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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

In what groups is the prevalence of childhood asthma higher?

A
  • low birthweight
  • family history, male
  • bottle fed, pollution, atopy
  • past lung disease
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2
Q

Diagnosis of asthma in children is done using:

A

spirometry (<70%) and bronchodilator reversibility test (12% FEV1 increase is +)

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3
Q

Asthma management in children uses stepwise approach, Go up if using reliever >3xweek and down when completely controlled for x months.

A

3 months

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4
Q

What are the steps in paediatric asthma control (on top of a SABA reliever inhaler):
1)
2)
3)
4)
5) daily oral steroid, ICS and refer to specialist

A

1) ICS e.g. beclomethasone or LTRA (not in under 5)
2) ICS+LABA combined e.g. Seretide or ICS + LTRA
3) If no response to LABA, stop LABA and increase ICS dose
- If mild LABA response, continue but increase ICS dose or trial LTRA
4) increase ICS more or consider 4th drug e.g. theophylline and refer to specialist

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5
Q

What can LTRAs for asthma in children under 5 cause?

A

-hyperkinesia and behavioural problems

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6
Q

How can you treat an asthma exacerbation in an infant?

A

-treat early with rescue prednisolone for 5 days (30-40mg/day if 5yrs+ or 20mg/day if 2-5yrs)

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7
Q

What is involved in the general management of paediatric asthma (hollistic)

A
  • annual symptom review
  • time of school/nursery
  • check inhaler/spacer use and adherence
  • make a personalised self-management plan
  • advice re: smoking risk
  • monitor growth charts
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8
Q

Treating acute severe asthma:

  • sit up, high flow O2, maintain sats 94%+
  • give salbulamol 5mg (2.5mg if <5yrs) and __ 250mcg +/- __ all O2 nebulised every __ mins for __ hour
  • give __4mg/kg/6hr IV or 2mg/kg __ for 3 days
  • consider 1 IV dose of __ 40mg/kg over 20mins as 1st IV therapy if nebuliser response is poor
  • consider starting CPAP, discuss with seniors
A
  • ipratropium bromide
  • magnesium sulphate
  • every 20mins for 1 hour
  • hydrocortisone, prednisolone
  • IV magnesium sulphate
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9
Q

What are very worrying signs in acute severe asthma?

A
  • confused, tiring, silent chest

- sats <92% after Rx, high CO2

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10
Q

Before discharge from acute severe asthma what should you ensure (3+)

A
  • stable on 4hrly bronchodilators
  • peak flow >75% predicted
  • good inhaler technique
  • written management plan
  • follow up GP in 2days and paeds asthma clinic in 2 months if life-threatening episode
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11
Q

Moderate asthma = PEFR – % predicted
Acute Severe = PEFR –% predicated
Near fatal = PEFR –% predicated, sats

A
  • moderate = 50-70%
  • acute severe= 33-50%, increased RR and HR
  • near fatal= <33%resp acidosis/needed mechanical ventilation, <92%sats, silent chest..hypotension..
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12
Q

Croup is typically fever and coryza followed by what symptoms and why?

A
  • hoarseness (due to infalmm. vocal cords)
  • barking cough (due to tracheal oedema & collapse
  • difficult breathing, symptoms worse at night
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13
Q

Croup causing chest recession at rest can be treated with the first line therapy of ___ which decreases the need for hospitalisation, severity and duration of croup.

A

-oral or nebulised steroids

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14
Q

In severe upper airway obstruction from croup, nebulised ___ with oxygen can transiently improve things, watch closely over next few hours as effects wear off.

A

-adrenaline

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15
Q

Why are young children prone to AOM?

A

-Eustachian tubes are short, horizontal and function poorly

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16
Q

What should every child presenting with a fever have checked?

A

-their tympanic membranes (rule out AOM)

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17
Q

What are the findings on otoscopy of a child with AOM?

A

-tympanic membrane is bright red, bulging and loss of the normal light reflection +/- perforation and puss in external canal

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18
Q

Name 3 common causative organisms of AOM in children:

A
  • RSV, rhinovirus

- pneumococcus, H. influenzae, Moraxella Catarrhalis

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19
Q

Most widely used Abx to treat AOM that hasn’t self-resolved, is__

A

Amoxicillin

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20
Q

If a child with glue ear is treated once with grommets but these fail, what is the next option.. x with adjuvant ..

