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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

0
Q

If a child is using his inhaler more than 2 times a week would you move them on to the next step of asthma management?

A

Yes

Inhaled beclometasone 200-400 micrograms OD.

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1
Q

Why should long term use of LARGE dose steroids be avoided in children?
What can it cause?

A

Can induce adrenal suppression

Can reduce growth in large doses.

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2
Q

What is the third stage of chronic asthma treatment?

A

Add on long acting B2 agonist eg salmeterol or formoterol

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3
Q

What is the starting dose of inhaled steroids in step 2 of chronic asthma?

A

100-400 micrograms beclometasone Twice daily

Usually start at 200.

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4
Q

Name 3 symptoms that asthma may present with..

A

Wheeze
Cough (dry)
Difficulty breathing +/- chest tightness

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5
Q

What time of the day may asthmatic symptoms be worse?

A

Night time or early morning

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6
Q

What can trigger asthma?

A

Exercise
Pets
Cold
Emotions

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7
Q

What is it important to ask in the social Hx in asthma?

A

Smoking
Pets
Housing conditions (could be mouldy and damp)

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8
Q

Is stridor inspiratory or expiratory?

A

Inspiratory

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9
Q

What are the 4 main differentials of stridor?

A

Croup
Inhaled foreign body
Laryngomalacia
Epiglottitis

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10
Q

What age is it appropriate to diagnose asthma?

What is more common in younger children?

A

3-4 years

Viral induced wheeze

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11
Q

What virus causes bronchiolitis?

What other ones cause it?

A

RSV - respiratory syncytial virus

hMPV- human metapneovirus
Adenovirus
Parainfluenza

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12
Q

At what age is bronchiolitis most common?

A

2-6 months old

It is only seen in under 1’s

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13
Q

What are the symptoms of bronchiolitis?

A

Rhinorrhoea
Cough
Fever

Also:wheeze, vomiting, irritability, poor feeding, cyanosis.

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14
Q

What is laryngomalacia?

A

Collapse of upper larynx during inspiration as it has immature cartilage

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15
Q

What signs might you see in bronchiolitis?

A

Increased resp effort
Widespread inspiratory crackles
Liver and spleen may be palpable

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16
Q

How long does bronchiolitis last for?

A

7-10 days

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17
Q

What is the treatment for bronchiolitis?

A

Supportive care if serious.
Eg, oxygen, fluids or NG feed

Passive immunity to immunocompromised

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18
Q

What is the main cause of croup?

What are the other causes?

A

Parainfluenza virus (type 1)

Respiratory syncytial virus
Adenovirus
Rhinovirus

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19
Q

What is croup?

A

Upper airway inflammation caused by a viral infection

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20
Q

What is the most common age group for croup to present in?

A

6 months to 3 years

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21
Q

You have a 2 year old child with a barking cough, what do you think that have?

A

Croup

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22
Q

What are non specific symptoms of URTI?

A

Rhinorrhoea
Fever
Cough
Sore throat

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23
Q

How long does croup last for?

A

3-7 days

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24
Q

What might a chest X-ray show in bronchiolitis?

A

Hyperinflation of the lungs die to small airways obstruction and air trapping

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25
Q

What can you give to prevent bronchiolitis?

Who would you give this to?

A

Monoclonal antibody to RSV

Premature babies to as it is expensive

26
Q

Why might the liver be displaced downwards in bronchiolitis?

A

Because the hyper inflated chest pushes it down

27
Q

What virus causes croup?

A

Parainfluenza virus

28
Q

What organism causes epiglotitis?

A

Haemophilia influenza B

29
Q

When does bronchiolitis peak at it’s worse?

A

3-4 days

30
Q

What age group is bronchiolitis associated with a more serious morbidity?

A

Less than 3 months

31
Q

What is Palivisumab?

A

A treatment for the prevention of bronchiolitis - antibody to give passive immunity

32
Q

How often is Palivisumab given?

A

Once a month over the winter months

33
Q

Who is Palivisumab given to?

A

Young children with
Chronic lung disease
Or
Significant cardiac abnormality

34
Q

In asthma if no evidence of airway obstruction is found you might consider testing atopy status - how is this done?

A

Skin tests
Blood eosinophilia
raised specific IGE to cat dog/ mite

35
Q

What happens in a ‘test of airway reversibility’?

A

Used when asthma diagnosis is unsure

Do spirometery before and after using a bronchodilator

36
Q

What is a test of airway responsiveness?

A

Stimulate airway with exercise or methacholine

For when diagnosis of asthma is unclear

Good at ruling out asthma but not ruling in

37
Q

At what age should a child be able to do a peak flow/spirometery?

A

5 years old

38
Q

What is the max dose of inhaled steroids under 5’s should get on the asthma steps?

A

400 micrograms per day

39
Q

What next dose should the 5-12 year olds get of inhaled steroids?

A

800 micrograms per day

40
Q

What is fluticasone?

A

Corticosteroid used in asthma

41
Q

What are he drug management steps in asthma under 5’s?

A
  1. Salbutamol
  2. Corticosteroid
  3. Montelukast (can be also be given at step 2 instead)
  4. Refer to consultant
42
Q

What is the steps for managing asthma over 5’s?

A 
Salbutamol 
Corticosteroid 
Long acting B2 agonist (salmeterol) 
(Or try monteleukast/ sr theophylline) 
4. Increase corticosteroid
5. Add daily steroid tablet
43
Q

What is xanthine?

A

Oral bronchodilator can be used in step 4 management of asthma in over 5’s

44
Q

What is seretide?

A

Fluticasone plus salmeterol

45
Q

How long to steroid inhalers take to work after being started?

A

3-7 days

46
Q

Name some inhaled steroids..

A

Beclometasone
Budesonide
Fluticasone
Mometasone

47
Q

Name 2 short acting B2 agonists..

A

Salbutamol

Terbultaline

48
Q

Name two long acting B2 agonists?

A

Formeterol

Salmeterol

49
Q

How much salbutamol is in one puff?

A

100 micrograms

50
Q

How much salbutamol should be taken in any day?

A

1-2 puffs up to QDS 800 micrograms

Although 10 puffs if asthma attack

51
Q

What is the most common gene mutation to cause CF?

A

Delta F508

52
Q

How common is CF?

A

1:2500 newborns

53
Q

What is the carrier rate of CF in the Caucasian population?

A

1:25

54
Q

What is the gold standard test to diagnose CF?

A

Sweat test

55
Q

How much sweat do you need in a sample for a sweat test?

How much sodium chloride is diagnostic of CF?

A

100 mg of sweat

Over 60mmol/ L

56
Q

How can CF present in children who have been missed on the Guthrie card?

A 
FFT
Recurrent LRTI
Diarrhoea
Nasal polyps 
Rectal prolapse
In neonates:
Meconium illeus
Prolonged jaundice
57
Q

What are the fat soluble vitamins?

A

ADEK

58
Q

What treatment can be given in whooping cough?

A

None to actually treat but erythromycin to make them less contagious

59
Q

When using aminophyline what measurements do you need to have in place?

A

Cardiac monitoring

Regular sampling because of narrow therapeutic window

60
Q

What is the peak flow in life threatening asthma?

A

Less than 33%

61
Q

What is the peak flow in severe asthma?

A

33-50%

62
Q

What is the peak flow in moderate asthma?

A

50-75%

Paediatrics (12 decks)

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