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LS YEAR 4 Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is asthma

A

obstructive disorder of the airway
it is reversible
characterised by increased mucus production, mucosal swellingg and bronchospam

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2
Q

what three key features define it asthma

A

tachypnea
wheeze
nocturnal cough

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3
Q

percentage of population affected asthma

A

5-8%

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4
Q

what is it commonly associate withasthma

A

atopy- hay fever
allergies
eczema esp in children

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5
Q

triggers

two meds triggering itasthma

A 
fur
dust mites
cold weather
emotion
pollen
exercise
nSAID
beta blockers
smoke/pollution
infection
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6
Q

60% also have what”asthma

A

gord

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7
Q

symptoms and signs of.asthma

A 
tachypnea 
wheeze
reduced air entry 
reduced breath sounds 
hyperinflation of the chest 
hyper-resonant on percussion
polyphonic wheeze]
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8
Q

signs and symptoms of acute episode/severe

asthma

A 
silent chest
cyanosis
PEFR < 35-55% resp effort
rr over 25 in adults but need to know paeds
increased heart rate
bradycardia
feeble resp effort
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9
Q

investigations of asthma

A

abg blood gas
spirometry
peak flow

xray
cultures
salbutamol trial

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10
Q

management

of asthma

A

avoid trigger
SABA- salbutamol
add inhaled corticosteroid

increases ICS

add LABA for over 5 year olds
in under 2 refer to pediatrican
over 2 can try montelukast -leuktriene receptor

for over 5, can try ICS again and oral CS then refer

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11
Q

route of meds depends on asthma

A

age
spacer can be given after 2 years
before that, will need nebs

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12
Q

hw many puffs of salbutamol

A

10puffs four hourly

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13
Q

what is broncholiltis

A

inflammation of the airway -lower airway bronchioles

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14
Q

what is bronchitis caused by

A

rsv

respiratory synival virus

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15
Q

who does it affect

broncholitis

A

<2 year old esp below 1 years of age

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16
Q

how does it present broncholiti

A 
wheeze
dry cough
cyanosis 
tachypnea
prolonged expiration
use of accessory muscles 
apnea
pauses in breathing
breathlessness worsening 
feeding diffculities
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17
Q

examinations for broncholitis

A

listen to chest
oxygen sats- need to be over 92%
CXR
nasopharyngeal swab to confirm diagnosis

consider xray

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18
Q

mangement is done how for broncholitis

A 
supportively
so give oxygen if sats low
can give salbutamol to aid breathing 
10 puffs 4 hourly then wean down
NG for feeding
ventotherm -humidified high flow oxygen
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19
Q

when can child go home? with bromcholitis

A

10 puffs per 6 hours

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20
Q

who is at risk and what can be done?
whats it called
broncholitis

A

premature babies and immunocomprised therefore RSV vaccine available as prophylaxis
Palivizumab prophylaxis

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21
Q

what else is available?broncholitis

A

oral montelukast granules to go with food to reduce symptoms

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22
Q

other viral causes of broncholitis

A

adneovirus
rhinovirus
influenze

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23
Q

what is seen on xray for broncholitis

A

hyperinflation and atelectasis

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24
Q

what is croup

another name

A

laryngotrachitis

inflammation of trachea and pharynx

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25
Q

what is croup characterised by

A

barking cough

harsh stridor

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26
Q

what is stridor?

A

inspiratory wheeze

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27
Q

describe nature of course croup

A 
progressively worse over days
worse at night
hoarse voice
coryza mild fever
sneezing
runny nose
heavy breathing
cyanosis
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28
Q

how do you differentiate croup from epiglottis

A

no cough in epiglottis and no prodome
drooling and hot potato voice in epiglottis
sudden onset in epiglotitis

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29
Q

investigations for croup

A

moderate to severe need hospital admission
rule out other causes
laryngoscopy if atypical ilnness
swab test influenza A

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30
Q

cause of croup

A

parainfluenza

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31
Q

what scoring is used for diagnosis for crou

A

Westley

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32
Q

features of Westley

A 
cyanosis
consciousness altered
intercostal recession
stridor
reduced air entry
steeples sign on xray -urt narrowing
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33
Q

management of croup

A

dethametosone for inflammation

adrenaline nebs

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34
Q

what is epiglottis

A

inflammation of the epiglottis

it is a medical emergency

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35
Q

how does epiglottis present

A 
hot potato voice
sudden onset
sore throat
drooling
whispering
tripoding
unable to swallow
tachycardia
 dysphagia dysphonia dyspenea
NO COUGH NOR PRODOME
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36
Q

investigations epiglottis

A

do not press tongue down with depressor or irritate child
lateral xray will show thumb print sign
laryngoscopy

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37
Q

management epiglottis

A 
ampicillin
intubation
iv fluids
gain senior help
neb adrenaline
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38
Q

side effects of inhaled corticosteroids

A

Impaired growth
Adrenal suppression
Oral candidiasis
Altered bone metabolis

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39
Q

management of acute 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/20min
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40
Q

what is a wheeze

A

breathe sound heard on expiration
with prolongation of the expiratory phase of breathing
indicating obstruction to airflow within thorax

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41
Q

is it high or low pitch?

