Respiratory Flashcards

1
Q

What is the incidence of asthma in children?

Why is Dx difficult?

A

Affects 15-20% children

Approx 50% all children wheezy unto 3y/o

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2
Q

What are the 2 types of wheezing and how are they different?

A

Transient early:
Grow out of + due to resp infection
Due to inflamm/narrowing of small airway
RF - mum smoking

Persistent recurrent:
Continues into school aged + due to common inhalant allergens (IgE - mediated)
Persistent symptoms + reduced lung func
RF - allergies (≥1 = atopic)

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3
Q

What are some features of asthma that differentiate it from viral wheeze? (5)

A
Interval symptoms b/wn acute exacerbations
Symptoms worse at night/early morn
Symptoms w. trigger (e.g. pets)
\+ve response to therapy
PMH/FH
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4
Q

What would be seen O/E in asthma (not in acute exac)? (3)

What 3 signs may be seen in long-term?

A

Harrison sulci
Other allergic disorders (eczema, rhinitis)
Growth normal

Hyperinflation
Generalised expiratory wheeze
Prolonged expiratory phase

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5
Q

What 3 signs would indicate chronic infection rather than asthma? (CF/bronchiectasis)

A

Clubbing
Wet productive cough
Poor growth

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6
Q

When are Ix done for asthma?

What Ix can be done (3)

A

Only to exclude other conditions (asthma is clinical Dx)

Skin prick test
CXR
PEFR

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7
Q

What would PEFR show in asthma (2)

A

Only in >5yrs
Shows diurnal/daily variations (lower in morn)
10-15% improvement in PEFR with treatment

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8
Q

What 5 other common conditions can mimic asthma?

A
Viral-induced wheeze
Bronchiolitis
Reflux
CF
Croup
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9
Q

What incidence/age group does viral induced wheeze occur in?

A

50% of U3s
More commonly boys
Grow out of by 5 (airways bigger)

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10
Q

What features must be assessed/looked for in acute asthma exacerbation? (12)

A
Wheeze
Tachypnoea (>50 2-5s; >30 5+s)
Tachycardia (>150; >120)
Recession
O2 sats (92%)
PEFR

Severe:
Accessory mm
Pulsus paradoxus
Too breathless to talk/feed

Life-threatening:
Cyanosis
Lethary/drowsiness
Silent chest

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11
Q

What O2 sats / PEFR would be seen in mild acute exacerbation of asthma?
How is it managed (3)

A

Sats > 92%
PEFR > 50%

SABA (via spacer) - 2-4 puffs (+2 /2mins and up to 10)
Oral prednisolone
Reassess within 1hr

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12
Q

What O2 sats / PEFD in severe asthma attack?

How managed? (4)

A

Sats < 92%
PEFR < 50%

O2
SABA 10 puffs / 20-30mins - spacer/neb
Oral prednisolone / IV hydrocortisone
If no response to steroid → Neb ipratropium bromide

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13
Q

What O2 sats / PEFR in life-threatening asthma attack?

How managed? (6)

A

Sats <92%
PEFR < 33%

O2
Neb B2-agonists / 20-30mins
Neb ipratropium bromide
IV hydrocortisone
Senior review/PICU
Oral prednisolone upto 3d
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14
Q

List the different types of drugs used in asthma (8) + how each works

A

B2-agonists - B2-Rs
Anticholinergic bronchodilators (ipra) - via sympathetic
Inhaled steroids - prevent inflame prots/ reduce IgE response
LABAs
Methylxanthines (theophylline) - relax bronchiole SM
Oral steroids
Leukotriene inhibitors (stops leukotriene bronchoconstricting)
Anti-IgE (omalizumab)

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15
Q

Describe the Asthma management guideline steps for children 5-12? (5)
How is it different for U5s?

