Respiratory Flashcards
Whooping cough Bronchiolitis Croup Acute epiglottitis Cystic fibrosis Pneumonia
1
Q
What is the commonest lung infection in infants?
A
bronchiolitis
2
Q
What is the most common causative organism of bronchiolitis?
A
Respiratory syncytial virus (80%)
3
Q
What are other organisms that can cause bronchiolitis?
A
human metapneumovirus
parainfluenza virus
rhinovirus
adenovirus
4
Q
What age is bronchiolitis more common?
A
1-9m
5
Q
What are the risk factors for severe bronchiolitis?
A
− Premature developing bronchopulmonary dysplasia
− Underlying lung disease e.g. CF, CHD
6
Q
What are the clinical features of bronchiolitis?
A
preceding coryza
dry cough
increasing dyspnoea
feeding difficulty
7
Q
What are the signs on examination of bronchiolitis?
A
tachypnoea high pitched wheezes (expiratory) tachycardia inspiratory crackles intercostal recession +/- cyanosis \+/- fever
8
Q
what signs should prompt immediate admission w bronchiolitis?
A
inadequate feeding resp distress - grunting, chest recession, RR 70/min LOOKS UNWELL hypoxia (<92% OA) apnoea use of accessory muscles
9
Q
What are the ix for bronchiolitis?what do they show?
A
- PCR of nasopharyngeal secretions to identify virus
2. CXR - hyperinflation, focal atelectasis (collapse)
10
Q
What is the management of bronchiolitis:?
A
supportive
humidified oxygen (nasal cannulae, stop when >92%)
fluid?
assisted ventilation?
11
Q
What is the prevention of bronchiolitis and who needs it th most?
A
high risk preterm infants
mostly IM injections of palivizumab
12
Q
How long do infants tend to take to recover from bronchiolitis?
A
2 weeks
13
Q
What is the causative organism that can cause permanent damage in bronchiolitis? what is the name of what it causes?
A
adenovirus
bronchiolitis obliterans
14
Q
what is the most common causative organism of pneumonia in the newborn?
A
GBS
Gram -ve enterococci
from mothers genitals
15
Q
what is the most common causative organism of pneumonia in infants and young children?
A
resp viruses - RSV
Bacterial - H. influenza, bordetella pertussis, chlamydia
16
Q
what is the most common causative organism of pneumonia in over 5yrs
A
mycoplasma pneumoniae
strep. pneumonaie
chlamydia pneumonaie
17
Q
what cause of pneumonia should be considered in all ages?
A
TB
18
Q
What is the causative organism of pneumococcal pneumonia?
A
strep pneumoniae
19
Q
What are the symptoms of pneumonia?
A
fever dyspnoea preceded by URTI Cough lethargy poor feeding looks unwell
20
Q
What clinical features suggest a bacterial cause of pneumonia?
A
localised pain in the chest/abdo/neck
21
Q
What is seen on examination in pneumonia?
A
tachypnoea nasal flaring chest indrawing reduced sats end inspiratory coarse crackles over affected area
22
Q
What are the classic signs of pneumonia that are often absent in young children?
A
consolidation w dullness on percussion
decreased breath sounds
bronchial breathing
23
Q
What are the ix for pneumonia and what can be seen?
A
CXR
nasopharyngeal aspirate - identifies viral cause
24
Q
What causative organism shows a classic lobar pneumonia?
A
strep pneumoniae
25
wHen are ix not required in pneumonia?
community acquired pneumonia in a child going home
26
When can pneumonia be managed at home?
those w mild symptoms
27
what is the first line pharmacological treatment of pneumonia? give alternatives
Amoxicillin
| Alternatives: co-amoxiclav, azithromycin, clarithromycin
28
What is croup also known as?
acute laryngotracheobronchitis
29
What is the pathophysiology of croup? why is it potentially dangerous?
mucosal inflammation
increased secretions
oedema of the subglottic area, dangerous as results in critical narrowing of the trachea
30
What are the causes of croup?
1. parainfluenza - commonest
2. Human metapneumovirus
3. RSV
4. Influenza
31
What age group does croup most commonly affect?
6m-6yrs
32
when are epidemics of croup most common?
autumn
33
What are the clinical features of croup?
```
barking cough
harsh stridor
hoarseness
sx worse at night
preceded by fever and coryza
```
34
What are severe signs of croup?
