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Phase 3a - Paediactrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Pneumonia

A

Infection of the lower respiratory tract and lung parenchyma which leads to consolidation.

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2
Q

Highest incidence of Pneumonia is in who?

A

in infants

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3
Q

What is the more common cause of Pneumonia in young infants?

A

Viral

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4
Q

What is the more common cause of Pneumonia in older children?

A

Bacterial

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5
Q

Viral disease for Pneumonia is more common in ____

A

Winter

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6
Q

Causes of Pneumonia in Neonates

A

Group B Strep, E coli, Klebsiella, Staph Aureus

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7
Q

Causes of Pneumonia in Infants

A

Strep pneumoniae, Chlamydia

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8
Q

Causes of Pneumonia in School Age children

A

: Strep pneumoniae, Staph Aureus, group A Step, Mycoplasma pneumoniae

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9
Q

Pneumonia is usually preceded by ____

A

an upper respiratory tract infection

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10
Q

Symptoms of Pneumonia

A

Fever - SOB - Lethargy

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11
Q

Signs of Pneumonia

A

Signs of respiratory distress - Auscultation signs: dullness to percuss, crackles, decreased breath sounds, bronchial breathing - Wheeze and hyperinflation more typical of viral infection

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12
Q

Ix for Pneumonia

A
  • Mainly clinical - CXR - fluid in the lunds (associated with Staph - Perinasal swab
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13
Q

Tx for Pneumonia

A

Management at home with analgesia - If admitted: Oxygen therapy and IV fluids - Abx

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14
Q

Abx for Pneumonia - Neonates

A

Broad spec IV Abx

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15
Q

Abx for Pneumonia - Infants

A

Amoxicillin/Co-Amoxiclav

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16
Q

Abx for Pneumonia in children> 5 y/o

A

Amoxicillin/Erythromycin

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17
Q

Complications of Pneumonia

A

Risk of parapneumonic collapse and empyema if so follow up at 4-6 weeks with a fluid sample

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18
Q

Croup

A

Acute laryngotracheobronchitis (Mucosal inflammation anywhere between the nose and the trachea). Mucosal Inflammation of upper airways.

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19
Q

Croup is common in children between :

A

6 months - 3 years old

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20
Q

Peak incidence of croup is at

A

2 years old

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21
Q

Which seasons is Croup common in

A

Autumn and Spring

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22
Q

Is Croup more common in boys or girls

A

boys

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23
Q

Causative organims for Croup

A

Parainfluenza virus mainly, Adenovirus, Rhinovirus, Enterovirus

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24
Q

Clinical features of mild croup

A

Occasional barking cough with no audible stridor, no recession, child happy to eat and drink as normal

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25
Q

Clinical features of moderate croup

A

Frequent barking cough with audible stridor at rest, suprasternal recession, child not agitated

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26
Q

Clincal features of severe croup

A

Frequent barking cough, prominent stridor (high pitched breathing indicating an upper airway obstruction), marked sternal recession, agitated and distressed child potentially with tachycardia

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27
Q

Symptoms of Croup

A

1-4 days history of non-specific rhinorrhea (thin, nasal discharge), fever and barking cough - Worse at night - Harsh Inspiratory Stridor - Prodrome of coryza and fever

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28
Q

Signs of Croup

A

Decreased bilateral air entry - Tachypnoea - Costal recession

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29
Q

Respiratory failure red flags

A

Drowsiness - Lethargy - Cyanosis - Tachycardia - Laboured breathing

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30
Q

Ix for croup

A

FBC, CRP U+E - CXR to exclude foreign body

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31
Q

Tx for croup

A

Paracetamol/Ibuprofen for fever/sore throat - Admission if moderate/severe and consider if dehydrated - Single dose dexamethasone 0.15mg/kg or prednisolone - Nebulised adrenaline for relief of severe symptoms - Oxygen if required - Monitor for needed ENT intervention if suspected airway blockage

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32
Q

First Line Tx for Croup

A

Single dose Oral Dexamethasone (0.15 mg/kg)

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33
Q

Complications of Croup

A

Otitis Media - Dehydration due to reduced fluid intake - Superinfection: pneumonia

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34
Q

How long do symptoms from Croup last.

