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Paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is bronchiolitis

A

Inflammation and infection of the bronchioles

Usually caused by a virus (RSV)

Very common in winter

Usually in children under 1

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2
Q

How might a patient with bronchiolitis present

A

Coryzal symptoms

Signs of respiratory distress

Dyspnoea

Tachypnoea

Poor feeding

Mild fever

Apnoea episodes

Wheeze

Crackles

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3
Q

What are the signs of respiratory distress

A

Raised respiratory rate

Use of accessory muscles

Intercostal recessions

Subcostal recessions

Nasal flaring

Head bobbing

Tracheal tug

Cyanosis

Wheeze

Grunting

Stridor

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4
Q

What is the pathophysiology of a wheeze

A

Airway narrowing

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5
Q

What is the pathophysiology of grunting

A

Exhalation with glottis partially closed

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6
Q

What is the pathophysiology of stridor

A

Upper airway obstruction

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7
Q

What are the indications for admitting a child with bronchiolitis

A

< 3 months

Pre-existing condition

< 50-75% normal milk intake

Clinical dehydration

Respiratory rate > 70

Saturations < 92%

Deep recessions

Head bobbing

Apnoea

Parents not able to manage at home

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8
Q

What is the management of bronchiolitis

A

Ensure adequate intake (consider NG, IV fluids)

Saline nasal drops

Nasal suctioning

Oxygen

Palivizumab (monoclonal antibody, targets RSV, given monthly to at risk babies)

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9
Q

What does RSV stand for

A

Respiratory syncytial virus

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10
Q

What is a viral-induced wheeze

A

Usually due to RSV or rhinovirus

Due to narrowing of small airways (inflammation, oedema, smooth muscle contractions, swelling)

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11
Q

How can viral-induced wheeze be differentiated from asthma

A

Before age 3

No atopic history

Only during viral illness

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12
Q

How might a patient with viral induced wheeze present

A

Symptoms of viral illness for 1-2 days, then:

Shortness of breath

Signs of respiratory distress

Expiratory wheeze throughout chest

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13
Q

What is the management of viral induced wheeze

A

Oxygen

Bronchodilators (salbutamol, ipratropium, IV magnesium sulphate, IV aminophylline)

Steroids (oral prednisolone, IV hydrocortisone)

Antibiotics (amoxicillin, erythromycin)

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14
Q

How are mild cases of viral induced wheeze managed

A

As outpatients

Regular salbutamol inhalers via spacer (4-6 puffs every 4 hours)

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15
Q

How are moderate/severe cases of viral induced wheeze managed

A

Stepwise approach

Salbutamol inhalers (10 puffs every 2 hours)

Nebulised salbutamol and ipratropium

Oral prednisolone

IV hydrocortisone

IV magnesium sulphate

IV salbutamol

IV aminophylline

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16
Q

How might a patient with acute asthma present

A

Progressively worsening shortness of breath

Signs of respiratory distress

Tachypnoea

Expiratory wheeze

Tight chest on auscultation (reduced air entry)

Look out for silent chest

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17
Q

How is moderate asthma classified

A

Peak flow > 50% predicted

Normal speech

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18
Q

How is severe asthma classified

A

Peak flow < 50% predicted

Saturations < 92%

Unable to complete sentences

Signs of respiratory distress

Respiratory rate (40+ in 1-5s, 30+ in over 5s)

Heart rate (>140 in 1-5s, >125 in over 5s)

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19
Q

How is life-threatening asthma classified

A

Peak flow < 33% predicted

Saturations < 92%

Exhaustion

Poor respiratory effort

Hypotension

Silent chest

Cyanosis

Altered consciousness/confusion

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20
Q

What is the management of acute asthma

A

Oxygen

Bronchodilators

Steroids

Antibiotics

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21
Q

How might a patient with chronic asthma present

A

Episodic symptoms with intermittent exacerbations

Diurnal variability (worse at night and early in morning)

Dry cough

Wheeze

Shortness of breath

History of atopy

Family history of asthma/atopy

Symptoms improve with bronchodilators

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22
Q

What are the typical triggers for chronic asthma

A

Dust

Animals

Cold air

Exercise

Smoke

Food allergens

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23
Q

What are the investigations for chronic asthma

A

Usually a clinical diagnosis in children (diagnosed around age 3)

