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Paediatrics Specialty > 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

> 5 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

A. Children <5 years
B. Children aged 5-12 years

A

A. LABA

B. Montelukast (leukotriene antagonist)

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5
Q

Give 3 side effects of long-term steroid inhalers

A
  1. Oral thrush (candida)
  2. Sore throat/hoarse voice
  3. glaucoma

NB: side effects are rare and only occur in very high doses over a long period of time

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6
Q

How should you advise parents regarding cleaning spacers?

A

Clean with warm, soapy water (fairy liquid is very effective) and rinse.

Leave to dry (do not wipe as it will create static which causes the dry to to stick to the spacer)

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7
Q

When are children’s asthma management monitored with PEFR?

A

> 5 years old

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8
Q

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

A. mild-moderate asthma attack
B. Severe asthma attack

A

Mild-moderate:
Burst therapy
3x 10 puffs of salbutamol (MDI with spacer)
Wean from hourly to 4-hourly

Severe:
3x 10 puffs of salbutamol (MDI with spacer) hourly
IV magnesium sulphate
IV aminophylline

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9
Q

What is the most common cause of pneumonia in neonates?

A

Organisms from maternal genital tract: e.g. GBS (Group B Strep), E.coli, Chlamydia trachomatis

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10
Q

What is the most common cause of pneumonia in infants?

A

Bacterial (60%):

  • Strep. pneumoniae
  • Staph. aureus
  • Haemophilus influenzae

Viral (40%)

  • Parainfluenza
  • Influenza
  • Adenovirus
  • RSV
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11
Q

What is the most common cause of pneumonia in older children and adolescents?

A

Bacterial (60%):

  • Strep. pneumoniae
  • Staph. aureus
  • Haemophilus influenzae

Viral (40%)

  • Parainfluenza
  • Influenza
  • Adenovirus
  • RSV

Atypical organisms:

  • Mycoplasma pneumonia
  • Chlamydia pneumonia
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12
Q

What is the most common cause of aspiration pneumonia?

A

Enteric gram -ve bacteria

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13
Q

What are the most common causes of pneumonia in immunocompromised children?

A

Viral:

  • CMV
  • Varicella zoster virus VZV
  • Herpes zoster virus HZV
  • measles and adenovirus

Bacterial:

  • Pneumocystis carinii
  • TB
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14
Q

When does sputum usually appear rusty?

A

Strep. pneumoniae infection

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15
Q

Give 3 clinical signs of consolidation

A
  1. Reduced breath sounds
  2. Dullness to percussion
  3. Increased tactile/ vocal remits
  4. Bronchial breathing
  5. Coarse crepitations
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16
Q

Give 3 signs of respiratory distress

A
  1. Cyanosis
  2. Grunting
  3. Nasal flaring
  4. Marked tachypnoea
  5. Intercostal and suprasternal recession
  6. Subcostal recession
  7. Abdominal breathing
  8. Tripod positioning
  9. Reduced oxygen saturations
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17
Q

What does focal consolidation on a CXR suggest?

A

Bacterial pneumonia

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18
Q

What does a diffuse consolidation on a CXR suggest?

A

Viral bronchopneumonia

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19
Q

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

A. Urine culture
B. Blood film
C. Immunofluorescence

A

A. Legionnaires antigen (in urine)
B. Mycoplasma - RBC agglutination
C. RSV on nasopharyngeal exudate

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20
Q

What is the first line management of pneumonia in children?

A

Oral amoxicillin or erythromycin (if penicillin allergic)

If severe, IV cefuroxime +/- erythromycin

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21
Q

What is the antibiotic treatment for aspiration pneumonia?

A

Metronidazole

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22
Q

What is the most common cause of bronchiolitis?

A

RSV

Other causes: adenovirus, parainfluenza

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23
Q

At what age does bronchiolitis usually occur?

A

2 - 6 months

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24
Q

When is the peak incidence of bronchiolitis?

A

Winter months (Nov-Feb)

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25
Q

What is the clinical presentation of bronchiolitis?

