Respiratory Flashcards
What are the signs & symptoms of asthma in a child?
50% of paeds cases present before 10yrs Post-exercise cough Early morning cough/ nocturnal cough interrupting sleep SOB Wheeze Failure to thrive Barrel chest/hyperinflation
What are the investigations for asthma?
ONLY IN KIDS >5yrs
Spirometry: PEFR <80% predicted for height, FEV1/FVC <80% predicted
Bronchodilator reversibility response 15% inc in FEV1 or PEFR
CXR
How is asthma in a child <5yrs treated?
Step1: SABA: Salbutamol/Terbutaline Step2: Step1 & PREVENTER- Inhaled corticosteroid <5y: 200-400micro/daily Step3: Step2 & <5 Leukotriene: Montelukast <2yrs STEP4 Step4: Refer to specialist
How is asthma in a child 5-12 treated?
Step1: SABA
Step2: PREVENTER- Inhaled corticosteroid 200micro/daily
Step3: LABA (if no effect stop & inc steroid to 400micro)
Step4: Inc Steroid to 800micro
Step5: Steroid tablet OD (Prednisolone) & Steroid inhaler & refer to specialist
What are the side effects of inhaled steroids?
Impaired growth
Adrenal suppression
Oral candidiasis
Altered bone metabolism
How are asthma exacerbations in children graded?
Mild: PEFR >75%
Moderate: PEFR 50-75% normal speech
Severe: PEFR 33-50%, RR >25 in 12yr or >40 in 2-5yrs, no full sentences, accessory muscle use, HR >110 in 12yr or 140 in 2-5yrs
Life-threatening: PEFR <33%, cyanosis, Sats <92%, altered consciousness, silent chest, raised/normal CO2
What is the treatment for a severe asthma attack?
Salbutamol 4puffs then 2puffs/2mins (max 10puffs) Call 999 15L/min Oxygen Salbutamol nebs 5mg w/8L O2 every 20mins Ipratropium 500micro/4hourly Hydrocortisone IV 100mg Call for help Salbutamol IV 15micro/10mins Aminophylline 5mg/kg IV bolus/20mins Magnesium Sulphate 2g IV/20mins
What are the causes of bronchiolitis?
RSV 80%
(para)Influenza
Adenovirus
Mycoplasma pneumoniae
What is the pathophysiology of bronchiolitis?
Invades nasopharyngeal epithelium
Spreads to lower airways
Causes increased mucous production, desquamation bronchiolar obstruction
What are the signs & symptoms of bronchiolitis?
Winter months- COMMON! Dry high-pitched cough Runny nose & mild fever Worsening breathlessness Wheeze Difficulty feeding Episodes of apnoea Auscultations: Fine crepitations Respiratory distress: Head bobbing, intercostal recession, nasal flaring
WORSE IN: Bronchopulmonary dysplasia (premature), CF, congenital heart disease
What investigations are done for bronchiolitis?
Sats
CXR
Nasopharyngeal swabs w/immunofluorescence
How is bronchiolitis treated?
Supportive Sats <92%: Humidified Oxygen Poor feeding: NG tube Wheeze: Bronchodiators Pending respiratory failure: CPAP
What are the causes of Croup?
Parainfluenza 80%
Influenza
RSV
What are the signs & symptoms of Croup?
Seal bark cough 6m-6yrs old Symptoms worse at night Sternal recession at rest Stridor Severe: Lethargy
How is croup treated?
Mild: No stridor at rest
150micro/kg 1 dose Dexamethasone & Supportive care at home
Moderate: Stridor at rest no agitation
Dexamethasone & Supportive
Severe: Stridor at rest w/agitation
Hospital admission, Dexamethasone given on transfer may repeat after 12hours, nebuliser Adrenaline 0.5ml/kg of 1:1000
What can be given to infants at high risk of bronchiolitis?
Palivizumab prophylaxis
What are the causes of epiglottitis?
H. Influenzae type B
What should not be done when considering a diagnosis of epiglottitis?
Throat examination
How is epiglottitis different from croup?
Time: C= Days E= hours Prodrome: C= Coryza E= nil Cough: C= Barking E= silent/none Feeding: C= Drinking E= nil Mouth: C= Closed E= Drooling Toxic: C= No E= Yes Fever: C <38.5 E >38.5 Stridor: C= Rasping E= Soft Voice: C= Hoarse E= Silent/weak
How is epiglottitis treated?
ET Tube ICU admission Blood Cultures IV Abx: IV Cefuroxime/ Ceftriaxone/ Cefotaxime for 7-10days Rifampicin prophylaxis to close contacts
What are the different classes of epiglottitis?