A
  1. SABA prn
    • Steroid (inhaled)
    • LABA (± increase steroid / ± leukotriene antag / ± theophylline)
  2. Increase inhaled steroid
  3. Oral steroids
  4. SABA prn
    • Steroid / leukotriene antag
    • leukotriene antag / Steroid
  5. Senior referral
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16
Q

What things can be done to advise parents on managing asthma? (4) (PERFO)

A

Provide PLAN (regime + technique)
EDUCATE on drugs (usage + compliance)
Educate on RED FLAGS (worsening cough / SOB/ wheeze; difficulty walk/talking/sleeping; less bronchodilator relief)
Provide ORAL steroid dose

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17
Q

What age does bronchiolitis present in
What is the incidence
What are the RFs

A

<18m (90% 1-9m)
20-30% (1/4) all infants every winter

RFs:
Premature (/ventilated)
CLD 
CF 
Congenital heart disease
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18
Q

How does Bronchiolitis present?

A

Coryzal symptoms → Dry cough + SOB → Feeding difficulties (worst at day 4)

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19
Q

List the clinical features of bronchiolitis (ACBDE + Resp signs)

A
A: Cyanosis / Pallor
B: Unsettled, cannulae/nebs
C: no change centiles but current feeding probs
D: possibly with feeding probs
E: Tachypnoea/cardia, Sats, Temp

Periph stigmata: none
RESP: I: Sharp dry cough, Nasal flaring, recession (inter/subcostal/sternal), Tracheal tug, P: hyperinflation, P: Displaced liver, A: Prolonged expiration + Exp wheeze, End-inspiratory crackles

20
Q

What Ix can be done for bronchiolitis?

A

PCR of NPA (may show RSV)
Continuous O2 sats

Rarely: blood gases (only if considering artificial vent), CXR

21
Q

How is bronchiolitis managed? (5)

A
SUPPORTIVE NOT CURATIVE
Humidified O2 via nasal cannulae
Monitor for apnoeas
IV fluids / NG tube
Assisted vent in small %
22
Q

What management is NOT useful in bronchiolitis? (4)

A

Mist
Abx
Steroids
Neb bronchodilators

23
Q

What are the common causative organisms of pneumonia in the newborn? (2)
in infants + young children (4)
>5y/o? (3)
All ages? (1)

A

NB younger = viral; older = bacterial
Newborn: GrpB strep, E.Coli
Infants: RSV, S./Chlamydia pneumonia, HiB, Pertussis
Children: Mycoplasma/S./Chlamydia pneumoniae
All ages: consider TB

24
Q

What are the main features seen in pneumonia? (2)

+ other possible features? (5)

A

Fever + Increased WOB

Preceding URTI
Cough
Lethargy
Poor feeding
Chest/abdo/neck pain (pleural - bact inf)
25
Q

What signs may be seen O/E in pneumonia?

NB what signs (common in adults) in pneumonia are often absent in children (3)

A

Tachypnoea (>60/>50/>40)
Chest recessions + nasal flaring + tracheal tug
Poss end-inspiratory crackles over affected area
NB absent - dull percussion/bronch breathing/ reduced breath sounds

26
Q

What are the indications for hosp admission with child pneumonia? (4)

A

Sats <93%
Severe tachypnoea / WOB
Not feeding
Family unable to provide approp care

27
Q

Describe the management of pneumonia (5)

A

General supportive:
O2 (for hypoxia)
Analgesics
IV fluids

Abx (newborns - broad spec; infants/older - amoxi)
Chest drain (if develop empyema)
28
Q

What complications of pneumonia would require a FU at 4-6wks (3)

A

Lobar collapse
Atelactasis (partial collapse / incomplete inflation)
Empyema

FU CXR

29
Q

What advice can be given to parents on caring for chest infection (as most are managed at home)? (5)

A
Supportive care
Analgesics
Abx
S+S of concern (indicative symps for admission)
Reassurance
30
Q

Describe the presentation / natural history of Pertussis (Whooping cough)

A

1wk Catarrhal phase (coryza)
3-6wks Paraoxysmal phase
Months - Convalescent phase (symps gradually decrease)

31
Q

Describe 4 features about the cough in Pertussis

What 3 subsequent symptoms may it lead to?

