Respiratory Flashcards
Most common cause of bronchiolitis
RSV
Most common age group to get bronchiolitis
Under 6 months
Rarer under 1 year
Symptoms of bronchiolitis
Coryzal symptoms, dyspnoea, tachypnoea, LOW GRADE FEVER, wheeze and crackles
5 signs of respiratory distress
Use of accessory muscles, nasal flaring, head bobbing, tracheal tugging, recessions.
Cause of grunting
Exhaling with glottis partially closed to increase PEEP
Typical RSV infection history
URTI with coryzal symptoms
3-4 days later, half develop bronchiolitis
Reasons to admit children with bronchiolitis
Under 3 months
Prematurity, downs, CF
Clinical dehydration
O2 sats below 92, resps above 70
Bronchiolitis management
Supportive
High flow humidified O2
RSV vaccination drug
Palivizumab
Which children should receive Palivizumab
Congenital heart disease and premature
Which children should receive Palivizumab
Congenital heart disease and premature
Monthly until 1/2 years
Poiseuille’s law
Flow rate is proportional to radius^4
Half airways = 1/16th flow
Features of viral induced wheeze instead of asthma
Presenting before 3 years
No atopic history
Only occurs during viral infections
Does asthma cause a focal wheeze
NO - foreign body or tumour
Management of viral induced wheeze
Same as acute asthma
Type of wheeze in asthma
Expiratory
Heard throughout the chest
Asthma severity in extremely tachycardic and tachypnoeic children
Severe
Any HR/ RR cannot cause life threatening asthma. Raised causes severe
Type of asthma severity with 91% sats
Can be severe or life threatening.
Depends on other symptoms
4 key types of management in VIW/ acute asthma
O2, bronchodilators, steroids, abx
4 common bronchodilators
Salbutamol, ipatropium, MgSO4, aminophylline
7 step wise management in acute asthma
Salbutamol spacer, salbutamol/ ipratropium nebs, oral prednisone, iv hydro, iv mgso4, iv salbutamol, iv aminophylline
3 causes of a focal wheeze
foreign body, tumour, lobular pneumonia
NOT VIW/ ASTHMA
Step down approach for child on inhaled salbutamol and starting dose
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
What do you need to check when giving high doses of salbutamol
Potassium (of course)
Course of steroids in asthma
3 days
When is asthma typically worse
Night and early morning (unless obvious triggers such as a pet)
4 ways to diagnose asthma (all ages)
Fractional exhaled nitric oxide
Spirometry with reversible testing (salbutamol)
Direct bronchial challenge test (with histamine)
Peak flow diary
Management of asthma is split by age. What are the different age groups?
Under 5 years - montelukast or ICS 2nd line
5-12 years - LABA line 3
12 + years (adults) - LABA line 3
Effects of steroids in children
If treatment greater than 12 months 1 cm growth height reduction and growth velocity reduction
Atypical bacterial cause of pneumonia in kids and treatment
Mycoplasma
Macrolide - erythromycin
Pneumonia sound on acusultation
Bronchial breath sounds
Focal course crackles
(Dull to percussion)
Most common cause of pneumonia in children
Streptococcus pneumonia
Most common viral cause of pneumonia
RSV
First line treatment of pneumonia
Amoxicillin
Macrolide if concerned about atypical
Most common cause of croup
Parainfluenza virus
Barking cough -> dx
Croup
Croup 1st line treatment
Oral dexamethasone single dose 150mcg/kg
Treatments for croup other than oral dex
O2, neb budesonide (ICS), neb adrenalin
Pathophysiology of croup
Oedema in the larnyx caused by parainfluenza virus
Most common cause of epiglottis
Haemophilus influenza type B
Common presentation/ signs of epiglottis
Drooping, sitting forward in tripod position, high fever, muffled voice
Unvaccinated child with fever, sore throat and drooling -> dx
Epiglottis
haem influ B vaccinated against (most common cause)
Management of epiglottis
Early anaesthetic help (?intubtation/ trachy) IV ABX (ceftriaxone) Steroids (dex)
Management of epiglottis
Early anaesthetic help (?intubtation/ trachy) IV ABX (ceftriaxone) Steroids (dex)
Common complication of epiglottis (other than airway obstruction)
Epiglotis abcess - can also threaten airway
Laryngomalacia cause and presentation
Partial airway obstruction above vocal chords due to shape of larynx
Chronic stridor in inspiration
Peak age of laryngomalacia presentation
6 months
Is the inspiratory stridor in laryngomalacia persistent
No
Worse when eating, upset or lying on back
Laryngomalacia management
Self limiting
Trachy if obstructive
Whooping cough is cause by?
Bordetella pertussis (gram negative)
Vaccinated against in UK
Whooping cough presentation
Mild corzyl symptoms
Severe coughing fits with gaps in between (paroxysmal) cough
Cough so hard develop pneumothorax, faint or vomit
How to diagnose whooping cough
PCR if first 2 weeks
Anti-pertussis toxin IgG if after 2 weeks
Management of whooping cough
Notifiable disease and close contact prophylactics
Supportive care
Macrolide abx if within first 21 days
Complication of whooping cough
Most resolve within 8 weeks but some “100 week cough”
Bronchiectasis
Chronic Lung Disease of Prematurity typically occurs in which babies
Born before 28 weeks
How can risk of Chronic Lung Disease of Prematurity be reduced after birth
CPAP instead of ventilation
Caffeine to stimulate resp effort
Not over oxygenating
What injection do babies with Chronic Lung Disease of Prematurity need?
Palivizumab - protects against RSV (bronchiolitis)
How to manage babies with Chronic Lung Disease of Prematurity
Palivizumab
Formal sleep study to titrate minimal required O2
Most common gene mutation in CF
Delta-F508
Codes for chloride channel
3 key consequences of CF
Thick pancreatic secretions (blocked ducts, lack of lipase)
Low volume but thick airway secretions -> bilateral consolidation
Bilateral absence of vas defrays
CF inheritance
AR
How if CF diagnosed
Sweat test
Newborn heal prick
Genetic testing
First sign of CF in newborn
Meconium ileus
Should be black and passed within 24 hours
Positive CF sweat test result
Chloride concentration of greater than 60 mmol/l
2 key respiratory infection organisms in CF
Staph A
Pseudomonas aeruginosa
Organism that causes significant increase in mortality in CF
Pseudomonas aruginosa
Hard to treat as resistant -> tobramycin nebulised
Should CF kids meet each other
No as spreads pseudomonas aeruginosa
Treatment of pseudomonas aeruginosa in CF
Neb ABX - tobramycin/ oral ciprofloxacin
Treatment of pancreatic insufficiency in CF
CREON tablets
What is neb DNase used for
Enzyme that breaks down DNA in respiratory secretions to make it less thick
Prophylaxis abx in CF
Flucoxacilin
Key endocrine disease that patients with CF develop
DM that needs treatment with insulin
Name of Primary Ciliary Dyskinesa
Kartagners syndrome
Kartagners syndrome inheritence
AR
Kartagners triad of symptoms/ signs
Situs inversus (everything reversed in body)
Bronchiectasis
Paranasal sinusitis
Kartagners pathophysiology
Dysfunction of motile cilia
Resp tract infections and infertility
Consanguinity meaning
Parents related
Management of Kartagners
Similar to CF
Daily physio, abx pro, high calorie diet
