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Child Health > Respiratory > Flashcards

Respiratory Flashcards

1
Q

List the common respiratory infections seen in children?

A

Bronchiolitis

Pneumonia

Croup

Acute epiglottitis

Whooping cough

Viral induced wheeze

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2
Q

What is bronchiolitis?

A

Inflammation of the bronchioles caused by infection, usually viral

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3
Q

What are the symptoms of bronchiolitis?

A 
Coryza
Cough
Wheeze
Fever
Tachypnoea
Respiratory distress
Tachypnoea + cardia
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4
Q

What causes bronchiolitis?

A

It’s an infection causing inflammation of the bronchioles.

Usually RSV (resp syncytial virus)

Sometimes:

  • parainfluenza
  • influenza
  • human metapneumovirus
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5
Q

What investigations would you do in suspected bronchiolitis?

A

Don’t really need any investigations.

Bloods:

  • FBC
  • U+E
  • CRP/ESR
  • (LFTs, TFTs)

Nasal swab

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6
Q

What’s the management of bronchiolitis?

A

Humidified oxygen via nasal cannulae

Fluids or NG tube if struggling with feeding

CPAP, intubation + ventilation in severe cases

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7
Q

In a viral infection what would you expect to see on FBC?

A

Raised white count

Specifically lymphocytes

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8
Q

In a bacterial infection what would you expect to see on FBC?

A

Raised white count

Specifically neutrophils

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9
Q

What is used as prophylaxis for bronchiolitis? How often should it be given? Who should get it?

A

Palivizumab, a monoclonal antibody

Given IM once a month

Children who are likely to get severely ill with bronchiolitis, congenital heart defects, preterm with chronic lung disease

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10
Q

What is croup? (clue: what’s it also known as?)

What’s the pathology?

A

Laryngotracheobronchitis

Inflammation of larynx, trachea, bronchi caused by infection, usually viral

You get inflammation, oedema and exudate which causes symptoms

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11
Q

What causes croup?

A

Viral infection:

  • parainfluenza
  • RSV
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12
Q

What are the symptoms of croup?

A 
Seal like barking cough
SOB: respiratory distress
Hoarse voice
Stridor
Coryza
Fever
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13
Q

What is stridor? Why does it happen?

A

Inspiratory breath sound

High pitched, harsh

Due to turbulent air flow caused by partial obstruction of upper airway

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14
Q

You need to be careful when examining children with which of the following?

  • bronchiolitis
  • croup
  • asthma exacerbation
  • acute epiglottitis?
A

In croup and acute epiglottitis, because if they’re distressed their already partially obstructed airway could close completely.

Don’t examine them!

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15
Q

In the following conditions, what time of year are most cases seen and in which age group?

  • croup
  • bronchiolitis
  • whooping cough?
A

Croup:

  • autumn and early winter
  • 6 months - 3 years

Bronchiolitis:

  • autumn and winter
  • 3 months - 2 years

Whooping cough:

  • any time of year
  • infants and over 14yrs
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16
Q

What are the signs found OE of croup?

A 
Stridor
Low grade fever
Low oxygen saturations
No crackles
Respiratory distress signs
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17
Q

What are the signs of respiratory distress?

A

Intercostal and subcostal recession

Tracheal tug

Head bobbing

Use of accessory muscles

Tachypnoea

Grunting

Nasal flaring

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18
Q

What is the management of mild croup?

A

Oral steroids
Dexamethasone 150mcg/kg
Prednisolone 1-2mg/kg

Can also give nebulised budesonide (a steroid)

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19
Q

In severe croup, what’s the management?

A

ABCDE

Nebulised adrenaline
Oxygen

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20
Q

What is pneumonia?

A

Inflammation of alveoli and surrounding structures

Caused by infection, usually bacterial

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21
Q

What is the most common cause of pneumonia?

Only list one for this question!)

A

Strep pneumoniae

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22
Q

In neonates which bugs are usually the cause of pneumonia?

A

Group B strep (picked up from mother at birth)

Gram negative enterococci

TB

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23
Q

In infants which bugs are usually the cause of pneumonia?

A 
Strep pneumoniae
Staph aureus
RSV
H. influenzae
Chlamydia trichomonas
TB
24
Q

In children over 5 which bugs are usually the cause of pneumonia?

A

Strep pneumoniae
Mycoplasma pneumoniae
S aureus
TB

25
Q

What are the symptoms of pneumonia?

A 
Cough (productive)
Respiratory distress
Fever
Malaise
Poor feeding
26
Q

What are the signs of pneumonia?

A 
Hypoxia
Fever
Crackles
Bronchial breathing
Respiratory distress
27
Q

What investigations would you do in suspected pneumonia?

A

Bloods: FBC, U+E, CRP etc.

Blood gases: pH, bicarb, CO2 and O2, lactate

Blood cultures

CXR

28
Q

Management of pneumonia?

