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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are common differentials for stridor in children?

A

Croup
Epiglottitis
Anaphylaxis
Bacterial Tracheitis
Foreign Body Aspiration

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2
Q

Why would rashes be important to consider in a stridor history?

A

Urticarial rashes or swellings might be important to ask about because this could indicate anaphylaxis.

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3
Q

Why would allergens be important to note in a stridor history?

A

This could help point to possible anaphylaxis

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4
Q

What does drooling indicate? (in stridor history)

A

Severe Upper Airway Obstruction (UAO), possibly cause by epiglottitis.

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5
Q

What does a high fever indicate in a stridor history?

A

Bacterial infection (sepsis until otherwise)

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6
Q

What does a barking, seal-like cough indicate?

A

Croup (laryngotracheobronchitis)

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7
Q

What is the most common cause of stridor in young children?

A

Croup

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8
Q

Why is Epiglottitis rare in young children nowadays?

A

Because they get immunised against Haemophillus Influenza type B (HiB) which is the bacterial that causes Epiglottitis

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9
Q

What is the age of onset for Croup?

A

6 months to 3 years

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10
Q

At what age is Foreign Body Aspiration most likely to occur?

A

Younger than 3 years

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11
Q

What is the most common causative organism in Croup?

A

Parainfluenza (virus)

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12
Q

What is the causative organism in Epiglottitis?

A

Haemophillus Influenza Type B (bacteria)

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13
Q

What is the causative organism in Bronchiolitis?

A

Respiratory Syncytial Virus (RSV) (Viral)

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14
Q

What three physical signs could be seen in anaphylaxis?

A

Hypotension, broncho-constriction and airway compromise

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15
Q

What is sensitisation?

A

When the body has develop IgE and mast cells for an allergen so that reinfection causes an allergic reaction.

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16
Q

What chemicals are released when a mast cell degranulates?

A

Histamine, Prostaglandins and Leukotrienes

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17
Q

What sign is seen on XR of the neck for someone with Croup?

A

Steeple sign

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18
Q

How would you investigate someone with Croup?

A

Viral PCR

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19
Q

How do you treat/manage Croup?

A

Steroids to manage the symptoms

(Prednisolone for mild cases)

(Dexamethasone for serious cases)

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20
Q

How would you treat very severe Croup?

A

Nebulised Adrenaline

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21
Q

What is the scientific name for Croup?

A

Laryngotracheobronchitis

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22
Q

What is bronchiolitis?

A

Inflammation of the small airways in children, which causes increased mucus production, bronchospasms and later airway obstruction.

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23
Q

What is the peak age of incidence for Bronchiolitis?

A

2-6 months old

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24
Q

How old are the children that are generally affected by Bronchiolitis?

A

Younger than 2 years old

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25
Q

What are the 3.5 ways to identify someone with bronchiolitis?

A
  1. Increased work of breathing (recessions, tracheal tug and nasal flaring)
  2. Reduced oxygen saturation (less than 90%)
  3. Reduced fluid intake and output (less than 50% of norm - 150ml/kg/day)
    1. Parental concern
26
Q

What are 4 signs of Bronchiolitis?

A

Wheeze, nasal flaring, subcostal/intercostal recessions and hyperinflation

27
Q

Can oxygen be given in Bronchiolitis?

A

Yes - it helps with breathing

28
Q

How is bronchiolitis managed?

A

Conservatively

29
Q

What symptoms should be asked about in a respiratory history?

A

PC - SOCRATES

Cough, breathlessness, recessions and other signs of difficulty breathing,

Cyanosis, cold peripheries, flu symptoms

Poor feeding, reduced wet nappies/stool output, lethargy/irrtation

Depending on age, do a full systems review also

(don’t forget immunisations and antenatal history)

30
Q

What are common differentials for difficulty breathing?

A

Asthma, CHDs, foreign body aspiration, URTI/LRTI, DKA, Cystic Fibrosis, Anxiety (panic attack)

31
Q

What is Harrison’s Sulci?

A

An indentation on the chest roughly along the 6th rib which corresponds with the costal insertion of the diaphragm.

32
Q

What does morning cough/dyspnoea indicate?

A

Asthma

33
Q

What is the triad of asthma

A

Airway obstruction

Smooth muscle hyperplasia with hyperresponsiveness

Inflammation

34
Q

Is Asthma reversible or irreversible?

