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Phase 3a - Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is pneumonia?

A

Infx of lung tissue that causes inflm of lung tissue and sputum filling the airways and alveoli.

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2
Q

What are some examples of bacterial and viral causes of pneumonia?

A

Bacterial:
* Strep pneumonia MC
* Group A strep
* Group B strep - in pre-vax infants, often contracted during birth
* Staph Aureus
* H. influenza

Viral:
* Respiratory syncytial virus (RSV) MC
* Parainfluenza
* Influenza

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3
Q

Sx of pneumonia?

A

Cough (typically wet and productive)
High fever (> 38.5ºC)
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium and hypotension (shock)
Hypoxia (low oxygen)

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4
Q

What are the characteristic chest sx of pneumonia?

A
  1. Bronchial breath sounds - harsh breath sounds, equally loud on inspiration and expiration
  2. Focal course crackles - similar to using straw to blow into a drink
  3. Dullness to percussion - consolidation
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5
Q

Ix for pneumonia?

A

CXR - GS
Sputum cultures and throat swabs
If they have sepsis - blood cultures

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6
Q

Tx of pneumonia?

A
  • 1st line - amoxicillin
  • Add macrolide (erythromycin, clarithromycin or azithromycin) to cover atypical pneumonia
  • If penicillin allergy - only give macrolide
  • O2 to maintain sats above 92%
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7
Q

What presentations suggest moderate asthma attack?

A
  • Peak flow > 50 % predicted
  • Normal speech
  • No features listed across
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8
Q

What presentations suggest severe asthma attack?

A
  • Peak flow < 50% predicted
  • Saturations < 92%
  • Unable to complete sentences in one breath
  • Signs of respiratory distress
  • Respiratory rate:
    > 40 in 1-5 years
    > 30 in > 5 years
  • Heart rate:
    > 140 in 1-5 years
    > 125 in > 5 years
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9
Q

What presentations suggest life threatening asthma attack?

A
  • Peak flow < 33% predicted
  • Saturations < 92%
  • Normal PaCO2!!
  • Exhaustion and poor respiratory effort
  • Hypotension
  • Silent chest
  • Cyanosis
  • Altered consciousness / confusion
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10
Q

Mx of acute asthma in children?

A

O2 (if sats <94%)

Bronchodilators (step up):
1. Inhaled or nebulised salbutamol (a beta-2 agonist)
2. Inhaled or nebulised ipratropium bromide (an anti-muscarinic)
3. IV magnesium sulphate
4. IV aminophylline

Steroids - oral prednisone or IV hydrocortisone

If bacterial cx sus = give abx (e.g. amoxicillin)

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11
Q

How are mild cases of asthma attacks managed as an outpatient?

A

Salbutamol inhalers via a spacer (e.g. 4-6 puffs every 4 hours)

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12
Q

How are moderate to severe asthma attacks managed?

A
  1. Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
  2. Nebulisers with salbutamol / ipratropium bromide
  3. Oral prednisone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline

If at this point you don’t have control then they may need intubation and ventilation

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13
Q

Ix for asthma?

A

Children are usually not diagnosed with asthma until they are at least 2-3 yrs

  • Spirometry with reversibility testing (in children aged over 5 years)
  • Direct bronchial challenge test with histamine or methacholine
  • Fractional exhaled nitric oxide (FeNO)
  • Peak flow variability - peak flow diary
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14
Q

Medical therapy for asthma in under 5’s?

A
  1. SABA inhaler - as required
  2. Add low dose ICS inhaler or LTRA (i.e. oral montelukast)
  3. Add other option from step 2
  4. Specialist referral
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15
Q

Medical therapy for asthma for those aged 5-12 yrs?

A
  1. SABA (e.g. salbutamol)
  2. Add low dose ICS
  3. Add LABA (e.g. salmeterol)
  4. Inc dose ICS to med dose + consider adding LTRA
  5. Inc ICS dose to high
  6. Specialist referral
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16
Q

Medical therapy for asthma for those aged over 12 yrs?