A

48 hours - 1 week

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35
Q

Asthma

A

Reversible paroxysmal constriction of the airways with inflammatory exudate and followed by airway remodelling

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36
Q

What is the most chronic condition of children?

A

Asthma

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37
Q

Aetiology of Asthma

A
  • Genetic - Prematurity - Low birth weight - Parental smoking - Viral bronchiolitis in early life - Cold air - Allergen exposure e.g. dust
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38
Q

Symptoms of Asthma

A

Episodic wheeze which is infrequent/frequent and persistent most days and nights - Dry cough often worse at night - SOB - Wheeze

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39
Q

Ix of Asthma

A
  • Reduced peak flow - FEV1 significantly reduced
  • FVC normal
  • FEV1:FVC may be <70% if poorly controlled
  • Reversible spirometry is highly suggestive of asthma
  • ENO levels of nitric oxide correlate to inflammation
  • Baseline chest x ray
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40
Q

Management of Asthma includes how many steps?

A

7

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41
Q

Step 1 of Asthma Management

A

SABA PRN - Salbutamol

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42
Q

Step 2 of Asthma Management

A

: ICS Preventer therapy - Beclomethasone

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43
Q

Step 3 of Asthma Management

A

LTRA Montelukast

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44
Q

Step 4 of Asthma Management

A

Strop LTRA if hasn’t helped and add LABA - Salmeterol

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45
Q

Step 5 of Asthma Management

A

Switch ICS/LABA for ICS MART: Formoterol and ICS

46
Q

Step 6 of Asthma Management

A

Add a separate LABA

47
Q

Step 7 of Asthma Management

A

High dose ICS (>400mcg), referral

48
Q

Management of Asthma in children < 5 y/o involves how many steps?

A

3

49
Q

Step 1 of Asthma Managment in <5 y/o

A

SABA PRN - Salbutamol

50
Q

Step 2 of Asthma Managment in <5 y/o

A

SABA + 8 week trial of ICS if symptoms reoccur within 4 weeks, restart ICS

51
Q

Step 3 of Asthma Managment in <5 y/o

A

Refer to specialist

52
Q

Viral Induced Wheeze : Episodic Wheeze

A
  • a symptom of viral URTI and symptom free in between events
53
Q

Viral Induced Wheeze : Multiple trigger Wheeze

A
  • URTI and other factors trigger wheeze
54
Q

Viral Induced Wheeze - Symtomatic Tx

A

SABA inhaler via spacer maximum of 4 hourly up to 10 puffs - LTRA and ICS via spacer - Multiple trigger wheeze: trial ICS or LTRA for 4-8 weeks

55
Q

Causes of Viral Induced Wheeze

A

RSV or Rhinovirus

56
Q

Symptoms of Viral Induced Wheeze

A

-Under 3 years old -Viral illness 1 to 2 days preceding -SOB -Signs of respiratory distress -Expiratory wheeze throughout the chest

57
Q

Management of Viral Induced Wheeze

A

-SABA inhaler -± LTRA and ICS via spacer

58
Q

Bronchiolitis

A

Viral infection of the bronchioles

59
Q

Bronchiolitis commonly affects children under the age of ___

A

2 (commonly infants (rare after 1 y/o))

60
Q

Which seasons is Bronchiolitis common in

A

winter and spring months

61
Q

Bronchiolitis is commonly caused by…

A

RSV (Respiratory Syncytial Virus)

62
Q

Risk factors for Bronchiolits

A

Breastfeeding for < 2 months - Smoke exposure - Older siblings who attend nursery/school - Chronic lung disease of prematurity