A

can be either and indicates where obstruction is - small and large airway respectively

42
Q

causes of extrinsic airway lower

A

lung parenchyma -penumona
vascular
enlarged hilar lymph dnodes
chest deforomities

43
Q

causes of intrinsic changes

A 
asthmes
allergy
bronchilitis
Cf
bronchiestasis
haemangioma 
cilary disease
44
Q

intraluminal causes

A

aspiration of milk or food in gord

foriegn body

45
Q

viral wheeze can be managed how

A

with bronchodilators
10 puffs salbutamol 4 hourly on first day
5 puffs, 4 hourly second
2 puffs 4 hourly unti improves

46
Q

what is cystic fibrosis

A

an inherited autosomal recessive condition affecting df508 in 85% of cases
results in a defective cf transporter protein resulting in accumulation of chloride ions inside cell
this causes influx of sodium and water into cell and causes dry sticky mucus on surface of epithelium

47
Q

symptoms of CF

A 
affects multiple systems
respiratory: increased infections, mucus production, chronic cough with sputum and mucus
osteoporosis
malabsorption of vitamins
male inferility
diabetes 
arthritis
LRTI
liver disease for example
48
Q

what is the most common resp infection cause IN CF

A

s. aureus

49
Q

what is the most worrying infection cause IN CF

A

non TB myobacteria
resistent to many drugs
can be an exclusion feature for transplant

50
Q

how is diagnosis made INCF

A

better in recent years meaning children can live to 40-50years of life, older individuals have an estimated lifespan of 30.
early diagnosis needed to prevent damage
sweat test- sodium chloride >60mmol/l
or new born screening ITR high in babies

51
Q

what is dios

A

distal intestinal obsutction sydnrome
seen with bilious vomiting
n and v
distended abdomen

52
Q

10% of infants picked up with cF because of

A

meconium ileum

meconium should pass within 48hours of birth

53
Q

symptoms in infancy IN CF

A

failure to thrive
clubbing
infections reccurent

54
Q

management OF CF

A 
high fat diet
vitamin ADEk supplementation
creon
diabetes OGGT annually once teen
xray annually
transplants
gastronomy feeds
inhaled/nebs -bronchodilators
physiotherapy
55
Q

what is tonsillitis

A

inflammation of tonsillis
seen in 5-15 year old most commonly
most common causes are ebb, and group A beta haemolytic streptococci

56
Q

symptoms of tonsillitis

A 
sore throat
fever
pain on swallowing
red enlarged inflamed tonsilis
white exudate on tonsilis
nausea and vomiting
bad breathe
fever
abdo pain in kids
57
Q

how many are self limiting

A

9/10

58
Q

diagnosis OF TONSILITIS

A

apperance
swabs
blood if suspected ebv

59
Q

managementTONSILITIS

A

rest fluid gargle with mouthwash

ent referral for removal if recurrent or causing difficulty with breathing

60
Q

complicationsTONSILITIS

A

quinsy - pericellular abscess

61
Q

scoring system used and its featureTONSILITIS

A 
centor scoring
anterior cervical lymphodenopathy
absence of cough
tonsillar exudate
fever history
over 44 remove1 point
add 1 point if under 15
62
Q

what condition is associated with a barking cough?

A

croup
at night
change in temp and allergies

63
Q

what is associated with whooping cough

A

pertussis bordetella

64
Q

cough with a wheeze

A

asthma
broncholitis
foreign body

65
Q

a cough with stridor

A

this cough is associated with epiglottitis

66
Q

suden cough

A

obstruction or foreign body

67
Q

night time

A

asthma, viral wheeze, generally lying down makes wheeze worse

68
Q

chronic cough

A

asthma

allergies

69
Q

infant

A

broncholilitis

pneumonia

70
Q

what is tuberculosis

A

a chronic granulomatous disease caused by mycobacterium tuberculosis droplet infection

71
Q

what are risk factors for TB

A 
contact with individual with tv
ASIAN
homeless
drug abusers
HIV
from high risk country
elderly
72
Q

presentation of tb

A 
night sweats
weight loss
fever
chronic productive cough
fatigue
malaise
purulent sputum-may or maybe not be blood stained
73
Q

what can TB lead to

A

abscess formation, lobular collapse, p. effusion, bronchestasis

74
Q

other more systemic consequences of tb

A

infertility, salpingitis, kidney lesions, arthritis, ostoemyletisis mengititis

75
Q

management of TB

A

ripe

2 months of ripmaizin, izonaid, pyrazamide, ethambutal, then RI for 4 months

76
Q

what is treatment of milary tb

A

same but instead 3 months of ripe AND THEN 12-18 months of RI

77
Q

how is tb DIAGNOSISED?

