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Respiratory Flashcards

1
Q

What is the commonest cause of serious respiratory infection of infancy?

A

Bronchiolitis

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2
Q

What percentage of those with bronchiolitis are between 1-9months?

A

90%

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3
Q

What pathogen commonly causes bronchiolitis?

A

RSV (respiratory syncytial virus) - 80% cases.

Others:

  • Parainfluenza virus
  • Rhinovirus
  • Adenovirus
  • Influenza virus
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4
Q

What findings are typically found on examination in bronchiolitis?

A
  • Dry cough
  • Cyanosis and pallor
  • Subcostal and intercostal recession
  • Hyperinflation of the chest:
    • Sternum prominent
    • Liver displaced downwards
  • fine end-inspiratory crackles
  • prolonged expiration with wheeze
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5
Q

What Ix is typically done in bronchiolitis?

A
  • PCR for identifying virus.

- CXR in more serious cases = hyperinflation of lung

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6
Q

What is the management in bronchiolitis?

A

Supportive -
- Humidified oxygen

RSC is highly infective so good hand hygiene is essential.

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7
Q

What is the prognosis like of bronchiolitis?

A

recovery ~ 2 weeks.

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8
Q

In severe cases of bronchiolitis, what permanent damage can be done to the airways, what is this know as?

A

Bronchiolitis obliterans.

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9
Q

List the most common respiratory illnesses in - neonates, infants, under-5s and over 5s:

A

Neonates (0-28days):

  • Respiratory distress syndrome
  • Pneumonia

Infants (up to 1 yr):

  • Bronchiolitis
  • Pneumonia
  • Croup

Under-5s:

  • Viral induced wheeze
  • Croup
  • Pneumonia

Over-5s:

  • Asthma
  • Pneumonia

(basically only difference is in definition of those with asthma like symptoms)

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10
Q

List 7 signs which can be seen in respiratory distress:

A
  • Head bobbing
  • Nasal flaring
  • Tracheal tug
  • Tachypnoea
  • Recessions
  • Use of accessory muscles
  • Abdominal breathing
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11
Q

What is a ‘buzz phrase’ in terms of describing respiratory distress?

A

‘Increased work of breathing’

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12
Q

What is stridor and in what conditions can it be heard?

A

Sound hear on inspiration, low to medium pitched. Signifies airway obstruction.
Associated with croup and epiglottitis

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13
Q

What is stertor? When is it typically heard?

A

Noisy snoring-type breathing that results from airway obstruction in the nose, nasopharynx or oropharynx.

Viral URTI (snotty nose) or obstructive sleep apnoea.

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14
Q

What is grunting and when is it heard?

A

End-expiratory sounds due to closure of epiglottis. Self-induced positive end-expiratory pressure to keep airways open (self-PEEP). Similar to pursed lips expiration in adults with emphysema.

Heard due to severe respiratory distress.

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15
Q

What is wheeze? When is it typically heard?

A

A whistling sound on expiration: flow of high-velocity air through narrowed airways.

Heard in asthma, viral induced wheeze, anaphylaxis and foreign body aspiration.

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16
Q

What are the symptoms of bronchiolitis?

A 
Prodrome (3 days):
- Cold/harsh cough
Illness (3 days):
- Fever
- wheeze
- Breathlessness
(3 day recovery)
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17
Q

List 4 features prompting admission in those with bronchiolitis:

A
  • Poor feed (<50%/24hrs)
  • RR >50/min
  • Apnoea
  • Dehydration
  • SpO2 <94%
  • Respiratory distress
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18
Q

What children are at risk of severe bronchiolitis?

A
  • Preterms
  • Chronic lung disease
  • Heart condition
  • Immunodeficiency
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19
Q

Why does respiratory acidosis occur?

A

Due to decreased ventilation resulting in a higher pCO2 (hypercapnia). Respiratory alkalosis occurs due to hyperventilation (?)

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20
Q

What would you see in an FBC in whooping cough?

A

Lymphocytosis (more lympocytes)

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21
Q

What is given to those with increased risk of bronchiolitis?

A

Palivizumab - MAb to RSV surface protein (passive immunity). Make illness less severe.

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22
Q

What is asthma?

A

Chronic inflammatory disorder characterised by reversible obstruction of the airways.

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23
Q

Under what age is it difficult to diagnose asthma?

A

Under 3

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24
Q

What features of asthma suggest life threatening asthma?

A
  • Any sign of altered consciousness
  • Signs of respiratory falling/failing
  • PEF <33% normal
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25
Q

What are signs of moderate asthma?

A
  • PEF >50%

- No clinical Features of severe asthma

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26
Q

Outline the management of moderate, severe and life threatening asthma:

A

Moderate:

  • Beta2 agonists 2-10 puffs via spacer
  • oral prednisolone

Severe:

  • Beta2 agonist 1- puff via spacer or nebulised
  • Oral prednisolone or IV hydrocortisone
  • If poor response nebulise ipratropium bromide

Life-threatening:

  • Nebulise Beta2 agonist and ipratropium bromide
  • Oral prednisolone or IV hydrocortisone
  • Discuss with senior clinician, PICU team or paediatrician
27
Q

What acronym is used for the acute treatment of asthma?

A 
(OSHIT!)
O - O2
S - Salbutamol
H - Hydrocortisone
I - Ipratropium bromide
T - Theophylline (relaxes airway)
! - MgSulphate (bronchodilating and anti-inflammatory effect)
28
Q

What is nor present in viral induced wheeze?

A
  • Interval symptoms

- PMH of atopy

29
Q

What is viral induced wheeze and who does it typically affect?

