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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
What is the management of chronic asthma in 5-12s
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
26
What is the management of chronic asthma in over 12s
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
27
What is pneumonia
Infection of lung tissue Inflammation of lung Sputum fills airways and alveoli Seen as consolidation on X-ray
28
What are the common bacterial causes of pneumonia
Strep pneumoniae Group A/B strep Staph aureus Haemophilus influenzae Mycoplasma pneumonia
29
What are the common viral causes of pneumonia
RSV Influenza Parainfluenza
30
How might a patient with pneumonia present
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
What investigations are needed for pneumonia
Chest X-ray Sputum culture Throat swab Blood cultures (if septic)
32
What is the management for pneumonia
Antibiotics (amoxicillin, erythromycin) Oxygen
33
What is croup
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
What are the common causes of croup
Parainfluenza Influenza Adenovirus RSV
35
How might a patient with croup present
Increased work of breathing Barking cough (clusters of episodes) Hoarse voice Stridor Low grade fever
36
What is the management for mild/moderate croup
Mostly supportive (at home, sit child up, comfort them) Oral dexamethasone (single dose, repeat at 12 hours if needed)
37
What is the management of severe croup
Stepwise approach Oral dexamethasone Oxygen Nebulised budesonide Nebulised adrenaline Intubation and ventilation
38
What is epiglottitis
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
How might a patient with epiglottitis present
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
What are the investigations for epiglottitis
If unwell, do not attempt to investigate Lateral X-ray neck (thumbprint sign)
41
What is the management for epiglottitis
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
What is the prognosis for epiglottitis
Most recover without need for intubation Death if not diagnosed on time Can develop epiglottic abscess (manage same as epiglottitis)
43
What is laryngomalacia
Larynx structured in a way that causes airway obstruction (aryepiglottic folds shortened) Chronic stridor Peak at 6 months
44
How might a patient with laryngomalacia present
Intermittent stridor (usually when feeding/upset/lying on back/ill) Do not usually have respiratory distress
45
What is the management for laryngomalacia
Usually spontaneously resolves as larynx matures If very severe, tracheostomy
46
What is whooping cough
URTI Due to infection with bordetella pertussis Children and pregnant women vaccinated (but immunity does not last) Usually resolves in around 8 weeks
47
How might a patient with whooping cough present
Mild coryzal symptoms Low grade fever Mild dry cough Severe coughing fits Struggle to breathe during fits Loud inspiratory whoop when cough ends
48
What are the investigations for whooping cough
Nasal swab Anti-pertussis toxin IgG (if cough present for more than 2 weeks)
49
What is the management for whooping cough
Notify public health Simple supportive care Antibiotics (azithromycin, erythromycin) Prophylactic antibiotics to vulnerable close contacts
50
What is the main complication of whooping cough
Bronchiectasis
51
What is chronic lung disease of prematurity
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
How might a patient with chronic lung disease of prematurity present
Low oxygen saturations Increased work of breathing Poor feeding Insufficient weight gain Chest crackles Wheeze
53
What are the preventative measures for chronic lung disease of prematurity
Corticosteroids to mothers showing signs of preterm labour Once babies born, CPAP and caffeine (stimulate respiratory drive)
54
What is the management for chronic lung disease of prematurity
Monthly palivizumab injections (monoclonal antibodies against RSV)
55
What is cystic fibrosis
Autosomal recessive condition Affects chloride channels in mucus glands Screened for in newborn heel prick test
56
What are the key consequences of cystic fibrosis
Thickened pancreatic and biliary secretions (lack of digestive enzymes) Thick airway secretions (increased susceptibility to infections) Congenital bilateral absence of vas deferens
57
How might a patient with cystic fibrosis present
Meconium ileus Recurrent LRTIs Failure to thrive Pancreatitis Chronic cough Thick sputum production Steatorrhoea Salty sweat Nasal polyps Clubbing Crackles Wheeze
58
What are the investigations for cystic fibrosis
Newborn heel prick test Sweat test (gold standard, look for chloride concentration in sweat) Genetic testing for CFTR gene
59
What are the common microbial colonisers of cystic fibrosis
Staph aureus Haemophilus influenzae Klebsiella pneumoniae E coli Pseudomonas aeruginosa
60
What is the management for cystic fibrosis
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
What monitoring is needed for cystic fibrosis
Clinic every 6 months Screen for: diabetes, osteoporosis, vitamin D deficiency, liver failure
62
What is the prognosis for cystic fibrosis
Median life expectancy 47
63
What is primary ciliary dyskinesia
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
What are the investigations for primary ciliary dyskinesia
History of consanguinity in parents Imaging for sinus inversus Sample ciliated epithelium (nasal brushing, bronchoscopy)
65
What is the management for primary ciliary dyskinesia
Daily physiotherapy High caloric diet Prophylactic antibiotics

Paeds (17 decks)

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