Respiratory Flashcards
BRONCHIOLITIS OVERVIEW
i) what is the most common causative organism? under what age is most common? why is there difficulty breathing?
ii) name five symptoms? how does it start off
iii) what % spontaneously resolve? what happens to those who dont?
i) RSV - under 1yr is most common and most are under 6m
difficulty breathing due to small airway inflammation and mucus - cant get air out (wheeze and crackles)
ii) coryzal symptoms initially (snot, sneeze, watery eyes) like a viral URTI then can progress to resp distress, SOB, tachypnoea, decreased feeding, mild fever, apnoea
iii) 50% spont resolve after viral URTI symptoms and 50% go on to progress to chest symptoms 1-2 days later
BRONCHIOLITIS MANAGEMENT
i) how long do symptoms usually last? give three reasons for admitting a child
ii) what is the mainstay of management? what can be given for excess mucus?
iii) name three things that can be given if there is decreased work of breathing
i) symptoms usually last 7-10days
admit if <3m, PMH eg premature, CF, downs
if clinically dehydrated, RR >70, sats <92%, mod/severe resp dsitress, apnoeas
ii) mainstay is supportive - ensure oral intake, saline nasall drops and suction prior to feeding, o2 if needed
iii) decreased WOB - give ventilatory support
high flow humidified oxygen via tight NC, CPAP, intubation/ventilation
RESPIRATORY DISTRESS
i) name six signs
ii) name three abnormal airway noises and what causes each
i) increased RR, accessory muscle use (SCM, abdo, intercostal), nasal flaring, head bobbing, tracheal tug, cyanosis
ii) wheezing - whistling on expiration
grunting - exhalation with the glottis partially closed
stridor - upper airway obstruction
VIRAL INDUCED WHEEZE
i) what is it? which two things cause a narrowed airway?
ii) how is it different to asthma?
iii) how does it present initially? then what happens?
iv) how is it managed?
i) acute wheezy illness caused by a virus
smooth muscle in airway constricts and restriction to airflow
ii) presents in under 3s with no atopic history and only occurs when there is a viral infection (doesnt have normal asthma triggers)
iii) initially px with a viral illness for 1-2 days then SOB, resp distress, expiratory wheeze throughout the chest
iv) manage the same as acute asthma
ACUTE ASTHMA
i) name four features? name a particularly worrying feature
ii) how are mod, severe and life threat classified in relation to peak flow, ability to speak?
iii) when are bronchodilators started?
i) rapid deterioration of symptoms
- worsening SOB, resp distress, increased RR, expiratory wheeze throughout the chest
- worrying = silent chest
ii) mod - PEFR >50% predicted and normal speech
severe - PEFR <50% predicted, broken sentences
life threat - PEFR <33%, silent chest, confusion, cyanosis
iii) if mod to severe - start bronchodilators
ACUTE ASTHMA TREATMENT
i) what bronchodilator is usually started? what three things can ths progress to
ii) name two other drugs that may be given
iii) what may happen to serum potassium on bronchodilator treatment?
iv) when can a child be discharged
i) started inhaled or nebulised salbutamol > inhaled/nebs ipatropium > IV magnesium sulphate > IV aminophylline
ii) can also give steroids eg oral pred or IV hydrocortisone
iii) monitor serum potassium as high dose salbutamol causes hypokalemia
iv) discharge when well on 5 puffs 4hourly of salbutamol
CHRONIC ASTHMA
i) what happens to smooth muscle? what is it reversed by?
ii) name four presenting features? name three other conditions a patient may have
iii) what type of wheeze is heard?
iv) name three types of investigations that can be done?
i) hypersensitive smooth muscle > bronchoconstriction reversible by bronchodilators
ii) episodic symptoms, diurnal variability (worse at night and early AM), dry cough, wheeze, SOB
atopic conditions - eczema, hayfever, food allergy
iii) bilateral widespread polyphonic wheeze
ib) spirometry >5yrs, direct challenge with histamine or methacholine, FeNO, PEFR variability
CROUP
i) what is it? what is the most common cause? between what ages is it most common?
ii) how quickly does it usually improve? what tx does it respond well to?
iii) what is a common presenting feature? what type of cough is heard? name two other features
iv) what is the mainstay of treatment? is it infectious?
v) a single dose of what medication can be given? what four things can be done if this does not work?
i) URTI that causes oedema in the larynx
most commonly caused by parainfluenza virus - also by influnza, adenovirus, RSV
common between 6m-2yrs
ii) usually improves in 48hours and responds well to steroids (dex)
iii) increased work of breathing
barking cough with clusters of episodes
hoarse voice, stridor, low grade fever
iv) mainstay is supportive management at home (fluid and rest)
it is infectious so avoid spread eg hand washing
v) single dose of dex > oxygen > neb budesonide, neb adrenaline > intubation
PNEUMONIA
i) name four signs? what type of breathing may be seen? why?
ii) name two other chest signs
iii) what is the most common bacterial causative organism? name three others? name two viral causes
iv) which two investigations should be done to find the cause?
