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Leeds MBCHB Year 4 Peads > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Most common cause of bronchiolitis

A

RSV

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2
Q

Most common age group to get bronchiolitis

A

Under 6 months

Rarer under 1 year

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3
Q

Symptoms of bronchiolitis

A

Coryzal symptoms, dyspnoea, tachypnoea, LOW GRADE FEVER, wheeze and crackles

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4
Q

5 signs of respiratory distress

A

Use of accessory muscles, nasal flaring, head bobbing, tracheal tugging, recessions.

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5
Q

Cause of grunting

A

Exhaling with glottis partially closed to increase PEEP

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6
Q

Typical RSV infection history

A

URTI with coryzal symptoms

3-4 days later, half develop bronchiolitis

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7
Q

Reasons to admit children with bronchiolitis

A

Under 3 months
Prematurity, downs, CF
Clinical dehydration
O2 sats below 92, resps above 70

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8
Q

Bronchiolitis management

A

Supportive

High flow humidified O2

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9
Q

RSV vaccination drug

A

Palivizumab

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10
Q

Which children should receive Palivizumab

A

Congenital heart disease and premature

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11
Q

Which children should receive Palivizumab

A

Congenital heart disease and premature

Monthly until 1/2 years

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12
Q

Poiseuille’s law

A

Flow rate is proportional to radius^4

Half airways = 1/16th flow

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13
Q

Features of viral induced wheeze instead of asthma

A

Presenting before 3 years
No atopic history
Only occurs during viral infections

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14
Q

Does asthma cause a focal wheeze

A

NO - foreign body or tumour

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15
Q

Management of viral induced wheeze

A

Same as acute asthma

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16
Q

Type of wheeze in asthma

A

Expiratory

Heard throughout the chest

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17
Q

Asthma severity in extremely tachycardic and tachypnoeic children

A

Severe

Any HR/ RR cannot cause life threatening asthma. Raised causes severe

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18
Q

Type of asthma severity with 91% sats

A

Can be severe or life threatening.

Depends on other symptoms

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19
Q

4 key types of management in VIW/ acute asthma

A

O2, bronchodilators, steroids, abx

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20
Q

4 common bronchodilators

A

Salbutamol, ipatropium, MgSO4, aminophylline

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21
Q

7 step wise management in acute asthma

A

Salbutamol spacer, salbutamol/ ipratropium nebs, oral prednisone, iv hydro, iv mgso4, iv salbutamol, iv aminophylline

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22
Q

3 causes of a focal wheeze

A

foreign body, tumour, lobular pneumonia

NOT VIW/ ASTHMA

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23
Q

Step down approach for child on inhaled salbutamol and starting dose

A 
10 puffs every 1 hour
10 puffs every 2 hours
10 puffs every 4 hours
6 puffs every 4 hours
4 puffs every 6 hours
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24
Q

What do you need to check when giving high doses of salbutamol

A

Potassium (of course)

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25
Q

Course of steroids in asthma

A

3 days

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26
Q

When is asthma typically worse

A

Night and early morning (unless obvious triggers such as a pet)

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27
Q

4 ways to diagnose asthma (all ages)

A

Fractional exhaled nitric oxide
Spirometry with reversible testing (salbutamol)
Direct bronchial challenge test (with histamine)
Peak flow diary

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28
Q

Management of asthma is split by age. What are the different age groups?

A

Under 5 years - montelukast or ICS 2nd line
5-12 years - LABA line 3
12 + years (adults) - LABA line 3

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29
Q

Effects of steroids in children

A

If treatment greater than 12 months 1 cm growth height reduction and growth velocity reduction

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30
Q

Atypical bacterial cause of pneumonia in kids and treatment

A

Mycoplasma

Macrolide - erythromycin

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31
Q

Pneumonia sound on acusultation

A

Bronchial breath sounds
Focal course crackles

(Dull to percussion)

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32
Q

Most common cause of pneumonia in children

A

Streptococcus pneumonia

33
Q

Most common viral cause of pneumonia

A

RSV

34
Q

First line treatment of pneumonia

A

Amoxicillin

Macrolide if concerned about atypical

35
Q

Most common cause of croup

A

Parainfluenza virus

36
Q

Barking cough -> dx

A

Croup

37
Q

Croup 1st line treatment

A

Oral dexamethasone single dose 150mcg/kg

38
Q

Treatments for croup other than oral dex

A

O2, neb budesonide (ICS), neb adrenalin

39
Q

Pathophysiology of croup

A

Oedema in the larnyx caused by parainfluenza virus

40
Q

Most common cause of epiglottis

A

Haemophilus influenza type B

41
Q

Common presentation/ signs of epiglottis

A

Drooping, sitting forward in tripod position, high fever, muffled voice

42
Q

Unvaccinated child with fever, sore throat and drooling -> dx

A

Epiglottis

haem influ B vaccinated against (most common cause)