Class I: Slight swelling, entire vocal cord visualisation
Class II: Mod swelling of epiglottis, >50% of post vocal cord visualised
Class III: S.swelling, <50% of post vocal cord visualised
What are the causes of pneumonia in a child?
Neonates: Group B Strep, E.Coli, Staph Aureus
Infant: Strep Pneumoniae, Chlamydia
School: Strep Pneumoniae, Staph Aureus, Group A Strep
Who are at high risk of pneumonia?
Congenital lung cysts Chronic lung disease CF Sickle Cell anaemia Immunodeficiency Trache in situ
What are the signs & symptoms of pneumonia?
FEVER RR >50 Rx URTI Pleuritic chest pain or abdominal pain SOB Cough & Sputum production No wet nappies Vomiting after cough Dec breath sounds Bronchial breathing Dull percussion
How is pneumonia investigated?
Blood culture: Severe bacterial pneumonia
O2 sats
Nasopharyngeal aspirate
CXR
How is pneumonia treated?
Antipyretics Fluids Oxygen 1-5: 250mg TDS Amoxicillin/ Co-Amoxiclav >5: 500mg TDS Amoxicillin, Staph Aureus: Erythromycin Severe: IV Co-Amoxiclav
What tests should be done in a child with chronic/recurrent pneumonia?
Bloods: FBC, ESR, Complement screen
Immunology: IgA, IgE, IgG, IgM, rheumatoid factor
Genetics: CF phenotype
What are the causes of pharyngitis?
Rhinovirus
Enterovirus
Adenovirus
How is pharyngitis treated?
Supportive care
What are the signs & symptoms of pharyngitis?
Cough
Nasal congestion & discharge
Rhinorrhoea
Pharyngeal exudate
Define wheeze
Expiratory whistling that occurs during breathing when the airways are narrowed
High pitched= Small airway obstruction
Low pitched= Large airway obstruction
What are the causes of wheeze?
Extrinsic: Pneumonia, Pulmonary oedema, hilar nodes, enlarged LA, Scoliosis
Intrinsic: Asthma, Bronchiolitis, CF, Polyps, Bronchiectasis
Intraluminal: Aspiration, GORD, Mucus, pus, blood, foreign body
What are the investigations for a Wheeze?
Bronchodilator reversibility
Spirometry (>6yrs)
CXR
CF testing
What is the pathophysiology of CF?
Autosomal Recessive-most common condition in UK caucasians
CFTR Gene defect with F508 deletion
Abnormal Na & Cl transport in exocrine glands
Thick mucus, inadequate ciliary clearance, chronic colonisation, lung damage
Also affects the pancreas, liver & infertility in men
What are the signs & symptoms of CF?
Cough &Wheeze SOB Sputum Haemoptysis Rx Chest infections Weight loss/ failure to thrive Meconium ileus Nasal polyps Prolonged neonatal jaundice Malabsorption Limited growth/ short stature Clubbing Rectal prolapse Liver disease: Cirrhosis & portal hyperT Aspergillosis
How is CF investigated?
Sweat test: >60 Cl levels (abnormal function= excess secretion of NaCl in sweat) AT LEAST 2 performed
CXR: Hyperinflated, inc AP diameter, cysts, infiltrates, bronchial dilatation
Lung function: Obstructive pattern, dec FVC, inc lung vol
What screening is available for CF?
Genetic screening
Guthrie heel prick: raised IRT, CFTR deletion
How is CF managed?
Meconium ileus: Gastrograffin enema Physiotherapy: BD- percussion, postural change, deep breathing Abx: PO Flu Vaccine Bronchodilators: Salbutamol Mucolytics: Dornase Alfa 2500u OD Hypertonic Saline nebs Acetylcysteine: Meconium ileum or obstruction Lactulose Creon: Pancreatic enzyme replacement Multivitamins: Vit A, D, E, K
What annual investigations should be done on a patient with CF?
Bloods: FBC, Clotting, LFTs, Glucose, Immunology, U&Es
CXR
DEXA Scan
USS bowel & liver
Lung function tests
Physiology, nutrition, social, med review
What are the complications of CF?
DM Hepatic Cirrhosis Infertility in males S.pulmonary HTN/ Cor Pulmonale Chronic lung infections: Pseudomonas, Burkholderia
What are the signs & symptoms of acute epiglottitis?
LIFE-THREATENING Stridor Drooling Fever Toxic-looking child (Shocked, Tachypnoea) Sits upright & immobile Quiet Stridor/wheeze-may be faint
For a child with bronchiolitis when is immediate admission needed & when should a Dr consider admission?
Immediate: Apnoea, looks unwell to Dr, Central cyanosis, severe respiratory distress- grunting/recession/RR>70, sats <92% on air
Consider: RR >60, inadequate intake/difficulty breast feeding, clinical dehydration