v) what is the first line abx used in management? what can be given to cover atypicals?
i) wet cough, high fever, high RR, HR, WOB, delirium
bronchial breathing (harsh sounds, equal noise on insp and exp) due to consolidation of lung tissue around the airway
iii) strep pneumoniae, strep pyogenes, group B strep, staph aureus, haemoph influ if unvacc
viral - RSV, parainfluenza
iv) sputum culture and throat swab - bacterial culture and viral PCR
v) amox first line, macrolide (erythromycin) to cover atypicals
CYSTIC FIBROSIS
i) what is the inheritance pattern? which gene on which chromo is mutated?
ii) name three consequences of having CF
iii) how is it screened for? what is commonly the first sign in babies?
iv) name two ways it may present in later life?
v) name four symptoms and four signs
i) auto recessive > CFTR gene on chromosome 7
ii) thick panc/billiary secretions, low volume thick airway secretions (allowing bacterial colonisation), congenital bilateral absence of vas deferens
iii) screen on newborn bloodspot test
first sign can be meconium ileus - if they dont pass meconium in 24hrs, abdo distention and vomiting
iv) later - recurrent URTIs, failure to thrive, pancreatitis
v) symptoms - chronic cough, thick sputum, recurrent RTIs, steatorrea, salty sweat, abdo pain
signs - low height and weight, nasal polyps, finger clubbing, crackles, abdo distention
CYSTIC FIBROSIS MANAGEMENT
i) what is the gold standard dx text? how it it done? what chloride level is diagnostic of CF?
ii) which bacteria is a key airway coloniser? which bacteria leads to increased morbid/mortality? which abx can be given prophylactically to prevent?
iii) name five ways CF can be managed? what can be given to digest fats in pts with pancreatic insufficiency?
iv) what can be given to breakdown DNA in secretions? which antibiotic may be given? which vaccines are reccomended?
v) name three complications?
i) sweat test is gold standard > add pilocarpine, stim with electrodes to produce sweating and test sweat for Cl conc - >60mmol/l is dx
ii) staph aureus
pseudomonas can increase mortality
give prophylactic flucloxacillin
iii) bronchodilators, prophylactic fluclox, chest physio, exercise, high calorie diet
CREON tablets for pan insuff
iv) dornase alfa
may give neb tobramycin or oral ciprofloxacin
vaccines > pneumococcal, influenza, varicella
v) 90% patients have pancreatic insufficiency
50% have CF related diabetes
liver disease
INFLUENZA
i) what type of virus is it?
ii) name five presentingn features
iii) what investigation is done?
iv) what two drugs can be given to patients at risk of complications? within what time frame should this be done?
i) RNA virus
ii) fever, coryza, lethargy, fatigue, low appetite, headache, dry cough
iii) viral/nasal swab for viral PCR analysis
iv) oral oseltamivir or inhaled zanamivir within 48 hours
WHOOPING COUGH
i) does it affect upper or lower resp tract? what bacteria causes it? which two groups are vaccinated against it?
ii) how does it first present? what happens after a week?
iii) what is the character of the cough? what is this called? what happens when the cough fit ends?
iv) how may infants present?
v) what test is done to diagnose? what should be tested for when there has been a cough for over 2 weeks?
i) URTI caused by bordatella pertussis (gram negative bac)
vacc for children and pregnant women
ii) starts with mild coryzaal symptoms (low grade fever and mild cough) then severe coughing after 1 week
iii) sudden and recurring cough attacks with cough free periods in betwen
iv) infants can px with apnoeas
v) naasopharyngeal swabs with PCR testing/bacterial culture
test for anti pertussis toxin IgG in saliva or blood if cough >2weeks
WHOOPING COUGH MANAGEMENT
i) what is treatment mainstay? give three reasons to admit
ii) which antibiotic may be given?
iii) what can be given to close contacts?
iv) how long does it usually take to resolve?
v) what is the key complication?
i) supportive tx
admit if <6m w apnoea, cyanosis, severe cough
ii) macrolide abx eg erythromycin
iii) give prophylactic abx to close contacts
iv) usually resolves in 8 weeks
v) bronchiectasis
EPIGLOTTITIS
i) what is it? what bacteria most commonly causes it? what vaccine protects against this?
ii) name three key presenting symptoms?
iii) what imaging can be done? what is this used to exclude? what sign is seen on imaging?
iv) how quickly does it need to be managed? what should be done differently when investigating?
v) which two drugs can be given once the airway is secure? name a complication
i) inflammation/swelling of epiglottis
caused by haaemophilus influenza B > vacc against haemophilus
ii) sore throat, stridor, drooling, tripod position
iii) lateral x ray of the neck - to exclude foreign body > see thumb sign (thumb pressed into trachea due to oedema and swollen epiglottis)
iv) medical emergency > dont distress the patient so may not examine
v) give IV abx eg ceftriaxone or steroids eg dex
complication - epiglottic abscess
