Respiratory Flashcards
Pneumonia
Infection of the lower respiratory tract and lung parenchyma which leads to consolidation.
Highest incidence of Pneumonia is in who?
in infants
What is the more common cause of Pneumonia in young infants- viral or bacterial ?
Viral
What is the more common cause of Pneumonia in older children?
Bacterial
Viral disease for Pneumonia is more common in ____
Winter
Causes of Pneumonia in Neonates
Group B Strep, E coli, Klebsiella, Staph Aureus
Causes of Pneumonia in Infants
Strep pneumoniae, Chlamydia
Causes of Pneumonia in School Age children
Strep pneumoniae
Staph Aureus
Group A Step
Mycoplasma pneumoniae
Pneumonia is usually preceded by ____
an upper respiratory tract infection
Symptoms of Pneumonia
Fever - SOB - Lethargy
Signs of Pneumonia
Signs of respiratory distress
Auscultation signs: dullness to percuss, crackles, decreased breath sounds, bronchial breathing
Wheeze and hyperinflation more typical of viral infection
Ix for Pneumonia
Mainly clinical
CXR - fluid in the lungs (associated with Staph)
Perinasal swab
Tx for Pneumonia
Management at home with analgesia
If admitted: Oxygen therapy and IV fluids
Abx
Abx for Pneumonia - Neonates
Broad spec IV Abx (meropenem, piperacillin, tazobactam, cefepime)
Abx for Pneumonia - Infants
Amoxicillin/Co-Amoxiclav
Abx for Pneumonia in children> 5 y/o
Amoxicillin/Erythromycin
Complications of Pneumonia
Risk of parapneumonic collapse and empyema if so follow up at 4-6 weeks with a fluid sample
Croup
Acute laryngotracheobronchitis (Mucosal inflammation anywhere between the nose and the trachea). Mucosal Inflammation of upper airways.
Croup is common in children between :
6 months - 3 years old
Peak incidence of croup is at
2 years old
Which seasons is Croup common in
Autumn and Spring
Is Croup more common in boys or girls
boys
Causative organims for Croup
Parainfluenza virus mainly
Adenovirus
Rhinovirus
Enterovirus
Clinical features of mild croup
Occasional barking cough with no audible stridor, no recession, child happy to eat and drink as normal
Clinical features of moderate croup
Frequent barking cough with audible stridor at rest, suprasternal recession, child not agitated
Clincal features of severe croup
Frequent barking cough, prominent stridor (high pitched breathing indicating an upper airway obstruction), marked sternal recession, agitated and distressed child potentially with tachycardia
Symptoms of Croup
1-4 days history of non-specific rhinorrhea (thin, nasal discharge), fever and barking cough
Worse at night
Harsh Inspiratory Stridor
Signs of Croup
Decreased bilateral air entry
Tachypnoea
Costal recession
Respiratory failure red flags
Drowsiness
Lethargy
Cyanosis
Tachycardia
Laboured breathing
Ix for croup
Bloods: FBC, CRP U+E
CXR to exclude foreign body
Tx for croup
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
First Line Tx for Croup
Single dose Oral Dexamethasone (0.15 mg/kg)
Complications of Croup
Otitis Media
Dehydration due to reduced fluid intake
Superinfection: pneumonia
How long do symptoms from Croup last.
48 hours - 1 week
Asthma
Reversible paroxysmal constriction of the airways with inflammatory exudate and followed by airway remodelling
What is the most chronic condition of children?
Asthma
Aetiology of Asthma
Genetic
Prematurity
Low birth weight
Parental smoking
Viral bronchiolitis in early life
Cold air
Allergen exposure e.g. dust
Symptoms of Asthma
Episodic wheeze which is infrequent/frequent and persistent most days and nights
Dry cough often worse at night
SOB
Wheeze
Ix of Asthma
- 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
Management of Asthma includes how many steps?
