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Y4 Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is bronchiolitis?

A

inflammation and infection of the small airways (bronchioles)
most common in under 6 months (not common in up to 2 years of age - usually ex-premature / congenital heart defects

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2
Q

What is the presentation and course of bronchiolitis?

A

Corzyal symptoms, resp distress, tachypnoea, dyspnoea, poor feeding, mild fever, apnoea, wheeze / crackles / grunting / stridor
Starts as URTI + corzyal symptoms > chest symptoms (first 1-2 days) > 7-10 days total (most recover within 2-3 weeks)

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3
Q

What are the reasons for admission for a child with bronchiolitis?

A

Aged under 3 months + pre-existing condition e.g. prematurity, Down’s, CF
50-75% less than normal milk intake clinical dehydration
RR > 70, O2 sat < 92%
Mod-Sev respiratory distress e.g. head bobbing, deep recessions
Apnoeas
Parents not confident in ability

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4
Q

What is the management for bronchiolitis?

A

Supportive management
- NG tube / IV fluids
- saline nasal drops
- supplementary oxygen
- ventilatory support

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5
Q

What are the ventilatory support options used in paediatrics?

A

High-flow humidified oxygen via tight nasal cannula
Continuous positive airway pressure (CPAP)
Intubation
Intubation / ventilation

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6
Q

How can ventilation status be monitored in paediatrics?

A

Capillary blood glucose
(^ pCO2 / v pH = type 2 respiratory failure)

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7
Q

What is the role of palivizumab?

A

= MAB that targets respiratory syncytial virus
provides passive protection (temporarily) against RSV to prevent bronchiolitis until child has developed innate immune system (after being exposed)
provided to high risk babies e.g. ex-premature / congenital heart defects

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8
Q

What is viral induced wheeze?

A

Acute wheezy illness caused by viral infection

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9
Q

What is the presentation of viral induced wheeze?

A

Presence of viral infection (cough, fever, corzyal symptoms) for 1-2 days before development of:
SOB
Signs of respiratory distress
Expiratory wheeze throughout chest (non-focal)

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10
Q

How can viral induced wheeze be differentiated from asthma?

A

VIW = presents before 3 years of age, no atopic history, only occurs during viral infections
Asthma = variable and reversible airflow obstruction that can be triggered due to viral and bacterial infections

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11
Q

What is the management for viral induced wheeze?

A

Manage as acute asthma exagerbation

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12
Q

What is the management of moderate to severe asthma?

A

Step-wise approach
- salbutamol inhalers
- nebulisers (salbutamol / ipratropoium bromide)
- oral prednisolone
- IV hydrocortisone
- IV magnesium sulphate
- IV salbutamol
- IV aminophylline

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13
Q

How can patients admitted with acute asthma be discharged?

A

Salbutamol prescription in step-down approach: 6 puffs 4 hourly for 48 hours, 4 puffs 6 hourly for 48 hours, 2-4 puffs as required
Finish course of steroids
Provide safety-netting information
Provide individualised asthma action plan

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14
Q

What is a presentation that would indicate a non-asthmatic cause of chronic wheeze / cough etc.?

A

Wheeze only related to coughs / colds (more likely viral)
Isolated or productive cough
Normal investigations
No response to treatment
Unilateral wheeze (focal lesion, FIB, infection)

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15
Q

What is the management for chronic asthma in an under 5 year old?

A

Step-wise approach:
SABA inhaler
+ low dose corticosteroid inhaler OR LRTA PO
+ other option from previous step
Specialist referral

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16
Q

What is the management for chronic asthma in a child aged 5-12 years?

A

Step-wise approach:
SABA inhaler PRN
+ regular low-dose corticosteroid inhaler
+ LABA inhaler e.g. salmeterol (continue only in case of response to treatment)
Titrate corticosteroid to medium dose and consider: PO LRTA / PO theophylline
Increase corticosteroid to high dose
Referral to specialist (may req PO OD steroids)

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17
Q

What is pneumonia?

A

infection of lung tissue > lung tissue inflammation + sputum in airways and alveoli
caused by bacteria, virus, or atypical pneumonia

18
Q

What can be seen on CXR in a patient with pneumonia?

A

consolidation

19
Q

How will pneumonia present?

A

Chest sounds: bronchial breath sounds equally loud on IN/EX (consolidation), focal coarse crackles (air passing through sputum), dullness to percussion (lung tissue collapse, consolidation)
cough, pyrexia, tachypnoea, tachycardia, lethargy, delirium

20
Q

What are the most common bacterial and viral causes of pneumonia in children?

