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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What pathogen causes most resp infections in childhood?

A

Viruses

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2
Q

Which are the important viruses in resp infections? X6

A

RSV (respiratory syncytial virus), rhino viruses, parainfluenza, influenza, metapneumovirus and adenoviruses

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3
Q

Most important bacterial pathogens in resp infections x5

A

Streptococcus pneumoniae (pneumococcus), haemophilus influenzae, moraxella catarrhalis, bordetella pertussis (whooping cough), mycoplasma pneumoniae

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4
Q

Environmental risk factors for resp infection x3

A

Parental smoking - especially maternal, poor socio-economic status (overcrowding, large family, damp), poor nutrition

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5
Q

Host risk factors for resp infections x4

A

Underlying lung disease, male gender, haemodynamically significant congenital heart disease, immunodeficiency

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6
Q

Underlying lung disease which increase risk for resp infection x3

A

Bronchopulmonary dysplasia (preterm infants), cystic fibrosis or asthma

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7
Q

What is encompassed by URTI? X4

A

Common cold (coryza), sore throat (pharyngitis including tonsillitis), sinusitis

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8
Q

What can URTI cause in infants?

A

Poor feeding as blocked nose obstructs breathing
Febrile convulsions
Acute exacerbations of asthma

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9
Q

Classic features of common cold

A

Blocked nose and clear/mucopurulent nasal discharge

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10
Q

Commonest pathogenic causes of common cold

A

Viruses - rhinoviruses, corona viruses, RSV

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11
Q

Treatment of common cold

A

Self-limiting and no curative treatment

Fever and pain - treat with paracetamol and ibuprofen

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12
Q

What is pharyngitis?

A

Inflammation of pharynx and soft palate

Local lymph nodes enlarged and tender

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13
Q

What usually causes sore throat/pharyngitis? And in older children

A

Viruses - adenoviruses, enteroviruses and rhinoviruses

In older children group a b-haemolytic streptococcus

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14
Q

Common pathogens for tonsillitis?

A

Group a b-haemolytic strep and EBV

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15
Q

How do you tell between viral and bacterial tonsillitis

A

Clinically you can’t!
EBV exudate meant to be more membranous
Bacterial may have more constitutional disturbance (headache, apathy and abdominal pain, white exudate and cervical lymphadenopathy)

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16
Q

What is treatment for pharyngitis and tonsillitis - how long?

A

If severe often antibiotics even though only 1/3 are bacterial
To eradicate organism (b-haem strep) and prevent rheumatic fever need 10days of treatment

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17
Q

What antibiotic should be used in pharyngitis/tonsillitis and what should be avoided?

A

Penicillin and erythromycin (if penicillin allergy) usually used
Avoid amoxicillin because can cause maculopapular rash if due to EBV

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18
Q

When is acute otitis media most common?

A

6-12months

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19
Q

Symptoms and signs of acute otitis media?

A

Pain in ear and fever
Tympanic membrane bright red and bulging - loss of normal light reflection
May be visible pus if perforation of eardrum

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20
Q

Pathogens of acute otitis media

A

Viruses especially RSV and rhinovirus

Bacterial include pneumococcus, h.influenzae and moraxella catarrhalis

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21
Q

Serious complications of acute otitis media

A

Mastoiditis and meningitis

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22
Q

Treatment of acute otitis media

A

Paracetamol or ibuprofen for pain - constant rather than as required - more effective - may be needed for up to a week

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23
Q

Significance of antibiotics in acute otitis media

A

Shown to reduce the duration of pain but not affect risk of hearing loss - if no improvement after 4 days - give 5days of amoxicillin (erytho/clarithro if pen allergic)
Don’t wait for 4days if bilateral AOM or perforation in children

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24
Q

What can recurrent ear infections lead to?

A

Otitis media with effusion

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25
Q

Symptoms and signs of otitis media with effusion

A

Children asymptomatic apart from possible decreased hearing

Eardrum is retracted and dull and can often see a fluid level

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26
Q

Diagnosis of otitis media with effusion

A

Flat trace on tympanometry
Conductive hearing loss on pure tone audiometry (if >4) or reduced hearing on distraction hearing test in younger children

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27
Q

When is otitis media with effusion common

A

Age 2-7

Peak incidence 2.5-5

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28
Q

Treatment of otitis media with effusion

A

No evidence for benefit of long term antibiotics, steroids or decongestants
Condition usually resolves spontaneously
If affecting hearing - grommet insertion

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29
Q

What surgery can be useful for otitis media with effusion

A

Adenoidectomy because believed adenoids can harbour organisms contributing to infection spreading up Eustachian tubes
Also hypertrophied adenoids can obstruct and affect function of Eustachian tubes - poor ventilation of Middle ear

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30
Q

Another name for otitis media with effusion

A

Glue ear

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31
Q

When does sinusitis occur

A

Infection of para nasal sinuses with viral URTIs

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32
Q

What can occur with sinusitis and symptoms?