7
Step 1 of Asthma Management
SABA PRN - Salbutamol
Step 2 of Asthma Management
ICS Preventer therapy - Beclomethasone
Step 3 of Asthma Management
LTRA Montelukast
Step 4 of Asthma Management
Strop LTRA if hasn’t helped and add LABA - Salmeterol
Step 5 of Asthma Management
Switch ICS/LABA for ICS MART: Formoterol and ICS
Step 6 of Asthma Management
Add a separate LABA
Step 7 of Asthma Management
High dose ICS (>400mcg), referral
Management of Asthma in children < 5 y/o involves how many steps?
3
Step 1 of Asthma Managment in <5 y/o
SABA PRN - Salbutamol
Step 2 of Asthma Managment in <5 y/o
SABA + 8 week trial of ICS if symptoms reoccur within 4 weeks, restart ICS
Step 3 of Asthma Managment in <5 y/o
Refer to specialist
Viral Induced Wheeze : Episodic Wheeze
- a symptom of viral URTI and symptom free in between events
Viral Induced Wheeze : Multiple trigger Wheeze
- URTI and other factors trigger wheeze
Viral Induced Wheeze - Symtomatic Tx
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
Causes of Viral Induced Wheeze
RSV or Rhinovirus
Symptoms of Viral Induced Wheeze
-Under 3 years old
-Viral illness 1 to 2 days preceding
-SOB
-Signs of respiratory distress
-Expiratory wheeze throughout the chest
Management of Viral Induced Wheeze
-SABA inhaler -± LTRA and ICS via spacer
Bronchiolitis
Viral infection of the bronchioles
Bronchiolitis commonly affects children under the age of ___
2 (commonly infants (rare after 1 y/o))
Which seasons is Bronchiolitis common in
winter and spring months
Bronchiolitis is commonly caused by…
RSV (Respiratory Syncytial Virus)
Risk factors for Bronchiolits
Breastfeeding for < 2 months
Smoke exposure
Older siblings who attend nursery/school
Chronic lung disease of prematurity
Pathophysiology of Bronchiolitis
RSV invades nasopharyngeal epithelium –> increased mucus production –> bronchial obstruction
Symptoms of Bronchiolitis
Symptom onset in 2-5 days
Low grade fever
Rhinorrhea and nasal congestion
Cough
Reduced feeding
Signs of Bronchiolitis
Signs of Respiratory distress: nasal flaring, tracheal tug, head bobbing, grunting, sub/intercostal recessions
Inspiratory crackles
Ix for Bronchiolitis
Nasopharyngeal aspirate for RSV culture
FBC
Urine
Blood gas if severely unwell
CXR - not used usually
What might be seen on CXR for Bronchiolitis
hyperinflation, air trapping and flattened diaphragm
Management of Bronchiolitis
Supportive management from home + Palvizumab vaccine against bronchiolitis
Palvizumab vaccine against bronchiolitis should be considered in who?
- Infants and young children with certain underlying health conditions:
• Premature infants (especially those born before 29 weeks of gestation).
• Infants with chronic lung disease of prematurity or bronchopulmonary dysplasia (BPD).
• Infants with congenital heart disease, particularly those with hemodynamically significant heart disease.- Infants under 12 months of age who are at high risk of RSV infection during the RSV season (typically fall through spring in many regions).
- Children younger than 2 years old who have severe immunocompromising conditions, such as those undergoing stem cell transplantation or receiving chemotherapy.
Urgent Hospital Admission for Bronchiolitis
Apnoea
Resp Rate > 70
Central cyanosis
SpO2 < 92%
Non-Urgent Hospital Admission for Bronchiolitis
Resp Rate > 60 - Clinical dehydration
Inpatient Managment for Bronchiolitis
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
Prophylaxis for Bronchiolitis
-IM Palivizumab -Monthly injections for high risk babies (autumn to winter months)
What is cystic fibrosis?
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.
Cystic fibrosis is caused by mutations in the ________ gene, affecting chloride ion transport.
CFTR
What is the inheritance pattern of cystic fibrosis?
Cystic fibrosis is inherited in an autosomal recessive manner.
The inheritance pattern of cystic fibrosis is ________.
Autosomal recessive
What is the most common mutation causing cystic fibrosis?
The most common mutation is ΔF508, a deletion of phenylalanine at position 508 in the CFTR protein.
The most common CFTR mutation in cystic fibrosis is ________.
