Respiratory Flashcards
How many peak flow measurements should be taken?
three, take average reading
What are peak flow results dependent on?
height
Child is snoring at night. What study can be conducted?
home oximetry study
Name an important aspect of a history of someone with wheeze and cough?
sleep quality
What specific question should be asked about wheeze?
where can you hear the wheeze? in chest then likely asthma, if in mouth then something else
six month baby, five day hx of cough and coryzal symptoms. Wheeze and crackles. Nappies are normal. What is the most appropriate initial management?
reassure and discharge home with worsening advice. Self-limiting + encouraging observations (feeding, normal nappy)
At what age can you diagnose a child with asthma?
Not until >5 due to compliance with peak flow and spirometry
What diagnosis is wheeze + cough associated with in children <2 years old?
bronciolitis
What diagnosis is wheeze + cough associated with in older children >2?
viral induced wheeze
What is the difference between bronchiolitis and viral induced wheeze?
While bronchiolitis is wet lungs, viral wheeze is bronchospasm. Plus difference in age of child
Why doesn’t bronchiolitis respond to salbutamol?
babies don’t develop B2 receptors until a later stage
4 year old, barking cough and stridor, given adrenaline. Temp is still 38.2. What is the diagnosis and next step in management?
Croup, oral steroids.
Should you examine the throat of a child with croup?
Never examine throat of patient with child, or blood tests, don’t do anything the child will be distressed by, crying will make it worse, therefore clinical diagnosis.
2 hours after c section, term baby develops tachyopnoea. Mother had uncomplicated pregnancy, no infection, amniotic fluid clear. What is the likely diagnosis?
transient tachyopnoea of the newborn
TTN
Why does transient tachyopnoea of the newborn (TTN) happen?
TTN due to residual fluid in lungs. C section without mechanical push leaves residual fluid, this resolves within hours.
What is the difference between TTN and respiratory distress?
Respiratory distress in preterm neonates due to poor development of lungs and is more serious and requires medical input. TTN is transient and resolves spontaneously.
Questions to ask in history about a cough
duration, worse during day or night, exercise, triggers, wheeze/bark
What are the components of the 6-in-1 vaccine?
diptheria, tetanus, pertussis, polio, Hib disease
Harrison sulcus is a sign of which condition?
Chronic asthma
=indentation of chest around 6th rib
Nasal polyps is a sign in which respiratory condition?
cystic fibrosis
Name three factors which influence lung function
Height
Sex
Age
Ethnicity
What is the main virus that causes bronchiolitis?
RSV
Three signs of respiratory distress?
raised RR
accessory muscles
nasal flaring
head bobbing
cyanosis
abnormal airway noises
List three abnormal airway noises
wheezing
grunting
stridor
What is the time course of RSV infection?
Coryzal symptoms
Chest symptoms day 1-2
Worst on day 3/4
Symptoms last 7-10 days in total and most recover fully within 2-3 weeks
Name a drug given in the prevention of bronchiolitis?
Palivizumab
Why is it important to feel for liver edge in respiratory exam in child?
may be pushed down by hyper expanded lungs
Three differentials for acute cough
URTI
Croup
Bronchiolitis
Pneumonia
Pertussis
Inhaled foreign body
Two differentials for chronic cough in child
asthma
infection- TB
GORD
Cystic fibrosis
Kartagener syndrome
Two differentials for acute stridor
Inhaled foreign body
Croup
Epiglottitis
Which organism typically causes croup
parainfluenza
How is cough described in croup?
barking
Briefly describe the pathophysiology of cystic fibrosis
disorder of exocrine gland function wherein mutations in CFTR causes thickened secretions which accumulate in the lunga
Which organs are affected in cystic fibrosis?
pancreas
lungs
reproductive tract
Three features of cystic fibrosis?
respiratory
poor growth
pancreatic insufficiency
anaemia of chronic disease
What screening is involved in cystic fibrosis?
Neonatal blood spoot- immunoreactive trypsin levels (newborn screening)
sweat test
genetic test
What is the mode of inheritance of cystic fibrosis?
autosomal recessive
both parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?
We know the child doesn’t have the condition, so the answer is two in three.
What is the first sign of cystic fibrosis in newborn?
meconium ileus
Three signs of cystic fibrosis?
low weight growth charts
nasal polyps
finger clubbing
abdominal distention
crackles and wheeze
Name two common colonisers in cystic fibrosis
staph aureus
pseudomonas
Three causes of finger clubbing in children?
cyanotic heart disease
cystic fibrosis
TB
IBD
Liver cirrhosis
Infective endocarditis
List three differences between the presentation of a pneumonia and URTI
URTI- runny nose, sore throat, sneeze, ear pain. Clear sounds upon auscultation!!!
Pneumonia- Cyanosis, tachyopnoea, abnormal breath sounds, general body malaise
Cystic fibrosis can cause which condition in children?
Diabetes!
Cystic fibrosis presents in childhood with respiratory symptoms, but as the disease progresses, further features begin to develop. If the pancreas becomes affected, then diabetes mellitus can develop. It can take time for the pancreas to be affected enough to cause diabetes, which is why children with cystic fibrosis may develop diabetes later in life.
State two severity markers for croup deterioration?
Sternal/intercostal recession, asynchronous chest wall and abdominal movement.
Fatigue, pallor or cyanosis, decreased level of consciousness or tachycardia.
The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires.
A respiratory rate of over 70 breaths/minute is also indicative of severe respiratory distress.
After dexamethasone, which treatment should you offer if child continues to deteriorate with croup?
nebulised adrenaline
