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Med Finals - Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define bronchiolitis

A

Inflammation and infection of the bronchioles. Generally considered to occur in children under 1

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2
Q

What is the most common causative organism in bronchiolitis

A

Respiratory syncytial virus (RSV)

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3
Q

Presentation of bronchiolitis

A

Coryzal symptoms
Respiratory disetress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Apnoea
Wheeze
Crackles

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4
Q

Clinical signs of respiratory distress

A

Raised resp rate
Use of accessory muscles - sternocleidomastoid, abdominal, intercostal
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal noises - wheezing, grunting, stridor

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5
Q

Reasons for admission in bronchiolitis

A

<3 months
Pre-existing condition - prematurity, Downs or cystic fibrosis
50-75% reduction in milk intake
Clinical dehydration
Resp rate >70
O2 <92
Signs of moderate to severe respiratory distress
Apnoeas
Parents not confident to manage at home

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6
Q

Management of bronchiolitis

A

Supportive
Adequate intake - NG, IV, frequent feed
Saline nasal drops, suctioning,
Supplementary O1
Ventilatory support

Prevention in those at high risk (prem or congenital heart disease) - palivizumab

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7
Q

Define viral induced wheeze

A

Acute wheezy illness caused by viral infection. Caused by inflammation of the small airways leading to swelling and constriction,

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8
Q

Presentation of viral induced wheeze

A

Viral illness - fever, cough, coryza
Shortness of breath
Signs of respiratory distress
Expiratory wheeze through out chest

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9
Q

Management of viral induced wheeze

A

Same as acute asthma
O2
Bronchodilators - salbutamol, ipratropium, magnesium,
Steroids
Antibiotic if bacterial

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10
Q

Define acute asthma

A

Rapid deterioration of asthma symptoms - triggered by infection, exercise or cold weather.

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11
Q

Presentation of acute asthma

A

Progressively worsening shortness of breath
Signs of respiratory distress
Fast resp rate
Expiratory wheeze throughout chest
Chest sounds “tight” with reduced air entry

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12
Q

Parameters for moderate asthma exacerbation

A

Peak flow >50% predicted
Normal speech
No features of severe or life threatening asthma exacerbation

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13
Q

Parameters for severe asthma exacerbation

A

Peak flow <50 % predicted
Saturations <92
Unable to complete sentences
Signs of respiratory distress
Resp rate > 40 (1-5 years) >30 (>5)
Heary rate >140 (1-5) >125 (>5)

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14
Q

Parameters for life threatening asthma exacerbation

A

Peak flow <33%
Saturations <92%
Exhaustion and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered conciousness/confusion

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15
Q

Management of acute asthma

A

O2
Bronchodilators
Steroids
Antibiotics

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16
Q

Parameters for discharge in acute asthma

A

6 puff 4 hourly
Once steroids complete
Safety net

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17
Q

Define chronic asthma

A

Chronic inflammatory airway disease leading to variable airway obstruction -

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18
Q

Presentation of asthma

A

Episodic symptoms - exacerbations
Diurnal variability - worse at night or early morning
Dry cough
Triggers
History of atopy - eczema, hayfever and food allergies
FH of asthma
Bilateral wheeze
Improvement with bronchodilators

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19
Q

Typical triggers of asthma

A

Dust
Animals
Cold air
Exercise
Smoke
Food allergens

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20
Q

Investigations of asthma

A

Clinical trial of bronchodilator
Spirometry with bronchodilator reversibility
Fractional exhaled nitric oxide
Peak flow diary

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21
Q

Management of asthma

A
  1. SABA
  2. ICS
  3. leukotriene receptor antagonist
    Refer
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22
Q

Define pneumonia

A

Infection of the lung tissue - seen as consolidation on chest xray

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23
Q

Presentation of pneumonia

A

Cough
High fever
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium

24
Q

Clinical signs of pneumonia

A

Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

25
Q

Common causes of pneumonia

A

Streptococcus pneumonia
Group A strep
RSV
Parainfluenza
Influenza

26
Q

Investigations in pneumonia

A

CXR
Sputum and throat cultures
Blood gas
Lactate!

