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Paediatrics and Child Health > Respiratory > Flashcards

Respiratory Flashcards

1
Q

When in children is asthma worse?

A

Early morning and at night

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2
Q

At what age, generally, are children investigated using spirometry?

A

> 6 years old

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3
Q

In terms of spirometry, what degree of reversibility should bronchodilator therapy cause in a child with asthma?

A

> 12% increase

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4
Q

Which asthma treatments are generally not used in:

  1. Children under 5?
  2. Children aged 5 - 12?
A
  1. LABA

2. Leukotriene antagonists e.g. montelukast

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5
Q

Give three side effects of long-term steroid inhalers

A 
Sore throat/mouth
Hoarse/croaky voice
Cough
Oral thrush
Nose bleeds
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6
Q

In asthma, how does the route of administration change with age?

A

Nebulisers: < 2 years, children who can’t cooperate and in acute severe asthma attacks

Spacers: Toddlers (2 - 8 years)

Dry powder systems: School age child

Metered dose inhaler: Children > 8 years

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7
Q

How should you advise parents regarding cleaning spacers?

A

Clean with warm, soapy water and rinse

Do not dry as it will cause static!

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8
Q

Generally, when are children monitored using PEFR?

A

Over 5 years

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9
Q

After ABCDE, what is the pharmacological management of an acute asthma attack in a child?

A

In children:

Oral or nebulised salbutamol:
2-4 puffs every 20-30mins in mild attacks; severe may require up to 10 puffs. If failing with inhalers or needing oxygen - give 2.5mg nebulised

Oral prednisolone:
20mg if aged 2 - 5 years; 30-40mg if over 5 years
Maintenence steroids: 2mg/kg, max = 60mg
Repeat if child vomits.

IV salbutamol bolus: 15ug/kg if severe

Nebulised ipratropium bromide: 250mcg mixed with salbutamol, in the first 2 hours or a severe attack

IV aminophylline with severe bronchospasm

IV magnesium sulphate

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10
Q

What is the most common causes of pneumonia in:

  1. Neonates?
  2. Infants?
  3. Older children and adolescents?
A
  1. Organisms from the female genital tract
    e. g. Group B strep, E. coli, gram -ve bacilli, Chlamydia trachomatis
  2. Bacterial (60%) and Viral (40%)

Bacterial: strep. pneumoniae (90%), staph. aureus, haemophilus influenza

Viral: parainfluenza, influenza, adenovirus, RSV

  1. As above + atypical organisms such as mycoplasma pneumoniae and chlamydia pneumoniae
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11
Q

What is the most common cause of aspiration pneumonia?

A

Enteric gram -ve bacteria

Can be strep. pneumoniae or staph. aureus

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12
Q

What are the most common causes of pneumonia in:

  1. non-immunised children?
  2. immunocompromised children?
A
  1. Haem. influenza, bordatella pertussis, measles
  2. Viral: CMV, VZV, HZV, measles and adenovirus
    Bacterial: pneumocystis carinii, TB
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13
Q

When does the sputum usually appear rusty?

A

Strep. pneumoniae infection

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14
Q

Give three signs of consolidation.

A

Decreased breath sounds

Dullness to percussion

Increased tactile/vocal fremitus

Bronchial breathing

Coarse crepitations

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15
Q

Give three signs of respiratory distress in children

A

Cyanosis (severe)

Grunting

Nasal flaring

Marked tachypnoea

Intercostal and suprasternal recession

Subcostal recession

Abdominal, see-saw breathing

Tripod positioning

Reduced oxygen saturation

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16
Q

What does focal consolidation on a chest x-ray suggest?

A

Bacterial pneumonia

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17
Q

What does diffuse consolidation on a CXR suggest?

A

Viral bronchopneumonia

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18
Q

For suspected pneumonia, for which causes would the following investigations be useful:

  1. Urine culture?
  2. Blood film?
  3. Immunofluorescence?
A
  1. Legionnaires antigen
  2. Mycoplasma - RBC agglutination
  3. RSV on nasopharyngeal exudate
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19
Q

What is the first line management of pneumonia in children?

A

Oral amoxacillin or erythromycin

If severe, IV cefuroxime +/- erythromycin

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20
Q

What is the antibiotic treatment for aspiration pneumonia?

A

Metronidazole

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21
Q

What is the most common cause of bronchiolitis?

A

RSV

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22
Q

At what age does bronchiolitis usually occur?

A

2 - 6 months old

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23
Q

When is the peak incidence of bronchiolitis?

A

Winter months

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24
Q

What is the clinical presentation of bronchiolitis?