Frequent barking cough
prominent inspiratory stridor at rest
marked sternal wall retractions
significant distress or agitation, or lethargy or restlessness
tachycardia occurs w more severe obstructive sx and hypoxaemia
35
What are mild signs of croup?
Occasional barking cough
No audible stridor at rest
No/mild suprasternal +/- intercostal recession
Child happy
36
What are mod signs of croup?
Frequent barking cough
easily audible stridor at rest
suprasternal and sternal wall retraction at rest
no/little distress or agitation
37
What is the management of mild croup?
Can be sent home w dose of dexamethasone or prednisolone
38
What is the management of severe croup?
nebuliser epinephrine
39
what is an important differential of severe croup?what are the features?
bacterial tracheitis
thick mucopurulent sputum
tracheal mucosal sloughing that is not cleared by coughing
40
What must be avoided in the management of acute epiglottitis?
DO NOT EXAMINE THE THROAT THIS CAN CAUSE OBSTRUCTION
41
What age is most commonly affected by acute epiglottitis?
2-7yrs
42
What is the most common causative organism of epiglottitis?
H. Influenzae type B
43
What are the clinical features of epiglottitis?
1. sudden onset
2. high fever
3. v painful throat preventing them from speaking or swallowing so drools
4. soft inspiratory strider and rapidly increasing dyspnoea over hours
5. child sitting immobile, upright w mouth open
44
What is the management of acute epiglottitis?
1. SECURE THE AIRWAY - intubate w GA
| 2. Blood cultures, cefuroxime or ceftriaxone IV
45
What is used for prophylaxis of acute epiglottitis?
rifampicin
46
What is the difference in onset between acute epiglottis and croup?
croup - days
| epiglottitis - sudden (hrs)
47
between acute epiglottis and croup, which has preceding coryza?
croup
48
what is the difference in cough between acute epiglottis and croup?
croup - severe barking
| epiglottitis - absent or slight
49
between acute epiglottis and croup, which is unable to drink?
epiglottitis
50
between acute epiglottis and croup, which has drooling?
epiglottitis
51
what is the difference in appearance of the child between acute epiglottis and croup?
croup - unwell
| epiglottitis - v ill
52
what is the diff in feverbetween acute epiglottis and croup?
croup <38.5
| epiglottitis >38.5
53
Explain the difference in the nature of the stridor between acute epiglottis and croup
croup - harsh and rasping
| epiglottitis - soft whispering
54
what is the difference in nature of voice between acute epiglottis and croup?
croup - hoarse voice
| epiglottitis - muffled reluctant to speak
55
What is the causative organism of whooping cough?
bordetella pertussis
56
How is whooping cough spread/
aerosolised drops in cough
57
what is the incubation period of whooping cough
10-14 days
58
What are risk factors of whooping cough
Non-vaccination
| exposure to infected person
59
what causes the characteristic whoop in whooping cough
inspiration against a closed glottis
60
What are the stages of whooping cough, how long are they
1st phase: catarrhal - 1-2 weeks
2nd phase: paroxysmal - 3-6 weeks
3rd phase: convalescent - months
61
What are the signs/sx of the catarrhal phase in whooping cough?
```
rhinitis
conjunctivitis
irritability
sore throat
low grade fever
dry cough
```
62
What are the signs/sx of the paroxysmal phase of whooping cough?
severe paroxysms of whoops
worse at night - can cause vomiting
complications occur a lot (pneumonia, convulsions, bronchiectasis)
apnoea in <3m
63
What is a paroxysm in whooping cough?
going red or blue in the face and mucus flows from the nose
64
what happens in the convalescent phase of whooping cough?
sx gradually decrease
65
What are the Ix for whooping cough?
culture of per-nasal swab
| marked lymphocytosis on blood film
66
What is the management of whooping cough?
1. erythromycin (doesn't improve sx)
2. erythromycin prophylaxis in close contacts
3. vaccination
67
What are the leading causes of stridor in children?
```
viral croup
bacterial tracheitis
epiglottitis
anaphylaxis
obstructive malignancy
foreign body inhalation
laryngomalacia
```
68
What is the incidence of CF
1 in 2500
69
What is the carrier rate of CF
1 in 25
70
Explain the pathophysiology behind CF
Defect in CFTR protein - chloride channel in membrane of cells
Abnormal ion transport across epithelial cells leads to decrease in airway surface liquid layer and impaired ciliary function and retention of mucopurulent secretions
71
How is cystic fibrosis diagnosed in the newborn?
heel-prick bloodspot
| used in biochemical screen (Guthrie test)
72
How does CF present in infancy?
