Respiratory Flashcards
What is the most common cause of bronchiolitis?
RSV
In which age group is bronchiolitis most common?
3-6 months
Describe the typical presentation of bronchiolitis.
Coryzal symptoms Respiratory distress Dyspnoea Tachypnoea Poor feeding Mild fever Apnoeas Wheeze and crackles on auscultation
What are the signs of respiratory distress?
Tachypnoea Use of accessory muscles Intercostal and subcostal recessions Nasal flaring Head bobbing Tracheal tugging Cyanosis Abnormal airway noises
What are the criteria for admission in bronchiolitis?
Age <3 months and any underlying health conditions 50-75% less of normal milk intake Clinical dehydration RR >70 O2 sats <92% Moderate-to-severe respiratory distress Apnoeas Parents feeling incapable of managing at home
What is the management for bronchiolitis?
Supportive management only
Saline nasal drops and suctioning
What role does Palivizumab play in bronchiolitis?
Prevention
Monoclonal antibody that targets RSV
Monthly injection to prevent bronchiolitis
Given to high-risk babies
What are the causes of croup?
Most common:
Parainfluenza
Influenza
Less common:
Adenovirus
RSV
Diphtheria
How does croup present?
Increased work of breathing 'Barking' cough, occurring in clusters of coughing episodes Hoarse voice Stridor Low-grade fever
What is the management for croup?
Oral dexamethasone (150 micrograms/kg)
In which age group is croup most common?
6 months - 3 years
What is the cause of whooping cough?
Bordetella pertussis (gram -ve bacteria)
How does whooping cough typically present?
Croyzal symptoms Low grade fever Severe coughing fits Large, loud inspiratory whoop when coughing ends Post-tussive vomiting Fainting and/or pneumothorax Apnoeas
How can whooping cough be diagnosed?
Nasopharyngeal/nasal swab with PCR testing or bacterial culture
Test for anti-pertussis toxin immunoglobulin G (when cough has been present for more than 2 weeks)
How is whooping cough managed?
Supportive care
Macrolide abx (azithromycin, erythromycin, clarithromycin)
Vulnerable close contacts should be given abx
What is a potential complication of whooping cough?
Bronchiectasis
What is laryngomalacia?
Where the structure of the larynx causes partial obstruction of the airway
What is the characteristic shape of the larynx in laryngomalacia?
Omega
How does laryngomalacia typically present?
Stridor - more prominent when feeding, laying on back, or during URTI
No associated respiratory distress
How is laryngomalacia managed?
Usually no intervention is required - resolves as the larynx matures and grows and is better able to support itself
Rarely a tracheostomy may be required
What is the most common cause of epiglottitis?
Haemophilus influenza type B
Describe the typical presentation of acute epiglottitis.
Sore throat and stridor Drooling Tripod position High fever Difficulty or painful swallowing Muffled voice Scared and quiet Septic and unwell appearance
What is the typical appearance of epiglottitis on x-ray?
Thumbprint sign - soft tissue shadow that looks like a thumb pressed into the trachea
Caused by oedematous and swollen epiglottis
What is the management for acute epiglottitis?
Alert the most senior paediatrician and anaesthetist
Ensure the airway is secure
IV abx (ceftriaxone)
Steroids (dexamethasone)
What a common complication of epiglottitis?
Epiglottic abscess - life-threatening emergency
What is primary cilia dyskinesia/Kartagner’s syndrome?
Autosomal recessive condition affecting the cilia, particularly of the respiratory tract
How does PCD usually present?
Similar presentation to CF
Frequent and chronic chest infections
Poor growth
Bronchiectasis
What is Kartagner’s triad?
3 key features of PCD
Paranasal sinusitis
Bronchiectasis
Situs inversus
How is PCD diagnosed?
Sample of ciliated epithelium of the upper airway via nasal brushing or bronchoscopy and examine cilia action
How is PCD managed?
Similar to CF and bronchiectasis - daily physiotherapy, high calorie diet, abx
How does pneumonia usually present?
Cough (productive) High fever Tachypnoea Tachycardia Increased work of breathing Bronchial breath sounds Focal coarse crackles Lethargy Delirium
What are the bacterial causes of pneumonia?
Streptococcus pneumonia (most common) Group A strep Group B strep Staphylococcus aureus Haemophilus influenza Mycoplasma pneumonia, atypical bacteria
What are the viral causes of pneumonia?
RSV
Parainfluenza virus
Inlfuenza virus
What is the imaging modality of choice in pneumonia?
CXR
What is the 1st line treatment for pneumonia?
Amoxicillin
When are macrolides used for the treatment of pneumonia?
Atypical pneumonia
Penicillin allergy
