Respiratory Flashcards
What complications can occur in a child with an urti? (2)
Feeding problems due to nose breathing
Febrile convulsions
Acute exacerbation of asthma
What is the main cause of childhood respiratory infections? (1)
Give two examples. (2)
80-90% viral RSV Rhinovirus Para influenza Influenza
What is the pathogen that causes tonsillitis?
2
EBV (2/3)
Group A b-haemolytic streptococcus (1/3) ie Strep pyogenes
Treat with phenoxymethylpenicillin, not amoxicillin which may cause rash.
Why are children more prone to acute otitis media infection? (3)
Eustachian tubes are shorter, horizontal and function poorly.
What is the treatment for acute otitis media? (2)
Most will resolve spontaneously.. Treat supportively.
Antibiotics can marginally shorten duration of pain, best to give post dated prescription to be used if not resolved within 3 days.
Amoxicillin best choice.
Decongestants and antihistamines not helpful.
What complication can repeated otitis media cause? (1)
What form of hearing loss may it cause? (1)
How might it be treated long term? (1)
Glue ear aka otitis media with effusion.
Most common cause of conductive hearing loss in children, usually otherwise asymptomatic. Can affect speech development and school achievements.
Can be treat with grommets to ventilate middle ear also possibly adenoidectomy.
What are the indications for tonsillectomy? (3)
Recurrent severe tonsillitis (reduces episodes by a third) Peritonsillar abscess (quinsy) Obstructive sleep apnoea (adenoids also removed)
NOT large tonsils… They will shrink spontaneously in late childhood.
Causes of acute upper airways obstruction in a child? (3)
Common: croup
Rare: epiglottitis, foreign body, anaphylaxis, lymphadenopathy.
Name 4 signs of acute upper airways obstruction in a child. (4)
Stridor
Hoarseness - due to inflammation of the vocal cords
Barking cough
Dyspnoea - varying degrees
How should acute upper airways obstruction be assessed? (1)
Do not examine the throat.. Can make worse
Assess clinically by degree of chest retraction and degree of stridor.
Central cyanosis and drowsiness indicate severe hypoxaemia and need for urgent intervention.
What is the main cause of croup? (1)
95% is viral.
Mainly parainfluenza but also RSV and influenza.
What age group is affected by croup? (1)
6 months to 6 years old, but peak incidence in 2nd year of life.
What are the symptoms of croup? (1)
What time of day are symptoms worse? (1)
Fever and coryza followed by barking cough, harsh stridor and hoarseness. Symptoms worse at night.
What is the management of croup? (Split into mild and severe) (2)
Mild ie stridor and recession disappear at rest.
Treat at home
Observe for signs of increasing severity.
Oral dexamethasone or prednisolone reduce severity and duration
Severe
Nebulised adrenaline with oxygen provides transient improvement
Closely monitor with advice from anaethestist re rebound symptoms once adrenaline effects have worn off.
What is acute epiglottitis? (2)
Medical emergency.
High risk of respiratory obstruction caused by haemophilis influenza type B (bacteria)
Intense swelling of epiglottis and surrounding area associated septicaemia.
Give 3 ways to differentiate between acute epiglottitis and croup? (4)
Onset: E- sudden C- over days
Preceding coryza: E- no. C- yes
Cough: E - absent. C- severe, barking
Able to drink: E- no. C- yes
Drooling: E- yes. C- no
Fever: E- >38.5 C- <38.5c
What is the immediate management of epiglottitis? (2)
Intubation and general anaesthetic
Then blood cultures and IV cefuroxime
What is the infective cause of whooping cough? (1)
Bordetella pertussis (bacteria)
What are the symptoms of whooping cough? (3)
Clue: 3 phases
A week of coryza, (catarrhal phase)
Characteristic cough followed by characteristic inspiratory whoop. (Paroxysmal phase) lasts 3-6 weeks
Cough worse at night and may result in vomiting.
During a paroxysm child may go red or blue and may get epistaxis or subconjunctival haemorrhages.
Symptoms may decrease (convalescent phase) but may persist for months.
Name 2 complications of pertussis? (2)
Pneumonia, convulsions and bronchiectasis. All uncommon.
What age group are affected by bronchiolitis? (1)
Under 1 year. Mainly 1 month to 9 months.
What is the main infective cause of bronchiolitis? (1)
Respiratory synctial virus
What are the clinical features of bronchiolitis? (2)
Prodrome of coryzal symptoms
Dry cough and increasing breathlessness. (Feeding difficulty)
Define asthma. (3)
Chronic inflammatory airways disease characterised by variable reversible airways obstruction, airway hyperesponsiveness and bronchial inflammation.
15 month old child comes into A&E with acute SOB.
Name 3 differentials you would consider. (3)
Asthma Pneumonia Bronchiolitis Anaphylaxis Aspiration
What symptoms of asthma would you expect in a child. (2)
Persistent or recurrent dry nocturnal cough
Wheezing during exercise or URTIs
From what age is peak flow useful for? (1)
5+
Name 4 signs you may find in a child during an acute exacerbation of asthma. (4)
End expiratory wheeze. I/C or s/c recession, or tracheal tug Tachypnoea Use of accessory muscles Hyperexpansion & hyperresonant percussion Diminished air entry
Name 4 signs of life threatening asthma in a child. (4)
Silent chest Poor respiratory effort Exhaustion Confusion Coma Cyanosis Hypotension Peak flow <33% predicted
Name the accessory muscles of breathing. (2)
Sternocleidomastoid and scalenes. (Main)
Also serratus anterior, latissimus dorsi, pectoralis major.