27
Q

Management of pneumonai

A

Antibiotics - amoxicillin
O2

28
Q

Define croup

A

An acute infection of the upper respiratory tract causing oedema in the larynx typically affecting young children

29
Q

Causative organism in croup

A

Parainfluenza virus
(influenza, adenovirus, RSV)

30
Q

Presentation of croup

A

Increased work of breathing
Barking seal like cough
Hoarse voice
Stridor
Low grade fever

31
Q

Management of croup

A

Dexamethasone!!!
O2
Nebulised budesonide
Nebulised adrenaline
Intubation and ventilation

32
Q

Define epiglottis

A

Inflammation and swelling of the epiglottis caused by infection

33
Q

Causative organism in epiglottitis

A

Haemophili’s influenza type B

34
Q

Presentation of epiglottitis

A

Sore throat and stridor
Drooling
Tripod position
High fever
Difficulty
Muffled voice
Scared and quiet child
Septic and unwell appearance

35
Q

Investigations in epiglottitis

A

Do not examine!
Refer to ENT
Lateral xray of neck - thumb sign.

36
Q

Management of epiglotitis

A

Refer to ENT!
Secure airway - ?intubate
IV abx
Teroids

37
Q

Define Laryngomalacia

A

A condition that affects infants where the part of the larynx above the vocal cords is structured in a way that allows partial obstruction of the airway - leading to chronic stridor on inhalation.

38
Q

Define whooping cough

A

Upper respiratory tract infection where child has classic coughing fits followed by loud whooping noise sucking air in.

39
Q

Causative organism in whooping cough

A

Bordetella pertussis

40
Q

Presentation of whooping cough

A

Mild coryzal
Low grade fever
Mild dry cough
Severe coughing fits - paroxysmal
Inspiratory whoop at ends of coughing fit.
May develop pneumothorax
Apnoeas

41
Q

Investigations in whooping cough

A

Nasopharyngeal or nasal swab and PCR testing or bacterial culture

42
Q

Management of whooping cough

A

Notifiable disease
Supportive care
Avoid contacts - prophylactic abx
Macrolides - clarithromycin

43
Q

Define chronic lung disease of prematurity

A

Also known as bronchopulmonary dysplasia
Premature babies suffer respiratory distress.

44
Q

Features of bronchopulmonary dysplasia

A

Low O2
Increased work of breathing
Poor feeding and weight gain
Crackles and wheezes
Increased infections

45
Q

Prevention of chronic lung disease of prematurity

A

Steroids in premature labour
CPAP
Caffeine
Not over oxygenating

46
Q

Management of chronic lung disease of prematurity

A

Low dose home oxygen
Monthly RSV monoclonal antibodies

47
Q

Define cstic fibrosis

A

Autosomal recessive conditiong affecting mucus glands. Affects chloride channels

48
Q

Key consequences of cystic fibrosis mutation

A

Thick pancreatic and biliary secretions - lack of digestive enzymes
Low volume thick airway secretions - reduce airway vlearance
Congenital bilateral absence of the vas deferens

49
Q

Presentation of cystic fibrosis

A

Newborn bloodspot test - heel prick
Meconium ileus
Recurrent lower resp tract infection
Chronic cough
Thick sputum
Loose greast stools
Abdo pain
Parents report child tastes salts
Poor weight gain

50
Q

Clinical signs of cystic fibrosis

A

Low weight or height
Nasal polyps
Finger clubbing
Crackles and wheezes
Abdo distension

51
Q

Causes of clubbing in children

A

Hereditary
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculossis
Inflammatory bowel disease
Liver cirrhosis

52
Q

Investigations in cystic fibrosis

A

Newborn bvlood spot test
Sweat test - gold standard
Genetic testing -

53
Q

Common infectious organisms in cystic fibrosis

A

Staphylococcus aureus
Pseudomonas aeruginosa
Haemophilus influenza
Klebsiella penumoniae
E. Coli
Burkhodeheria cepacia

54
Q

Management of cystic fibrosis

A

Chest physio
Exercise
Hight calorie diet
Creon tablets
Prophylactic flucloxacillin
Treat infection
Bronchodilatiors
Nebulised DNase
Nebulised hypertonic saline
Pneumococcal influenza and varicella vaccines
Lung transplant
Liver transplant
Fertility treatment - soerm extraction
Genetic counsellingd

55
Q

Define primary ciliary dyskinesia

A

Also knowns as kartagner’s syndrome
Autosomal recessive condition affecting the cilia of various cells in the body. Common in inbred populations

Med Finals - Paediatrics (17 decks)

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