A

It usually begins as an URTI with rhinorrhea and then:
SOB, cough, wheeze and bilateral crepitations.
Decreased feeding with irritability
Signs of respiratory distress +/- apnoea
Tachypnoea, fever and possible dehydration.
Worse on day 5

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26
Q

What is croup usually caused by?

A

Viruses

Parainfluenza, RSV, rhinovirus, adenovirus

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27
Q

Who does croup most commonly affect?

A

6 months - 3 years

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28
Q

What are the clinical features of croup?

A 
Barking cough
Hoarse voice
Low grade fever
Stridor
Decreased air entry but normal chest sounds
Respiratory distress if moderate-severe
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29
Q

What is the management of croup?

A

Mild- managed at home with analgesia and fluid. Oral dexamethasone stat dose and reassurance.

Moderate:
Important to keep patient calm and be as uninvasive as possible.
Admit for observations
Oral dexamethasone
Reassess - think could this be sepsis!! Could this be bacterial tracheitis- in which antibiotics would be required.

Severe:
Nebulised adrenaline
Dexamethasone
High flow oxygen mask
Call paediatrician, ENT and anaesthetists
CATS/ PICU
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30
Q

What should you rule out/ consider when investigating croup?

A
  1. Epiglottitis
  2. Sepsis
  3. Bacterial tracheitis
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31
Q

At what age are children more likely to get tonsillitis?

A

5-10 years and young adults

32
Q

Which type of viral tonsillitis causes blisters in the mouth?

A

Coxsackie virus

33
Q

What is the most common bacterial cause of tonsillitis?

A

Group A haemolytic streptococcus (group A strep)

34
Q

When should you prescribe antibiotics in patients with suspected tonsillitis?

A

Systemic features secondary to acute sore throat
Unilateral peritonisillits
History of rheumatic fever
Increased risk factor from acute infections e.g. diabetes mellitus
3 or more of the centor criteria

35
Q

Which criteria is used in diagnosing bacterial tonsillitis?

A

Centor criteria:

History of fever
Tonsillar exudates
No cough
Tender anterior cervical lymphadenopathy

36
Q

What advice should be given for non-pharmacological management of tonsillitis?

A

Salt water gargle

Antipyretics

37
Q

In tonsillitis, where can the pain be referred to?

A

Ears

38
Q

What is the treatment for bacterial tonsillitis?

What should you NOT give?

A

Penicillin V
Erythromycin/Clarithromycin if penicillin allergic

You should not give Amoxicillin in case it is viral tonsillitis caused by EBV. (Causes rash)

39
Q

Give 3 complications of tonsillitis

A
  1. Acute otitis media
  2. Peritonsillar abscess (quinsy)
  3. Cervical abscess
  4. Guttate psoriasis
  5. Rheumatic fever (delayed)
  6. Acute nephritis (delayed)
40
Q

When should a child be referred for a tonsillectomy?

A

Recurrent attacks of tonsillitis
Enlarged tonsils causing obstruction of the airway, which may be the cause of obstructive sleep apnoea
Possible malignant disease of the tonsils

41
Q

What is the most common cause of epiglottitis?

A

Haemophilus influenza B

Since the introduction of the Hib vaccine, streptococcus is becoming more common

42
Q

Who does epiglottis usually affect?

A

2 - 5 years

43
Q

What are the differentiating clinical features of epiglottitis?

A 
Odynophagia (pain on swallowing)
Hot potato voice
Tripod position and sitting very still
Stridor
Drooling
44
Q

What should you not in kids with suspected epiglottitis?

A

Examine the throat with a tongue depressor as this can cause obstruction of the airways. Need anaesthetists to manage airways first.

45
Q

What is the management of epiglottitis?

A

IV fluids
IV ampicillin
Intubation/ tracheostomy if airways is compromised

46
Q

When is a wheeze heard?

A

On expiration

47
Q

What is transient early wheeze and what is it caused by?

A

In infancy, non-atopic infants can get intermittent wheeze, which usually disappears after the age of 3.
It is commonly caused by RSV

48
Q

What is a persistent wheeze?

