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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the signs & symptoms of asthma in a child?

A 
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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2
Q

What are the investigations for asthma?

A

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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3
Q

How is asthma in a child <5yrs treated?

A 
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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4
Q

How is asthma in a child 5-12 treated?

A

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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5
Q

What are the side effects of inhaled steroids?

A

Impaired growth
Adrenal suppression
Oral candidiasis
Altered bone metabolism

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6
Q

How are asthma exacerbations in children graded?

A

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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7
Q

What is the treatment for a severe asthma attack?

A 
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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8
Q

What are the causes of bronchiolitis?

A

RSV 80%
(para)Influenza
Adenovirus
Mycoplasma pneumoniae

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9
Q

What is the pathophysiology of bronchiolitis?

A

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

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10
Q

What are the signs & symptoms of bronchiolitis?

A 
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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11
Q

What investigations are done for bronchiolitis?

A

Sats
CXR
Nasopharyngeal swabs w/immunofluorescence

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12
Q

How is bronchiolitis treated?

A 
Supportive
Sats <92%: Humidified Oxygen
Poor feeding: NG tube
Wheeze: Bronchodiators
Pending respiratory failure: CPAP
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13
Q

What are the causes of Croup?

A

Parainfluenza 80%
Influenza
RSV

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14
Q

What are the signs & symptoms of Croup?

A 
Seal bark cough
6m-6yrs old
Symptoms worse at night
Sternal recession at rest
Stridor
Severe: Lethargy
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15
Q

How is croup treated?

A

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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16
Q

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

A

Palivizumab prophylaxis

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17
Q

What are the causes of epiglottitis?

A

H. Influenzae type B

18
Q

What should not be done when considering a diagnosis of epiglottitis?

A

Throat examination

19
Q

How is epiglottitis different from croup?

A 
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
20
Q

How is epiglottitis treated?

A 
ET Tube
ICU admission
Blood Cultures
IV Abx: IV Cefuroxime/ Ceftriaxone/ Cefotaxime for 7-10days
Rifampicin prophylaxis to close contacts
21
Q

What are the different classes of epiglottitis?

A

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

22
Q

What are the causes of pneumonia in a child?

A

Neonates: Group B Strep, E.Coli, Staph Aureus
Infant: Strep Pneumoniae, Chlamydia
School: Strep Pneumoniae, Staph Aureus, Group A Strep

23
Q

Who are at high risk of pneumonia?

A 
Congenital lung cysts
Chronic lung disease
CF
Sickle Cell anaemia
Immunodeficiency
Trache in situ
24
Q

What are the signs & symptoms of pneumonia?

A 
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
25
Q

How is pneumonia investigated?

A

Blood culture: Severe bacterial pneumonia
O2 sats
Nasopharyngeal aspirate
CXR

26
Q

How is pneumonia treated?

A 
Antipyretics
Fluids
Oxygen
1-5: 250mg TDS Amoxicillin/ Co-Amoxiclav
>5: 500mg TDS Amoxicillin, Staph Aureus: Erythromycin
Severe: IV Co-Amoxiclav
27
Q

What tests should be done in a child with chronic/recurrent pneumonia?

A

Bloods: FBC, ESR, Complement screen
Immunology: IgA, IgE, IgG, IgM, rheumatoid factor
Genetics: CF phenotype

28
Q

What are the causes of pharyngitis?

A

Rhinovirus
Enterovirus
Adenovirus

29
Q

How is pharyngitis treated?

A

Supportive care

30
Q

What are the signs & symptoms of pharyngitis?

A

Cough
Nasal congestion & discharge
Rhinorrhoea
Pharyngeal exudate

31
Q

Define wheeze

A

Expiratory whistling that occurs during breathing when the airways are narrowed
High pitched= Small airway obstruction
Low pitched= Large airway obstruction

32
Q

What are the causes of wheeze?

A

Extrinsic: Pneumonia, Pulmonary oedema, hilar nodes, enlarged LA, Scoliosis
Intrinsic: Asthma, Bronchiolitis, CF, Polyps, Bronchiectasis
Intraluminal: Aspiration, GORD, Mucus, pus, blood, foreign body

33
Q

What are the investigations for a Wheeze?

A

Bronchodilator reversibility
Spirometry (>6yrs)
CXR
CF testing

34
Q

What is the pathophysiology of CF?

A

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

35
Q

What are the signs & symptoms of CF?

A 
Cough &amp;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 &amp; portal hyperT
Aspergillosis
36
Q

How is CF investigated?

A

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

37
Q

What screening is available for CF?

A

Genetic screening

Guthrie heel prick: raised IRT, CFTR deletion

38
Q

How is CF managed?

A 
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
39
Q

What annual investigations should be done on a patient with CF?

A

Bloods: FBC, Clotting, LFTs, Glucose, Immunology, U&Es
CXR
DEXA Scan
USS bowel & liver
Lung function tests
Physiology, nutrition, social, med review

40
Q

What are the complications of CF?

A 
DM
Hepatic Cirrhosis
Infertility in males
S.pulmonary HTN/ Cor Pulmonale
Chronic lung infections: Pseudomonas, Burkholderia
41
Q

What are the signs & symptoms of acute epiglottitis?

A 
LIFE-THREATENING
Stridor
Drooling
Fever
Toxic-looking child (Shocked, Tachypnoea)
Sits upright &amp; immobile
Quiet
Stridor/wheeze-may be faint
42
Q

For a child with bronchiolitis when is immediate admission needed & when should a Dr consider admission?

A

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

Paediatrics (26 decks)

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