```
meconium ileus
prolonged neonatal jaundice
failure to thrive
recurrent chest infections
malabsorption + steatorrhoea
```
73
What is the most common mutation in the CFTR gene?
ΔF508
74
What are the most common causative organisms of chest infections in CF
S. aureus and H. influenza initially then
| Psuedomonas or burkholderia
75
What is steatorrhoea?
frequent large pale offensive stools
76
why does meconium ileus occur in cF?
thick viscid meconium is produced in the intestine leading to bowel obstruction
77
What are the clinical features of CF in young children?
bronchiectasis
rectal prolapse
nasal polyps
sinusitis
78
What are the clinical features of CF in older children
```
ABPA
DM
Cirrhosis and portal HTN
distal intestinal obstruction
pneumothorax or recurrent haemoptysis
sterility in males
```
79
How does CF lead to malabsorption?
there is pancreatic enzyme deficiency due to pancreatic ducts being blocked by thick secretions
80
what can be found on examination in children w CF?
hyperinflation of the chest
coarse inspiratory crepitations
expiratory wheeze
finger clubbing
81
How is CF diagnosed?
Sweat test - chloride is 60-125mmol/L
| Test for gene abnormalities in the CFTR protein
82
What are the main principles of respiratory management of CF?
1. monitor lung function e.g. spirometry and FEV1
2. physio - clear secretions
3. Abx
4. Nebulised DNAse or hypertonic saline to decrease viscosity of sputum
5. lung transplant
83
What types of abx treatment is there for CF?
Continuous and prophylactic
Nebulised antipseudomonal abx for chronic pseudomonas inf.
azithromycin to reduce respiratory exacerbations
84
What is the nutritional management of CF?
high calorie diet, including high fat intake*
vitamin supplementation
pancreatic enzyme supplements taken with meals
85
What complications of CF are seen at later ages
DM
Liver disease
Distal intestinal obstruction syndrome
increased chest infections - leading to pneumothorax and life threatening haemoptysis
86
How is liver disease treated in CF?
Ursodeoxycholic acid
87
How is distal intestinal obstruction syndrome treated?
gastrografin
88
What is asthma?
reversible airway obstruction
89
What increases likelihood of developing asthma?
* Low birthweight
* FHx and PHx of atopy (eczema, allergic rhinitis, allergic conjunctivitis)
* Exposure to inhaled particulates
* Male
* Prenatal exposure to smoking
90
What are the dd for. asthma?
```
croup
foreign body
whooping cough
CF
pneumonia
TB
```
91
What are the clinical features of asthma in children?
1. Wheeze, breathlessness, chest tightness, cough
Sx worse at night and early morning (diurnal variation)
2. Hx of atopic disorder
3. Widespread bilateral expiratory wheeze - polyphonic on auscultation
92
What are the possible triggers for exacerbations of asthma?
```
− Exercise
− Allergen exposure
− Cold air
− Viral infection
− Emotions and laughter
```
93
What are the IX for asthma?
i. Spirometry - FEV1/FVC >70%
ii. Peak flow
iii. Bronchodilator reversibility
iv. Fraction exhaled NO
v. Direct bronchial challenge w histamine or methacholine
vi. CXR to rule out other conditions e.g. TB, pneumonia
94
What is complete control of asthma defined as?
```
No daytime sx
No night-time waking
No need for rescue meds
No asthma attacks
No limitations on activity
Normal lung function FEV1/PEF>80% predicted or best
```
95
Describe the Rx algorithm for children 5-16yrs newly diagnosed w asthma
1. SABA
2. If using SABA 3x a week or sx ≥3x a week or night-time waking = SABA + paed low dose ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA
5. SABA + MART (w low dose ICS)
6. SABA + MART (w mod dose ICS)
7. SABA + either high dose ICS (MART or fixed dose regimen) or trial of additional drug e.g. theophylline
96
Give an example of SABA
Salbutamol
97
Give an example of LABA
Salmeterol
98
give an example of ICS
budenoside
99
give an example of LRTA and the administration
montelukast
| oral tablet
100
What is MART?
