Respiratory Flashcards
What is the commonest cause of serious respiratory infection of infancy?
Bronchiolitis
What percentage of those with bronchiolitis are between 1-9months?
90%
What pathogen commonly causes bronchiolitis?
RSV (respiratory syncytial virus) - 80% cases.
Others:
- Parainfluenza virus
- Rhinovirus
- Adenovirus
- Influenza virus
What findings are typically found on examination in bronchiolitis?
- 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
What Ix is typically done in bronchiolitis?
- PCR for identifying virus.
- CXR in more serious cases = hyperinflation of lung
What is the management in bronchiolitis?
Supportive -
- Humidified oxygen
RSC is highly infective so good hand hygiene is essential.
What is the prognosis like of bronchiolitis?
recovery ~ 2 weeks.
In severe cases of bronchiolitis, what permanent damage can be done to the airways, what is this know as?
Bronchiolitis obliterans.
List the most common respiratory illnesses in - neonates, infants, under-5s and over 5s:
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)
List 7 signs which can be seen in respiratory distress:
- Head bobbing
- Nasal flaring
- Tracheal tug
- Tachypnoea
- Recessions
- Use of accessory muscles
- Abdominal breathing
What is a ‘buzz phrase’ in terms of describing respiratory distress?
‘Increased work of breathing’
What is stridor and in what conditions can it be heard?
Sound hear on inspiration, low to medium pitched. Signifies airway obstruction.
Associated with croup and epiglottitis
What is stertor? When is it typically heard?
Noisy snoring-type breathing that results from airway obstruction in the nose, nasopharynx or oropharynx.
Viral URTI (snotty nose) or obstructive sleep apnoea.
What is grunting and when is it heard?
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.
What is wheeze? When is it typically heard?
A whistling sound on expiration: flow of high-velocity air through narrowed airways.
Heard in asthma, viral induced wheeze, anaphylaxis and foreign body aspiration.
What are the symptoms of bronchiolitis?
Prodrome (3 days): - Cold/harsh cough Illness (3 days): - Fever - wheeze - Breathlessness (3 day recovery)
List 4 features prompting admission in those with bronchiolitis:
- Poor feed (<50%/24hrs)
- RR >50/min
- Apnoea
- Dehydration
- SpO2 <94%
- Respiratory distress
What children are at risk of severe bronchiolitis?
- Preterms
- Chronic lung disease
- Heart condition
- Immunodeficiency
Why does respiratory acidosis occur?
Due to decreased ventilation resulting in a higher pCO2 (hypercapnia). Respiratory alkalosis occurs due to hyperventilation (?)
What would you see in an FBC in whooping cough?
Lymphocytosis (more lympocytes)
What is given to those with increased risk of bronchiolitis?
Palivizumab - MAb to RSV surface protein (passive immunity). Make illness less severe.
What is asthma?
Chronic inflammatory disorder characterised by reversible obstruction of the airways.
Under what age is it difficult to diagnose asthma?
Under 3
What features of asthma suggest life threatening asthma?
- Any sign of altered consciousness
- Signs of respiratory falling/failing
- PEF <33% normal
What are signs of moderate asthma?
- PEF >50%
- No clinical Features of severe asthma