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3a Child Health > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is Croup also known as

A

Acute laryngotracheobronchitis

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2
Q

Describe the epidemiology of croup

A
  • Typically affects children: 6 months - 3 years
  • Peaks incidence at 2 years old
  • Mc in boys
  • mc in autumn
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3
Q

What causes croup

A

Viral infection
* parainfluenza virus
* adenovirus
* enterovirus

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4
Q

Give 4 clinical features of croup

A
  • seal-like barky cough
  • increased (non-specific upper resp tract) symptoms with agitation
  • hoarse voice
  • may be worse at night
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5
Q

Give 5 features of severe croup

A
  • Frequent barking cough
  • Prominent stridor at rest
  • persistent agitation
  • marked sternal recession
  • tachycardia
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6
Q

How is croup diagnosed

A
  • Clinical diagnosis
  • CXR anteroposterior and lateral neck
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7
Q

What sign may show in anteroposterior CXR view in croup

A

Steeple sign - narrowed trachea

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8
Q

When should children with croup be admitted

A
  • moderate or severe croup
  • < 3 months of age
  • known upper airway abnormalities
  • uncertainty about diagnosis
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9
Q

What is the first line treatment for croup

A
  • Dexamethasone 0.15mg/kg orally as a single dose (prednisolone if unavailable)
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10
Q

What should be administered alongside the first line treatment of croup when children present with stridor or sternal indrawing at rest

A

Nebulised adrenaline

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11
Q

Describe the management for severe croup

A
  • Oral dexamethasone
  • Nebulised budesonide
  • Nebulised adrenaline
  • blow-by Oxygen - 8-10L/min
  • Intubation if impending resp failure
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12
Q

When is nebulised budesonide preferred over oral dexamethasone in children with croup

A
  • Severe hypoxia
  • Persistent vomiting
  • Respiratory distress
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13
Q

What is bronchiolitis

A

Viral infection of the bronchioles

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14
Q

What is the leading cause of hospital admission in infants under 1 years old

A

Bronchiolitis

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15
Q

What is the most common cause of bronchiolitis

A

Respiratory syncytial virus

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16
Q

Give 4 RFs of bronchiolitis

A
  • < 3 years
  • Prematurity
  • Passive tobacco smoke exposure and air pollution
  • Winter months
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17
Q

Give 5 features of bronchiolitis

A
  • Variable cough increasing in severity over several days
  • Wheezing
  • Tachypnoea and dyspnoea
  • Low grade fever
  • Rhinitis
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18
Q

5 signs of respiratory distress in paeds

A
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging
  • Grunting
  • Intercostal and subcostal recessions
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19
Q

What is stridor

A

high pitched inspiratory noise caused by upper airway obstruction

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20
Q

How is bronchiolitis investigated

A
  • immunofluorescence of nasopharyngeal secretions may show RSV
  • Reverse transcriptase PCR
  • CXR: not required for diagnosis - may show hyperinflation and interstitial inflammation
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21
Q

How is bronchiolitis managed

A

Most infants can be managed as outpatients
* Ensure adequate intake - Oral/ NG/ IV fluids
* Oxygen if sats below 92%
* Ventilation support if required
* Ribavirin in severe disease

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22
Q

What prophylaxis is used for bronchiolitis

A

IM palivizumab once monthly during RSV season

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23
Q

When is prophylaxis considered in bronchiolitis

A
  • Preterm infants with chronic lung disease of prematurity
  • Children less than 24m who will be profoundly immunocompromised during RSV season
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24
Q

Give 5 indications for hospital admission in children with bronchiolitis

A
  • Resp rate >70
  • SpO2 < 92%
  • Apnoea
  • severe resp distress, e.g. grunting, marked chest recession
  • central cyanosis
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25
Q

Does whooping cough affect the upper or low respiratory tract

A

Upper respiratory tract

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26
Q

What causes whooping cough

A

Bordetella pertussis

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27
Q

What is the classification of the microorganism that causes whooping cough

A

Gram negative bacteria

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28
Q

Describe the presentation of whooping cough (4)

A
  • persistent Cough that is usually worse at night
  • Coryzal symptoms
  • Inspiratory whooping
  • Paroxysms of coughing ending in vomiting or gagging
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29
Q

