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Respiratory Flashcards

1
Q

URTI- presentation

A

fever, painful throat, nasal discharge, earache

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2
Q

URTI- complications

A

difficulty in feeding, febrile convulsions, acute exacerbations of asthma

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3
Q

commonest pathogens in coryza

A

RSV, rhinovirus, coronavirus

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4
Q

tonsilitis pathogens

A

viruses or bacteria- group A b haemolytic strep, EBV

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5
Q

bacterial causes in tonsilitis shown by

A

constitutional symptoms- headache, apathy, abdominal pain, white tonsillar exudate, cervical lymphadenopathy

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6
Q

what do you treat tonsilitis with

A

penicillin or erythromycin. avoid amoxicillin as if EBV infection then will lead to maculopapular rash

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7
Q

indications for tonsillectomy

A

recurrent severe, Quinsy, obstructive sleep apnoea

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8
Q

why are infants prone to acute otitis media

A

short, horizontal Eustachian tubes which dont function well

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9
Q

what is seen on examination of tympanic membrane in acute otitis media

A

red bulging tympanic membrane, loss of normal light reflex

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10
Q

complications acute otitis media

A

mastoiditis and meningitis

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11
Q

what can be given to treat acute otitis media

A

amoxicillin

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12
Q

indications for adenoidectomy

A

recurrent otitis media with effusion with hearing loss, obstructive sleep apnoea

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13
Q

presentation of laryngeal/tracheal infection

A

stridor, hoarseness, barking cough, dyspnoea. chest recession, RR, HR, agitation. do not examine throat

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14
Q

most common pathogen in croup

A

parainfluenza. others- influenza, RSV

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15
Q

presentation croup

A

barking cough, hoarse. preceded by coryza. worse at night

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16
Q

treatment moderate croup

A

oral dexamethasone, prednisolone, nebulised steroids

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17
Q

treatment severe croup

A

neb adrenaline and warm humidified O2 via face mask

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18
Q

what happens in croup

A

laryngotracheobronchitis. mucosal inflammation and increased secretions. oedema of subglottic area is the dangerous part as leads to narrowing of trachea

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19
Q

what is bacterial tracheitis (pseudomembranous croup)

A

similar to croup but fever, appears toxic, copious secretions. caused by staph aureus, treat with IV antibios and intubate and ventilate

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20
Q

what is acute epiglottitis due to

A

H influenza type b

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21
Q

what happens to patient with epiglottitis

A

intubation with anaesthetic. then cefuroxime for 3-5 days

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22
Q

what prophylactic drug should be given to household contacts of pt with acute epiglottitis

A

rifampicin

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23
Q

difference between croup and acute epiglottitis

A

epiglottitis- more acute onset, no cough, soft insp stridor instead of harsh, no preceding coryza, high grade fever, not able to drink, drooling, toxic very ill appearance

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24
Q

what is whooping cough caused by

A

bordatella pertussis

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25
Q

phases of whooping cough

A

catarrhal phase (runny nose, coryza for a week), paroxysmal phase (coughing followed by whoop, can lead to vomiting- lasts 3-6 weeks), convalescent phase (symptoms decline, lasts months)

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26
Q

what happens in infants when whooping is absent

A

apnoea

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27
Q

treatment of whooping cough

A

erythromycin but given in catarrhal phase. prophylactic erythromycin to household contacts

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28
Q

what is the commonest serious respiratory infection

A

bronchiolitis

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29
Q

what age is common in bronchiolitis and what pathogen

A

1-9 months, rare after 1 year. RSV in 80%

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30
Q

features bronchiolitis

A

coryzal symptoms, dry cough, SOB, difficulty feeding, recurrent apnoea

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31
Q

those at risk of severe bronchiolitis

A

premature (bronchopulmonary dysplasia), underlying lung disease, congenital heart disease

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32
Q

signs in bronchiolitis

A

recession, tachypnoea, fine end inspiratory crackles, wheeze, tachycardia, cyanosis/pallor

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33
Q

investigations in bronchiolitis

A

PCR analysis of nasopharyngeal secretions, CXR- hyperinflated chest, atelactesis

34
Q

management in bronchiolitis- when to admit patient

A

supportive, humidified Ox. fluids assisted ventilation. admit if sats

35
Q

what is a rare complication of bronchiolitis

A

bronchiolitis obliterans- permanent damage to airways

36
Q

what 2 pathogens are the cause in severe bronchiolitis

A

RSV, metapneumovirus

37
Q

pathogens implicated in pneumonia in newborn

A

organisms from mothers genital tract- group B strep

38
Q

pathogens in pneum- infants and young children

A

RSV, strep pneum, H influenza, bordatella pertussis, chlamydia trachomatis

39
Q

pathogens in pneum- children >5 years

A

mycoplasma pneum, strep pneum, chlamydia pneum

40
Q

what does the conjugate vaccine in pneum work against

A

13 of most common serotypes of strep pneum

41
Q

features pneumonia

A

fever, difficulty breathing, preceded by URTI, cough, lethargy, poor feeding, unwell child