A

Reversible

35
Q

What are the two types of asthma?

A

Extrinsic and Intrinsic

36
Q

What is atopic asthma general caused by?

A

Allergens in the environment (outside sources)

37
Q

What is intrinsic asthma caused by?

A

This is when the body reacts abnormally to normal stimuli like stress, exercise or medicines.

38
Q

Is asthma IgE mediated or T cell mediated?

A

Trick question - it uses both (it is phasic)

Immediate IgE response and later T cell response

39
Q

Which T cell do the antigen presenting dendritic cells bind to?

A

T helper 2 (Th2)

40
Q

What interleukins do the T cells release in asthma?

A

Interleukins 4 and 5

41
Q

Which type of immune cell causes the most damage in asthma?

A

Eosinophils

42
Q

Where can mast cells be found in the airway histology?

A

Within the epithelium and the lamina propria?

43
Q

What are the clinical features of Asthma?

A

Cough

Difficulty breathing (SOB)

Wheeze

Exercise intolerance

Chest tightness

44
Q

What kind of lung disease is asthma?

A

Obstructive lung disease (FVC/FEV1 ratio is markedly)

45
Q

How does spirometry help with diagnosing asthma?

A

The FVC/FEV1 ratio is reduced and when bronchodilator therapy causes this to be reversed.

46
Q

What are the signs of a moderate asthma exacerbation?

A

Normal speech

Respiratory rate <25 breaths/minute

Pulse rate <110 beats per minute

PEF 50% to 75% of best or predicted.

47
Q

What are the signs of severe acute exacerbation of asthma?

A

Patient can’t complete a sentence without taking a breath

Respiratory rate >25/minute

Pulse rate > 110 beats per minute

PEF 33% to 50% of best (or predicted if unknown)

48
Q

What are the signs of a life-threatening asthma exacerbation?

A

Silent chest and Poor respiratory effort

Cyanosis

Arrhythmia

Hypotension

Exhaustion and Altered consciousness

PEF <33% of best or predicted

Oxygen saturation (SpO2) <92%

Partial pressure of oxygen (PaO2) <8 kPa (<60 mmHg)

‘Normal’ partial pressure of carbon dioxide (PaCO2) 4.6 to 6.0 kPa (35-45 mmHg)

Raised PaCO2 is a marker of near-fatal asthma.

49
Q

What is the first line treatment in asthma treatment?

(Not acute exacerbation)

A

Short acting beta agonist (SABA - salbutamol) as needed

50
Q

What is the second line treatment in asthma treatment?

A

Low-dose Inhaled Corticosteroid (ICS)

(Budesonide or Fluticasone)

and SABA PRN

51
Q

What is the third line treatment for asthma?

A

Medium-dose ICS (Budesonide or Fluticasone, but higher dosage)

OR

option for 5-11 years old:

Low-dose ICS and Long acting beta agonist/montelukast/theophylline

and SABA PRN

52
Q

What kind of genetic condition is cystic fibrosis?

A

Autosomal recessive

53
Q

On which chromosome is the faulty gene for the Cystic Fibrosis?

A

Chromosome 7

54
Q

What is the faulty gene called in the disease of Cystic Fibrosis

A

CFTR (cystic fibrosis transmembrane conductance regulator)

55
Q

Which channel is affected in cystic fibrosis?

A

Chloride ions on the apical membrane of the epithelial cells

56
Q

There are 5 main mutations for the CFTR gene which result in Cystic Fibrosis. What are they?

A

Protein production mutations (Class 1)

Protein processing mutations (Class 2) [f508del]

Gating mutations (Class 3)

Conduction mutations (Class 4)

Insufficient protein mutations (Class 5)

57
Q

What is the most common mutation for CF?

A
58
Q

Which clinical test can be used to diagnose Cystic Fibrosis?

A

Sweat Chloride Test

59
Q

What are the clinical features in Cystic Fibrosis?

A

Haemopytsis - due to chronic chest problems

Nasal polyposis

Recurrent pancreatitis

Constipation

Hepatomegaly

Failure to thrive - not getting enough nutrients from diet

Steatorrhoea

60
Q

Which newborn test is carried out to help identify CF (and other diseases)?

A

Guthrie Heel Prick Test

61
Q

How is Cystic Fibrosis treated?

A

By managing each damaged system individually

Paediatrics (10 decks)

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