A

Same as adults
Step 1 → SABA (e.g. salbutamol)
Step 2 → SABA + ICS (e.g. beclomethasone inhaler)
Step 3 → SABA + ICS + LABA (e.g. salmeterol)
Step 4 → SABA + ICS + LABA + LTRA (e.g. montelukast) → if LTRA no tolerated then stop and increase ICS dose instead

17
Q

Sx of resp distress in infants

A
  • Raised respiratory rate
  • Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
  • Intercostal and subcostal recessions
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging
  • Cyanosis
18
Q

What is a viral-induced wheeze?

A

Acute wheezy illness caused by a viral infection. The inflammation caused by the virus trigger the smooth muscles of the airways to constrict further narrowing the space in the airway.

19
Q

What’s the difference between a viral induced wheeze and asthma?

A

In VIW unlike asthma:
* typically presents before 3yrs
* No atopic history
* Only occurs during viral infx

20
Q

Sx of viral induced wheeze?

A

SOB
Sx of resp distress
Expiratory wheeze throughout chest

21
Q

Tx of viral induced wheeze?

A

Same as acute asthma attack

O2 (if sats <94%)

Bronchodilators (step up):
1. Inhaled or nebulised salbutamol (a beta-2 agonist)
2. Inhaled or nebulised ipratropium bromide (an anti-muscarinic)
3. IV magnesium sulphate
4. IV aminophylline

Steroids - oral prednisone or IV hydrocortisone

22
Q

What is epiglottitis?

A

Rapidly progressive infx that leads to inflm of epiglottis and adjacent tissues. The inflm can progress to blockage of upper airway posing a death risk.

MC in children aged 1-6 yrs

23
Q

What is the main bacteria that causes epiglottitis?

A

Haemophilus influenza B (Hib)

24
Q

Sx of epiglottitis?

A
  • High fevers
  • Intense throat pain - prevents speaking or swallowing, leading to drooling
  • Soft inspiratory stridor
  • Rapid inc in respiratory difficulty over hours
  • A tendency to sit upright with an open mouth to optimize airway patency
  • Minimal or absent cough

Remember 4 D’s: dysphagia, dysphonia, drooling, and distress

25
Q

Ix for acute epiglottitis?

A

Laryngoscopy - inflamed epiglottis
Culture - identify causative organism

26
Q

Mx of acute epiglottitis?

A
  • Secure airway - endotracheal intubation
  • IV antibiotics, typically cefuroxime
27
Q

What kind of genetic inheritance is cystic fibrosis and what mutation do people with CF have?

A

Autosomal recessive
CFTR protein mutation

28
Q

What is cystic fibrosis?

A

A progressive disorder that causes persistent lung infx and limits ability to breathe over time.

29
Q

Sx of CF?

A
  • Meconium ileus
  • Salty sweat (observed when kissing baby)
  • Nasal polyps
  • Recurrent chest infx (persistent productive cough + SOB)
  • Malabsorption syndrome + steatorrhoea
  • Delayed onset of puberty

  • Meconium ileus is a bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium
30
Q

Ix for CF?

A

GS - Sweat test - measures conc of chloride in sweat

Initially - neonatal blood spot test done within first few days of life (identify raised blood immunoreactive trypsinogen)

31
Q

Mx of CF?

A
  • Daily chest physio techniques - clear mucus = prevent pneumonia
  • Prophylactic abx and bronchodilators
  • Pancreatic enzyme replacement (e.g., Creon) and fat-soluble vitamin supplementation (ADEK)
  • Regular vax (i.e. influenza and pneumococcal)

Bilateral lung transplant if end-stage pul. disease

32
Q

What is a complication of bronchiolitis?

A

Bronchiolitis obliterans - aka popcorn lung, MC associated w/adenovirus infx

Phase 3a - Paediatrics (14 decks)

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