A

Secondary bacterial infection

Pain, swelling and tenderness over cheek from infection of maxillary sinus

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33
Q

What sinuses not usually affected in childhood sinusitis

A

Frontal sinuses because they do not develop until late childhood

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34
Q

Treatment for sinusitis

A

Reassure that >95% are viruses and can take 2.5 weeks to get better
Analgesia, intranasal steroids and decongestants, saline irrigation, warm face packs
but if bacterial suspected then antibiotics

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35
Q

Treatment for bacterial sinusitis

A

But if bacterial suspected (purulent discharge, severe pain, temp >38, worsening after initial being okay) then give antibiotics
Amox 7 days, or phenoxymethylpenicillin 7 days (pen allergic doxy (not children) erythro or clarithro)

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36
Q

Growth of tonsils and adenoids in childhood

A

Large in childhood and then gradually regress

If too large can cause trouble such as obstruction of airways (adenoids) and therefore be indication for removal

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37
Q

Number of resp infections in preschool children per year

A

6-8

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38
Q

Most common laryngeal/tracheal infection (acute upper airway obstruction)

A

Croup - viral laryngotracheobronchitis

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39
Q

What are symptoms and signs of acute upper airway obstruction x6

A

Stridor (rasping sound heard on inspiration)
Hoarseness (inflammation of vocal cords)
Barking cough
Dyspnoea
Tachypnoea (severe)
Tachycardia (severe)

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40
Q

How can you assess severity of upper airway obstruction

A

Degree of chest retraction (none, only on crying, at rest)

Degree of stridor (none, only on crying, at rest or biphasic)

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41
Q

What is pathology of croup x3

A

Mucosal inflammation and increased secretions

Oedema of subglottic area - most dangerous factor as causes critical tracheal narrowing

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42
Q

Pathogenic cause of croup

A

Viruses 95% including metapneumovirus, RSV, influenza

Most common is parainfluenza virus

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43
Q

Peak incidence of croup

A

Occurs from 6months-6 years but peak is in 2nd year of life

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44
Q

What season is croup most common

A

Autumn

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45
Q

Typical features of croup x6

A

Barking cough, harsh stridor and hoarseness
Usually preceded by fever and coryza
Symptoms often start and are worse at night

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46
Q

Treatment of croup

A

Oral Dexamethasone, prednisolone or neb budesonide

one dose - repeat next day if not better

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47
Q

Treatment of severe upper airway obstruction

A

Neb adrenaline - needs careful monitoring because risk of rebound symptoms 2hours after adrenaline when effects wear off

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48
Q

What is bacterial tracheitis?

A

Pseudomembranous croup
Rare but dangerous
Similar to viral croup but high fever, toxic and rapidly progressive obstruction with thick airway secretions

49
Q

What causes bacterial tracheitis?

A

Staph aureus - treated with IV antibiotics

50
Q

What is epiglottis and incidence?

A

Life threatening emergency caused by h.influenza type b - now massively reduced due to immunisation in infancy
Swelling of epiglottis and surrounding tissues

51
Q

What complicates epiglottis?

A

Septicaemia

52
Q

What age group is epiglottis common in?

A

Children 1-6

But can occur in all ages

53
Q

Differences of presentation between croup and epiglottis

A

Epiglottis onset over hours without preceding coryza - no cough, can’t drink or swallow so drooling saliva. They appear very toxic and ill with high fever. Have soft whispering stridor not harsh and muffled voice rather than hoarse

54
Q

Appearance of child with epiglottis

A

Sitting upright with open mouth to optimise airway

55
Q

Treatment of epiglottis

A

Intubated with general anaesthetic (24hours)
Blood for culture
IV antibiotics such as cefuroxime (3-5days)

