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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
What are the symptoms of pneumonia?
``` Cough (productive) Respiratory distress Fever Malaise Poor feeding ```
26
What are the signs of pneumonia?
``` Hypoxia Fever Crackles Bronchial breathing Respiratory distress ```
27
What investigations would you do in suspected pneumonia?
Bloods: FBC, U+E, CRP etc. Blood gases: pH, bicarb, CO2 and O2, lactate Blood cultures CXR
28
Management of pneumonia?
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
What is whooping cough? | Which bug is it caused by?
Infection of lower respiratory tract that causes severe bouts of coughing Bordatella pertussis
30
What are the symptoms of whooping cough?
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
What causes the whoop in whooping cough?
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
What is the glottis?
The slit-like opening to the trachea
33
How would you investigate a child with suspected whooping cough?
Nasal swab PCR Serology possibly Not much else
34
What's the management of whooping cough?
Antibiotics, but only if within 3 weeks of onset Macrolides: clarithromycin, azithromycin Supportive if needed
35
What antibiotics would you prescribe in whooping cough in a pregnant woman?
Macrolide, erythromycin
36
List some macrolides.
Clarithromycin Azithromycin Erythromycin
37
List some penicillins.
Amoxicillin Flucloxacillin Ampicillin
38
If you're treating a child with whooping cough what two things should you do?
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
What is acute epiglottitis?
Acute inflammation of the epiglottis (and surrounding areas) causing partial airway obstruction Usually bacterial
40
Which bugs commonly cause acute epiglottitis?
Bacterial usually | H influenzae Strep pneumoniae
41
What are the symptoms of acute epiglottitis?
``` Stridor Unable to swallow secretions Sore throat Muffled voice (hot potato voice) Fever In severe cases breathing difficulty ```
42
Investigations of suspected acute epiglottitis?
Be very careful not to upset the child by examining them as this could close off their airway totally Clinically?
43
Management of acute epiglottitis?
Call the anaesthetist and ENT surgeon to get them intubated and ventilated Antibiotics: cefotaxime Oxygen Fluids if dehydrated
44
What is bacterial tracheitis?
Inflammation of trachea leading to thick mucopurulent exudate which isn't cleared by coughing Can lead to airway occlusion
45
Symptoms of bacterial tracheitis?
Often preceded by viral infection, so they may have been coryzal Stridor Hoarse voice Fever Barking cough
46
Differential diagnosis of stridor? Simply, how would you differentiate?
Croup: barking cough, not drooling Acute epiglottitis: drooling, very ill/toxic, not much cough Bacterial tracheitis: very hoarse, ill/toxic, not drooling
47
Management of bacterial tracheitis?
Antibiotics: cefotaxime and Flucloxacillin Intubation and ventilation Fluids
48
What's the pathophysiology of cystic fibrosis?
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
What's the effect of CF on the lungs?
Poor functioning cilia Excessive mucupurulent secretions Creates the perfect environment for bacteria Chronic infections, damage to lungs (bronchiectasis)
50
What's the effect of CF on the pancreas?
``` Mucopurulent secretions build up blocking pancreatic ducts So enzymes (amylase, lipases, proteases) can't get from pancreas to bowel ``` So there's malabosorption
51
What's the effect of CF on the small bowel?
In newborns meconium is really thick | Causes meconium ileus, bowel gets blocked with meconium
52
Which bacteria commonly affect CF patients?
``` Staph aureus H. influenzae Pseudomonas aeruginosa Burkholderia cepacia Mycobacterium abscessus? ```
53
What's the name of the mutated gene?
CFTR | cystic fibrosis transmembrane conductance regulator
54
Which infections do CF patients need to be kept in isolation for?
Psuedomonas aeruginosa | Burkholderia cepacia
55
What types of bowel obstruction can occur in CF patients during infancy?
Meconium ileus | Intussusception
56
Long term complications of CF?
``` 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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