Respiratory Flashcards
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?
Yes
Inhaled beclometasone 200-400 micrograms OD.
Why should long term use of LARGE dose steroids be avoided in children?
What can it cause?
Can induce adrenal suppression
Can reduce growth in large doses.
What is the third stage of chronic asthma treatment?
Add on long acting B2 agonist eg salmeterol or formoterol
What is the starting dose of inhaled steroids in step 2 of chronic asthma?
100-400 micrograms beclometasone Twice daily
Usually start at 200.
Name 3 symptoms that asthma may present with..
Wheeze
Cough (dry)
Difficulty breathing +/- chest tightness
What time of the day may asthmatic symptoms be worse?
Night time or early morning
What can trigger asthma?
Exercise
Pets
Cold
Emotions
What is it important to ask in the social Hx in asthma?
Smoking
Pets
Housing conditions (could be mouldy and damp)
Is stridor inspiratory or expiratory?
Inspiratory
What are the 4 main differentials of stridor?
Croup
Inhaled foreign body
Laryngomalacia
Epiglottitis
What age is it appropriate to diagnose asthma?
What is more common in younger children?
3-4 years
Viral induced wheeze
What virus causes bronchiolitis?
What other ones cause it?
RSV - respiratory syncytial virus
hMPV- human metapneovirus
Adenovirus
Parainfluenza
At what age is bronchiolitis most common?
2-6 months old
It is only seen in under 1’s
What are the symptoms of bronchiolitis?
Rhinorrhoea
Cough
Fever
Also:wheeze, vomiting, irritability, poor feeding, cyanosis.
What is laryngomalacia?
Collapse of upper larynx during inspiration as it has immature cartilage
What signs might you see in bronchiolitis?
Increased resp effort
Widespread inspiratory crackles
Liver and spleen may be palpable
How long does bronchiolitis last for?
7-10 days
What is the treatment for bronchiolitis?
Supportive care if serious.
Eg, oxygen, fluids or NG feed
Passive immunity to immunocompromised
What is the main cause of croup?
What are the other causes?
Parainfluenza virus (type 1)
Respiratory syncytial virus
Adenovirus
Rhinovirus
What is croup?
Upper airway inflammation caused by a viral infection
What is the most common age group for croup to present in?
6 months to 3 years
You have a 2 year old child with a barking cough, what do you think that have?
Croup
What are non specific symptoms of URTI?
Rhinorrhoea
Fever
Cough
Sore throat
How long does croup last for?
3-7 days
What might a chest X-ray show in bronchiolitis?
Hyperinflation of the lungs die to small airways obstruction and air trapping
What can you give to prevent bronchiolitis?
Who would you give this to?
Monoclonal antibody to RSV
Premature babies to as it is expensive
Why might the liver be displaced downwards in bronchiolitis?
Because the hyper inflated chest pushes it down
What virus causes croup?
Parainfluenza virus
What organism causes epiglotitis?
Haemophilia influenza B
When does bronchiolitis peak at it’s worse?
3-4 days
What age group is bronchiolitis associated with a more serious morbidity?
Less than 3 months
What is Palivisumab?
A treatment for the prevention of bronchiolitis - antibody to give passive immunity
How often is Palivisumab given?
Once a month over the winter months
Who is Palivisumab given to?
Young children with
Chronic lung disease
Or
Significant cardiac abnormality
In asthma if no evidence of airway obstruction is found you might consider testing atopy status - how is this done?
Skin tests
Blood eosinophilia
raised specific IGE to cat dog/ mite
What happens in a ‘test of airway reversibility’?
Used when asthma diagnosis is unsure
Do spirometery before and after using a bronchodilator
What is a test of airway responsiveness?
Stimulate airway with exercise or methacholine
For when diagnosis of asthma is unclear
Good at ruling out asthma but not ruling in
At what age should a child be able to do a peak flow/spirometery?
5 years old
What is the max dose of inhaled steroids under 5’s should get on the asthma steps?
400 micrograms per day
What next dose should the 5-12 year olds get of inhaled steroids?
800 micrograms per day
What is fluticasone?
Corticosteroid used in asthma
What are he drug management steps in asthma under 5’s?
- Salbutamol
- Corticosteroid
- Montelukast (can be also be given at step 2 instead)
- Refer to consultant
What is the steps for managing asthma over 5’s?
Salbutamol Corticosteroid Long acting B2 agonist (salmeterol) (Or try monteleukast/ sr theophylline) 4. Increase corticosteroid 5. Add daily steroid tablet
What is xanthine?
Oral bronchodilator can be used in step 4 management of asthma in over 5’s
What is seretide?
Fluticasone plus salmeterol
How long to steroid inhalers take to work after being started?
3-7 days
Name some inhaled steroids..
Beclometasone
Budesonide
Fluticasone
Mometasone
Name 2 short acting B2 agonists..
Salbutamol
Terbultaline
Name two long acting B2 agonists?
Formeterol
Salmeterol
How much salbutamol is in one puff?
100 micrograms
How much salbutamol should be taken in any day?
1-2 puffs up to QDS 800 micrograms
Although 10 puffs if asthma attack
What is the most common gene mutation to cause CF?
Delta F508
How common is CF?
1:2500 newborns
What is the carrier rate of CF in the Caucasian population?
1:25
What is the gold standard test to diagnose CF?
Sweat test
How much sweat do you need in a sample for a sweat test?
How much sodium chloride is diagnostic of CF?
100 mg of sweat
Over 60mmol/ L
How can CF present in children who have been missed on the Guthrie card?
FFT Recurrent LRTI Diarrhoea Nasal polyps Rectal prolapse In neonates: Meconium illeus Prolonged jaundice
What are the fat soluble vitamins?
ADEK
What treatment can be given in whooping cough?
None to actually treat but erythromycin to make them less contagious
When using aminophyline what measurements do you need to have in place?
Cardiac monitoring
Regular sampling because of narrow therapeutic window
What is the peak flow in life threatening asthma?
Less than 33%
What is the peak flow in severe asthma?
33-50%
What is the peak flow in moderate asthma?
50-75%
