Respiratory Flashcards
CXR showing thickening around bronchi , flattened heme-diaphragms and incomplete inflation?
Asthma
What colour spacers are used at different ages?
Neonate - orange, child - yellow, 5+ - blue
What would be the next step in Mx of 7y/o child currently taking salbutamol inhaler PRN and 200mcg/day beclomethasone
Introduce LABA. If only partial response, keep LABA & increase beclomethasone to 400mcg/day.
What are the steps in managing asthma in children <5y?
SABA –> ICS 200-400mcg/day –> leukotriene antagonist –> refer to paeds
At what age would you have expected children airways to have grown enough to stop wheezing?
5y. If still wheezy –> likely asthma Dx
What are the features of viral-induced wheeze?
typically <5y, episodic with no interval Sx, absence of atopy.
What might cause displacement of liver downwards?
Hyperinflation of chest - bronchiolitis
At what age range are you most likely to get croup? When is most common age?
6m-6y. Peak at 2y
Sx of croup?
Preceding coryza & fever. Barking cough, harsh stridor, worse at night
Causative organism of epiglottitis?
H influenza type B. Decreased in incidence due to Hib vaccine
Mx of epiglottitis?
Call anaesthetist –> intubate with nasotracheal tube. IV cefotaxime 3-5days
When might you give rifampicin to family members of unwell child?
If child had epiglottitis. Rifampicin = prophylactic
How is croup Mx in hospitals?
Nebulised adrenaline - transient relief Sx. Oral prednisolone - 3d, or oral dex - stat dose.
Most common mutation causing CF? what type of mutation is this?
Delta F508 = missense
Sx of meconium ileum in CF?
Abdo distension, intestinal obstruction, vomiting
Possible presenting Sx of CF?
FTT, malabsorption, steatorrhea, prolonged neonatal jaundice, recurrent chest infections
Examination of child shows chest hyperinflation, coarse insp crackles and exp wheeze. Possible Dx of child?
CF - recurrent infections, bronchiectasis & air trapping
How is CF normally Dx?
Raised immunoreactive trypsin on Guthrie, positive sweat test
Nutritional Mx of CF?
Creon & high calorie diet
Dx criteria for bronchiectasis?
coryza prodrome + persistent cough + raised RR or chest recession + wheeze/crackles
What increases risk of bronchiolitis?
Prematurity, heart murmur, CF
4m old baby comes in with feeding difficulty, raised RR and cold/cough Sx. What is most appropriate investigations and Mx plan?
Bronchiolitis.
Investigations - PCR of nasopharyngeal secretions.
Mx - suportive - O2, fluids if need, bronchodilators for wheeze.
Dx of child with fine-end insp crackles & high pitched wheeze and hyper inflated chest?
Bronchiolitis.
How can you prevent bronchiolitis in high-risk children?
Prophylactic monoclonal Ab to RSV. Monthly IM injections
RR above what level indicates severe illness in infants and in children?
> 70 in infants, >50 in children
Auscultation of end inspiratory coarse crackles might be indicative of…?
pneumonia
Opacification of R middle lobe on CXR might suggest what?
Pneumonia caused by strep pneumoniae. Classic lobar appearance
Tx of pneumonia in <5y?
Amoxicillin
What is the Centor criteria used for? What are the domains?
Dx of tonsillitis.
- No cough
- tonsillar exudate
- Hx fever >38
- cervical lymphadenopathy
Tx bacterial tonsillitis?
Penicillin or erythromycin (avoid amoxicillin)
8m old child with bulging, red tympanic membrane with loss normal light reflection?
Acute otitis media
What is glue ear? What age is it common?
Secretory otitis media, age 2-7y
Dull and retracted tympanic membrane with visible fluid level?
Secretory otitis media (glue ear)
Cause of monophonic wheeze in child?
Bronchial obstruction - foreign body
Tx of TB?
Isonazid + rifampicin + pyrazinamide
Tx whooping cough?
erythromycin
