Respiratory Flashcards by Amy Spicer

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

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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

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How is asthma in a child <5yrs treated?

Step1: SABA: Salbutamol/Terbutaline
Step2: Step1 &amp; PREVENTER- Inhaled corticosteroid <5y: 200-400micro/daily 
Step3: Step2 &amp; 
<5 Leukotriene: Montelukast
<2yrs STEP4
Step4: Refer to specialist

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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

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What are the side effects of inhaled steroids?

Impaired growth
Adrenal suppression
Oral candidiasis
Altered bone metabolism

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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

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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

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What are the causes of bronchiolitis?

RSV 80%
(para)Influenza
Adenovirus
Mycoplasma pneumoniae

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What is the pathophysiology of bronchiolitis?

Invades nasopharyngeal epithelium
Spreads to lower airways
Causes increased mucous production, desquamation bronchiolar obstruction

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What are the signs & symptoms of bronchiolitis?

Winter months- COMMON!
Dry high-pitched cough
Runny nose &amp; 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

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What investigations are done for bronchiolitis?

Sats
CXR
Nasopharyngeal swabs w/immunofluorescence

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How is bronchiolitis treated?

Supportive
Sats <92%: Humidified Oxygen
Poor feeding: NG tube
Wheeze: Bronchodiators
Pending respiratory failure: CPAP

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What are the causes of Croup?

Parainfluenza 80%
Influenza
RSV

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What are the signs & symptoms of Croup?

Seal bark cough
6m-6yrs old
Symptoms worse at night
Sternal recession at rest
Stridor
Severe: Lethargy

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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

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What can be given to infants at high risk of bronchiolitis?

Palivizumab prophylaxis

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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 &amp; 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