What are the 3 identifiable stages in whooping cough

A
  • Catarrhal: 1-2w - coryzal symptoms
  • Paroxysmal: 1-6w - severe paroxysmal coughing , infants may present with apnoeas
  • Convalescent: w-m - gradual recovery, non-paroxysmal cough
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30
Q

How is whooping cough investigated (3)

A
  • Culture of nasal swab - high specificity
  • PCR - high sensitivity
  • FBC - elevated WBC
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31
Q

What test can be conducted for patients with a whooping cough persisting for more than 2 weeks

A

Detection of anti-pertussis immunoglobulin G in oral fluid

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32
Q

How is whooping cough managed

A
  • Notify public health
  • Macrolides: Azithromycin (5 days) or clarithromycin (7d)
  • CI Macrolides: Trimethoprim/sulfamethoxazole (14d)
  • Abx should be offered if the onset of the cough is within the previous 21 days
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33
Q

What is the preferred treatment for pregnant women with whooping cough

A

Erythromycin

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34
Q

Close contacts with a patient infected with whooping cough are given prophylactic Abx if they are in a high risk health group. Give 3 examples of these high risk groups

A
  • Pregnant women
  • Infants <1 years old
  • Healthcare workers in contact with above 2 groups
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35
Q

What is pneumonia

A

Infection of the lower resp tract and lung parenchyma

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36
Q

Which age group is more likely to develop viral pneumonia

A

Young infants

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37
Q

When does the likelihood of bacterial pneumonia increase in children

A

Becomes more common in older children (over 5)

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38
Q

Give 3 causes of pneumonia in neonates

A
  • Group B strep (mc)
  • E.coli
  • Staph aureus
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39
Q

Why is group B strep a common cause of pneumonia in neonates

A

occurs in pre-vaccinated infants, often contracted during birth as it often colonises the vagina

40
Q

Give 3 causes of pneumonia in infants and young children (u5)

A
  • Respiratory syncytial virus (RSV) - mc
  • Strep pneumoniae
  • H.influenzae
41
Q

Give 3 causes of pneumonia in older children (over 5)

A
  • Mycoplasma pneumoniae
  • Strep pneumoniae
  • Chlamydia
42
Q

Give 5 ways pneumonia may present in children

A
  • Fever
  • Rapid breathing
  • Productive cough
  • Lethargy
  • Usually precede a upper resp infection
43
Q

4 signs of pneumonia in children

A
  • Tachypnoea
  • Nasal flaring
  • Chest indrawing
  • Oxygen saturation may be decreased
44
Q

Give 3 auscultation signs of pneumonia in children

A
  • dullness to percuss
  • End-inspiratory coarse crackles
  • decreased breath sounds and
    bronchial breathing over affected area
45
Q

How is pneumonia diagnosed in children

A
  • CXR - consolidation
  • Sputum cultures and throat swabs for cultures and PCR
46
Q

Most children with pneumonia can be managed at home. What are 3 indications for admission

A
  • O2 Sats below 92%
  • Recurrent apnoea
  • Grunting and/or an inability to maintain adequate fluid/ feed intake
47
Q

What is the general supportive management for children with pneumonia (3)

A
  • Oxygen for hypoxia
  • Analgesia for pain
  • IV fluids to correct dehydration and for sodium balance
48
Q

Management of pneumonia in children

A
  • Amoxicillin is first-line for all children with pneumonia
  • Macrolides may be added if there is no response to first line therapy
  • Macrolides should be used if mycoplasma or chlamydia is suspected
  • In pneumonia associated with influenza, co-amoxiclav is recommended
49
Q

What is asthma

A

chronic inflammatory airway disease leading to variable airway obstruction.

50
Q

Explain the pathophysiology of asthma

A

The smooth muscle in the airways is hypersensitive, and responds to inhaled stimuli by constricting and causing reversible airflow obstruction.