56
Q

What should be done for contacts of epiglottis patients

A

As with all serious h.influenzae infections - prophylaxis with rifampicin

57
Q

Presentation of bronchitis in childhood

A

Cough and fever are main symptoms (not usually wheeze presentation)
Cough may persist for 2 weeks

58
Q

What is whooping cough

A

Highly contagious infection caused by bordetella pertussis

59
Q

Incidence of whooping cough

A

Epidemic - occurring every 3-4 years

60
Q

Presentation of whooping cough

A

1) catarrhal phase - week of coryza

2) paroxysmal phase - spasmodic cough followed by inspiratory whoop (3-6weeks)

61
Q

What can occur as a result of the cough in whooping cough

A

Often worse at night - may lead to vomiting
May also get epistaxis and subconjunctival haemorrhages if vigorous coughing
Red/blue in face during coughing and mucus flows from nose and mouth

62
Q

Uncommon complications of whooping cough x3

A

Pneumonia
Convulsions
Bronchiectasis

63
Q

Blood count in whooping cough

A

Typically lymphocytosis >15 x 10(9)

64
Q

Treatment of whooping cough and its effect

A

Started within 21days of cough onset
under 1m clarithro
>1m azithro or clarithro

65
Q

Contact treatment with whooping cough

A

Prophylaxis in close contact and vaccination of any unvaccinated infant contacts
same unless pregnant in which case erythro

66
Q

Most common age for bronchiolitis

A

90% are 1-9months

Rare after age 1

67
Q

Pathogen in bronchiolitis

A

RSV in 80%

Also other viruses and mycoplasma pneumoniae

68
Q

Symptoms of bronchiolitis

A

Coryzal symptoms precede:
Dry cough, increasing dyspnoea and difficulty feeding
Cyanosis, pallor, hyperinflation, SDL

69
Q

Auscultation in bronchiolitis x2

A

Fine end-inspiratory crackles

High pitched wheeze (exp>insp)

70
Q

Chest X-ray in bronchiolitis

A

Hyperinflation due to air trapping following small airway obstruction

71
Q

Management of bronchiolitis

A

Humidified oxygen

Antibiotics, steroids and bronchodilators not shown to reduce severity or duration of illness

72
Q

Prognosis of bronchiolitis

A

Most recover within 2 weeks

Adenovirus can have permanent damage to airways - bronchiolitis obliterans

73
Q

What is palivizumab?

A

Monoclonal antibody to RSV given to high risk preterm infants

74
Q

Pathogenic cause of pneumonia

A

50% cause not found

Can be viral or bacteria (viral more common in younger children and bacterial in older)

75
Q

Most common pathogen in newborn pneumonia

A

Group b strep

76
Q

Clinical features of pneumonia - most common presentation

A

Fever and difficulty breathing

Usually preceded by URTI

77
Q

Other symptoms of pneumonia - including indication of bacterial infection

A

Cough, lethargy, poor feeding

Localised pain may suggest pleural irritation and therefore bacterial infection

78
Q

Signs of pneumonia

A

SDL - tachypnoea, nasal flaring, chest indrawing

79
Q

Auscultation in pneumonia

A

End inspiratory resp coarse crackles over affected area

Classical signs of consolidation (dullness on percussion, reduced air entry and bronchial breathing) not usually present

80
Q

Management of pneumonia x4

A

Oxygen for hypoxia
Analgesia if pain
IV fluids if dehydrated
Antibiotics depending on age

81
Q

Antibiotics in newborn with pneumonia

A

Broad spectrum - amox

82
Q

Antibiotics in older infants with pneumonia

A

Oral amoxicillin
Broad spectrum eg co-amoxiclav for complicated or unresponsive
Can add in macrolides (azithro etc) if not responding

83
Q

%of children affected by asthma

A

15-20

84
Q

Two patterns of wheezing in children- indications of asthma

A

Transient early wheezing

Persistent and recurrent wheezing

85
Q

What is transient early wheezing?

A

Virus associated wheeze or episodic viral wheeze
Due to small airways being more likely to narrow and obstruction due to inflammation from viral infection
Hence episodically triggered by viral infections

86
Q

Risk factors for transient early wheezing x5

A

Decreased lung function from birth due to small airway diameter
Maternal smoking during and or after pregnancy
Preterm
Family hx of atopy not a risk factor
More common in males

87
Q

When does transient early wheezing resolve

A

Age 5

88
Q

What is persistent and recurrent wheezing

A

Wheezing due to IgE hypersensitivity - aka asthma

89
Q

3 main pathological features of asthma

A

Bronchial inflammation, bronchial hyperresponsiveness and airway narrowing

90
Q

What triggers most asthma exacerbations

A

Rhinovirus infection

91
Q

Signs of long standing asthma x3

A

Hyperinflation
Generalised polyphonic wheeze
Prolonged expiratory phase

92
Q

Indications of another cause of wheeze (not asthma) x3 and what do they indicate?

