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Phase 3a Paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What type of ventilation is:
good?
ok?
bad?

A

High flow 02
CPAP
Intubation

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2
Q

What are respiratory distress Sx?

A

-Tracheal tug
-intercostal + diaphragm recession
-Nasal flaring
-RR>60
-Accessory muscle use
-wheeze
-stridor
-cyanosis
-head bobbing

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3
Q

What is a wheeze?
Conditions that have a wheeze?
what is heard?

A

obstructed lower airway

Asthma, COPD, bronchiectasis, CF, bronchiolitis

Expiratory whistle

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4
Q

What is a stridor?
Conditions that have a stridor?
what is heard?

A

Obstructed upper airway

Croup, epiglottitis, Laryngomalacia, foreign body

High pitched harsh inspiration

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5
Q

In a stridor, what % of airway is blocked?

Inspiratory =
Biphasic =
Expiratory =

A

70+%

larynx
trachea + glottis
bronchi

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6
Q

What is coryza?
causes?
Tx?

A

common cold

Rhinovirus, adenovirus

Supportive

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7
Q

What is pneumonia?

A

Infection and inflammation of the lung parenchyma

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8
Q

what are the causes of pneumonia in the neonate?

A

GBS
Gram -ve rods

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9
Q

what are the causes of pneumonia in the infant?

A

S.pneumo
HiB (if not vaccinated)
Rare + serious = S.aureus

TB

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10
Q

what are the causes of pneumonia in the >5y?

A

Mycoplasma pneumoniae
S.pneumo

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11
Q

Sx of pneumonia?

A

Resp distress
Fever >38c (before URTI)
Poor feed
productive cough
End inspiratory coarse crackles

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12
Q

Dx of pneumonia?
what would be seen?

A

FBC + bloods
Low SP02
Sputum MC+S
GS = Chest xray - upper lobe consolidation

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13
Q

what would be seen on chest xray in an S.aureus caused pneumonia?

A

pneumatoceles + multi lobar

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14
Q

Tx of pneumonia?

A

<93% O2 = admit
Antibiotics :
Infant = Amoxicillin
Mycoplasma = macrolide eg. erythromycin

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15
Q

What is croup?
due to?
Incubation time?

A

URTI
Laryngotracheobronchitis due to parainfluenza virus
10 or less days

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16
Q

Croup
what age range is affected? what age affected most?
what time of year?
M or F?
Epidemiology?

A

Between 6 months - 3 year old

2 years old

In winter

M 4:1

Preterm/intubation Hx

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17
Q

Sx of croup?

A

Low grade fever
Coryza (start/worse at night)
Horseness, stridor
then seal like barking cough
Worse at night

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18
Q

Dx of croup?
what is seen on investigations?

A

Clinical
AP Xray = steeple sign (subglottic tracheal narrowing)

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19
Q

what is used to assess the severity of croup?
out of?

A

Westley croup score
/17
guides Tx

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20
Q

What must not be done in Dx and why?

A

do not examine airway
Could trigger a spasm (sudden narrowing) of the airway

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21
Q

Tx of croup?
last line?

A

Single dose 0.15mg/kg PO Dexamethasone (+/- repeat in 12hr)
(nebulised budesonide - if PO steroid not able to take)

-Nebulised adrenaline 0.5ml 1:1000 (for Sx relief)

LL = ITU Intubate

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22
Q

when do you admit a Px with croup?
When can the kid go back to school?

A

Mod/severe, <6 months, laryngomalacia

No school till fever gone

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23
Q

Complication of croup?
Cause?
Sx?
Tx?

A

Bacterial superinfection or obstruction
S.aureus pseudomembranous croup, thick green secretion
Tx = IV Flucloxicillin

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24
Q

Ddx of croup?
Sx of that?

A

Bacterial Tracheitis
Barking cough, stridor, No steroid response

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25
Q

What diseases are notifiable to Public Health England?

A

Whooping cough
Epiglottitis

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26
Q

What is whooping cough?
Caused by?
noise?
what is whooping cough also called?

A

Pertussis
severe URTI caused by bacterium gram -ve bordetella pertussis
Adheres to resp epithelium
Loud inspiratory whoop
100 day cough

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27
Q

Sx of whooping cough?

A

Incubation period 7 days
1. >2weeks Catarrh (phlegm in airways)
2. Paroxysmal episodic whooping cough spells with:
post tussive vomiting, apnoeic attacks (common in infants)
3. Convalescence (recovery)

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28
Q

Dx of whooping cough?

