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YEAR 4-PAEDIATRICS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is Bronchiolitis?

A

Infection and inflammation of the bronchioles.

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2
Q

Bronchiolitis commonly affects infants under 1. During what months is it most common?

A

The winter months

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3
Q

Bronchiolitis is almost always caused by a virus.
What is the most common cause? and name 2 others.

A
  1. Respiratory Synctial Virus (RSV)- is the most common
  2. Rhinovirus
  3. Adenovirus
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4
Q

True or false.
Infants with bronchiolitis are more likely to develop viral-induced wheeze or asthma during childhood.

A

True

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5
Q

Explain the pathophysiology of bronchiolitis?

A

-Infection with the virus causes inflammation, oedmea and increased mucus production in the bronchioles.

-This causes the airway to narrow, obstructing the air flow.

-Infants airways are very small, so even minimal narrowing can cause significant symptoms.

-Obstruction of air flow results in reduced oxygen saturations & increased work of breathing.

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6
Q

Respiratory syncytial virus (RSV) infection usually starts with coryzal symptoms.
What is meant by coryzal symptoms?

A

-Runny nose
-Sneezing
-Watery Eyes
-Sore throat

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7
Q

Around half of infants with RSV infection go on to develop bronchiolitis.
Suggest 6 features of bronchiolitis?

A
  1. Coryzal symptoms
  2. Reduced feeeding
  3. Dyspnoea (difficulty breathing)
    4.Tachypnoea (fast breathing)
    5.Cyanosis
  4. Mild fever (under 39 degrees C)
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8
Q

When auscultating an infant with suspected bronchiolitis.
What would you expect to hear?

A
  • Wheeze
  • Crackles
  • Harsh breath sounds
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9
Q

Respiratory distress can occur as a result of bronchiolitis.
Suggest 8 features of respiratory distress in infants.

A
  1. Raised resp rate
  2. Use of accessory muscles
  3. Intercostal and Subcostal recessions
    5.Nasal flaring
    6.Tracheal tugging
    7.Cyanosis
  4. Abnormal airway noises
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10
Q

Name 3 abnormal airway noises?

A
  1. Wheeze
  2. Grunting
  3. Stridor
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11
Q

What is a wheeze?

A

A high pitched whistling sound heard more predominantly on expiration due to airway obstruction and narrowing.

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12
Q

What is the difference between a widespread and focal wheeze?

A

Widespread wheeze is usually heard in children with bronchiolitis, astha, and viral-induced wheeze.

Focal wheeze suggests a localised condition such as a foreign body aspiration or an obstructing tumour.

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13
Q

What is stridor?

A

A high-pitched inspiratory noise caused by obstruction of the upper airway.

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14
Q

Stridor is not typically a feature of bronchiolitis.
Suggest 4 conditions which can cause stridor.

A
  1. Foreign body aspiration
    2.Croup
    3.Epiglottitis
    4.Laryngomalacia
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15
Q

Most infants with bronchiolitis can be managed at home. But sometimes they need to be admitted.

Suggest 6 reasons for admission.

A
  1. Aged under 3 months
  2. Pre-existing condition e.g. Cystic fibrosis
  3. Signs of dehydration
  4. Resp rate above 70
  5. Oxygen saturations below 92%
  6. Persistent, sever signs of respiratory distress e.g. deep recessions
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16
Q

How would you manage suspected bronchiolitis?

A
  1. Ensure adequete intake (e.g. oral,IV fluids, NG)
  2. Saline nasal drops and nasal suctionaing may help clear nasal secretions
  3. Respiratory support may be required
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17
Q

Suggest 4 types of respiratory support that may be needed in severe bronchiolitis.

A
  1. Low-flow oxygen ( e.g. 2 litres via nasal cannula)
  2. High-flow humidified oxygen via tight nasal cannula (e.g. Airvo)
  3. Continuous positive airway pressure (CPAP)
  4. Intubation & Ventilation ( e.g endotracheal tube & mechanical ventilation)
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18
Q

What test is used to monitor the response to treatment in severe bronchiolitis requiring respiratory support?

What result would suggest inadequete ventilation?

A

Capillary blood gases

Signs of inadequete ventilation:

-Rising pCO2 (severe airway obstruction reduces the clearance of carbon dioxide)
- Falling pH ( rising C02 causes respiratory acidosis)

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19
Q

The Respiratory Syncytial virus vaccine is recommened for all pregnant women from what week gestation?

A

From 28 weeks gestation.

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20
Q

The Respiratory syncytial virus vaccine creates an immune response in the mother, generating antibodies that pass through the placenta to the fetus.
These antibodies offer the baby protection for the first 6 months of life. Why only the first 6 months of life?

A

Because at 6 months the mothers IgG antibodies begin to wean and the newborn begins to makes its own antibodies.

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21
Q

There is a monoclonal antibody that targets the respiratory syncytial virus which can be given to high risk babies.
What is the name of this drug?

A

Palivizumab

22
Q

Palivizumab is given as a monthly injection.
Why are repeated doses necessary?

