Respiratory Flashcards
what are some congenital respiratory disorders that can present with cyanosis hours after birth
pulmonary hypoplasia persistant pulmonary hypertension of the newborn surfactant deficiency meconium aspiration diaphragmatic hernia
most common organisms to cause pneumonia in a neonate
group B strep
gram negative enteric bacteria
classic age for croup
2 years
Range - 6months-6years
describe the childhood presentation of CF
- suppurative lung disease
- recurrent chest infections
- nasal polyps
- haemoptysis
- DIOS
- rectal prolapse
- multifocal biliary cirrhosis
describe the neonatal presentation of CF
- meconium ileus
- prolonged jaundice
- antenatal bowel perforation
treatment of critical asthma
- oxygen
- continuous ventolin
- nebulised atrovent
- methyl prednisolone
- consider aminophylline and MgSO4
- consider intubation/BiPAP/CPAP
most common organisms to cause pneumonia in a pre-schoooler
respiratory viruses
non typeable haemophilus influenzae
stepwise approach to asthma management
- SABA
- SABA + low dose ICS
- SABA + high dose ICS OR low dose ICS + LABA
- SABA + high dose ICS + LABA
genetics of CF
autosomal recessive condition
Defect in CFTR gene on chromosome 7 - codes for apical chloride channel on epithelial and mucosal surfaces
when should you admit a baby with bronchiolitis
- underlying comorbidities such as CHD
- requiring supplemental oxygen
- poor feeding
- episodes of apnoeas/cyanosis
- moderate-severe respiratory distress
how many hours does a child have to be wheeze free after ventolin before they can be discharged
3-4 hours
how many puffs of ventolin do you give a child with an asthma attack
- 6 years = 12 puffs, 4 breaths
epidemiology of CF affected and carriers
1: 2500 - affected
1: 25 - carriers
which signs of Xray are specific for bronchiectasis
- tram tracking (parallel narrow lines radiating form the hilum)
- cystic spaces
- honeycomb like structures
clinical presentation of subglottic stenosis
biphasic stridor
clinical features of laryngomalacia
noising breathing when crying or upset but absent when settled or sleeping
treatment of protracted bacterial bronchitis
prolonged (4 weeks) of oral antibiotics
treatment of laryngomalacia
self resolving - usually by 12 months
what causes croup
viral mucosal inflammation of the upper airway, larynx, trachea and bronchi
AB for severe pneumonia in a child >3 months
flucloxacillin + 3rd gen cephalosporin
describe the infant presentation of CF
- pancreatic insufficiency causing steatorrhoea and FTT
- anaemia, hypoporteinaemia
- hyponatraemia, hypochloraemia, metabolic alkalosis
what is protracted bacterial bronchitis
persistent infection of the conducting airways
most common organisms to cause pneumonia in an older child
strep pneumo
mycoplasma pneumoniae
chlamydia pneumoniae
which signs of HRCT are specific for bronchiecatsis
dilated bronchi with thickened walls where diameter of bronchus > diameter of accompanying artery
treatment of severe asthma
- oxygen
- 6-12 puffs of ventolin MDI with spacer 3 times in first hour
- 2 or 4 puffs of atrovent 3 times in first hour
- oral prednisolone
- admission to hospital
treatment of moderate asthma
- 6-12 puffs of ventolin MDI with spaces 3 times in first hour
- oral prednisolone
- observe for at least 1 hour
which organism most frequently causes empyema in childhood
strep pneumo
peak severity of bronchiolitis is typically which day
day 2-3
describe how sweat testing for CF works
use pilocarpine and electrodes to induce sweating on the arm - measure the concentration of chloride that is excreted in sweat
risk factors for severity of bronchiolitis
- less than 6 weeks
- ex prem
- CHD
- neurological conditions
- chronic respiratory illness
- PHTN
what does the CF mutation cause (at a cell level)
causes abnormalities in the transport of chloride across epithelial and mucosal surfaces causing a relative dehydration of airway secretions causing impaired mucociliary transport and airway obstruction. Also causes abnormal pancreatic enzymes
definition of bronchiectasis
abnormal and irreversible dilatation of the bronchi
most common viral cause of bronchiolitis
RSV
management of mild pneumonia in a child >3 months
oral amoxycillin for 7 days
principles of management of croup
MINIMAL HANDLING
- mild-moderate: prednisolone
- severe: nebulised adrenaline and IM/IV dexamethasone
2 causes of nasal polypa
CF
allergy
clinical presentation of primary ciliary dyskinesia
- sinusitis/rhinitis
- chronic suppurative lung disease
- otitis media
- male infertility
- dextrocardia in 50%
clinical features of croup
- barking cough
- inspiratory stridor
- increased WOB
- peaks at night 2-3
when should you tell your patient to go to hospital with asthma
if you need more than one set of 6/12 puffs in an hour or more than 3 times in a day
3 causes of gum hypertrophy
drugs
leukaemia
gingivitis
describe the pathogenesis of protracted bacterial bronchitis
predisposing viral infection –> impaired mucociliary clearance –> infection of bronchi with bacteria –> biofilm formation
AB for moderate pneumonia in a child that suggests mycoplasma pneumoniae
oral roxithromycin for 10 days
describe the newborn screening of CF
heel prick on day 2-4 of life - measures serum trypsinogen
- those levels above 99th percentile –> gene mutation testing
- 2 mutations –> CF clinic
- 1 mutation –> sweat testing
what is primary ciliary dyskinesia
genetic condition that causes ultrastructural and function defects of the cilia leading to impaired mucociliary clearance
which organism in particulary is associated with deterioration in LF of a CF patient
pseudomonas aeruginosa
treatment of mild asthma
6-12 puffs of ventolin MDI with spacer