A

Nasopharyngeal swab - PCR or bacterial culture

Cough >2 weeks = anti pertussis toxin IgG

FBC = Leukocytosis with lymphocytosis

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29
Q

Tx of whooping cough?

A

<1y = clarythromycin
>1y = azithromycin

within 21 days of cough

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30
Q

How long does the child have to be off school in whooping cough?

A

at least 48hrs post Abx

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31
Q

what prophylaxis is given in whooping cough?

what is given to close contacts that have been exposed to whooping cough?

A

DTaP Vaccine

erythromycin

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32
Q

What is the MC LRTI in under 2 year olds?

A

Bronchiolitis

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33
Q

What is epiglottitis?

A

EMERGENCY
Infection causing acutely inflamed epiglottis which obstructs airway

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34
Q

what is epiglottitis due to?
found in which age?

A

In 6-12yr M due to HiB (+ S.pneumo and S.pyogenes)

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35
Q

Sx of epiglottitis?

A

Dysphagia (difficulty swallowing)
Dysphonia (abnormal voice)
Drooling
Dehydration
Resp Distress
Tripoding (lean forward to help breathe better)
Inspiratory stridor +/- minimal cough
(5Ds)

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36
Q

Dx of epigottitis?

A

Clinical
Call ENT + Anaesthetics
(DO NOT EXAMINE AIRWAY)
Later do FBC, Laryngoscopy
Lateral neck xray = thumb sign

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37
Q

Tx of Epiglottitis?

A

ABCDE
O2 = Good, Intubation or tracheostomy = bad
IV ceftriaxone +/- nebulised adrenaline

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38
Q

What is given to close contacts of epiglottitis?
what is given as prophylaxis?

A

Rifampicin

HiB vaccine (>99% reduction)

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39
Q

What is bronchiolitis?

A

Inflammation and infection of the bronchioles causing atelactesis (partial collapse / impaired filling of lung), mucous hypersensitivity, obstruction

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40
Q

what % of Px with bronchiolitis need hospital admission?
what is the cause of it in older kids?

A

2-3%

S.Pyogenes = 20-30% older kids

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41
Q

Bronchiolitis:
what ages does it affect?
which age most?
cause?
what does it cause?
what time of year?

A

3 months - 1 year old
-6 months

RSV

Widespread wheeze

Winter and spring

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42
Q

RF of bronchiolitis?

A

CHD
Preterm
CF
Winter
Immunocompromised

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43
Q

why are <1 year olds affected by bronchiolitis?

A

<1y = smaller airway therefore minor bronchiole inflammation = big effect on lumen size + work of breath

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44
Q

Sx of bronchiolitis?

A

Resp distress Sx
Coryza
Mild fever (<39c) - high grade = suspect Ddx
Apnoea
Wet nappies less

around 9 days of Sx, day 5 peak

45
Q

Dx of bronchiolitis?

A

Clinical
widespread wheeze
Cap blood gas = severe
Chest xray = hyperinflated +/- atelactesis
Nasopharyngeal PCR

46
Q

Tx for bronchiolitis?

A

Supportive
Consider CPAP/O2 if severe (most cases self resolve)
eg. <90% O2 sats, 50-75% fluid intake, RR>70

47
Q

What prophylaxis is given in bronchiolitis and to who?

A

IM Palivizumab - for high risk
eg. premature, CHD, CF, Lung defect, Immunocompromised

Monthly injection for passive immunity - not vaccine

48
Q

what protects a baby against RSV?

A

Maternal IgG vs RSV protects baby vs that

49
Q

What is a complication of bronchiolitis?

A

Bronchiolitis obliterans

50
Q

what is bronchiolitis obliterans?
Dx?

A

(post transplant or recurrent infection)
scarring / permanent narrowing of airways - FEV1:FVC 16-20%

HRCT (High resolution CT) = Mosaic pattern

51
Q

What is pharyngitis?

A

Inflammation of the pharynx (sore thorat) - mucous membranes of the oropharynx +/- tonsils (tonsillitis) +/- Local lymphadenopathy

52
Q

What are the causes of pharyngitis?

A

Viral:
EBV (Glandular fever) - MC
Rhinovirus, adenovirus

Bacterial:
S.Pyogenes
S.pneumo

53
Q

Who does S.pyogenes affect and %?
what may it cause and Sx?

