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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are complications of otitis media?

A 
Mastoiditis
Meningitis
Labyrinthitis
Cholesteatoma - after recurrent or persistent infection
Brain abscess
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2
Q

How is acute otitis media treated?

A

Regular analgesic rather than PRN - 1 week

Prescription for amoxicillin to be used if still in pain after 2/3 days

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3
Q

How is glue ear diagnosed?

A

Tympanogram - flat

Conductive hearing loss

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4
Q

What causes tonsillitis?

A

Group A beta-haemolytic streptococci

EBV (mononucleosis)

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5
Q

What symptoms are more common in bacterial tonsillitis?

A 
Headache
Apathy
Abdo pain
White tonsillar exudate
Cervical lymphadenopathy
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6
Q

How is tonsillitis treated?

A

Penicillin/erythromycin
May lead to scarlet fever so given 10 days
Amoxicillin -> widespread maculopapular rash if mono

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7
Q

What is croup?

A

Mucosal inflammation
Increased secretions
Oedema of subglottic region

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8
Q

What causes croup?

A

Parainfluenza virus
Human metapneumovirus
RSV
Influenza

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9
Q

What are the clinical features of croup?

A 
Onset around 2yo
Common in Autumn
Previous coryza and fever
Barking cough
Harsh voice
Stridor
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10
Q

How is croup treated?

A 
Oral dexamethasone and prednisolone
Neb budesonide (steroids)

Neb adrenaline with oxygen

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11
Q

What are differential diagnosis for upper airway obstruction?

A 
Viral laryngotracheobronchitis (croup)
Epiglottitis
Bacterial tracheitis
Smoke inhalation
Retropharyngeal abscess
Anaphylaxis
Measles
Diptheria
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12
Q

What is bacterial tracheitis?

A

Pseudomembranous croup
Croup features + fever, toxic, thick airway secretions

IV Abx, intubation

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13
Q

What is pertussis and what are the phases?

A

Whooping cough, endemic every 3-4 years
One week of coryza (catarrhal phase)
Paroxysmal/spasmodic cough (red/blue face with mucus from nose)then inspiratory whoop (paroxysmal phase)
Worse at night -> vomiting
Lasts 3-6 weeks
Symptoms decrease (convalescent phase) but may take months

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14
Q

What are complications of pertussis?

A

Pneumonia
Convulsions
Bronchiectasis

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15
Q

How is pertussis diagnosed and treated?

A

Per-nasal swab or PCR
Lymphocytosis

Erythromycin (prophylaxis for contacts)

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16
Q

How does immunisation affect the presentation of pertussis?

A

Reduces risk and severity but protection decreases throughout childhood

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17
Q

What causes acute otitis media?

A

Viruses - RSV, rhinovirus

Bacteria - pneumococcus, H. influenza, Moraxella catarrharia

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18
Q

What organisms cause pneumonia in newborns?

A
  • Organisms from mother’s GU tract
  • Group B streptococcus
  • Gram-negative enterococcus
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19
Q

What organisms cause pneumonia in infants?

A
  • Respiratory VIRUSES (RSV)
  • Streptococcus pneumonia
  • H. influenzae
  • Bordetella pertussis
  • Chlamydia trachomatis
  • Staph aureus
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20
Q

What causes pneumonia in children >5?

A

BACTERIA

  • Mycoplasma pneumonia
  • Streptococcus pneumonia
  • Chlamydia pneumonia
  • Mycobacterium tuberculosis
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21
Q

What are the clinical features of pneumonia?

A 
URTI -> fever and difficulty breathing
Cough
Lethargy
Poor feeding
Pain in chest/abdo/neck - pleural irritation due to bacterial infection

Chest hyperinflation and wheeze more suggestive of viral/mycoplasma infection
Inspiratory coarse crackles

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22
Q

How is pneumonia diagnosed?

A

CXR - pneumococcal pneumonia shows lobar consolidation
Nasopharyngeal aspirate - identifies viral cause
Ultrasound - differentiates parapneumonic effusion and empyema

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23
Q

How is pneumonia treated?

A 
Admission if low sats, tachypnoea
Oxygen and analgesia
Antibiotics - newborns have broad-spectrum IV
- oral amoxicillin then co-amoxiclav
- oral erythromycin
24
Q

What organisms cause URTI?

A

Rhinovirus
Coronavirus
RSV

25
Q

What organisms cause pharyngitis?

A

Adenovirus
Enterovirus
Rhinovirus
Group A beta-haemolytic Streptococcus (-> scarlet fever with strawberry tongue)

26
Q

How does TB present?

A

Asymptomatically - 50% of infants and 90% of older children
Symptomatically (fever, anorexia, weight loss, cough)
May become dormant but then reactivate and spread by lymphohaematological routes
-> local disease or military TB (bones, joints, kidneys, pericardium, CNS)
-> tuberculous meningitis

27
Q

How does TB spread?