43
Q

Management of epiglottis

A 
Early anaesthetic help (?intubtation/ trachy)
IV ABX (ceftriaxone)
Steroids (dex)
43
Q

Management of epiglottis

A 
Early anaesthetic help (?intubtation/ trachy)
IV ABX (ceftriaxone)
Steroids (dex)
44
Q

Common complication of epiglottis (other than airway obstruction)

A

Epiglotis abcess - can also threaten airway

45
Q

Laryngomalacia cause and presentation

A

Partial airway obstruction above vocal chords due to shape of larynx

Chronic stridor in inspiration

46
Q

Peak age of laryngomalacia presentation

A

6 months

47
Q

Is the inspiratory stridor in laryngomalacia persistent

A

No

Worse when eating, upset or lying on back

48
Q

Laryngomalacia management

A

Self limiting

Trachy if obstructive

49
Q

Whooping cough is cause by?

A

Bordetella pertussis (gram negative)

Vaccinated against in UK

50
Q

Whooping cough presentation

A

Mild corzyl symptoms

Severe coughing fits with gaps in between (paroxysmal) cough

Cough so hard develop pneumothorax, faint or vomit

51
Q

How to diagnose whooping cough

A

PCR if first 2 weeks

Anti-pertussis toxin IgG if after 2 weeks

52
Q

Management of whooping cough

A

Notifiable disease and close contact prophylactics
Supportive care
Macrolide abx if within first 21 days

53
Q

Complication of whooping cough

A

Most resolve within 8 weeks but some “100 week cough”

Bronchiectasis

54
Q

Chronic Lung Disease of Prematurity typically occurs in which babies

A

Born before 28 weeks

55
Q

How can risk of Chronic Lung Disease of Prematurity be reduced after birth

A

CPAP instead of ventilation
Caffeine to stimulate resp effort
Not over oxygenating

56
Q

What injection do babies with Chronic Lung Disease of Prematurity need?

A

Palivizumab - protects against RSV (bronchiolitis)

57
Q

How to manage babies with Chronic Lung Disease of Prematurity

A

Palivizumab

Formal sleep study to titrate minimal required O2

58
Q

Most common gene mutation in CF

A

Delta-F508

Codes for chloride channel

59
Q

3 key consequences of CF

A

Thick pancreatic secretions (blocked ducts, lack of lipase)
Low volume but thick airway secretions -> bilateral consolidation
Bilateral absence of vas defrays

60
Q

CF inheritance

A

AR

61
Q

How if CF diagnosed

A

Sweat test
Newborn heal prick
Genetic testing

62
Q

First sign of CF in newborn

A

Meconium ileus

Should be black and passed within 24 hours

63
Q

Positive CF sweat test result

A

Chloride concentration of greater than 60 mmol/l

64
Q

2 key respiratory infection organisms in CF

A

Staph A

Pseudomonas aeruginosa

65
Q

Organism that causes significant increase in mortality in CF

A

Pseudomonas aruginosa

Hard to treat as resistant -> tobramycin nebulised

66
Q

Should CF kids meet each other

A

No as spreads pseudomonas aeruginosa

67
Q

Treatment of pseudomonas aeruginosa in CF

A

Neb ABX - tobramycin/ oral ciprofloxacin

68
Q

Treatment of pancreatic insufficiency in CF

A

CREON tablets

69
Q

What is neb DNase used for

A

Enzyme that breaks down DNA in respiratory secretions to make it less thick

70
Q

Prophylaxis abx in CF

A

Flucoxacilin

71
Q

Key endocrine disease that patients with CF develop

A

DM that needs treatment with insulin

72
Q

Name of Primary Ciliary Dyskinesa

A

Kartagners syndrome

73
Q

Kartagners syndrome inheritence

A

AR

74
Q

Kartagners triad of symptoms/ signs

A

Situs inversus (everything reversed in body)
Bronchiectasis
Paranasal sinusitis

75
Q

Kartagners pathophysiology

A

Dysfunction of motile cilia

Resp tract infections and infertility

76
Q

Consanguinity meaning

A

Parents related

77
Q

Management of Kartagners

A

Similar to CF

Daily physio, abx pro, high calorie diet

Leeds MBCHB Year 4 Peads (21 decks)

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