A

Wheeze episode associated with viral URTI.

Typically in children <5 years old.

30
Q

What is the ‘buzz phrase for viral wheeze?

A

‘No interval symptoms’

31
Q

What is the management for viral induced wheeze?

A

ABCD

steroids not currently indicated

32
Q

What is acute viral laryngotracheobronchitis know as?

A

Croup

33
Q

What is the commonest cause of stridor in children?

A

Croup

34
Q

What characterises croup? What age group is typically affected?

A
  • Hoarse voice
  • Barking cough
  • +/- respiratory distress

Affects those 6 months - 6 years

35
Q

What typically causes acute viral laryngotrachealbronchitis?

A

Parainfluenza virus

36
Q

What is the management for croup?

A

Steroids

+/- adrenaline nebs

37
Q

What is seen in acute epiglottitis but not in croup?

A
  • Drooling

- Very unwell/toxic

38
Q

Why is epiglottits rare?

A

Rare due to Hib vaccination

39
Q

Outline the management in someone with epiglottitis?

A
  • Leave patient alone
  • Summon Paeds anaesthetist and ENT surgeon
  • Abx once airway is secured
40
Q

Give 6 indications for hospitalisation:

A
  • Cyanosis
  • Pallor
  • Respiratory distress
  • Hypoxaemic
  • Stridor
  • Toxic looking child
41
Q

What is the inheritance pattern in Cystic Fibrosis (CF)?

A

Autosomal recessive.

1 in 25 people in the UK are CF carriers.

42
Q

What is the commonest mutation in those with CF?

A

Chromosome 7 - Delta F508

43
Q

Outline why the symptoms of CF develop:

A

1) Mutation of chromosome 7
2) Abnormal cystic fibrosis transmembrane conductance regulator protein (CFTR)
3) Responsible for cellular chloride secreations
4) Thick secretions
5a) This results in pancreatic insufficiency -> DM and malabsorption
5b) Recurrent chest infections + Bronchiectasis
6) These both results in faltering growth and chronic poor health

(infertility is also a feature)

44
Q

When should CF be diagnosed? What would be raised in a positive result?

A

During the Guthrie test at day 5.

Raised immunoreactive trypsin (IRT).

45
Q

List 5 features of CF:

A
  • Short stature
  • Malabsorption
  • Failure to thrive
  • Chronic cough
  • Recurrent chest infections
46
Q

What is the gold standard test in diagnosis of CF? What results suggest a CF?

A

Sweat test.

> 60mmol/l - 2 abnormal tests necessary for diagnosis.

47
Q

What other investigations maybe performed in someone suspected of CF and what would be seen?

A

Genetics - 98% detected on genetic testing.

CXR - Hyperinflation, peribronchial thickening, bronchiectasis

Lung function testing - Obstructive picture

Sputum - haemophilus influenzae, staph. aureus, pseudomonas aeruginosa, burkholderia cepacia, E. Coli, klebsiella

48
Q

Outline what services may be involved in the care of someone with CF?

A
  • Physiotherapy (to bring up muccus)
  • Medical - Paeds, endocrine, GP, transplant team
  • Nursing
  • Psychosocial
  • Education
  • Dietician (fat soluble vitamins, DM may develop)
49
Q

What respiratory management may be needed for those with CF?

A
  • Bronchodilators
  • Chest physio
  • Mucolytics (carbocystine)
  • Abx +/- prophylaxis
50
Q

List one mucolytic:

A

Carbocystine

51
Q

What may be found on examination in someone with CF?

A
  • Cyanosis
  • Clubbing
  • Weight loss
  • Dry skin
  • Steatorrhoea
52
Q

List the top 3 viral causes and the top 3 bacterial causes of pneumonia:

A

Viral:

  • RSV (Bronchiolitis)
  • parainfluenzae (croup)
  • Adenovirus

Bacterial:

  • Strep. pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
53
Q

How is a ‘mild chest infection managed’?

A

(mild pneumonia)
Generally well child with fever and cough. SpO2 >93%
Mangement:
- At home
- Oral abx (<5s = amoxicillin, >5s get erythromycin)
- Safety netting

54
Q

How should a child with ‘moderate to severe’ pneumonia be managed?

A 
Unwell child, respiratory distress, poor fluid intake.
Management:
- Admit on ward
- Oxygen to maintain sats >92%
- IV Abx and fluids
- Close observation
55
Q

When are asthma symptoms typically worse?

A
  • Night time
  • Exercise
  • cold to hot ect.
56
Q

How many puffs of salbutamol are equivalent to a nebuliser?

A

10 puffs. Nebuliser only needed if patient is on O2

57
Q

How many puffs 4 hourly should be allowed before help should be seeked? (shit grammer oh well)

A

10 puffs per 4 hours

58
Q

When should a preventer inhaler be introduced?

A

If a reliever inhaler is needed more than once a day 5 times per week.

59
Q

What therapy should be added on if a simple preventer/ beta2 agonist isn’t working?

A

LABA and/or montelukast

60
Q

What does montelukast do?

A

Leukotriene receptor antagonist. It is used as a preventer in chronic asthma. 2/3 of children respond

61
Q

What may present as a maculopapullar rash?

A 
Measles
Rubella
Scarlet fever
Kawasakis
Drugs
62
Q

What may present as a petechial purpuric rash?

A

HSP
ITP
Meningococcal

63
Q

What may present as a bullous rash/skin lesions?

A

Impetigo

Scalded skin syndrome

64
Q

What may present as a vesicular rash?

A
  • Chicken pox
  • Hand + foot + mouth
  • Herpes

Paeds (13 decks)

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