A
  • tubercle bacilli is inhaled and spreads to regional lymph nodes
  • lung lesion + lymph nodes = Ghon/primary complex which heals and may calcify
  • inflammatory reaction -> local enlargement of peri-bronchial lymph nodes -> bronchial obstruction and lung collapse
  • local dissemination to other areas of lung
  • may involve gut, skin and superficial lymph nodes
28
Q

How is TB diagnosed?

A
  • gastric washing on 3 consecutive mornings to gain culture
  • assess antibiotic sensitivity
  • Mantoux test >10mm w/o BCG or >15mm w/ BCG
29
Q

How is TB treated?

A

Rifampicin - continued
Isoniazid - continued
Pyrazinamide - for 2 months
Ethambutol - for 2 months

After puberty give pyridoxine to prevent peripheral neuropathy from isoniazid

30
Q

What organisms cause bronchiolitis?

A

Respiratory syncytial virus

31
Q

What are causes of wheeze?

A

Transient and recurring - viral induced wheeze

Persistent and recurring - atopic asthma

32
Q

What are differential diagnoses of asthma?

A 
Pneumonia
CF
Bronchiolitis
Viral induced wheeze
Reflux
Recurrent anaphylaxis
Croup
Inhaled foreign body
Recurrent aspiration of feed
33
Q

How is asthma investigated?

A

Spirometry before and after bronchodilator

Should cause 10-15% increase

34
Q

How is asthma classified?

A

Moderate

  • SpO2 >92%
  • peak flow >50%

Severe

  • can’t complete sentences
  • RR >30-50/min
  • pulse >130/min
  • peak flow 33-50%

Life threatening

  • silent chest
  • cyanosis
  • SpO2 less than 92%
35
Q

How is an acute asthma attack treated?

A

OSHImT!!!

Oxygen
Salbutamol
Hydrocortisone (IV) or prednisolone (oral)
Ipratropium bromide
Magnesium, salbutamol, aminophylline (IV)
Intubation

36
Q

What dose of salbutamol is used in acute asthma?

A

10 puffs via spacer

5mg nebulised

37
Q

What dose of ipratropium bromide is used in acute asthma?

A

500 micrograms

38
Q

What is the stepwise management of asthma?

A

SABA
+ inhaled steroid/montelukast
+ LABA/montelukast/increase steroid/theophylline
+ refer to paeds paediatrician/increase steroid
+ oral prednisolone

39
Q

What age group does bronchiolitis affect?

A

2 months to 2 years

40
Q

What causes bronchiolitis?

A

RSV

RSV + metapneumovirus = SEVERE
Adenovirus can cause permanent airway damage

41
Q

How does bronchiolitis present?

A

Coryzal symptoms which lead to difficulty feeding

Sharp, wet cough
Chest hyperinflation
Fine end inspiratory crackles
Expiratory wheeze

42
Q

What age does croup affect?

A

6 months to 6 years

43
Q

What is primary ciliary dyskinesia?

A

Abnormality in function of cilia which leads to impaired mucociliary clearance

Recurrent infection of upper and lower respiratory tract -> bronchiectasis

44
Q

How does primary ciliary dyskinesia present?

A

Recurrent productive cough
Snotty nose
Chronic ear infections -> speech delay as unable to hear

Dextrocardia and situs invertus

45
Q

What is a vascular ring?

A

Aorta forms around trachea and oesophagus

Breathing and swallowing difficulties

46
Q

What does right shift on the oxygen dissociation curve result in?

A

Release of more oxygen to cells

Less affinity to oxygen

47
Q

What does left shift on the oxygen dissociation curve result in?

A

Less release of oxygen to cells

More affinity to oxygen

48
Q

Where does right shift on the oxygen dissociation curve occur?

A 
Muscle and placenta
Low pH (lactic acid)
High temp
High pCO2
DPG (2,3 BPG) - result of glycolysis (increased in pregnancy)
Increased altitude
49
Q

Where does oxygen dissociation curve shift to the left?

A 
Lungs
High pH
Low temp
Low pCO2
Fetal Hb
50
Q

What is lymphocytic interstitial pneumonitis?

A

Occurs in HIV and EBV
Lymphadenopathy, hepatosplenomegaly, clubbing
Responds to steroids
Can be insidious onset

51
Q

What are risk factors for RDS?

A 
Increased maternal age
C-section
Caucasian
Congenital diaphragmatic hernia
Gestational diabetes
Hypothermia
Intrapartum asphyxia
Mec aspiration
Genetic deficiency of surfactant producing cells (occurs in term babies)
52
Q

What cells produce surfactant?

A

Alveolar type II cells

53
Q
  • What is the function of surfactant?
A

Thin waterproof layer to reduce tension of alveolar

54
Q

How does RDS present?

A 
Tachypnoea
Increased WOB - recessions, 
Grunting (generates PEEP)
Nasal flare
Presents within 4-6hrs of birth
55
Q

What is the management of RDS?

A

Antenatal corticosteroids >24hrs before birth

CPAP rather than I+V (can cause pneumothorax)

56
Q

What is the dose of surfactant given?

A

5-200mg/kg - but give full vial

Paediatrics (14 decks)

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