Respiratory Flashcards
1
Q
Where is pneumonia more likely to start and how does this present?
A
- pneumonia generally affects the alveoli first, cough receptors aren’t in the alveoli
- only when the infection travels to the lower airways.
2
Q
What is Bronchiolitis and what causes it?
A
- acute generalised viral LRTI with wheezing and respiratory distress
- infection of airways cause obstruction and hyperinflation, wheezing, atelectasis and interstitial inflammation.
- regrowth and recovery occurs after approx. 2 week.
- most are caused by RSV (50%) but others include:
- parainfluenza
- influenza
- rhinovirus
- adenovirus
- M pneumonia
3
Q
What does a child generally present with in Bronchiolitis?
A
Presentation:
- prodromal URTI
- cough
- rhinitis
- fever (usually low grade)
- Feeding difficulties
- fluctuating clinical course
- LRTI lasts 5-6 days: (worse on day 2-3)
- wheeze (may be absent)
- increased RR, HR
- SaO2 generally decrease
- resp distress (tracheal tug, intercostal recession, accessory muslce, nasal flaring)
- RED FLAG - resp failure if severe.
- if salbutamol responsive viral induced wheeze no bronchiolitis.
4
Q
What is the Management for a child with bronchiolitis?
A
- routine Ix if suspected:
- CXR
- air trapping
- peribronchial thickening
- atelectasis
- increased linear markings
- nasal aspirate (viral antigen detection)
- CXR
- Treatment:
- fluids PRN (IV, NGT)
- 2/3 maintenence fluids due to SIADH (beware hyponatremia)
- supportive care
- minimal handling
- some evidence for 3% inhaled saline
- no evidence for bonchodilators
- in severe (<92% SaO2)
- low flow O2
- NIV = CPAP (usually enough to splint airways)
- Antibiotics (prevent secondary pneumonia)
- fluids PRN (IV, NGT)
5
Q
What are some complications of bronchiolitis?
A
- respiratory failure
- bacterial pneumonitis
- recurrent wheezing
- paediatric asthma (50% develop asthma in later life)
- SIADH = <3mths/severe more prone
6
Q
Talk through the classification of Bronchiolitis?
A
Mild
- mild/no increased WOB
- no need for supplementary O2
- nearly normal fluid intake
Mod
- some increased WOB
- increased RR
- accessory muscle use
- +/- recession
- decreased fluid intake
- +/- SaO2 <92%
Severe = IV fluids and O2
- severe increased WOB
- SaO2 <92%
- severe decreased fluid intake
7
Q
Protracted Bacterial Bronchitis, what is it and how do you get it? What is the treatment?
A
- Most common cause of chronic cough (approx 40%)
- Causes chronic wet cough - doesn’t wax and wane
- persistent airway infection
- haemophilus (non-typable)
- strep
- moreaxella
- pathophysiology:
- predisposing viral infection
- decreased mucocilliary clearance
- secondary bacterial infection
- biofilm (won’t be cleared by antibiotics)
- treatment:
- long course antibiotics = 4-6weeks
- augmentin
8
Q
What are the causative organisms in different age groups?
A
- Neonates (bacterial)
- GBS
- Gram negative enteric bacteria
- Preschoolers (viral pneumonia)
- RSV
- Parainfluenze
- Adenovirus
- Rhinovirus
- Influenza
- CMV
- Older child (bacterial)
- Strep pneumoniae
- Mycoplasma pneumoniae
- Chlamydia pneumonia
9
Q
Reasons for doing a NPA in Bronchiolitis?
A
- If you suspect pertussis as a DDx
- If you are indecisive about the Dx
10
Q
What are some of the complications of CAP? How do you treat the two main ones?
A
-
parapneumonic effusion
- simple effusion - gravity would only be on the bottom. CXR.
-
empyema
- reduced air entry and dull to percussion on exam
- US to confirm - empyema with loculations
- Tx:
- drain with either VATS or drain + fibrinolytics
- antibiotics
- Causes:
- Staph, strep, mycoplasma, HIB
necrotising pneumonia
- pneumatoceles
- septicaemia
- metastatic infection
- osteomyelitis
- septic arthritis
- haemolytic uraemic syndrome
11
Q
Explain lung function tests for asthma, what do you expect to find?
A
- Disproportionate reduction in the FEV1 as compared to the FVC is reflected in the FEV1/FVC ratio and is the hallmark of obstructive lung diseases.
- bronchiolitis, bronchiectasis, asthma have this
- should be 12% improvement with trialled salbutamol.
12
Q
How do you consider severity of asthma?
A
- Episodic (frequent or infrequent)
- Persistent (mold, mod, severe)
- Nocturnal symptoms between exacerbations (>2/mth, >once/week, daily (mild mod sev)
- Symptom frequency 1x week, daily, continual (mild, mod, severe)
- Affects sleep?
- Affects treatment
- Intermittent - inhaled beta agonist
- Persistent - preventer (ICS add LABA or montelukast)
13
Q
What are other causes for something that can present like asthma or wheeze?
A
For asthma:
- episodic viral wheeze
- multiple trigger wheeze
Others:
- Laryngomalacia
- Subglottic stenosis
- Vocal cord palsy
- Subglottic haemangioma
- Laryngeal web, cyst or laryngocoele
- Cystic hygroma
- Tracheomalacia
- External tracheal compression – Vascular ring
14
Q
What is PCD? What are some features of this condition and how do we treat it?
A
Primary Ciliary Dyskinesis
- rare genetic condition causes impaired mucociliary clearance
- AR (several genes)
- Dx:
- ciliary beat pattern and frequency
- nasal nitric oxide
- clinical features:
- sinusitis
- rhinitis
- CSLD
- OM
- male infertility
- treatment:
- antibiotics
- airway clearance
- hearing aids
- routine vaccination
- grommets
- functional endoscopic sinus surgery
15
Q
What is CSLD? What causes it?
A
- a clinical syndrome which symptoms indicating chronic endobronchial infection
- overlaps with Protracted Bacterial Bronchitis and bronchiectasis
- irreversible dilatation of the bronchi
- causes:
- CF
- PCD
- immunodeficiency
- severe pneumonia
- foriegn body
- TB