A

IgE-associated wheeze; suggestive of asthma.

Lasting >4 weeks

49
Q

What is stridor?

A

Upper airway obstruction

Turbulent airflow causing abnormal high pitched sound

50
Q

What are the types of stridor?

A

Inspiratory:
Extra-thoracic – nose, pharynx, larynx, trachea
i.e. Above the vocal cords
Common

Biphasic stridor: (inspiratory AND expiratory)
Subglottic or Glottic

Expiratory stridor
Intra-thoracic - Tracheal or bronchial obstruction
Severe Upper Airway obstruction

51
Q

List 3 causes of stridor

A 
Croup
Inhaled foreign body 
Anaphylaxis
Bacterial tracheitis
Epiglottitis
52
Q

List 5 congenital cause of stridor

A 
Laryngomalacia (soft larynx)
Vocal cord dysfunction
Subglottis stenosis
Tracheomalacia
Choanal atresia (back of nasal passage is blocked)
53
Q

What is the pattern of infection in tracheitis?

A

Bacterial infection following a viral infection

54
Q

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

A

Retropharyngeal abscess: <6 years, pain on neck hyperextension.

Peritonsillar: Difficulty speaking

Both presents with fever and dysphagia (difficulty swallowing)

55
Q

When is laryngomalacia worst?

A

Lying supine
Crying
Feeding

56
Q

What is the most common congenital anomaly of the nose?

A

Choanal atresia: failed recanalisation of the nasal fosse during fatal development

57
Q

What is the most common cause of expiratory stridor?

A

Tracheomalacia

58
Q

What mutation causes cystic fibrosis (CF)?

A

CFTR gene on chromosome 7.

Reduces conductance of chloride ions and increases viscosity of mucus secretions

59
Q

Which tests are used for CF?

A

Chorionic villus sampling at 10 weeks
Sweat test
Guthrie test (heel prick) day 5-8

60
Q

Give 3 signs of CF

A

Finger clubbing
Cough with purulent sputum (recurrent infections despite adequate antibiotics)
Crackles

61
Q

What clinical features are associated with CF perinatally?

A

Bowel obstruction with meconium ileum
Prolonged jaundice
Failure to thrive
Haemorrhagic disease of the newborn

62
Q

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

A

vas deferens

aka. Congenital absence of the vas deferens (CAVD)

63
Q

What is the management of CF?

A 
Chest physiotherapy
Prophylactic antibiotics
Saline nebulisers
SABA/ LABA
Pancreatic enzymes (Creon)
64
Q

What nutritional advice should you give to patients with CF?

A

High fat and high protein diet
Vitamin supplements
Pancreatic enzymes - Creon

65
Q

Give 5 complications of CF

A 
Respiratory failure
Diabetes mellitus
Portal hypertension
Hepatic cirrhosis
Infertility
66
Q

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

A

~ 37years

67
Q

What is TB caused by?

A

Mycobacterium tuberculosis

68
Q

By what mode is TB spread?

A

Droplets

69
Q

What are the risk factors of TB?

A 
TB contact
HIV
South Asia travel
Homelessness
Drug users
70
Q

What are the features of TB?

A

Night sweats
fatigue
weight loss and anorexia
Purulent +/- bloodstained sputum

71
Q

How can you diagnose latent TB?

A

Mantoux test

72
Q

How do you manage TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

73
Q

How long does whooping cough (pertussis) infection usually last for?

A

6 - 8 weeks

Catarrhal phase followed by 2 weeks of cough

74
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)

75
Q

What is the presentation of whooping cough?

A

Catarrhal phase:
Malaise, conjunctivitis, coryza symptoms, mild fever

Paroxysmal coughing phase:
Severe prolonged coughing
Choking/gasping/flailing of extremities
Cyanosis

76
Q

How is whooping cough investigated?

A

Clinical examination
Routine bloods
Nasopharyngeal swabs

77
Q

Give 3 complications of whooping cough

A

Pneumonia
Apnoea
Seizures
Otitis media

Paediatrics Specialty (5 decks)

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