respiratory Flashcards
1
Q
common cold causes
A
- very common in kids, especially 6-8 years old
- rhinovirus
- respiratory syncytial virus
2
Q
common cold presentation
A
- sneezing, rhinorrhoea, mild fever
- associated sore throat and acute otitis media
3
Q
common cold management
A
- typically last for 10 days
- rest, fluids, analgesia
4
Q
common cold complications
A
- secondary bacterial infection
- bronchitis
5
Q
croup causes
A
- para-influenza virus is most common
- respiratory syncytial virus causes upper airway obstruction via subglottic inflammation, oedema and exudate
- most common in 6 months - 6 years
6
Q
what is croup
A
viral tracheolaryngobronchitis
7
Q
croup presentation
A
- intermittent loud, harsh stridor, especially when upset
- barking cough
- hoarseness
- apyrexial, no signs of systemic upset, able to swallow oral secretions
8
Q
indicators of moderate croup
A
stridor at rest with no agitation or lethargy
9
Q
indicators of severe croup
A
- agitation and restless
- sternal retractions
- constant stridor
- cyanosis
- lethargy
10
Q
croup diagnosis
A
- never examine throat in child with group as there is risk of airway obstruction
- diagnosis is usually clinical
- AP neck x-ray showing narrow trachea (steeple sign)
11
Q
mild croup management
A
- oral dexamethasone stat
- supportive care at home
12
Q
moderate croup management
A
- oral dexamethasone stat
- nebulaised adrenaline
13
Q
severe croup management
A
- oral dexamethasone stat
- O2
- nebulised adrenaline
- possible intubation
14
Q
epiglottitis causes
A
- H. influenzae type B
- most common 2-7 years old
15
Q
what is epiglottitis
A
acute bacterial infection of epiglottis
16
Q
epiglottitis presentation
A
- drooling and unable to swallow
- constant, soft stridor
- muffled voice
- fever, signs of systemic upset, respiratory distress, unable to lie down (adopts tripod position where patient leans forward with neck extended)
17
Q
epiglottitis diagnosis
A
- do not examine throat, frighten child or cause more distress
- lateral neck x-ray shows enlarged epiglottis (thumb print sign)
18
Q
epiglottitis management
A
- don’t wait for x-ray to start management
- call anaesthetics and ENT (critical paediatric airway needing rigid laryngoscopy and intubation)
- hold oxygen mask close to child
- supportive care and IV ceftriaxone
19
Q
bronchitis cause
A
often follows upper respiratory tract infection
20
Q
bronchitis presentation
A
- cough
- wheeze
- no fever
21
Q
bronchitis management
A
supportive
22
Q
bronchiolitis causes
A
- normally under 1 year old (peak 3-6 months)
- respiratory syncytial virus
23
Q
what is bronchiolitis
A
acute lower respiratory tract infection
24
Q
bronchiolitis presentation
A
- recent cold followed by cough
- wheeze
- intercostal recession
- cyanosis
- mild fever
25
bronchiolitis diagnosis
chest x-ray showing hyperinflation with patchy changes
26
bronchiolitis management
- supportive
- if grunting then admit urgently to hospital
- palivizumab is monoclonal antibody given to kids who are at increased risk of severe disease to prevent respiratory syncytial virus
27
whooping cough causes
Bordetella pertussis
28
whooping cough presentation
1-2 week history of cold symptoms and cough at night, followed by 2-3 weeks history of
- paroxysms of cough (coughing fits)
- followed by inspiratory whoop
- associated with vomiting and cyanosis
29
whooping cough diagnosis
culture of nasopharyngeal aspirate or swab
30
whooping cough management
- supportive care
- report to public health
- can give oral macrolide (clarithromycin or azithromycin if present within 21 days)
- household contacts offered antibiotic prophylaxis
- school exclusion (can return 48 hours after starting antibiotics or if no antibiotics then 21 days post-onset)
- infants under 6 months with suspected whooping cough should be admitted
31
pneumonia presentation
- malaise and high fever (> 39 C)
- respiratory distress
- pleural pain and crackles in older kids
32
pneumonia diagnosis
chest x-ray
33
community acquired non-severe pneumonia management
- under 1: co-amoxiclav
- > 1: amoxicillin
- penicillin allergy: clarithromycin
34
community acquired severe pneumonia management
co-amoxiclav with possible use of clarithromycin
35
hospital acquired pneumonia management
co-amoxiclav
36
what is stridor
harsh, inspiratory sound due to upper airway obstruction
37
name 4 causes of stridor
- anaphylaxis
- foreign body
- infection (croup, epiglottitis)
- laryngomalacia (most common cause of stridor in kids)
38
foreign body inhalation management if choking
back slaps or abdominal thrusts
39
foreign body inhalation management if not choking
removal via bronchoscopy under general anaesthetic
40
asthma step management
1. salbutamol as needed, inhaled coricosteroid (LTRA if < 5)
2. LABA if > 5, LTRA if < 5
3. stop LABA and up inhaled corticosteroid dose
4. inhaled corticosteroid and LTRA
5. consider trial of medium dose inhaled corticosteroid or theophylline
41
asthma acute attack presentation
- PO2 under 92%
- PEF 33-50% predicted
- can’t complete sentences in one breath/too breathless to speak
- heart rate (> 5: > 125 bpm, 1-5: > 140 bpm)
- respiratory rate (> 5: > 30, 1-5: > 40)
42
life threatening asthma attack presentation
- PO2 92%
- PEF less than 33% predicted
- silent chest with cyanosis
- poor respiratory effort and exhaustion
- confusion
- hypotension
43
asthma attack management
- salbutamol
- prednisolone
- aminophylline in unresponsive severe or life threatening attacks