If uncertain:

Spirometry with reversibility testing

Direct bronchial challenge test (histamines, methacholine)

Fractional exhaled nitric oxide (FeNO)

Peak flow variability

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24
Q

What is the management of chronic asthma in under 5s

A

Salbutamol inhaler PRN

Add low dose corticosteroid or leukotriene antagonist

Add other from step 2

Refer to specialist

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25
Q

What is the management of chronic asthma in 5-12s

A

Salbutamol inhaler PRN

Add low dose corticosteroid inhaler

Add LABA inhaler

Titrate up corticosteroid dose, consider adding leukotriene receptor antagonist

Increase corticosteroid to highest dose

Refer to specialist

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26
Q

What is the management of chronic asthma in over 12s

A

Salbutamol inhaler PRN

Add low dose corticosteroid inhaler

Add LABA inhaler

Titrate up corticosteroid dose, consider adding leukotriene receptor antagonist

Increased inhaled corticosteroid to highest dose, consider oral SABA, refer to specialist

Add oral steroids

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27
Q

What is pneumonia

A

Infection of lung tissue

Inflammation of lung

Sputum fills airways and alveoli

Seen as consolidation on X-ray

28
Q

What are the common bacterial causes of pneumonia

A

Strep pneumoniae

Group A/B strep

Staph aureus

Haemophilus influenzae

Mycoplasma pneumonia

29
Q

What are the common viral causes of pneumonia

A

RSV

Influenza

Parainfluenza

30
Q

How might a patient with pneumonia present

A

Bronchial breath sounds

Focal coarse crackles

Dullness to percussion

Wet productive cough

Fever

Tachypnoea

Tachycardia

Increased work of breathing

Lethargy

Delirium

Low oxygen saturations

Hypotension

31
Q

What investigations are needed for pneumonia

A

Chest X-ray

Sputum culture

Throat swab

Blood cultures (if septic)

32
Q

What is the management for pneumonia

A

Antibiotics (amoxicillin, erythromycin)

Oxygen

33
Q

What is croup

A

Acute infective respiratory disease

Affects young children (6 months - 2 years)

Upper respiratory tract infection

Leads to oedema of larynx

Usually improves within 48 hours

34
Q

What are the common causes of croup

A

Parainfluenza

Influenza

Adenovirus

RSV

35
Q

How might a patient with croup present

A

Increased work of breathing

Barking cough (clusters of episodes)

Hoarse voice

Stridor

Low grade fever

36
Q

What is the management for mild/moderate croup

A

Mostly supportive (at home, sit child up, comfort them)

Oral dexamethasone (single dose, repeat at 12 hours if needed)

37
Q

What is the management of severe croup

A

Stepwise approach

Oral dexamethasone

Oxygen

Nebulised budesonide

Nebulised adrenaline

Intubation and ventilation

38
Q

What is epiglottitis

A

Inflammation and swelling of epiglottis

Can cause complete airway obstruction within hours

Usually due to haemophilus influenza type B

Now rare due to routine vaccination

39
Q

How might a patient with epiglottitis present

A

Sore throat

Stridor

Drooling

Tripod position (sitting forward, one hand on each knee)

Fever

Difficulty swallowing

Painful swallowing

Muffled voice

Scared or quiet child

Septic and unwell

40
Q

What are the investigations for epiglottitis

A

If unwell, do not attempt to investigate

Lateral X-ray neck (thumbprint sign)

41
Q

What is the management for epiglottitis

A

Do not distress child

Alert most senior paediatrician and anaesthetist available

Prepare to intubate at any time

Tracheostomy

Once airway secured: IV antibiotics (ceftriaxone), steroids (dexamethasone)

42
Q

What is the prognosis for epiglottitis

A

Most recover without need for intubation

Death if not diagnosed on time

Can develop epiglottic abscess (manage same as epiglottitis)

43
Q

What is laryngomalacia

A

Larynx structured in a way that causes airway obstruction (aryepiglottic folds shortened)