A

Bacterial = streptococcus pneumonia
Viral = Respiratory syncytial virus (RSV)
Atypical bacterial = mycoplasma pneumonia (EP manifestations e.g. erythema multiforme)

21
Q

What is the management for pneumonia?

A

Abx (according to local guidelines)
Commonly: amoxicillin
+ macrolides (if atypical bacteria or as first line if penicillin allergy)

22
Q

What investigations can be completed in recurrent LRTIs and why?

A

FBC (abnormal white blood cells)
CXR (structural abnormalities / scarring from LRTIs)
Serum immunoglobulins (v Ab classes = selective antibody deficiency)
Immunoglobulin G to previous vaccines e.g. haemophilus / pneumococcus (inability to convert IgM to IgG ie. no LT immunity = immunoglobulin class-switch recombination deficiency)
Sweat test (CF)
HIV test

23
Q

What is croup?

A

Acute infective upper respiratory tract infection affecting children aged 6 months - 2 years
Infection > oedema in larynx
Usually improving in 48 hours

24
Q

What are the causes of croup?

A

Parainfluenza
Influenza
Adenovirus
Respiratory syncytial virus (RSV)
Diphtheria (not common due to vaccination in developed countries)

25
Q

What is the management of croup?

A

Usually: supportive (fluids and rest), sit up during attacks, infection control
Severe cases: step-wise approach
Oral dexamethasone > oxygen > Neb budesonide > Neb adrenaline > intubation & ventilation

26
Q

What is epiglottitis?

A

inflammation and swelling of the epiglottis caused by infection
life-threatening emergency

27
Q

What is the most likely pathogen involved in epiglottitis?

A

Haemophilus influenza type B
(epiglottitis is rare due to vaccination programme against Haemophilus)

28
Q

What is the common presentation of a child with epiglottitis?

A

Unvaccinated child
Sore throat + stridor
Drooling
Tripod position
Pyrexia
Difficulty swallowing + muffled voice
Septic, unwell appearance

29
Q

What is the investigations for epiglottitis?

A

Lateral neck XR = “thumb sign” (oedema and swelling of epiglottis)
Can also differentiate between foreign body

30
Q

What is the management of epiglottitis?

A

Keep child calm
Alert most senior paediatrician and anaesthetist
Prepare for intubation at any time (inc tracheostomy if airway completely closes)
When airway is secured, IV Abx / steroids e.g. ceftriaxone + dexamethasone

31
Q

What are the potential complications of epiglottitis?

A

Epiglottic abscess (similar treatment to epiglottitis)

32
Q

What is laryngomalacia?

A

supraglottic larynx is structured in a way that causes partial obstruction

33
Q

What is the presentation of laryncomalacia?

A

Infants (peaking at 6 months)
Inspiratory stridor (intermittent and worse when feeding, crying, lying down, or during URTI)
Absence of respiratory distress

34
Q

What is the investigation of choice for laryngomalacia?

A

Awake fiberoptic flexible laryngoscopy (to r/o other DDx)

35
Q

What is the management of laryngomalacia?

A

Typically, no interventions needed
Rarely: tracheostomy / surgery

36
Q

What is whooping cough and what is it caused by?

A

= URTI caused by Bordetella pertussis (gram negative bacteria)
sev cough > lough whooping inspiration sound

37
Q

What is the presentation of whooping cough?

A

Initially: corzyal symptoms, low grade fever, mild dry cough
After a week: sev sudden recurrent coughing fits + cough free period (paroxysmal cough), associated with fainting, vomiting, or > pneumothorax

38
Q

How is whooping cough diagnosed?

A

= nasopharyngeal / nasal swab for PCR testing / bacterial culture (within 2-3 weeks)
After 2 weeks: anti-pertussis toxin immunoglobulin G (oral 5-16 yrs, blood 17yrs)

39
Q

What is the management of whooping cough?

A

Supportive care
Notify Public Health (notifiable disease)
- preventative Abx for vulnerable contacts + infection control
Abx: macrolides / co-trimoxazole
Typically resolves (can develop into bronchiectasis)

40
Q

What is chronic lung disease of prematurity?

A

Bronchopulmonary dysplasia
occurs in premature babies (before 28 weeks gestation)

41
Q

What are the features of chronic lung disease of prematurity?

A

Low oxygen saturations
Increased work of breathing
Poor feeding
Crackles and wheezes

Y4 Paediatrics (5 decks)

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