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Respiratory Flashcards

Whooping cough Bronchiolitis Croup Acute epiglottitis Cystic fibrosis Pneumonia

1
Q

What is the commonest lung infection in infants?

A

bronchiolitis

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2
Q

What is the most common causative organism of bronchiolitis?

A

Respiratory syncytial virus (80%)

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3
Q

What are other organisms that can cause bronchiolitis?

A

human metapneumovirus
parainfluenza virus
rhinovirus
adenovirus

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4
Q

What age is bronchiolitis more common?

A

1-9m

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5
Q

What are the risk factors for severe bronchiolitis?

A

− Premature developing bronchopulmonary dysplasia

− Underlying lung disease e.g. CF, CHD

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6
Q

What are the clinical features of bronchiolitis?

A

preceding coryza
dry cough
increasing dyspnoea
feeding difficulty

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7
Q

What are the signs on examination of bronchiolitis?

A 
tachypnoea
high pitched wheezes (expiratory)
tachycardia
inspiratory crackles 
intercostal recession +/- cyanosis
\+/- fever
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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
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9
Q

What are the ix for bronchiolitis?what do they show?

A
  1. PCR of nasopharyngeal secretions to identify virus

2. CXR - hyperinflation, focal atelectasis (collapse)

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10
Q

What is the management of bronchiolitis:?

A

supportive
humidified oxygen (nasal cannulae, stop when >92%)
fluid?
assisted ventilation?

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11
Q

What is the prevention of bronchiolitis and who needs it th most?

A

high risk preterm infants

mostly IM injections of palivizumab

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12
Q

How long do infants tend to take to recover from bronchiolitis?

A

2 weeks

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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

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14
Q

what is the most common causative organism of pneumonia in the newborn?

A

GBS
Gram -ve enterococci
from mothers genitals

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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

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16
Q

what is the most common causative organism of pneumonia in over 5yrs

A

mycoplasma pneumoniae
strep. pneumonaie
chlamydia pneumonaie

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17
Q

what cause of pneumonia should be considered in all ages?

A

TB

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18
Q

What is the causative organism of pneumococcal pneumonia?

A

strep pneumoniae

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19
Q

What are the symptoms of pneumonia?

A 
fever
dyspnoea
preceded by URTI
Cough
lethargy 
poor feeding 
looks unwell
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20
Q

What clinical features suggest a bacterial cause of pneumonia?

A

localised pain in the chest/abdo/neck

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21
Q

What is seen on examination in pneumonia?

A 
tachypnoea
nasal flaring 
chest indrawing
reduced sats
end inspiratory coarse crackles over affected area
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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

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23
Q

What are the ix for pneumonia and what can be seen?

A

CXR

nasopharyngeal aspirate - identifies viral cause

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24
Q

What causative organism shows a classic lobar pneumonia?

A

strep pneumoniae

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25
Q

wHen are ix not required in pneumonia?

A

community acquired pneumonia in a child going home

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26
Q

When can pneumonia be managed at home?

A

those w mild symptoms

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27
Q

what is the first line pharmacological treatment of pneumonia? give alternatives

A

Amoxicillin

Alternatives: co-amoxiclav, azithromycin, clarithromycin

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28
Q

What is croup also known as?

A

acute laryngotracheobronchitis

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29
Q

What is the pathophysiology of croup? why is it potentially dangerous?

A

mucosal inflammation
increased secretions
oedema of the subglottic area, dangerous as results in critical narrowing of the trachea

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30
Q

What are the causes of croup?

A
  1. parainfluenza - commonest
  2. Human metapneumovirus
  3. RSV
  4. Influenza
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31
Q

What age group does croup most commonly affect?

A

6m-6yrs

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32
Q

when are epidemics of croup most common?

A

autumn

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33
Q

What are the clinical features of croup?

A 
barking cough 
harsh stridor 
hoarseness
sx worse at night 
preceded by fever and coryza
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34
Q

What are severe signs of croup?

A

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

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35
Q

What are mild signs of croup?

A

Occasional barking cough
No audible stridor at rest
No/mild suprasternal +/- intercostal recession
Child happy

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36
Q

What are mod signs of croup?

A

Frequent barking cough
easily audible stridor at rest
suprasternal and sternal wall retraction at rest
no/little distress or agitation

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37
Q

What is the management of mild croup?

A

Can be sent home w dose of dexamethasone or prednisolone

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38
Q

What is the management of severe croup?

A

nebuliser epinephrine

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39
Q

what is an important differential of severe croup?what are the features?

A

bacterial tracheitis
thick mucopurulent sputum
tracheal mucosal sloughing that is not cleared by coughing

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40
Q

What must be avoided in the management of acute epiglottitis?

A

DO NOT EXAMINE THE THROAT THIS CAN CAUSE OBSTRUCTION

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41
Q

What age is most commonly affected by acute epiglottitis?

A

2-7yrs

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42
Q

What is the most common causative organism of epiglottitis?

A

H. Influenzae type B

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43
Q

What are the clinical features of epiglottitis?

A
  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
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44
Q

What is the management of acute epiglottitis?

A
  1. SECURE THE AIRWAY - intubate w GA

2. Blood cultures, cefuroxime or ceftriaxone IV

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45
Q

What is used for prophylaxis of acute epiglottitis?

A

rifampicin

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46
Q

What is the difference in onset between acute epiglottis and croup?

A

croup - days

epiglottitis - sudden (hrs)

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47
Q

between acute epiglottis and croup, which has preceding coryza?