Chronic stridor

Peak at 6 months

44
Q

How might a patient with laryngomalacia present

A

Intermittent stridor (usually when feeding/upset/lying on back/ill)

Do not usually have respiratory distress

45
Q

What is the management for laryngomalacia

A

Usually spontaneously resolves as larynx matures

If very severe, tracheostomy

46
Q

What is whooping cough

A

URTI

Due to infection with bordetella pertussis

Children and pregnant women vaccinated (but immunity does not last)

Usually resolves in around 8 weeks

47
Q

How might a patient with whooping cough present

A

Mild coryzal symptoms

Low grade fever

Mild dry cough

Severe coughing fits

Struggle to breathe during fits

Loud inspiratory whoop when cough ends

48
Q

What are the investigations for whooping cough

A

Nasal swab

Anti-pertussis toxin IgG (if cough present for more than 2 weeks)

49
Q

What is the management for whooping cough

A

Notify public health

Simple supportive care

Antibiotics (azithromycin, erythromycin)

Prophylactic antibiotics to vulnerable close contacts

50
Q

What is the main complication of whooping cough

A

Bronchiectasis

51
Q

What is chronic lung disease of prematurity

A

Respiratory distress syndrome in neonates

Usually those born before 28 weeks

Need oxygen or intubation and ventilation at birth

Diagnosis based on chest X-ray changes

52
Q

How might a patient with chronic lung disease of prematurity present

A

Low oxygen saturations

Increased work of breathing

Poor feeding

Insufficient weight gain

Chest crackles

Wheeze

53
Q

What are the preventative measures for chronic lung disease of prematurity

A

Corticosteroids to mothers showing signs of preterm labour

Once babies born, CPAP and caffeine (stimulate respiratory drive)

54
Q

What is the management for chronic lung disease of prematurity

A

Monthly palivizumab injections (monoclonal antibodies against RSV)

55
Q

What is cystic fibrosis

A

Autosomal recessive condition

Affects chloride channels in mucus glands

Screened for in newborn heel prick test

56
Q

What are the key consequences of cystic fibrosis

A

Thickened pancreatic and biliary secretions (lack of digestive enzymes)

Thick airway secretions (increased susceptibility to infections)

Congenital bilateral absence of vas deferens

57
Q

How might a patient with cystic fibrosis present

A

Meconium ileus

Recurrent LRTIs

Failure to thrive

Pancreatitis

Chronic cough

Thick sputum production

Steatorrhoea

Salty sweat

Nasal polyps

Clubbing

Crackles

Wheeze

58
Q

What are the investigations for cystic fibrosis

A

Newborn heel prick test

Sweat test (gold standard, look for chloride concentration in sweat)

Genetic testing for CFTR gene

59
Q

What are the common microbial colonisers of cystic fibrosis

A

Staph aureus

Haemophilus influenzae

Klebsiella pneumoniae

E coli

Pseudomonas aeruginosa

60
Q

What is the management for cystic fibrosis

A

Chest physiotherapy

Exercise

High caloric diet

CREON tablets (replace lipase)

Prophylactic flucloxacillin

Treat any chest infections

Bronchodilators

Nebulised DNase (make secretions easier to clear)

Vaccines (pneumococcal, influenza, varicella)

Lung transplant

Liver transplant

Fertility treatment

Genetic counselling

61
Q

What monitoring is needed for cystic fibrosis

A

Clinic every 6 months

Screen for: diabetes, osteoporosis, vitamin D deficiency, liver failure

62
Q

What is the prognosis for cystic fibrosis

A

Median life expectancy 47

63
Q

What is primary ciliary dyskinesia

A

Aka Kartanger’s syndrome

Triad of: paranasal sinusitis, bronchiectasis, sinus inversus

Autosomal recessive

Affects cilia of various cells

Strongly linked to consanguinity

Build up of mucus in lungs

Infertility in males

64
Q

What are the investigations for primary ciliary dyskinesia

A

History of consanguinity in parents

Imaging for sinus inversus

Sample ciliated epithelium (nasal brushing, bronchoscopy)

65
Q

What is the management for primary ciliary dyskinesia

A

Daily physiotherapy

High caloric diet

Prophylactic antibiotics

Paeds (17 decks)

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