A

XRAY apices, lower lobe, coin lesions
Mantoux test
sputum

78
Q

what causes whooping cough?

A

boredella pertussis

79
Q

important things about whooping cough

A

notifable disease
cyclical disease every 3-4 years and lasts 6-8 weeks
severe in < 3 moths

80
Q

symptoms of whooping cough

A

cough with a hoop noise
2 week chough
paroxysm
followed by vomiting

81
Q

phases of whooping cough

A

catarrh phase- malaise, sore throat, fever, cough
(infective phase)
second phase- dry cough with whoops, post cough vomiting,

82
Q

diagnosis of whooopping cough

A

blods
swabs
igG antipertissus

83
Q

mx of whooping cough

A

clarithromycin
admission if < 6 month old
supportive management

84
Q

what is pneumonia

A

infection of lung parenchyma

causing air sacs to fill up

85
Q

symptoms and signs

A 
fever
tachypnea 
increased tactil fremitius
reduced breath sounds 
heart rate increases
dip in BP
coarse creptations 
bronchial breathing 
dull to percuss
poor feeding
diarrhoea 
cough
vomiting
86
Q

diagnosis of pneumonia

A

xray-consolidation
bloods
urine microbiology
immunfoluence

87
Q

management of pneumonia

A

admit if severe and signs of sepsis
>92% oxygen so may need oxygen, IV rhesus if dehydrated or in shock
abx- amocillin or erythromycin but if severe IV cefoxime with or without erythromycin and consider metronidazole
resp failure: CPAP

88
Q

causes in diff age brackets pneumonia

A

neonate -ecoli, group B strep, preschool-prainfluenze, sac, adenovirus, 60% bacterial streptococcus pneumonia, h. influenza and s.aureus

89
Q

management of pneumnoia

A

amoxcillin
erythromycin clarithromycin
cpap if necessary

90
Q

middle ear infection management and when you’d give antibiotics

A

admit if if under 3 months and temp of 38 or more
3-6 months and temp of 39 or more
signs of systemically unwell
signs of complications

anbitibotics if signs of perforation, lasting 4 days or more, <2 years old and bilateral but otherwise OK

amoxcillin
erythromycin clarithromycin
cpap if necessary

91
Q

wheeze plan

A 
day 1 -10 puffs, 4 hourly
day 2 - 6 - 6 hourly 
day 3 - 4- 8 hourly 
day 4 - 2 puffs, 12 hourly 
day 5 -as when needed

green managing with 2-6 puffs 4 hourly fine
yellow - 5-10 puffs 4 hourly, if effective no need to admit
red- breathless even with 10 puffs, if not helping admit

92
Q

when is bronchitis worse

A

day3-4

warn parents

93
Q

what is head box oxygen

A

old oxygen humidified
hardly used now
ventotherm used instead
broncholitis

94
Q

who have vaccines in bronhcolitis

A

resp dx
heart dx
congenital immunodifciencies
monthlyfor 4-5 months of winter period

95
Q

difference between croup and broncholitis

A

LRTI bronchilitis

croup is URTI

96
Q

when do u admit bronchiltitis

A 
DRAMAS
Dehydration 
Reduced wet napes 12 hr, resp rate 70
Apenic 
Milk < 50% normal feeds
Apperance ill or exhausted
sats < 92
97
Q

mild mod severe bronchiolitis

A

mild - minimal resp distress, feeding ok,, no oxygen no risk factors -send home
moderate- increased WOB, poor feed, low sats, admit for oxygen and feeding support
severe- if worsening respdistress, acidiosis, dehydration CPAPA ventilation admit for fluids

98
Q

what is PCD

A

primary ciliary dyskinesia
differential of cf

cilia don’t work properly.
mucus building up
infection in both the airways and ears, sinuses, pneumonia

Half of people with PCD have situs inversus- organs in their chest and tummy are on the opposite side of the body from usual.

autosomal recessive

99
Q

G6PD DEFICIENCY WHICH GENE

A

X chromosome

100
Q

In CF what else can be see

A 
polyps
FFT
pancreatitis
rectal prolapse
clubbting
mx by TERTIARY CENTRE
101
Q

oxygen in 15lnRM as %

A

80%

102
Q

thorecaentesis for what

A

tension pneumothorax

LS YEAR 4 Paediatrics (24 decks)

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