A

It usually begins as an upper tract infection (rhinorrhea) and then:

SOB, cough, wheeze and bilateral crepitations

Decreased feeding and irritability

Apnoea

Signs of respiratory distress

Tachypnoea/cardia, fever, dehydration

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25
Q

What is croup usually caused by?

A

Parainfluenza virus, but all other common viruses can also cause it

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26
Q

Who does croup most commonly affect?

A

6 months - 2/3 years

More common in boys

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27
Q

What are the clinical features of croup?

A

Barking cough

Hoarsness

Stridor

Decreased air entry but normal sounds

Respiratory distress

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28
Q

What is the management of croup?

A

Important to keep patient calm and be as uninvasive as possible to avoid further subglottal inflammation.

Oxygen

Dexamethasone 150ug PO or
Prednisolone 1mg/kg or
Nebulised budesonide

Nebulised adrenaline (if severe)

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29
Q

What is the most important thing to rule out when investigating ?croup?

A

Epiglottitis

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30
Q

At what age are children more likely to get tonsilitis?

A

5- 10 years and young adults

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31
Q

Which type of viral tonsillitis causes blisters in the mouth?

A

Coxsackie virus

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32
Q

What is the most common bacterial cause of tonsillitis?

A

Group A beta haemolytic streptococcus (group A strep)

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33
Q

When should you prescribe antibiotics in patients with suspected tonsillitis?

A

Systemic features secondary to acute sore throat

Unilateral peritonsillitis

History of rheumatic fever

Increased risk from acute infection e.g. kids with DM,

3 or more of the centor criteria

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34
Q

Which criteria is used in diagnosing bacterial tonsillitis?

What is it?

A

Centor criteria:

History of fever

Tonsillar exudates

No cough

Tender anterior cervical lymphadenopathy

35
Q

What advice should be given for non-pharamacological management of tonsilitis?

A

Salt water gargles

Antipyretics

36
Q

In tonsillitis, where can the pain be referred to?

A

Ears

37
Q

What is the treatment for bacterial tonsillitis?

What should you not give?

A

Penicillin V

Erythro-/Clarithro-mycin if peniciilin allergic

You should not give amoxicilin, in case of EBV

38
Q

Give three complications of tonsillitis

A

Acute otitis media

Peritonsillar abscess (quinsy)

Cervical abscess

Guttate psoriasis flare-up

Rheumatic fever (delayed)

Acute nephritis (delayed)

39
Q

When should a child be referred for a tonsillectomy?

A

Recurrent attacks of tonsillitis (typically streptococcal).

Enlarged tonsils causing obstruction of the airway, which may be the cause of obstructive sleep apnoea.

Possible malignant disease in the tonsils.

40
Q

What is the most common cause of epiglottitis?

A

Haemophilus influenzae B, but since the introduction of the Hib vaccination, streptococcus is more common

41
Q

Who does epiglottitis usually affect?

A

2 - 5 years

42
Q

What are the differentiating clinical features of epiglottitis?

A

Odynophagia

Hot potato voice

Tripod position

Anterior neck tenderness over hyoid bone

Stridor

Drooling

43
Q

What should you not do in kids with suspected epiglottitis?

A

Examine the throat with a tongue depressor

44
Q

What is the management of epiglottitis?

A

IV fluids

IV ampicillin

Intubation/tracheostomy if airway compromised

45
Q

When is wheeze heard?

A

On expiration

46
Q

What does perinatal wheeze suggest?

A

Structural abnormalities

47
Q

What is transient wheezing and what is it caused by?

A

In infancy, non-atopic infants can get an intermittent wheeze, which usually disappears after the age of 3.

It is most commonly caused by RSV

48
Q

What is classed as a ‘persistent/recurrent’ wheeze?

A

Lasting longer than 4 weeks - suggestive of asthma

49
Q

Which investigations should be done for infants and children with wheeze?

A

CXR

Sweat test - for CF

Allergy testing

Barium swallow - fistulae

Spirometry (> 6 years)

50
Q

When is stridor heard?

A

On inspiration, but if severe can be heard on expiration also

51
Q

What does biphasic stridor suggest?

A

Subglottic obstruction

52
Q

Give three causes of stridor

A

Croup

Tracheitis: under 3 years

Inhaled foreign body

Abscesses: retropharyngeal or peritonsillar

Anapyhlaxis

Epiglottitis

53
Q

Give five congential problems that can cause stridor

A

Laryngomalacia

Vocal cord dysfunction

Subglottic stenosis

Laryngeal disorders

Tracheomalacia

Choanal atresia

Tracheal stenosis

54
Q

When is the pattern of infection in tracheitis?