A

For community acquired pneumonia

If mild: amoxicillin

If severe, unable to tolerate PO: IV BenPen,

Others: co-amoxiclav
For mycoplasma cover: azithromycin, clarithromycin

Also supportive: oxygen, fluids, NG feeds

29
Q

What is whooping cough?

Which bug is it caused by?

A

Infection of lower respiratory tract that causes severe bouts of coughing

Bordatella pertussis

30
Q

What are the symptoms of whooping cough?

A

Severe paroxysmal cough
Whooping sound in small children
Infants can become cyanotic and apnoeic

Post-cough vomiting

Lasts for 6-8 weeks sometimes (100 day cough)

31
Q

What causes the whoop in whooping cough?

A

Because during coughing paroxysms the lungs are emptied of air, so they draw air in very quickly after emptying the lungs.

The sound is made because of quick inspiration against an almost closed glottis.

32
Q

What is the glottis?

A

The slit-like opening to the trachea

33
Q

How would you investigate a child with suspected whooping cough?

A

Nasal swab PCR
Serology possibly
Not much else

34
Q

What’s the management of whooping cough?

A

Antibiotics, but only if within 3 weeks of onset
Macrolides: clarithromycin, azithromycin

Supportive if needed

35
Q

What antibiotics would you prescribe in whooping cough in a pregnant woman?

A

Macrolide, erythromycin

36
Q

List some macrolides.

A

Clarithromycin
Azithromycin
Erythromycin

37
Q

List some penicillins.

A

Amoxicillin
Flucloxacillin
Ampicillin

38
Q

If you’re treating a child with whooping cough what two things should you do?

A

Notify PHE

Check they aren’t in contact with any pregnant women, if they are she needs to be vaccinated, to reduce risk of baby developing it

39
Q

What is acute epiglottitis?

A

Acute inflammation of the epiglottis (and surrounding areas) causing partial airway obstruction

Usually bacterial

40
Q

Which bugs commonly cause acute epiglottitis?

A

Bacterial usually

H influenzae
Strep pneumoniae

41
Q

What are the symptoms of acute epiglottitis?

A 
Stridor
Unable to swallow secretions
Sore throat
Muffled voice (hot potato voice)
Fever
In severe cases breathing difficulty
42
Q

Investigations of suspected acute epiglottitis?

A

Be very careful not to upset the child by examining them as this could close off their airway totally

Clinically?

43
Q

Management of acute epiglottitis?

A

Call the anaesthetist and ENT surgeon to get them intubated and ventilated

Antibiotics: cefotaxime

Oxygen

Fluids if dehydrated

44
Q

What is bacterial tracheitis?

A

Inflammation of trachea leading to thick mucopurulent exudate which isn’t cleared by coughing

Can lead to airway occlusion

45
Q

Symptoms of bacterial tracheitis?

A

Often preceded by viral infection, so they may have been coryzal

Stridor

Hoarse voice

Fever

Barking cough

46
Q

Differential diagnosis of stridor?

Simply, how would you differentiate?

A

Croup: barking cough, not drooling

Acute epiglottitis: drooling, very ill/toxic, not much cough

Bacterial tracheitis: very hoarse, ill/toxic, not drooling

47
Q

Management of bacterial tracheitis?

A

Antibiotics: cefotaxime and Flucloxacillin

Intubation and ventilation

Fluids

48
Q

What’s the pathophysiology of cystic fibrosis?

A

An autosomal recessive genetic condition.

Problem with CFTR channel that transports chloride ions through cell membrane on epithelial cells.

Affects lungs, small bowel, pancreas, skin

Get thick mucupurulent secretions that build up

49
Q

What’s the effect of CF on the lungs?

A

Poor functioning cilia
Excessive mucupurulent secretions
Creates the perfect environment for bacteria
Chronic infections, damage to lungs (bronchiectasis)

50
Q

What’s the effect of CF on the pancreas?

A 
Mucopurulent secretions build up blocking pancreatic ducts
So enzymes (amylase, lipases, proteases) can't get from pancreas to bowel

So there’s malabosorption

51
Q

What’s the effect of CF on the small bowel?

A

In newborns meconium is really thick

Causes meconium ileus, bowel gets blocked with meconium

52
Q

Which bacteria commonly affect CF patients?

A 
Staph aureus
H. influenzae
Pseudomonas aeruginosa
Burkholderia cepacia
Mycobacterium abscessus?
53
Q

What’s the name of the mutated gene?

A

CFTR

cystic fibrosis transmembrane conductance regulator

54
Q

Which infections do CF patients need to be kept in isolation for?

A

Psuedomonas aeruginosa

Burkholderia cepacia

55
Q

What types of bowel obstruction can occur in CF patients during infancy?

A

Meconium ileus

Intussusception

56
Q

Long term complications of CF?

A 
Bronchiectasis (need for transplant)
Osteoporosis
Failure to thrive
Subfertility in females due to low BMI and oligomenorrhoea
Diabetes
Liver failure
Nephrotoxicity
Ototoxicity

Child Health (17 decks)

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