whooping cough?

A

Bordetella pertussis

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21
Q

When are vaccines against whooping cough given?

A

2, 3 and 4 months of age

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22
Q

What are the clinical features of whooping cough?

A

Catarrhal phase (1-2 weeks) - rhinitis, dry cough, conjunctivitis, irritability, low grade fever, sore throat

Paroxysmal phase (2-8 weeks) - severe paroxysms of coughing followed by an inspiratory gasp (whoop sound)

Convalescent phase - cough gradually decreases in frequency and severity

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23
Q

What are the differentials of whooping cough?

A

Bronchiolitis, pneumonia, asthma

24
Q

How is whooping cough investigated?

A

Nasopharyngeal aspirate or swab if cough <2 weeks

Anti-pertussis toxin IgG serology if cough >2 weeks

25
Q

When is hospital admission indicated in whooping cough?

A
  • Acutely unwell and <6 months of age
  • Apnoeic episodes, cyanosis, respiratory distress
  • Feeding difficulties
26
Q

What antibiotic can be given in whooping cough?

A

Clarithromycin or azithromycin

Co-trimoxazole is 2nd line

27
Q

What are the complications of whooping cough?

A

Bacterial pneumonia
Seizures
Encephalopathy
Otitis media

28
Q

What is asthma characterised by?

A

Reversible and paroxysmal constriction of the airways, with airway occlusion by inflammatory exudate and late airway remodelling

29
Q

What are some risk factors for asthma?

A 
Family history of atopy
Low birth weight
Prematurity
Parental smoking
Viral bronchiolitis in early life
30
Q

What are some precipitating factors of asthma?

A
  • Cold air
  • Exercise
  • Pollution
  • Beta blockers
  • NSAIDs
  • Allergens
31
Q

How can asthma be investigated?

A

Spirometry (FEV1:FVC < 70%)

Peak expiratory flow rate

Forced exhaled nitric oxide

32
Q

What is the stepwise management of asthma?

A

Step 1 - SABA

Step 2 - Regular inhaled corticosteroids

Step 3 - LABA or montelukast

Step 4 - increase dose of corticosteroids

Step 5 - regular oral steroids

33
Q

What are the features of a mild/moderate exacerbation of asthma?

A 
Breathless
SpO2 > 92%
RR <30 for over 5s, <40 for under 5s
No or minimal accessory muscle use
Feeding well or talking in full sentences
Wheeze
34
Q

What are the features of a severe exacerbation of asthma?

A 
SpO2 < 92%
PEFR 33-50% predicted
RR >30 for over 5s or >40 for under 5s
Too breathless to feed or talk
HR >125 for over 5s or >140 for under 5s
Use of accessory muscles
Audible wheeze
35
Q

What are the features of a life threatening exacerbation of asthma?

A 
SpO2 < 92%
PEFR <33% predicted
Silent chest
Poor respiratory effort
Altered consciousness
Agitation/confusion
Exhaustion
Cyanosis
36
Q

What is the management of an exacerbation of asthma?

A 
Oxygen
Inhaled/nebulised salbutamol
Ipratropium bromide 
Oral prednisolone
Consider magnesium sulphate
37
Q

What is bronchiolitis?

A

Viral infection of the bronchioles commonly caused by respiratory syncytial virus

38
Q

What ages does bronchiolitis usually affect?

A

Children under the age of 2

39
Q

What are some risk factors for bronchiolitis?

A
  • Being breast fed for less than 2 months
  • Smoke exposure
  • Having siblings who attend nursery or school
  • Chronic lung disease due to prematurity
40
Q

What are the clinical features of bronchiolitis?

A

Nasal congestion, cough, rhinorrhoea, low-grade fever, difficulty feeding, tachypnoea, grunting, nasal flaring, recessions, crackles, wheeze, cyanosis

41
Q

What are some differentials of bronchiolitis?

A

Pneumonia, croup, cystic fibrosis, heart failure

42
Q

How is bronchiolitis investigated?

A

Nasopharyngeal aspirate or throat swab - RSV rapid testing and viral cultures

Blood/urine cultures

FBC

ABG if severely unwell

CXR

43
Q

When should a child with bronchiolitis be admitted to hospital?

A
  • Apnoea
  • Looking seriously unwell
  • Severe respiratory distress eg grunting, recessions
  • Central cyanosis
  • Sats < 92%
  • RR > 60
  • Inadequate fluid intake
44
Q

How is bronchiolitis managed?

A

Oxygen if sats <92%
Fluids via NG tube if inadequate oral intake
Consider CPAP if respiratory failure
Nebulised 3% saline may improve sx

No role for antibiotics, steroids or bronchodilators

45
Q

When can discharge of a child with bronchiolitis be considered?

A

When the child is clinically stable, taking adequate oral fluids and maintaining sats > 92% for more than 4 hours

46
Q

What are some complications of bronchiolitis?

A

Hypoxia, dehydration, respiratory failure, persistent cough or wheeze, bronchiolitis obliterans

47
Q

How long does bronchiolitis usually last?

A

7-10 days, can be coughing for up to 6 weeks

48
Q

What are the clinical features of acute epiglottitis?

A

Dyspnoea, dysphagia, drooling, dysphonia, fever, soft stridor, tripod position

49
Q

What organisms usually cause acute epiglottitis?

A

Haemophilus influenza, strep pneumoniae

50
Q

How is acute epiglottitis managed?

A

Secure airway, oxygen, nebulised adrenaline, IV cefotaxime/ceftriaxone, IV steroids

51
Q

Give some causes of wheeze

A

Viral induced, bronchiolitis, croup, foreign body, anaphylaxis asthma, reflux

52
Q

What causes cystic fibrosis?

A

Autosomal recessive mutation in CFTR gene which encodes a chloride channel - reduced amount of water in secretions

53
Q

What are the clinical features in cystic fibrosis in neonates?

A

Meconium ileus (abdominal distention, delayed passage of meconium and bilious vomiting in the first days of life)

Failure to thrive

Prolonged neonatal jaundice

54
Q

How can cystic fibrosis present in infancy?

A

Failure to thrive, recurrent chest infections, pancreatic insufficiency (steatorrhoea)

55
Q

How is cystic fibrosis investigated?

A 
Chloride sweat test
CXR 
OGGT
LFT and coagulation
Sputum sample
Spirometry
Faecal elastase
CT chest
56
Q

How is cystic fibrosis managed?

A
  • Patient education
  • Twice daily physiotherapy
  • Mucolytics
  • Exercise
  • Manage airway infections (at least 2 weeks of antibiotics)
57
Q

What are some complications of cystic fibrosis?

A 
Bronchiectasis
Allergic bronchopulmonary aspergillosis 
Pulmonary hypertension
Pneumothorax
Nasal polyps
Rectal prolapse
CF related diabetes
Distal intestinal obstruction syndrome
Cirrhosis
Delayed puberty

Paediatrics (7 decks)

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