A

-reinsert grommets with adjuvant adenoidectomy

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21
Q

What age group does bronchiolitis most commonly affect?

A

1-9months (affects children <2yrs)

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22
Q

What pathogen causes most cases of bronchiolitis? And this with which virus co-infection may cause a more severe disease?

A

RSV

+human metapneumovirus

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23
Q

What are symptoms of bronchiolitis, for what reason are most children admitted?

A
  • coryzal symptoms followed by dry cough and increasing breathlessness
  • feeding difficulty due to dyspnoea –> admission
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24
Q

Name 2 pre-disposing risk factors for the development of bronchiolitis?

A
  • premature infants w bronchopulmonary dysplasia
  • CF/underying lung disease
  • congential heart disease
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25
Q

What would you be concerned about in a child with: dry wheezy cough, high-pitched wheeze, tachypnoea, tachycardia… and what would you expect on chest exam? NB: liver may be displaced down

A

Bronchiolitis

  • O/E: subcostal and intercostal recession
  • hyperinflation of chest
  • fine end-inspiratory crackles
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26
Q

-What investigation should be done in suspected bronchiolitis?

A

Pulse oximetry

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27
Q

Name 3 reasons for bronchiolitis admission?

A
  • apnoea
  • O2 sats <92% On room air
  • inadequate oral fluid intake (dehydration)
  • severe resp distress
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28
Q

What are signs of respiratory distress in children?

A
  • grunting
  • marked chest recession
  • resp rate >60breaths/min
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29
Q

Outline the basics in bronchiolitis management.

A

-humidified O2 (conc dependent on O2 sats)
-monitor for apnoea
+/- fluids via IV or NG tube, rarely CPAP
-infection control measures

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30
Q

What is the time course of bronchiolitis symptoms, how long can it/cough last? And with which pathogen can permanent damage occur aka bronchiolitis ___.

A
  • illness peaks ~3-5days then resolves
  • cough may last 2 weeks+
  • ~50% may have recurrent cough and wheeze
  • adenovirus can -> bronchiolitis obliterans
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31
Q

What test can be used in the diagnosis of bronchiolitis?

A

Nasopharyngeal aspirate for RSV PCR or rapid antigen test

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32
Q

What is Palivizumab used for (albeit rarely due to cost and need for repeated IM injections)?

A

-prevention of brochiolitis of RSV origin

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33
Q

What signs may be present in a child presenting with pneumonia?
NB: always measure RESP RATE

A

-fever
-malaise, poor feeding
-respiratory distress
(older children: pleural pain, crackles, bronchial breathing)

34
Q

When should you admit a child presenting with pneumonia?

A
  • O2 <92%

- respiratory distress (tachypnoea, cyanosis, grunting, recessions, use of accessory muscles)..

35
Q

What tests would you consider running in a child with severe pneumonia, name 3

A
  • CXR
  • FBC
  • Blood & Sputum cultures
  • monitor TPR
36
Q

Should children <2yrs with mild symptoms of pneumonia routinely be given Abx? Why?

A

Viral LRTI is more common so no need, just ensure to safety net and follow up if symptoms persist

37
Q

Which antibiotic is most commonly used to treat pneumonia in children?

A

Amoxicillin

38
Q

Why is viral episodic wheeze common in some pre-school aged children?
NB: it is not an atopy related condition

A

-their small airways are more likely to narrow and obstruct due to inflammation and aberrant immune responses to viral infection

39
Q

viral episodic wheeze is triggered by viruses that cause the __.
sufferers often have reduced ___ from birth

A
  • common cold e.g. RSV

- diameter of the small airways

40
Q

Name 2 risk factors for the development/duration of viral episodic wheeze:

A
  • maternal smoking pre/post partum
  • prematurity
  • family hx of early viral wheezing
41
Q

viral episodic wheeze is more common in males, it usually resolves ~age__ probably because of the __in airway __

A
  • 5yrs

- increase in airway size

42
Q

What is the relationship between pre-partum smoking and passive smoking and viral episodic wheeze?

A

Pre-partum: increases risk of child developing it

Passive: It is not a trigger but it does prolong symptoms

43
Q

Rarely pneumonia in children associated with a pleural ___ (seen as __ of the costo-__ __ on CXR), this can develop into __ and __ strands may form leading to ___

A
  • effusion (blunting of costo-phrenic angle
  • empyema, fibrin strands
  • –> septations
44
Q

In paediatric pneumonia with persistent fever at 48hr post Abx (suggest pleural effusion -> empyema –> fibrin strands & septations..) how can they be treated?