What are the main muscles used during normal inspiration. (2)
Diaphragm
Intercostals
Name 4 drugs used in acute management of asthma in children. (4)
Oxygen Salbutamol Ipratropium Prednisolone Aminophylline (2nd line) Magnesium sulphate (safe but role not yet established)
How would you establish severe acute asthma in a child? (2)
O2125 if over 5y. HR>140 if 2-5y
RR >30 if over 5y. HR>40 if 2-5y
What are the differentials of wheezing in a child under 2? (3)
Asthma
Bronchiolitis
Viral induced wheeze
What is the management of chronic asthma in a child <5y? (4)
Step 1 inhaled SABA
Step 2 ICS 200-400mcg
Step 3 leukotriene receptor antagonist
Step 4 SPECIALIST
What is the management of chronic asthma in a child age 5-12? (5)
Step 1 inhaled SABA
Step 2 ICS 200-400mcg
Step 3 LABA then assess control
Good response ... Continue
Benefit but not adequate control.. continue but inc ICS
No response... Stop LABA and increase ICS to 400mcg
Step 4 increase ICS to 800mcg OD
Step 5 oral prednisolone and SPECIALISTName 5 side effects of steroids in children. (5)
Growth retardation
Nausea
Weight gain
Behaviour changes eg mood swings and irritability
Weakened immune system no live vaccines
What is the infective cause of Whooping cough? (1)
Bordetella pertussis
Name four causes of chronic or persistent cough in a child.
4
Asthma Cigarette smoking (active or passive) Suppurative lung disease (eg CF) TB Inhaled foreign body Recurrent respiratory infections Habit cough
What is the incidence of CF in caucasians? (2)
What is the inheritance pattern of CF? (1)
1: 2500 live births
1: 25 carrier rate
Autosomal recessive
What is the gene/protein affected in CF? (2)
Cystic fibrosis transmembrane conductance regulator (CFTR) which is a cyclic AMP dependent chloride channel.
Gene is on chromosome 7
What is the pathophysiology of CF? (3)
Abnormal ion transport leads to reduction in airway surface liquid layer
=> Impaired ciliary function
=> Retention of mucopurluent secretions
=> Chronic endobronchial infection with specific organisms such as pseudomonas aeruginosa
Defective CFTR also causes dysregulation of inflammation and defence against infection.
Intestines produce thick viscid meconium
=> meconium ileus in 10-20% of infants
Pancreatic ducts also become blocked by viscid secretions
=> pancreatic enzyme deficiency
=> malabsorption
Abnormal function of sweat glands
=> excessive concentrations of sodium and chloride in sweat
CF is a multi system disease. What symptoms/signs might you expect? (8)
Lungs. Repeat chest infections. Bronchiectasis. Abscess formation.
Persistent productive chesty cough. Hyperinflation.
Coarse inspiratory crepitations. Finger clubbing.
Pancreas. Pancreatic insufficiency. Malabsorption. Steatorrhoea.
Failure to thrive.
Sweat. High sodium and chloride content in sweat.
Intestines. Meconium ileus in infants. Vomiting. Abdominal distension.
What organisms tend to cause infections in CF patients? (2)
Staphylococcus aureus
Haemophilus influenza
Pseudomonas aeruginosa
Burkholderia
How are most children with CF picked up? (1)
Screening with Guthrie heel prick.
What tests are used for diagnosis of CF? (2)
** Sweat test - confirm concentration of chloride in sweat is high
Genetic testing for abnormalities in CFTR gene. Homozygous with 2 mutations is cystic fibrosis.
Name 2 other healthcare professionals involved in care of a CF child? (2)
Paediatricians Specialist nurse Dietitians Physiotherapists GP Teachers Child and parents
What are the aims of management of CF? (2)
Prevent progression of lung disease
Maintain nutrition and growth.
What management is needed to maintain nutrition in children with CF? (2)
150% of caloric intake… often need gastromy to feed overnight
Pancreatic enzyme supplements with all meals and snacks.
Main aim of CF management is to reduce respiratory disease progression.
What symptoms will a well controlled CF child have? (1)
How is this done? (3)
No signs or symptoms may be present if well controlled.
From diagnosis children will have physio twice a day to remove secretions.
Physical exercise is beneficial and should be encouraged.
Prophylactic antibiotics for staph aureus (flucloxacillin)
Rescue antibiotics usually IV for decline in lung function.
Chronic pseudomonas infection treat with inhaled antibiotics
What are longer term complications associated with CF? (4)
Diabetes mellitus
Liver disease - hepatomegaly, abnormal LFTs and abnormal uss
Name the Centor criteria? (4)
What are they used for? (1)
History of fever, No cough, Tonsilar exudate, Tender lymphadenopathy
Modified criteria- +1 for age44.
To determine likelihood of a bacterial or viral cause of sore throat, so dictate management. Swab and culture if 2-3 points, 4+ give abx
Colic is idiopathic, presents with excessive crying mainly in the evening. What age does colic present? (1)
Less than 3 months
Name 5 differential of a cough in an 8 month old child. (5)
Bronchiolitis - wheeze in <1 Viral induced cough - coryzal symptoms Whooping cough - lymphocytosis, charcteristic whoop Foreign body inhalation - sudden onset Pneumonia - high fever, dyspnoea, creps TB - contact with TB, travel abroad Asthma - wheeze, FH Suppurative lung disease e.g. CF - productive cough Croup - barking