A

20-30% older kids

may cause Scarlett fever - strawberry tongue

54
Q

Sx of pharyngitis?

A

FEVER PAIN
Fever >38c
Purulent exudate
Attend rapidly
Inflamed tonsils <72hrs
No/mild cough

55
Q

With the Sx, how many would you need to consider and give Antibiotics?

A

2-3 = consider Abx
4 or more = Give Abx
(62-65% bacterial)

56
Q

Dx of pharyngitis?

A

Clinical
Can do bloods (ASO titres)
Viral PCR swab
EBV monospot test - heterophile Ab vs EBV

57
Q

Tx of viral pharyngitis?

A

EBV = Supportive

58
Q

Tx of bacterial pharyngitis?
dosages for each age?

A

PO Phenoxymethylpenicillin
1-5y = 250mg BD
6-12y = 500mg BD
12+y = 1000mg BD

59
Q

With EBV causing pharyngitis, what must be safety netted to the Px and why?
How long does it take to resolve?

A

Must safety net to AVOID contact sports for at least 4 weeks due to risk of splenic rupture
Self resolving in 6-8 weeks

60
Q

what are some post strep complications?

A

Rheumatic fever
post strep glomerularnephritis
Scarlett fever
Invasive gas
Necrotising fascitis
SSSS
Toxic shock

61
Q

what may happen of you give a patient with EBV penicillin and why?

A

may cause a macropapular rash, EBV causes transient beta lactam hypersensitivity

62
Q

what is a complication of pharyngitis?

A

quinsy

63
Q

what is quinsy? Tx? what can it cause?
(complication of pharyngitis)

A

Peritonsillar abscess
IV Abx and drain
Causes jugulodiagastric LNadenopathy

64
Q

what are adenoids?
when do they usually regress?

A

lymphatic supratonsillar masses
Regress usually <7y

65
Q

what happens if adenoids persist?
Sx they can cause?
Tx?

A

Can cause Obstructive sleep apnoea
(adenotonsillarhypertrophy)
consider surgery

66
Q

what is a viral wheeze?

A

Viral Infection, inflammation of airway, transient viral induced wheeze in 5 or under due to lung immaturity (more likely obstruction)

67
Q

RF of a viral wheeze?
trigger?

A

maternal smoking
prematurity

Viral and multiple trigger (asthma like) - occurs only during infection

68
Q

what is a viral wheeze triggered by?
Otherwise?

A

viral infection
otherwise systemically well, no diurnal variation, minimal FHx

69
Q

Tx of a viral wheeze?

A
  1. SABA - 4 hourly (max), 10 puffs PRN with spacer
    • ICS (Paed low dose) trial for 8 weeks eg. 200-400mg beclomethasone then escalate
  3. consider LTRA
70
Q

What is asthma?

A

Chronic reversible airway obstruction characterised by mucus hypersecretion, airway hyperresponsiveness, bronchial inflammation

71
Q

RF of asthma?

A

FHx
atopy
PHx atopy
samters triad (asthma, nasal polyps, aspirin sensitivity)
Hygiene hypothesis

72
Q

Pathology of asthma?

A

allergen, hypersensitive smooth muscle, constriction

73
Q

allergic and non allergic causes of asthma?

A

Allergic = T1 IgE mediated

Non allergic =
Triggers - cold, exercise, infection, allergen, mould, smoking

74
Q

Sx of asthma?

A

persistent, recurrent, diurnal variation (worse at night + in morning)
Resp distress with wheeze
Harrison sulci = muscle insertions at diaphragm visible

75
Q

what could be the causes of poor control of asthma?

A

ABCDE
Adherence + technique
Bad disease
Choice of drug
Diagnosis incorrect
Environment

76
Q

What does total control of asthma mean?

A

No daytime Sx
No acute attacks
No exercise limit
No night waking asthmatic episodes

77
Q

Dx of asthma?
<5y?
>5y?

A

<5y = clinical
>5y =
-PEF diary >20% variability in 2-4 weeks
-Chest xray = hyper inflated lungs
FEV1:FVC <0.8
-Bronchodilator >12% reversibility with 4 puffs SABA
-FeNO >35ppb

78
Q

Tx for asthma <5y?

A

same as viral wheeze

79
Q

Tx for asthma >5y?