A
  • chest drain under US guidance to drain collection
  • regularly instil a fibrinolytic agent
  • if resistant surgery can be done
45
Q

What 2 atypical signs in an unwell child means you should consider pneumonia as a ddx?

A
  • neck stiffness

- acute abdo pain

46
Q

What is pharyngitis and the most common type of infective cause in younger vs older children?

A

=inflammation of pharynx and soft palate w locally enlarged tender LNs

  • viral in young vs GABHS (group A beta haemolytic streptococcus) in older child
  • NB: tonsillitis is a form of pharyngitis
46
Q

What is pharyngitis and the most common type of infective cause in younger vs older children?

A

=inflammation of pharynx and soft palate w locally enlarged tender LNs

  • viral in young vs GABHS (group A beta haemolytic streptococcus) in older child
  • NB: tonsillitis is a form of pharyngitis
47
Q

Name 2 common causes of tonsillitis in children:

A
  • EBV

- GABHS (group A beta haemolytic streptococcus)

48
Q

For severe pharyngitis/tonsillitis what abx is often prescribed, and if allergic, which? Duration of course __days

A
  • Penicillin V or erythromycin if allergic

- 10days

49
Q

Why is amoxicillin avoided in the treatment of suspected bacterial tonsillitis in a child?

A

-is causes is actually due to glandular fever (EBV), amox –> widespread maculopapular rash

50
Q

GABHS infection can -> scarlet fever:

  • most commonly affects children age ___
  • fever usually precedes the presence of h____ and to____ by 2-3__
  • rash is variable but classically described as “_____-like m___ with flushed cheeks and ____ sparing
  • tongue is often ___ and may be s____
A
  • age 5-12yrs
  • fever precedes headache and tonsillitis by 2-3 days
  • rash “sandpaper-like”, maculopapular, periorbital sparing
  • tongue - white and sore/swollen
51
Q

Tonsillitis by GABHS can –> Scarlet Fever, what are 2 complications of this disease
it requires treatment with which medication to prevent these?

A
  • acute glomerulonephritis, rheumatic fever

- Penicillin V (erythromycin if allergic)

52
Q

If a child had tonsillitis and presents a few days later with a widespread maculopapular rash, what is the medication that has likely been given?

A

-Amoxicillin to tonsillitis causes by EBV

53
Q

There are 3 indications for tonsillectomy, name 2:

A
  • recurrent, severe tonsillitis
  • a peritonsillar abscess (quinsy)
  • OSA (adenoids will be removed too)
54
Q

OSA is one indication for tonsillo-adenectomy, what is the other?

A

-recurrent otitis media with effusion (glue ear) with hearing loss, where it gives a signif long-term additional benefit

55
Q

Biochemical/Guthrie/Heel Prick Test is done on day ___ of life, babies are screened for what 3 diseases? And then 6 inherited metabolic diseases -name 2?

A
  • day 5
  • congenital hypothyroidism
  • haemoglobinopathies (SC & thalass)
  • cystic fibrosis
  • Inherited: phenylketonuria, MCAD, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1, homocystinuria
56
Q

Screening for cystic fibrosis (CF) is done in the Guthrie heel prick.. what does it measure?
-If it is positive, another analysis is done to reduce false-positive rate, this looks at what?

A
  • measures the serum immunoreactive trypsin (raised with pancreatic duct obstruction)
  • DNA analysis
57
Q

What is the most common cause of liver abnormality in children with cystic fibrosis?
What other liver pathology do 20% of children develop by mid-teens?

A
  • hepatic steatosis (fatty liver)

- 20% -> cirrhosis and portal hypertension

58
Q

In cystic fibrosis, rarely what can liver disease arises due to thick tenacious bile with abnormal bile acid concentration?

A

-progressive biliary fibrosis

59
Q

What is the pattern of inheritance for CF?

Approx expected life expectancy with the condition?

A

Autosomal Recessive
(1 in 25 Caucasians are carriers)
-approx 40yrs

60
Q

What protein is defective in CF?
What chromosome is it located on?
Over 900 mutations, what is the most common? Delta ____…
What is the function of it?