A

Bacterial infection following a viral infection

55
Q

What different types of abscess can children get and how do their clinical features differ?

A

Retropharyngeal: < 6 years, pain on neck hyperextension

Peritonsillar: adolescents, trismus, difficulty speaking

Both present with fever and dysphagia

56
Q

What is the most common cause of stridor in neonates?

A

Laryngomalacia

It is also the most common cause in early infancy

57
Q

When is laryngomalacia worst?

A

Prone position

Crying feeding

58
Q

What causes subglottic stenosis?

A

It can be congenital or acquired

It usually occurs as a result of prolonged intubation

59
Q

What is the most common cause of expiratory stridor?

A

Tracheomalacia

60
Q

What is the most common congenital anomaly of the nose?

A

Choanal atresia: failed recanalisation of the nasal fossae during fetal development

61
Q

What is the best first line management for any stridor?

A

Corticosteroids

62
Q

What mutation causes CF?

What does the mutation result in?

A

CFTR gene on Chromosome 7

Reduces conductance of chloride ions and increases viscosity of mucus secretions

63
Q

Which tests are used for CF?

A

Mouthwash carrier testing

Chorionic villus sampling at 10 weeks

Sweat test (>60mmol/L of NaCl)

Guthrie test (day 5 - 8)

CT head and thorax

64
Q

Give three signs of CF

A

Finger clubbing

Cough with purulent sputum

Crackles

Wheezes (mainly in the upper lobes)

Forced expiratory volume in one second (FEV1) showing obstruction

65
Q

What clinical features are associated with CF perinatally?

A

Bowel obstruction with meconium ileus (bowel atresia)

Haemorrhagic disease of the newborn

Prolonged jaundice

Failure to thrive

66
Q

Give five associated features/conditions of CF in infancy and childhood?

A

DR P5 HF

Diarrhoea and bulky, greasy stools

Recurrent respiratory infections

rectal Prolapse

acute Pancreatitis

Portal hypertension and variceal haemorrhage

Pseudo-Bartter’s syndrome: electrolyte abnormality

nasal Polyps (in children, nearly always due to CF)

Hypoproteinaemia and oedema

Failure to thrive (thriving does not exclude diagnosis)

67
Q

In CF, what commonly do you have a congenital absence of?

A

Vas deferens

68
Q

What is the management of CF?

A

Chest physio

Prophylactic Abx

Saline nebulisers

SABA/LABA

Pancreatic enzymes (Creon)

69
Q

What nutritional advice should you give to patients with CF?

A

High fat and protein diet

Vitamin supplements

150% of normal energy diet

Pancreatic enzyme (Creon)

70
Q

Give five complications of CF

A

Respiratory failure

DM

Portal hypertension

Hepatic cirrhosis

Cor pulmonale

Infertility

71
Q

What is the average life expectancy of a patient with CF?

A

40 -50 years old

72
Q

What is TB caused by?

A

Mycobacterium tuberculosis

73
Q

By what mode is TB spread?

A

Droplets

74
Q

What are the risk factors for TB?

A

TB contact (obviously)

South Asian

Homelessness

Drug abusers

HIV

Elderly

75
Q

What are the differentiating features of TB?

A

Nigh sweats

Fatigue and malaise

Weight loss and anorexia

Purulent +/- blood-stained sputum

76
Q

How can you diagnose latent TB?

A

Mantoux test

77
Q

How do you manage TB?

A

RIPE:

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

78
Q

What is unique about the timing of whooping cough?

A

It is cyclical; recurring every 3 - 4 years

79
Q

How long does whooping cough infection usually last for?

A

6 - 8 weeks

Catarrhal phase followed by 2 weeks of cough

80
Q

When is whooping cough most infectious?

A

Towards the end of the catarrhal phase/during the paroxysmal coughing stage (1 - 2 weeks after onset of symptoms)

81
Q

What is the presentation of whooping cough

A

Catarrhal phase:

Malaise, conjunctivits, coryzal symptoms, mild fever

Proxysmal coughing phase:

Severe prolonged coughing followed by whoop

Choking/gasping/flailing of extremeties

Cyanosis

82
Q

How is whooping cough investigated?

A

Clinical exam

Routine bloods

Nasopharyngeal swabs

Oral fluid testing for IgG antipertussis

PCR if very unwell

83
Q

Give three complications of whooping cough.

A

PASO:

Pneumonia

Apnoea

Seizures

Otitis media

Paediatrics and Child Health (11 decks)

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