ΔF508
What are the respiratory features of cystic fibrosis?
Chronic cough with sputum production.
Recurrent respiratory infections.
Bronchiectasis.
Nasal polyps.
Sinusitis.
Respiratory features of cystic fibrosis include chronic ________, bronchiectasis, and recurrent ________ infections.
Cough; respiratory
What gastrointestinal complications are associated with cystic fibrosis?
Meconium ileus in neonates.
Pancreatic insufficiency leading to malabsorption and steatorrhea.
Failure to thrive.
Rectal prolapse.
CF-related liver disease (e.g., biliary cirrhosis).
Meconium ________ is a neonatal gastrointestinal complication of cystic fibrosis.
Ileus
How does cystic fibrosis affect the pancreas?
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).
Pancreatic insufficiency in cystic fibrosis leads to malabsorption of ________ and fat-soluble ________.
Fats; vitamins
What is the gold standard test for diagnosing cystic fibrosis?
The sweat chloride test, which measures elevated chloride levels in sweat (>60 mmol/L in CF).
The gold standard test for diagnosing cystic fibrosis is the ________ chloride test.
Sweat
What newborn screening test is used for cystic fibrosis?
Immunoreactive trypsinogen (IRT) is used as a part of newborn screening for CF.
Newborn screening for cystic fibrosis measures elevated levels of ________.
Immunoreactive trypsinogen (IRT)
What are the common pathogens causing respiratory infections in cystic fibrosis patients?
Staphylococcus aureus (early in life).
Pseudomonas aeruginosa (later stages).
Haemophilus influenzae.
Burkholderia cepacia complex.
The most common pathogen causing respiratory infections in early cystic fibrosis is ________, while ________ is more common in later stages.
Staphylococcus aureus; Pseudomonas aeruginosa
What treatments are used to manage respiratory symptoms in cystic fibrosis?
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).
Airway clearance in cystic fibrosis is achieved through ________ physiotherapy and mucolytics like ________ alfa.
Chest; dornase
What is the role of CFTR modulators in cystic fibrosis treatment?
CFTR modulators, such as ivacaftor and lumacaftor, improve the function of the defective CFTR protein and are specific to certain mutations.
CFTR modulators, like ________, improve the function of the defective ________ protein in cystic fibrosis.
Ivacaftor; CFTR
What nutritional support is recommended for children with cystic fibrosis?
High-calorie, high-fat diet.
Pancreatic enzyme replacement therapy (PERT) ; CREON tablets
Fat-soluble vitamin supplementation (A, D, E, K).
Salt supplementation in hot weather.
Nutritional support in cystic fibrosis includes a high-________ diet and pancreatic ________ replacement therapy.
Calorie; enzyme
What are some complications of cystic fibrosis?
Chronic respiratory failure.
CF-related diabetes (CFRD).
Osteoporosis.
Liver disease (e.g., biliary cirrhosis).
Infertility (especially in males due to absence of vas deferens).
A common endocrine complication of cystic fibrosis is CF-related ________.
Diabetes (CFRD)
What is Epiglottits?
Life threatening emergency. Severe swelling of the epiglottis and surrounding tissues
Who does Epiglottis affect?
Common in ages 4-6, but can affect all ages
Epiglottitis is caused by ____
Caused by Haemophilus Influenzae Type B
Symptoms of Epiglottitis
Rapid onset - High fever - Stridor - Drooling and saliva
- Patient finds it easier to breathe leaning forward and extending neck (tripoding position)
Dx of Epiglottitis
Clinical
CXR (do not let the child lie down).
- Lateral XR of neck
- thumb print sign and exclude foreign body
What might CXR show for Epiglottitis ?
Thumb sign and acute epiglottis swelling
Should you examine the throat for someone with suspected Epiglottitis ?
Do not examine throat as there is a risk of acute airway obstruction
Management of Epiglottitis
O2
Nebulised adrenaline
IV Abx ; 3rd gen cephalosporins e.g. Ceftriaxone (7-10days)
Complications of Epiglottis
Epiglottic abscess,
bacteraemia
meningitis
airway obstruction
death
How does Epiglottis compare to Croup?
Fever, No cough, salvia drooling