A

Spasmodic + inspiratory whoop
Infants show apnoea instead of inspiratory whoop
Worse at night

May → vomiting
May → epistaxis/subconjunctival haemorrhages
May → red/blue in face

32
Q

How is whooping cough Dx? (2)

A

Nasal swab - cultures

Blood film - lymphocytosis

33
Q

What are the RFs for Pertussis?

What are the complications of Pertussis? (3)

A

Incomplete Vx at 4m

Pneumonia
Convulsions
Bronchiectasis

34
Q

How is Pertussis managed? (3)

A

Eventually self-resolves
Erythromycin (only reduces symptoms if catarrhal phase)
Erythromycin prophylaxis for close contacts

35
Q

What symptoms (5) may be seen in TB?

A
Symptoms: 
Fever
Cough
Lethargy
Night sweats
Failure to thrive/wt loss (anorexia)
36
Q

Where else in the body may be affected by normal TB?

Where is affected in disseminating military TB?
Where in body affected in seeding?

A

Superficial LNs / gut/ skin

Disseminated: bones / joints / kidneys / pericardial /CNS

Seeding (infants/young) → CNS (meningitis)

37
Q
What are some of the treatment options for TB 
in 1. uncomplicated
2. complicated
3. latent infection
4. if child post-puberty
What is the biggest problem?
A
Uncomplicated - 6m:
Quadruple therapy (rifampicin/isoniazid/pyrazinamide/ethambutol) → double therapy after 2m

Meningitis/disseminated: >6m

Latent: 2drugs 3m

Post-puberty - pyridoxine (prevent isoniazid → perish neuropathy)

Biggest prob is adherence

38
Q

List the DDx of an infant with tachypnoea + wheeze (8)

A
Bronchiolitis
Pneumonia
Transient early wheezing
Viral-induced wheeze 
Atopic asthma
Cardiac failure
Inhaled foreign body
Aspiration of feeds
39
Q

What is the carrier/incidence rate of CF?

What is the genetic cause?

A

1 in 25 carriers
1 in 2500 incidence

Defective CFTR (transport memb protein) on csome 7

40
Q

What is the main pathophysiology from the defective gene in CF? (6)

A

→ Abnorm Cl ion transport across epithelium

Increased + thickened mucopurulent secretions (impaired ciliary func + chronic infection)

41
Q

How is CF Dx? (3)

A

Meconium ileus strongly indicates
Heel prick (immunoreactive trypsinogen)
Sweat test (Cl high)
Genetic testing

42
Q

If not already picked up on screening, how may CF present? (3)

A

Recurrent chest infections
Poor growth
Malabsorption/steatorrhoea

43
Q

List some clinical respiratory features of CF (3S+4S)

A

Recurrent chest infections (esp Pseudomonas)
Producing purulent sputum
Persistent loose cough

Chest hyperinflation (prom sternum + liver) (due to air trapping)
Coarse inspiratory crackles
Expiratory wheeze
Finger clubbing (in estab disease)

44
Q

List the complications / long-term effects of CF? (6)

A
Diabetes (panc insufficiency)
Liver disease (1/3rd)
Intestinal obstructions
Pneumothorax
Haemoptysis (life-threatening)
Males infertile (vas blockage)
45
Q

List the various different management measures in CF (7) (LNNPPPP)

A

Physio (2+/day)
Physical exercise encouraged
Nutritional (fat-sol vits, overnight feeding / extra cals)
Neb DNAase / Hypertonic saline
Prophylactic Abx (fluclox, anti-pseudomonas, + rescues)
Lung/liver transplant
Panc replacement therapy (oral enteric coated tabs)

46
Q

What CXR changes may be seen in TB? (3)

A

Collapse / consolidation of affected lung
Peribronchial LN enlargement (bronch obstruction)
Poss pleural effusion