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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
What is croup usually caused by?
Parainfluenza virus, but all other common viruses can also cause it
26
Who does croup most commonly affect?
6 months - 2/3 years More common in boys
27
What are the clinical features of croup?
Barking cough Hoarsness Stridor Decreased air entry but normal sounds Respiratory distress
28
What is the management of croup?
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)
29
What is the most important thing to rule out when investigating ?croup?
Epiglottitis
30
At what age are children more likely to get tonsilitis?
5- 10 years and young adults
31
Which type of viral tonsillitis causes blisters in the mouth?
Coxsackie virus
32
What is the most common bacterial cause of tonsillitis?
Group A beta haemolytic streptococcus (group A strep)
33
When should you prescribe antibiotics in patients with suspected tonsillitis?
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
34
Which criteria is used in diagnosing bacterial tonsillitis? What is it?
Centor criteria: History of fever Tonsillar exudates No cough Tender anterior cervical lymphadenopathy
35
What advice should be given for non-pharamacological management of tonsilitis?
Salt water gargles Antipyretics
36
In tonsillitis, where can the pain be referred to?
Ears
37
What is the treatment for bacterial tonsillitis? What should you not give?
Penicillin V Erythro-/Clarithro-mycin if peniciilin allergic You should not give amoxicilin, in case of EBV
38
Give three complications of tonsillitis
Acute otitis media Peritonsillar abscess (quinsy) Cervical abscess Guttate psoriasis flare-up Rheumatic fever (delayed) Acute nephritis (delayed)
39
When should a child be referred for a tonsillectomy?
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
What is the most common cause of epiglottitis?
Haemophilus influenzae B, but since the introduction of the Hib vaccination, streptococcus is more common
41
Who does epiglottitis usually affect?
2 - 5 years
42
What are the differentiating clinical features of epiglottitis?
Odynophagia Hot potato voice Tripod position Anterior neck tenderness over hyoid bone Stridor Drooling
43
What should you not do in kids with suspected epiglottitis?
Examine the throat with a tongue depressor
44
What is the management of epiglottitis?
IV fluids IV ampicillin Intubation/tracheostomy if airway compromised
45
When is wheeze heard?
On expiration
46
What does perinatal wheeze suggest?
Structural abnormalities
47
What is transient wheezing and what is it caused by?
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
What is classed as a 'persistent/recurrent' wheeze?
Lasting longer than 4 weeks - suggestive of asthma
49
Which investigations should be done for infants and children with wheeze?
CXR Sweat test - for CF Allergy testing Barium swallow - fistulae Spirometry (> 6 years)
50
When is stridor heard?
On inspiration, but if severe can be heard on expiration also
51
What does biphasic stridor suggest?
Subglottic obstruction
52
Give three causes of stridor
Croup Tracheitis: under 3 years Inhaled foreign body Abscesses: retropharyngeal or peritonsillar Anapyhlaxis Epiglottitis
53
Give five congential problems that can cause stridor
Laryngomalacia Vocal cord dysfunction Subglottic stenosis Laryngeal disorders Tracheomalacia Choanal atresia Tracheal stenosis
54
When is the pattern of infection in tracheitis?
Bacterial infection following a viral infection
55
What different types of abscess can children get and how do their clinical features differ?
Retropharyngeal: < 6 years, pain on neck hyperextension Peritonsillar: adolescents, trismus, difficulty speaking Both present with fever and dysphagia
56
What is the most common cause of stridor in neonates?
Laryngomalacia It is also the most common cause in early infancy
57
When is laryngomalacia worst?
Prone position Crying feeding
58
What causes subglottic stenosis?
It can be congenital or acquired It usually occurs as a result of prolonged intubation
59
What is the most common cause of expiratory stridor?
Tracheomalacia
60
What is the most common congenital anomaly of the nose?
Choanal atresia: failed recanalisation of the nasal fossae during fetal development
61
What is the best first line management for any stridor?
Corticosteroids
62
What mutation causes CF? What does the mutation result in?
CFTR gene on Chromosome 7 Reduces conductance of chloride ions and increases viscosity of mucus secretions
63
Which tests are used for CF?
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
Give three signs of CF
Finger clubbing Cough with purulent sputum Crackles Wheezes (mainly in the upper lobes) Forced expiratory volume in one second (FEV1) showing obstruction
65
What clinical features are associated with CF perinatally?
Bowel obstruction with meconium ileus (bowel atresia) Haemorrhagic disease of the newborn Prolonged jaundice Failure to thrive
66
Give five associated features/conditions of CF in infancy and childhood?
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
In CF, what commonly do you have a congenital absence of?
Vas deferens
68
What is the management of CF?
Chest physio Prophylactic Abx Saline nebulisers SABA/LABA Pancreatic enzymes (Creon)
69
What nutritional advice should you give to patients with CF?
High fat and protein diet Vitamin supplements 150% of normal energy diet Pancreatic enzyme (Creon)
70
Give five complications of CF
Respiratory failure DM Portal hypertension Hepatic cirrhosis Cor pulmonale Infertility
71
What is the average life expectancy of a patient with CF?
40 -50 years old
72
What is TB caused by?
Mycobacterium tuberculosis
73
By what mode is TB spread?
Droplets
74
What are the risk factors for TB?
TB contact (obviously) South Asian Homelessness Drug abusers HIV Elderly
75
What are the differentiating features of TB?
Nigh sweats Fatigue and malaise Weight loss and anorexia Purulent +/- blood-stained sputum
76
How can you diagnose latent TB?
Mantoux test
77
How do you manage TB?
RIPE: Rifampicin Isoniazid Pyrazinamide Ethambutol
78
What is unique about the timing of whooping cough?
It is cyclical; recurring every 3 - 4 years
79
How long does whooping cough infection usually last for?
6 - 8 weeks Catarrhal phase followed by 2 weeks of cough
80
When is whooping cough most infectious?
Towards the end of the catarrhal phase/during the paroxysmal coughing stage (1 - 2 weeks after onset of symptoms)
81
What is the presentation of whooping cough
Catarrhal phase: Malaise, conjunctivits, coryzal symptoms, mild fever Proxysmal coughing phase: Severe prolonged coughing followed by whoop Choking/gasping/flailing of extremeties Cyanosis
82
How is whooping cough investigated?
Clinical exam Routine bloods Nasopharyngeal swabs Oral fluid testing for IgG antipertussis PCR if very unwell
83
Give three complications of whooping cough.
PASO: Pneumonia Apnoea Seizures Otitis media

Paediatrics and Child Health (11 decks)

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