A
  • CFTR - CF Transmembrane Conductance Regulator
  • Gene on chromosome 7, most common = delta F508
  • a cyclic-AMP dependent chloride channel found in membranes of cells
61
Q

CF -> abnormal ion transport across epithelium

-Give 3 changes causes in the lungs due to CF

A
  • reduced layer of liquid in airway surface
  • -> so impaired ciliary function
  • retention of mucopurulent secretions
  • -> chronic endobronchial infection e.g by Pseud Aerug.
  • dysregulated inflammation/immune responses
62
Q

CF -> abnormal ion transport across epithelium

  • Give 2 changes causes in the GIT due to CF
  • what happens to sweat?
A
  • intestine: thick, vescid meconium so 10-20% have meconium ileus
  • pancreatic ducts -> blocked by thick secretions -> panc enzyme deficiency hence malabsorption
  • excessive conc of sodium and chloride in sweat
63
Q

After positive heel prick, DNA analysis is done looking for common CF mutations, children with 2 mutations then undergo which test for what?

A

Sweat test

-to confirm the diagnosis

64
Q

If routine screening doesn’t pick up a CF child, suggest 2 ways in which they may present later?

A
  • recurrent chest infections
  • faltering growth
  • malabsorption
65
Q

In CF chronic lung infection -> viscid mucus in small airways what is the result of bronchial wall damage and what features will the child’s cough have?

A

—> bronchiectasis and abscess formation

-persistent ‘wet’ cough productive of purulent sputum

66
Q

With established CF respiratory disease what peripheral sign may be seen?

A

Clubbing

67
Q

90% CF children have pancreatic exocrine insufficiency, name 3 things this results in:

A
  • maldigestion/malabsorption
  • untreated -> faltering growth
  • frequent large pale greasy stools
  • diagnosed with low faecal elastase
68
Q

What is meconium ileus? (~15% CF neonates suffer)
1sx
1rx

A

-inspissated (thick) meconium —> intestinal obstruction
Sx: vomit, abdo distension, failure to pass meconium in 1st few days
Rx: surgery or gastrografin enema

69
Q

Sweat test: simulate it w low voltage current to skin, collect sweat, what is a positive CF Diagnosis result?

A

Markedly elevated chloride (more than triple normal eg 60-125 =CF

70
Q

What is the aim of CF therapy? How often are patients reviewed?

A
  • prevent progression of lung disease
  • maintain adequate nutrition/growth
  • at least annual review
71
Q

Suggest 2 things you may note when examining a child with CFs chest:

A
  • hyperinflation of chest due to air trapping
  • coarse inspiratory creps
  • +/- exp wheeze
72
Q

What prophylactic abx may a child with CF take? Oral rescue packs will be given for infection but is sx persist what must be given for how long via what?

A
  • flucloxacillin prophylaxis

- IV abx for 14days via a PIC line

73
Q

What does nebulised DNase / hypertonic saline help with in CF?

A

-decrease sputum viscosity and increase its clearance

May decrease no Resp exacerbations

74
Q

What is the one therapeutic option for end-stage CF lung disease

A

Bilateral sequential lung transplantation

75
Q

How is pancreatic insufficiency treated in CF?

A
  • oral enteric-coated pancreatic replacement therapy taken with all meals
  • often also fat-soluble vitamin supplements
76
Q

What 2 virulent infections are concerning for CF children to catch (often between patients) due to causing rapid decline in lung function?
Therefore what is advised?

A
  • -Pseudomonas and Burkholderia Cepacia

- segregate pts, advise not to socialise with others with CF

77
Q

Acute epiglottitis is..
with life-threatening risk of…
caused by organism…

A
  • swelling of epiglottis and surrounding tissues + sepsis
  • risk of respiratory obstruction
  • caused by H. Influenza type B (Hib)
78
Q

Suggest 4 features of how acute epiglottitis may present? (NB: children 1-6yrs mostly)

A
  • very acute onset
  • high fever, ill, toxic-looking child
  • intensely painful throat
  • prevents child speaking/swallowing
  • so saliva drools down chin
  • soft inspiratory stridor, worsens
  • child sitting immobile, upright
  • child’s mouth open (optimises airway)
79
Q

How does the presentation of acute epiglottitis differ from that of croup in a child?

A

-no/minimal cough
-acute onset
NB: must not examine throat! or lie child down can –> total airway obstruction

Paediatrics (12 decks)

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