A

Becasue unlike when given a vaccine the immune system does not create any new antibodies when given Palivizumab. The infant is injected with antibodies against RSV which decrease over time and thus repeated doses are required to maintain protection.

23
Q

Viral induced wheeze differs from bronchiolitis.
What is viral induced wheeze?

A

Viral-induced wheeze occurs when a viral infection causes airway narrowing, leading to SOB and wheeze.

24
Q

Viral-induced wheeze only occurs during viral infections. It is very common and typicall affecst children of what age?

A

Children under 3 years of age.

25
Suggest 3 features of viral induced wheeze?
1. Low-grade fever 2. Dry cough 3. Coryzal symptoms e..g runny nose,sore throat.
26
How is viral wheeze managed?
* **Bronchodilators** e.g. Inhaled salbutamol via a spacer * **Steroids** e.g. oral prednisolone for 3 days * **Supplementary oxygen**
27
How does viral-induced wheeze differ from Broncholitis?
1. Age of onset, younger in broncholitis (under 1) 2.Viral wheeze- may have multiple episodes with each viral infection they have.
28
What is Pneumonia?
A lung infection causing inflammation of the lung tissue and fluid accumualtion in the airways & alveoli.
29
What organisms cause pneumonia?
Pneumonia can be caused by bacteria, virus or atypical bacteria.
30
What is the most common bacterial cause of pneumonia?
1.Streptococcus pneumonia
31
What is the most common viral cause of pneumonia?
Respiratory syncytial virus (RSV)
32
What is the most common atypical bacteria that cause pneumonia?
Mycoplasma pneumonia
33
Suggest 3 symptoms and 3 signs of pneumonia?
Symptoms: 1. Cough (productive) 2. Lethargy 3. Confusion Signs: 1. High fever 2.Tachycardia 3.Tachypnoea (fast breathing)
34
What 3 features might you observe on examination of suspected pneumonia?
1. Bronchial breath sounds (harsh breath sounds) on auscultation (due to consolidation) 2. Focal coarse crackles on auscultation (due to air passing through sputum) 3. Dullness on percussion (due to consolidation)
35
How would you investigate suspected pneumonia?
Bedside: -Full set of observations -Sputum cultures -Throat swab ( for bacterial cultures and viral PCR) Bloods: **-Capillary blood gas (for child) -Blood cultures** -FBC -LFTs -U&Es -CRP/ ESR Imaging: **-Chest x-ray**
36
What would you expect to see on chest x-ray of someone with pneumonia?
Pneumonia can be seen as **consolidation** on chest x-ray. NB-Seen here on the left heart border.
37
How would you manage a patient with pneumonia?
1. **Antibiotics**- Amoxicillin usually 1st line, Erythromycin if allergic to penicllin. 2. Analgesia as necessary 3. Oxygen support if necessary 4. Maintain oral intake.
38
If a child is having recurrent admissions requring antibiotics for LRTI it is worth investigating underlying lung or immune system pathology. Suggest 4 tests which can be done to help identify underlying pathology.
1. Sweat Test- for cystic fibrosis 2.Chest X-ray- for structural abnormalities 3.Serum immunoglobulins- for selective antibody deficiency 4. HIV test-for HIV.
39
What is Croup?
Croup is an acute infective respiratory disease affecting young children.
40
What age group does croup typicall tend to affect?
6 months to 2 years
41
Is croup a upper or lower respiratory tract infection?
It is a upper respiratory tract infection causing oedema and swelling of the larynx.
42
Name 3 common causes of croup.
* Parainfluenza virus (most common) * Influenza virus * Adenovirus
43
Suggest 5 features of Croup?
1. **Barking cough** 2.Increased work of breathing 3.Hoarse voice 4.Low grade fever
44
How would you manage **croup**?
-Most cases can be managed at home with supportive treatment e.g. Fluids & rest -**Oral Dexamethasone** (single dose) is very effective.
45
What is Epiglottitis?
Inflammation and swelling of the epiglottis caused by infection.
46
What infection typically causes epiglottitis?
Haemophilius Influenza Type B
47
Why is epiglottitis a life threatening emergency?
Because the epiglottis can swell to the point of completely obstructing the airway within hours of symptoms developing.
48
Suggest 4 features of epiglottitis?
1. Drooling 2.Sore throat 3.Tripod position 4.High fever 5.Difficulty or painful swallowing
49
Why is epiglottitis now rare?
Due to the routine vaccination programme, which vaccinates all children against haemophilus. Nb-Suspect epiglottitis in the unvaccinated child.
50
If the patient is acutely unwell and epiglottitis is suspected then investigations should **not** be performed. How would you **manage** a patient with epiglottitis?
1. **Secure the airway** 2.Don't distress the patient- this will exacerbate symptoms and compromise the airway further 3. Alert senior paediatrician 4. IV antibioitcs e.g. ceftriaxone 5. Steroids e..g Dexamethasone +/-
51
The prognosis for epiglottitis is good, most make a full recovery. What is a common complication of epiglottitis?
**Epiglottic abscess** *A collection of pus around the epiglottis.*
52

YEAR 4-PAEDIATRICS (17 decks)

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