Combination inhaler used as both preventer and reliever
101
Explain the treatment algorithm for children <5 years
1. SABA
2. If using SABA 3x a week or sx ≥3x a week or night-time waking = SABA + 8 week trial mod dose ICS
3. SABA + low dose ICS + LRTA
3. Stop LTRA, refer to paediatric asthma specialist
102
What is low dose ICS?
≤200microgams budenoside or equivalent
103
what is mod dose ICS
200-400micrograms budenoside or equivalent
104
what is high dose ICS
>400microgram budenoside or equivalent
105
Give the management of severe asthma exacerbation
1. Sit up, high flow 100% O2
2. Salbutamol: 5mg O2 nebulised in 4ml saline w ipratropium bromide
3. IV hydrocortisone or prednisolone tablets
4. IV dose of MgSO4
5. IV aminophylline
6. Continuous nebulisers until improving
7. CPAP in ED,
106
What is type 1 brittle asthma?
wide variability in PEFR despite intensive therapy
107
what is type 2 brittle asthma?
sudden severe attacks despite apparently well controlled asthma
108
What are the features of life threatening asthma?
Sats <92%
| Silent chest, cyanosis, bradycardia, dysrhythmia, hypotension, confusion, coma
109
what are the features of acute severe asthma?
inability to complete sentences
| use of accessory muscles
110
What are the different classifications of pre-school wheeze that children can be divided into?
1. episodic viral wheeze - only wheezes when has a viral URTI and sx free between
2. multiple trigger wheeze - as well as viral URTIs, other factors trigger the wheeze e.g. exercise, allergens etc
111
which type of wheeze is associated w increased risk of asthma?
multiple trigger wheeze
112
What is the treatment of episodic viral wheeze?
symptomatic
1st line - SABA or anticholinergic via a spacer
2nd - LRA (montelukast) or ICS
113
What is rx of multiple trigger wheeze?
ICS or leukotriene receptor antagonist (montelukast)
114
what is general management of viral induced wheeze?
mother stop smoking
115
what is a big RF of viral induced wheeze?
smoking during pregnancy
116
what should be investigated in very early onset wheeze and how?
CF w sweat test (especially if failure to thrive. and loose stools)
117
If cough is a chronic problem what causes should be excluded?
TB
Asthma
foreign body
118
What is otitis media?
acute infection of the middle ear
119
What is the peak age of otitis media"
6-12m
120
Why are children more prone to getting otitis media?
eustachian tubes are short, horizontal and function poorly
121
What is an important part of the examine to do and why in a child w fever?
examine the tympanic membrane!!!
122
What are causative organisms of otitis media?
RSV
Rhinovirus
H. influenza
mortadella catarrhalis
123
How can the tympanic membrane appear in otitis media?
red, bulging w loss of normal light reflection
| pus visible in the external canal and acute perforation
124
What are possible complications of otitis media?
meningitis
| mastoiditis
125
what is the rx of otitis media?
analgesics
most resolve spontaneously
abx shorten duration of pain but don't reduce irisk of hearing loss (amoxicillin)
126
What is otitis media w effusion also known as?
glue ear
127
what age is OME commonly seen
2-7yr
128
why is OME important?
commonest cause of conductive hearing loss
129
how can OME affect a Childs development?
interfere w normal speech development and disrupt learning at school
130
Why does OME occur?
recurrent ear infections
131
How does the tympanic membrane appear in OME?
dull retracted w fluid level visible
132
how is a diagnosis of OME made?
flat trace on tympanometry
| pure tone audiometry - evidence of conductive hearing loss
133
How can OME present?
asymptomatic, hearin gloss
134
Give the possible management options of OME
Usually resolve spontaneously
Ventilation tubes (Grommets) if recurrent URTIs and chronic OME that don't resolve w conservative measures
Adenoidectomy
135
How long are grommets used for in rx of OME?
6-12 m then fall out
136
How do grommets work in OME?
allow air to pass through keep the pressure on either side equal
137
What are the causes of otitis externa?
```
Infection: staph. aureus, pseudomonas aeruginosa, fungal
Seborrhoeic dermatitis
Contact dermatitis (allergic and irritant)
```
138
What are the features of otitis external?
ear pain, itch, discharge
| red, swollen or eczematous canal
139
What is the management of otitis externa?
topical abx +/- steroid
if perforated membrane, aminoglycosides not usually used
removal of canal debris
ear wick if swollen