51
Q

Give 4 RFs of asthma in children

A
  • Genetic predisposition
  • Prematurity
  • FHx Atopy
  • Viral bronchiolitis in early life
52
Q

Give 6 key features associated with a high probability of a child having asthma

A
  • Episodic bilateral polyphonic wheeze
  • Dry cough and SOB
  • Diurnal variability of symptoms
  • Symptoms that have non-viral triggers
  • Sx improve with bronchodilators
  • FHx of atopic conditions
53
Q

State 4 environmental triggers of asthma

A
  • Allergens (house dust mites, pollen, pets)
  • Cold air
  • Exercise
  • Active/ passive smoking
54
Q

How is asthma diagnosed

A
  • Usually diagnosed from Hx and exam alone
  • Spirometry with reversible testing in kids over 5
55
Q

What percentage improvement confirms bronchodilator reversibility and is characteristic of asthma

A

12%

56
Q

What is the medical therapy for children under 5 with asthma

A
  1. Short acting B2 agonists (relievers)
  2. Low dose ICS - 8 week trial
  3. Oral Leukotriene receptor antagonist (LTRA)
  4. If still uncontrolled, refer to asthma specialist
57
Q

What is the medical therapy for children aged 5-16 with asthma

A
  1. SABA
  2. ICS preventor therapy
  3. Add LTRA
  4. Stop LTRA and add LABA
  5. SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS
58
Q

Give 4 side effects of theophylline in children

A
  • Vomiting
  • Insomnia
  • Headaches
  • Poor concentration
59
Q

What is important to monitor in children with asthma, specifically those take regular steroids

A

Growth

60
Q

Give 2 exampes of a long acting B2 agonist (LABA)

A
  • Salmeterol (purple)
  • Formeterol
61
Q

Give 2 examples of a short acting B2 agonist (SABA)

A
  • Salbutamol (blue)
  • Terbutaline
62
Q

Give an example of an LTRA

A

Montelukast

63
Q

Give 4 ways an acute asthma attack may present

A
  • Progressively worsening wheeze/ SOB
  • Becoming exhausted
  • Tachypnoea
  • Signs of respiratory distress
64
Q

Give some features of a moderate asthma attack in children

A
  • Able to talk
  • SpO2 >92%
  • Peak expiratory flow (PEF) >50% best/predicted
  • no clinical features of severe asthma
65
Q

Give the features of a severe asthma attack in children

A
  • Too breathless to talk
  • O2 sats <92%
  • PEF 33-50% (best/predicted)
  • use of accessory neck muscles
    RR:
  • 2-5yrs: >40
  • > 5yrs: >30
    HR:
  • 2-5yrs: >140
  • > 5yrs: >125
66
Q

Give 6 features of a life-threatening asthma attack in children

A
  • silent chest
  • cyanosis
  • Exhaustion, altered consciousness
  • peak flow <33% (best)
  • poor respiratory effort
  • O2 sats <92%
67
Q

What is a silent chest

A
  • airways are so tight that the child isn’t able to move enough air through airways to create a wheeze
  • associated with poor expiratory effort or exhaustion
68
Q

How are moderate asthma attacks in children managed

A
  • salbutamol via spacer - 2-4 puffs, increasing by 2 puffs (max 10 puffs)
  • Oral prednisolone (1mg/kg OD for 3d)
  • Monitor response for 15-30mins
  • if symptoms not controlled, seek urgent medical attention
69
Q

How are severe-life threatening asthma attacks in children managed

A
  • immediate referral to hospital
  • Salbutamol via spacer - 10 puffs or nebulised (assess response and repeat as required)
  • oral prednisolone or IV hydrocortisone
  • > 6yrs: Nebulised ipratropium bromide (SAMA)
  • High flow O2
70
Q

If a child having a life-threatening asthma attack is not responding to initial treatment what should be done

A
  • Transfer to PICU
  • Consider intubation/ ventilation
  • Consider CXR and blood glasses - infection? pneumothorax?
  • IV Magnesium sulphate, salbutamol or aminophylline
71
Q

Define complete control of asthma (5)

A
  • Absence of day/night time symptoms
  • No limit on activities
  • No need for reliever use
  • Normal lung function
  • no exacerbations in last 6 months
72
Q

What is the inheritance pattern of cystic fibrosis

A

Autosomal recessive

73
Q

Explain the pathophysiology of cystic fibrosis

A
  • Occurs due to mutations in the CF transmembrane conductance regulator gene
  • CFTR is a channel protein that pumps chloride into secretions making them thin and watery
  • Defective gene = thick secretions
74
Q