A
  1. SABA with spacer PRN
  2. SABA + ICS (Low dose)
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + MART (low ICS)
  6. SABA + MART (mod ICS)
  7. SABA + MART (High ICS)/Mod ICS + theophylline
80
Q

what is MART?

A

Maintenance and Reliever Therapy
ICS and Fast acting LABA eg. seretide, formeterol

81
Q

How is baseline status of asthma assessed?

A

Asthma control questionnaire /25
(measures control over last month)

82
Q

what are the 4 severities of asthma attacks?

A

mild - mod
severe
life threatening
fatal

83
Q

what is a mild-moderate asthma attack?

A

PEFR 50-75%
Breathlessness

84
Q

what is a severe asthma attack?

A

PEFR 33-49%
Can’t complete a sentence without breathlessness

85
Q

what is a life threatening asthma attack?

A

PEFR <33%
Silent chest, altered GCS, Hyperventilation, low effort to breathe

86
Q

what is a fatal asthma attack?

A

Lifethreatening + hypercapnic (T2 resp failure)

87
Q

In an acute exacerbation of asthma in a 2-17y/o, what assessment is done?

A

Paediatric resp assessment measure (PRAM)

88
Q

Tx of an asthma attack?

A
  1. Nebulised SABA (10 puffs + spacer) + PO prednisolone (3 or less days) + O2 if SpO2 <94%
  2. Nebulised ipatropium +/- MgSO4
  3. IV Aminophylline
89
Q

what is ICS?
examples?
How often is it taken?

A

Inhaled corticosteroids (ICS)

beclometasone, budesonide, ciclesonide, fluticasone, and mometasone

Taken regularly 2x day

90
Q

what is a spacer used for and what are some pros of it?

A

Increases bioavailability of drug by keeping it nebulised in vacuum for longer
-prevents thrush
-easier to administer
-avoid breathing medication too fast

91
Q

what is cystic fibrosis?

A

autosomal recessive
delta F508 mutation in CFTR gene on chromosome 7
Low CFTR expression
High Na+ and Cl- retention
Less watery secretions

92
Q

how many people are affected by CF?
How many people have CFTR mutation?

A

1/2500 affected

1/25 in UK have CFTR mutation

93
Q

Pathology of CF and organs it affects?

A

Lungs = Impaired mucociliary clearance

GIT = Impaired absorption due to thicker secretions

Pancreas = Beta islet damage + low enzyme secretion

Liver = Biliary stasis

94
Q

Sx of CF in neonates?

A

Failure to pass meconium within 48hrs birth

95
Q

Sx of CF in infant?

A

Jaundice
Failure to thrive
Recurrent chest infections (P.aurug - adult, ciprofloxacin), S.aureus - kids, mycoplasma)

96
Q

Sx of CF in children?

A

Bronchiectasis
Nasal polyps
sinusitis

97
Q

Sx of CF in older kids?

A

Congenital vas deferens absence (infertile)
Bronchopulmonary aspergillosis (allergic reaction to fungus)

98
Q

Complications of CF?

A

High risk of bowel cancer, T2DM, Pneumothorax, Cor pulmonale, liver cirrhosis, infertility

99
Q

Dx of CF?

A

Guthrie heel prick (d5-9 post birth) - serum innumoreactive trypsin

GS = Sweat test >60mmol/L Cl-

Genetic test

100
Q

Resp Tx for CF?

A

MDT
Chest physio 2x daily (clearance)
Breathing techniques
LL = Lung transplant (CI in burkholderia infection)

Mucoactive agents: Dornase alfa, lumacaftor, hypertonic saline, prophylactic Abx

101
Q

Pancreatic Tx for CF?

A

Creon + OGTT annually >10y/o

102
Q

GI Tx for CF?

A

High calorie high fat diet

103
Q

Liver Tx for CF?

A

LFT annual screen

104
Q

what advice would be given to CF Px?

A

advice CF Px not to play/sit together
(intertransmission)

105
Q

MC cause of death in CF Px?

A

Resp

106
Q

Prognosis of CF Px?

A

49.1y median

107
Q

what is laryngomalacia?
Tx?

A

congenital floppy larynx
self resolving

GORD
Must Tx eg,. PPI

108
Q

What is kartagener syndrome?

A

Auto recessive
-1^ ciliary dyskinesia (immotility)
-Situs inversus (organs on opposite side of body)
-Dextrocardia (heart on R instead of L)

Triad of bronchiectasis, sinusitis and situs inversus

Phase 3a Paeds (14 decks)

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