Respiratory Flashcards
What are complications of otitis media?
Mastoiditis Meningitis Labyrinthitis Cholesteatoma - after recurrent or persistent infection Brain abscess
How is acute otitis media treated?
Regular analgesic rather than PRN - 1 week
Prescription for amoxicillin to be used if still in pain after 2/3 days
How is glue ear diagnosed?
Tympanogram - flat
Conductive hearing loss
What causes tonsillitis?
Group A beta-haemolytic streptococci
EBV (mononucleosis)
What symptoms are more common in bacterial tonsillitis?
Headache Apathy Abdo pain White tonsillar exudate Cervical lymphadenopathy
How is tonsillitis treated?
Penicillin/erythromycin
May lead to scarlet fever so given 10 days
Amoxicillin -> widespread maculopapular rash if mono
What is croup?
Mucosal inflammation
Increased secretions
Oedema of subglottic region
What causes croup?
Parainfluenza virus
Human metapneumovirus
RSV
Influenza
What are the clinical features of croup?
Onset around 2yo Common in Autumn Previous coryza and fever Barking cough Harsh voice Stridor
How is croup treated?
Oral dexamethasone and prednisolone Neb budesonide (steroids)
Neb adrenaline with oxygen
What are differential diagnosis for upper airway obstruction?
Viral laryngotracheobronchitis (croup) Epiglottitis Bacterial tracheitis Smoke inhalation Retropharyngeal abscess Anaphylaxis Measles Diptheria
What is bacterial tracheitis?
Pseudomembranous croup
Croup features + fever, toxic, thick airway secretions
IV Abx, intubation
What is pertussis and what are the phases?
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
What are complications of pertussis?
Pneumonia
Convulsions
Bronchiectasis
How is pertussis diagnosed and treated?
Per-nasal swab or PCR
Lymphocytosis
Erythromycin (prophylaxis for contacts)
How does immunisation affect the presentation of pertussis?
Reduces risk and severity but protection decreases throughout childhood
What causes acute otitis media?
Viruses - RSV, rhinovirus
Bacteria - pneumococcus, H. influenza, Moraxella catarrharia
What organisms cause pneumonia in newborns?
- Organisms from mother’s GU tract
- Group B streptococcus
- Gram-negative enterococcus
What organisms cause pneumonia in infants?
- Respiratory VIRUSES (RSV)
- Streptococcus pneumonia
- H. influenzae
- Bordetella pertussis
- Chlamydia trachomatis
- Staph aureus
What causes pneumonia in children >5?
BACTERIA
- Mycoplasma pneumonia
- Streptococcus pneumonia
- Chlamydia pneumonia
- Mycobacterium tuberculosis
What are the clinical features of pneumonia?
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
How is pneumonia diagnosed?
CXR - pneumococcal pneumonia shows lobar consolidation
Nasopharyngeal aspirate - identifies viral cause
Ultrasound - differentiates parapneumonic effusion and empyema
How is pneumonia treated?
Admission if low sats, tachypnoea Oxygen and analgesia Antibiotics - newborns have broad-spectrum IV - oral amoxicillin then co-amoxiclav - oral erythromycin
What organisms cause URTI?
Rhinovirus
Coronavirus
RSV
What organisms cause pharyngitis?
Adenovirus
Enterovirus
Rhinovirus
Group A beta-haemolytic Streptococcus (-> scarlet fever with strawberry tongue)
How does TB present?
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
How does TB spread?
- 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
How is TB diagnosed?
- gastric washing on 3 consecutive mornings to gain culture
- assess antibiotic sensitivity
- Mantoux test >10mm w/o BCG or >15mm w/ BCG
How is TB treated?
Rifampicin - continued
Isoniazid - continued
Pyrazinamide - for 2 months
Ethambutol - for 2 months
After puberty give pyridoxine to prevent peripheral neuropathy from isoniazid
What organisms cause bronchiolitis?
Respiratory syncytial virus
What are causes of wheeze?
Transient and recurring - viral induced wheeze
Persistent and recurring - atopic asthma
What are differential diagnoses of asthma?
Pneumonia CF Bronchiolitis Viral induced wheeze Reflux Recurrent anaphylaxis Croup Inhaled foreign body Recurrent aspiration of feed
How is asthma investigated?
Spirometry before and after bronchodilator
Should cause 10-15% increase
How is asthma classified?
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%
How is an acute asthma attack treated?
OSHImT!!!
Oxygen
Salbutamol
Hydrocortisone (IV) or prednisolone (oral)
Ipratropium bromide
Magnesium, salbutamol, aminophylline (IV)
Intubation
What dose of salbutamol is used in acute asthma?
10 puffs via spacer
5mg nebulised
What dose of ipratropium bromide is used in acute asthma?
500 micrograms
What is the stepwise management of asthma?
SABA
+ inhaled steroid/montelukast
+ LABA/montelukast/increase steroid/theophylline
+ refer to paeds paediatrician/increase steroid
+ oral prednisolone
What age group does bronchiolitis affect?
2 months to 2 years
What causes bronchiolitis?
RSV
RSV + metapneumovirus = SEVERE
Adenovirus can cause permanent airway damage
How does bronchiolitis present?
Coryzal symptoms which lead to difficulty feeding
Sharp, wet cough
Chest hyperinflation
Fine end inspiratory crackles
Expiratory wheeze
What age does croup affect?
6 months to 6 years
What is primary ciliary dyskinesia?
Abnormality in function of cilia which leads to impaired mucociliary clearance
Recurrent infection of upper and lower respiratory tract -> bronchiectasis
How does primary ciliary dyskinesia present?
Recurrent productive cough
Snotty nose
Chronic ear infections -> speech delay as unable to hear
Dextrocardia and situs invertus
What is a vascular ring?
Aorta forms around trachea and oesophagus
Breathing and swallowing difficulties
What does right shift on the oxygen dissociation curve result in?
Release of more oxygen to cells
Less affinity to oxygen
What does left shift on the oxygen dissociation curve result in?
Less release of oxygen to cells
More affinity to oxygen
Where does right shift on the oxygen dissociation curve occur?
Muscle and placenta Low pH (lactic acid) High temp High pCO2 DPG (2,3 BPG) - result of glycolysis (increased in pregnancy) Increased altitude
Where does oxygen dissociation curve shift to the left?
Lungs High pH Low temp Low pCO2 Fetal Hb
What is lymphocytic interstitial pneumonitis?
Occurs in HIV and EBV
Lymphadenopathy, hepatosplenomegaly, clubbing
Responds to steroids
Can be insidious onset
What are risk factors for RDS?
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)
What cells produce surfactant?
Alveolar type II cells
- What is the function of surfactant?
Thin waterproof layer to reduce tension of alveolar
How does RDS present?
Tachypnoea Increased WOB - recessions, Grunting (generates PEEP) Nasal flare Presents within 4-6hrs of birth
What is the management of RDS?
Antenatal corticosteroids >24hrs before birth
CPAP rather than I+V (can cause pneumothorax)
What is the dose of surfactant given?
5-200mg/kg - but give full vial