63
Q

Pathophysiology of Bronchiolitis

A

RSV invades nasopharyngeal epithelium –> increased mucus production –> bronchial obstruction

64
Q

Symptoms of Bronchiolitis

A

Symptom onset in 2-5 days - Low grade fever - Rhinorrhea and nasal congestion - Cough - Reduced feeding

65
Q

Signs of Bronchiolitis

A

Signs of Respiratory distress: nasal flaring, tracheal tug, head bobbing, grunting, sub/intercostal recessions - Inspiratory crackles

66
Q

Ix for Bronchiolitis

A

Nasopharyngeal aspirate for RSV culture FBC, Urine, Blood gas if severely unwell CXR - not used usually

67
Q

What might be seen on CXR for Bronchiolitis

A

hyperinflation, air trapping and flattened diaphragm

68
Q

Management of Bronchiolitis

A

Supportive management from home + Palvizumab vaccine against bronchiolitis

69
Q

Palvizumab vaccine against bronchiolitis should be considered in

A
70
Q

:

A
  • Children <9 months with chronic lung disease of prematurity - Children < 2 years with severe immunodeficiency require long term ventilation
71
Q

Urgent Hospital Admission for Bronchiolitis

A

Apnoea - Resp Rate > 70 - Central cyanosis - SpO2 < 92%

72
Q

Non-Urgent Hospital Admission for Bronchiolitis

A

Resp Rate > 60 - Clinical dehydration

73
Q

Inpatient Managment for Bronchiolitis

A

Oxygen to bring SpO2 up - Fluids - CPAP if in respiratory failure
- Suctioning of secretions
- Ribavirin for severe cases
- No evidence for bronchodilatory, antibiotics or steroids in bronchiolitis

74
Q

Prophylaxis for Bronchiolitis

A

-IM Palivizumab -Monthly injections for high risk babies (autumn to winter months)

75
Q

What is cystic fibrosis?

A

Cystic fibrosis is a genetic condition caused by mutations in the CFTR gene, leading to defective chloride ion transport and resulting in thick, sticky secretions in various organs, especially the lungs and pancreas.

76
Q

Cystic fibrosis is caused by mutations in the ________ gene, affecting chloride ion transport.

A

CFTR

77
Q

What is the inheritance pattern of cystic fibrosis?

A

Cystic fibrosis is inherited in an autosomal recessive manner.

78
Q

The inheritance pattern of cystic fibrosis is ________.

A

Autosomal recessive

79
Q

What is the most common mutation causing cystic fibrosis?

A

The most common mutation is ΔF508, a deletion of phenylalanine at position 508 in the CFTR protein.

80
Q

The most common CFTR mutation in cystic fibrosis is ________.

A

ΔF508

81
Q

What are the respiratory features of cystic fibrosis?

A

Chronic cough with sputum production.
Recurrent respiratory infections.
Bronchiectasis.
Nasal polyps.
Sinusitis.

82
Q

Respiratory features of cystic fibrosis include chronic ________, bronchiectasis, and recurrent ________ infections.

A

Cough; respiratory

83
Q

What gastrointestinal complications are associated with cystic fibrosis?

A

Meconium ileus in neonates.
Pancreatic insufficiency leading to malabsorption and steatorrhea.
Failure to thrive.
Rectal prolapse.
CF-related liver disease (e.g., biliary cirrhosis).

84
Q

Meconium ________ is a neonatal gastrointestinal complication of cystic fibrosis.

A

Ileus

85
Q

How does cystic fibrosis affect the pancreas?

A

CF causes pancreatic insufficiency due to blockage of pancreatic ducts by thick secretions, leading to malabsorption of fats and fat-soluble vitamins (A, D, E, and K).

86
Q

Pancreatic insufficiency in cystic fibrosis leads to malabsorption of ________ and fat-soluble ________.

A

Fats; vitamins

87
Q

What is the gold standard test for diagnosing cystic fibrosis?