A

Wet cough or sputum production
Finger clubbing
Poor growth
Indicate chronic infection such as cystic fibrosis or bronchiectasis

93
Q

Ladder of treatment of asthma in infant >5

A 
Short acting inhaled bronchodilator 
Inhaled steroids ( 3 or more b2 needed per week) 
Long acting b2 
Increase steroid dose 
Oral steroids
94
Q

Other than b2 and steroids for asthma what can be added and when?

A

Leukotriene receptor antagonist or theophyllines - if no response to LABA

95
Q

Asthma ladder in less than 5 years old

A

Ipratropium bromide + SABA
Inhaled steroids or oral leukotriene r-antagonist (montelukast, zafirlukast) if inhalers not tolerated
LABA
refer to resp paediatrician

96
Q

What is good for exercise induced asthma

A

LABA + inhaled steroid

97
Q

Signs of severity in acute asthma attack

A

If less than 5 - RR > 50 (not as good as HR) or HR >130
If older than 5 RR >30 or HR >120
Accessory muscle use and chest recession
Pulsus paradoxus
Can’t talk

98
Q

Signs of life threatening asthma

A

Cyanosis fatigue, drowsiness and silent chest

99
Q

What is good in treating acute asthma

A

Ipratropium bromide

Steroids - IV if severe

100
Q

Most common cause of recurrent cough in children

A

1) URTI - common cold
2) Asthma
3) Wet - cystic fibrosis
4) GORD
5) Parents smoking

101
Q

Chronic wet cough is indicative of…

A

Chronic lung infection eg. Bronchiectasis due to cystic fibrosis, primary ciliary dyskinesia, immunodeficiency or chronic aspiration

102
Q

What is Kartagener syndrome?

A

Situs inversus
Dextrocardia
Primary ciliary dyskinesia (recurrent productive cough, purulent nasal discharge, chronic ear infections)

103
Q

Who has chronic aspiration

A

Children with neurodisability

104
Q

Incidence of cystic fibrosis

A

1 in 2500 live births

Carrier rate 1 in 25

105
Q

Correlation between genotype and phenotype in CF

A

Weak for lung disease but stronger for GI disease

Indicates that environmental factors influence lung disease (passive smoking, social deprivation, microbial pathogens)

106
Q

Pathogen usually causing infection in CF

A

Pseudomonas aeruginosa

107
Q

Incidence of meconium ileus in infants with CF

A

10-20%

108
Q

Other organ affected in CF

A

Pancreas - pancreatic enzyme deficiency leads to malabsorption
Also sweat glands - increased sodium and chloride in sweat

109
Q

Presentation of CF if not picked up at heel-prick screening x3

A

Recurrent chest infections, poor growth and malabsorption

110
Q

Examination (resp) in CF

A

Hyperinflation (air trapping), coarse inspiratory creps and/or expiratory wheeze
Established disease - clubbing

111
Q

Disease in older CF children

A

DM due to pancreatic dysfunction

112
Q

Diagnosis of CF

A

Sweat test
Cl 60-120 (10-40normal)
Stimulated by pilocarpine iontophoresis

113
Q

Drugs in CF

A

Prophylactic antibiotics - usually flucloxacillin
Nebulised DNAse or hypertonic saline to decrease sputum viscosity
Macrolide antibiotic azithromycin - immunomodulatory not antibiotic action

114
Q

Eventual treatment for CF lung disease

A

Lung transplant
Fortunately not needed in childhood
Usually 50% 10 year survival rate

115
Q

Diet in CF

A

High calorie 150% of normal

Fat soluble vitamin supplements

116
Q

Organ problems in older patients with CF

A

1/3 have evidence of liver disease - hepatomegaly or LFT abnormalities

117
Q

Fertility in CF

A

Females normal

Males always infertile due to absent vas deferens (have sperm therefore can have kids with ICSI)

118
Q

What is Guthrie test

A

Heel prick test for CF for all children

Paediatrics (16 decks)

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