42
Q

signs of examination in child with pneumonia

A

nasal flaring, tachypnoea, chest indrawing, increased resp rate

43
Q

classic signs pneum

A

dullness to percuss, decreased breath sounds and bronchial breathing- over consolidation. may be missed in children

44
Q

what does CXR show in pneumonia

A

in strep pneum- lobar consolidation

45
Q

investigations pneumonia

A

nasopharygeal aspirate for viral

46
Q

complications of pneumonia

A

effusion, empyema,

47
Q

management pneumonia- indications for admission

48
Q

management pneumonia

A

oxygen, analgesia, IV fluids

49
Q

choice of antibiotic in pneumonia

A

newborn- broad spec IV antibiotics, older infant- oral amoxicillin, child >5 years- amoxicillin or erythromycin

50
Q

how are parapneumonic effusions managed in pneumonia

A

antibiotics but small proportion that develop empyema need drainage- chest drain with fibrinolytic agent (urokinase) or surgical decortication

51
Q

causes of childhood wheeze

A

transient early wheezing, atopic asthma (IgE mediated), non atopic asthma, recurrent aspiration of feeds, foreign body, CF

52
Q

what is the pathophysiology of asthma

A

bronchial inflammation (oedema, mucus, infiltration with cells), hyperresponsiveness, airway narrowing, symptoms

53
Q

symptoms of asthma

A

polyphonic wheeze, cough, SOB, chest tightness, symptoms worse at night and early in morning, symptoms that have triggers, interval symptoms, personal or family history, positive response to asthma therapy

54
Q

assessment of child with asthma

A

how freq are symptoms, what triggers the symptoms, how often is sleep affected, how severe are interval symptoms, how much school has been missed

55
Q

investigations in asthma

A

skin prick testing, CXR, PEFR- should be 10-15% improvement after bronchodilator

56
Q

what happens to PEFR if uncontrolled asthma

A

increased variability in peak flow diurnal and day to day variability

57
Q

what are SABAs

A

salbutamol, terbutaline

58
Q

what is ipratropium bromide

A

anticholinergic bronchodilator

59
Q

examples of inhaled corticosteroids

A

budesonide, beclametasone, fluticasone, mometasone

60
Q

examples of LABA and when should they be used

A

salmeterol, formoterol- should be used with inhaled corticosteroid

61
Q

what is montelukast

A

leukotriene inhibitor

62
Q

what are the 5 steps in asthma management

A

1- SABA; 2- add inhaled steroid; 3- >5 add LABA, 5 increase inhaled steroid dose; 4- add extra eg montelukast; 5- add oral steroids

63
Q

what age should you refer to paediatrician if asthma

64
Q

signs severe asthma attack

A

sats 50 >5 >30; pulse >130 2-5 or >120 >5; peak flow

65
Q

signs life threatening asthma attack

A

silent chest, poor resp effort, altered conciousness, cyanosis, sats

66
Q

signs TB

A

anorexia, low fever, failure to thrive, malaise. cough common but may be absent.

67
Q

diagnosis TB

A

tuberculin tests. culture + ziehl neelsen stain of sputa and gastric aspirate. CXR- consolidation, cavities

68
Q

treatment TB

A

isoniazid, rifampicin, pyrazinamide, ethambutol

69
Q

inheritance CF and carrier rates

A

autosomal recessive, 1 in 25. mutation CFTR gene on chromosome 7

70
Q

how many CF infants present with meconium ileus. presentation of meconium ileus

A

10%. vomiting, abdominal distension, failure to pass meconium

71
Q

what can CF patients be chronically infected with

A

staph aureus, H influenza, pseudomonas

72
Q

features CF

A

recurrent chest infections, poor growth, malabsorption, persistent loose cough, purulent sputum, clubbing, steatorrhoea

73
Q

how does pancreatic insufficiency present in CF

A

maldigestion and malabsorption- leads to failure to thrive. freq offensive and greasy stools. low elastase in faeces

74
Q

diagnosis CF

A

sweat test- incr Cl

75
Q

management CF

A

physio 2x a day- chest percussion and draining; continuous antibiotic prophylaxis- flucloxacillin. take pancreatic enzymes (creon) with every meal- oral enteric coated pancreatic replacement therapy. high caloric diet. fat soluble vitamins.

76
Q

what are some complications CF

A

diabetes mellitus. infertility in males as absent vas deferens

77
Q

what should be considered in any patient with recurrent infections, loose stools, failure to thrive

78
Q

features CF infant

A

meconium ileus, neonatal jaundice, FTT, recurrent chest infections, malabsorption

79
Q

features CF young child

A

bronchiectasis, rectal prolapse, sinusitis, nasal polyp

80
Q

features CF older child

A

diabetes, cirrhosis, portal hypertension, pneumothorax, sterility, aspergillosis

Paeds (16 decks)

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