A

The sweat chloride test, which measures elevated chloride levels in sweat (>60 mmol/L in CF).

88
Q

The gold standard test for diagnosing cystic fibrosis is the ________ chloride test.

A

Sweat

89
Q

What newborn screening test is used for cystic fibrosis?

A

Immunoreactive trypsinogen (IRT) is used as a part of newborn screening for CF.

90
Q

Newborn screening for cystic fibrosis measures elevated levels of ________.

A

Immunoreactive trypsinogen (IRT)

91
Q

What are the common pathogens causing respiratory infections in cystic fibrosis patients?

A

Staphylococcus aureus (early in life).
Pseudomonas aeruginosa (later stages).
Haemophilus influenzae.
Burkholderia cepacia complex.

92
Q

The most common pathogen causing respiratory infections in early cystic fibrosis is ________, while ________ is more common in later stages.

A

Staphylococcus aureus; Pseudomonas aeruginosa

93
Q

What treatments are used to manage respiratory symptoms in cystic fibrosis?

A

Airway clearance techniques (e.g., chest physiotherapy).
Mucolytics (e.g., dornase alfa, hypertonic saline).
Inhaled antibiotics for Pseudomonas (e.g., tobramycin).
Bronchodilators.
Vaccination (e.g., influenza, pneumococcal).

94
Q

Airway clearance in cystic fibrosis is achieved through ________ physiotherapy and mucolytics like ________ alfa.

A

Chest; dornase

95
Q

What is the role of CFTR modulators in cystic fibrosis treatment?

A

CFTR modulators, such as ivacaftor and lumacaftor, improve the function of the defective CFTR protein and are specific to certain mutations.

96
Q

CFTR modulators, like ________, improve the function of the defective ________ protein in cystic fibrosis.

A

Ivacaftor; CFTR

97
Q

What nutritional support is recommended for children with cystic fibrosis?

A

High-calorie, high-fat diet.
Pancreatic enzyme replacement therapy (PERT).
Fat-soluble vitamin supplementation (A, D, E, K).
Salt supplementation in hot weather.

98
Q

Nutritional support in cystic fibrosis includes a high-________ diet and pancreatic ________ replacement therapy.

A

Calorie; enzyme

99
Q

What are some complications of cystic fibrosis?

A

Chronic respiratory failure.
CF-related diabetes (CFRD).
Osteoporosis.
Liver disease (e.g., biliary cirrhosis).
Infertility (especially in males due to absence of vas deferens).

100
Q

A common endocrine complication of cystic fibrosis is CF-related ________.

A

Diabetes (CFRD)

101
Q

What is Epiglottits?

A

Life threatening emergency. Severe swelling of the epiglottis and surrounding tissues

102
Q

Who does Epiglottis affect?

A

Common in ages 4-6, but can affect all ages

103
Q

Epiglottitis is caused by ____

A

Caused by Haemophilus Influenzae Type B

104
Q

Symptoms of Epiglottitis

A

Rapid onset - High fever - Stridor - Drooling and saliva
- Patient finds it easier to breathe leaning forward and extending neck (tripoding position)

105
Q

Dx of Epiglottitis

A

Clinical - CXR (do not let the child lie down). Lateral XR of neck - thumb print sign and exclude foreign body

106
Q

What might CXR show for Epiglottitis ?

A

Thumb sign and acute epiglottis swelling

107
Q

Should you examine the throat for someone with suspected Epiglottitis ?

A

Do not examine throat as there is a risk of acute airway obstruction

108
Q

Management of Epiglottitis

A

O2 - Nebulised adrenaline - IV Abx - 3rd gen cephalosporins e.g. Ceftriaxone (7-10days)

109
Q

Complications of Epiglottis

A

Epiglottic abscess, bacteraemia, meningitis, airway obstruction, death

110
Q

How does Epiglottis compare to Croup?

A

Fever, No cough, salvia drooling

Phase 3a - Paediactrics (17 decks)

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