Describe the epidemiology of cystic fibrosis

A
  • most life-limiting condition in caucasians
  • incidence of 1 in 2500 live births
  • 1 in 25 are carriers
75
Q

What is the most common genetic variant of cystic fibrosis in the UK

A

delta-F508

76
Q

What is the consequence of cystic fibrosis on the airways

A

Low volume thick airway secretions impair ciliary function and cause retention of mucopurulent secretions

77
Q

What are the effects of cystic fibrosis on the pancreas

A

pancreatic ducts are blocked by thick secretions leading to pancreatic enyzme deficiency and malabsorption

78
Q

How does CF present in newborns

A
  • All newborns are screened at birth
  • meconium ileus: too thick and sticky to pass and causes obstruction
  • Vomiting, abdo distention and failure to pass meconiumin first 24h
79
Q

What will be raised in newborn infants with CF during screening

A

Immunoreactive trypsinogen (IRT)

80
Q

Give 5 features of cystic fibrosis

A
  • Failure to thrive
  • Steatorrhoea
  • short stature and delayed puberty
  • Chronic cough with thick sputum
  • Recurrent chest infections
81
Q

Give 4 signs of cystic fibrosis

A
  • finger clubbing
  • coarse crackles and/or expiratory wheeze on auscultation
  • nasal polyps
  • Bilateral absence of vas deferens (male infertility)
82
Q

How is cystic fibrosis diagnosed

A
  • GS: sweat test
  • Genetic testing - 2 mutations
  • Newborn blood spot testing
83
Q

Describe the sweat test and state what would confirm a positive diagnosis of cystic fibrosis

A
  • Sweating is stimulated by applying a low-voltage current to pilocarpine on the skin
  • Sweat is collected and [Cl-] tested
  • Confirmation: [Cl-] >60 mmol/L
84
Q

How is cystic fibrosis managed

A

MDT
* Resp: chest physio at least twice daily, salbutamol, mucolytics (neb dornase alfa)
* Infection: prophylactic Abx
- s.aureus: flucloxacillin
- pseudonomas: neb tobramycin or oral ciprofloxacin
* GI: Pancreatin, omeprazole, fat-soluble vitamin supps
* high calorie, high fat diet
* Lung/liver transplant if failure

85
Q

Give 3 common colonisers in cystic fibrosis

A
  • Staph aureus
  • H.influenzae
  • P. aeruginosa
  • Burkholderia cepacia
86
Q

Give 5 complications of cystic fibrosis

A
  • Pancreatic insufficiency
  • CF-related diabetes mellitus
  • Nasal polyps
  • Cirrhosis and portal hypertension
  • respiratory failure
  • delayed puberty, short stature
87
Q

What is epiglottitis

A

Inflammation and intense swelling of the epiglottis and surrounding tissues

88
Q

What organism causes epiglottitis

A

H. influenzae type b

89
Q

Why is epiglottitis an emergency

A
  • Life-threatening as there is a high risk of complete respiratory obstruction within hours
90
Q

At what age is epiglottitis most common

A

aged 1 - 6 years

91
Q

Describe the presentation of epiglottitis

A
  • rapid onset
  • high fever in a toxic looking child
  • Severe sore throat
  • Drooling of saliva
  • inspiratory stridor and rapidly increasing resp difficulty
  • Tripod position: leaning forward with extended neck to optimise airway
92
Q

How is epiglottitis diagnosed

A

Clinical diagnosis - direct visulation by senior/ airway trained staff

93
Q

What investigations are omitted if epiglottitis is suspected

A
  • Laying child down
  • Examining throat with spatula
94
Q

What would a lateral neck XR show in epiglottitis

A

Thumb sign - oedematous and swollen epiglottis

95
Q

How is epiglottitis managed

A
  • Alert most senior anaesthetist, paediatrician and ENT surgeon
  • Secure airways - endotracheal intubation
  • IV Abx: Ceftriaxone
  • Prophylactic rifampicin for close contacts
96
Q

Give 5 contrasting features of croup and epiglottitis

A

Croup: onset over days, barking cough, able to drink, harsh stridor, hoarse voice
Epiglottitis: onset over hours, fever over 38.5, drooling saliva, soft stridor, muffled/ reluctant to speak

3a Child Health (19 decks)

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