A

croup

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48
Q

what is the difference in cough between acute epiglottis and croup?

A

croup - severe barking

epiglottitis - absent or slight

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49
Q

between acute epiglottis and croup, which is unable to drink?

A

epiglottitis

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50
Q

between acute epiglottis and croup, which has drooling?

A

epiglottitis

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51
Q

what is the difference in appearance of the child between acute epiglottis and croup?

A

croup - unwell

epiglottitis - v ill

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52
Q

what is the diff in feverbetween acute epiglottis and croup?

A

croup <38.5

epiglottitis >38.5

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53
Q

Explain the difference in the nature of the stridor between acute epiglottis and croup

A

croup - harsh and rasping

epiglottitis - soft whispering

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54
Q

what is the difference in nature of voice between acute epiglottis and croup?

A

croup - hoarse voice

epiglottitis - muffled reluctant to speak

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55
Q

What is the causative organism of whooping cough?

A

bordetella pertussis

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56
Q

How is whooping cough spread/

A

aerosolised drops in cough

57
Q

what is the incubation period of whooping cough

A

10-14 days

58
Q

What are risk factors of whooping cough

A

Non-vaccination

exposure to infected person

59
Q

what causes the characteristic whoop in whooping cough

A

inspiration against a closed glottis

60
Q

What are the stages of whooping cough, how long are they

A

1st phase: catarrhal - 1-2 weeks
2nd phase: paroxysmal - 3-6 weeks
3rd phase: convalescent - months

61
Q

What are the signs/sx of the catarrhal phase in whooping cough?

A 
rhinitis
conjunctivitis
irritability
sore throat
low grade fever
dry cough
62
Q

What are the signs/sx of the paroxysmal phase of whooping cough?

A

severe paroxysms of whoops
worse at night - can cause vomiting
complications occur a lot (pneumonia, convulsions, bronchiectasis)
apnoea in <3m

63
Q

What is a paroxysm in whooping cough?

A

going red or blue in the face and mucus flows from the nose

64
Q

what happens in the convalescent phase of whooping cough?

A

sx gradually decrease

65
Q

What are the Ix for whooping cough?

A

culture of per-nasal swab

marked lymphocytosis on blood film

66
Q

What is the management of whooping cough?

A
  1. erythromycin (doesn’t improve sx)
  2. erythromycin prophylaxis in close contacts
  3. vaccination
67
Q

What are the leading causes of stridor in children?

A 
viral croup
bacterial tracheitis
epiglottitis
anaphylaxis
obstructive malignancy
foreign body inhalation 
laryngomalacia
68
Q

What is the incidence of CF

A

1 in 2500

69
Q

What is the carrier rate of CF

A

1 in 25

70
Q

Explain the pathophysiology behind CF

A

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
Q

How is cystic fibrosis diagnosed in the newborn?

A

heel-prick bloodspot

used in biochemical screen (Guthrie test)

72
Q

How does CF present in infancy?

A 
meconium ileus
prolonged neonatal jaundice
failure to thrive
recurrent chest infections 
malabsorption + steatorrhoea
73
Q

What is the most common mutation in the CFTR gene?

A

ΔF508

74
Q

What are the most common causative organisms of chest infections in CF

A

S. aureus and H. influenza initially then

Psuedomonas or burkholderia

75
Q

What is steatorrhoea?

A

frequent large pale offensive stools

76
Q

why does meconium ileus occur in cF?

A

thick viscid meconium is produced in the intestine leading to bowel obstruction

77
Q

What are the clinical features of CF in young children?

A

bronchiectasis
rectal prolapse
nasal polyps
sinusitis

78
Q

What are the clinical features of CF in older children

A 
ABPA
DM
Cirrhosis and portal HTN
distal intestinal obstruction
pneumothorax or recurrent haemoptysis
sterility in males
79
Q

How does CF lead to malabsorption?

A

there is pancreatic enzyme deficiency due to pancreatic ducts being blocked by thick secretions

80
Q

what can be found on examination in children w CF?

A

hyperinflation of the chest
coarse inspiratory crepitations
expiratory wheeze
finger clubbing

81
Q

How is CF diagnosed?

A

Sweat test - chloride is 60-125mmol/L

Test for gene abnormalities in the CFTR protein

82
Q

What are the main principles of respiratory management of CF?

A
  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
Q

What types of abx treatment is there for CF?

A

Continuous and prophylactic
Nebulised antipseudomonal abx for chronic pseudomonas inf.
azithromycin to reduce respiratory exacerbations

84
Q

What is the nutritional management of CF?

A

high calorie diet, including high fat intake*
vitamin supplementation
pancreatic enzyme supplements taken with meals

85
Q

What complications of CF are seen at later ages

A

DM
Liver disease
Distal intestinal obstruction syndrome
increased chest infections - leading to pneumothorax and life threatening haemoptysis

86
Q

How is liver disease treated in CF?

A

Ursodeoxycholic acid

87
Q

How is distal intestinal obstruction syndrome treated?

A

gastrografin

88
Q

What is asthma?

A

reversible airway obstruction

89
Q

What increases likelihood of developing asthma?

A
  • Low birthweight
  • FHx and PHx of atopy (eczema, allergic rhinitis, allergic conjunctivitis)
  • Exposure to inhaled particulates
  • Male
  • Prenatal exposure to smoking
90
Q

What are the dd for. asthma?

A 
croup 
foreign body 
whooping cough
CF
pneumonia
TB
91
Q

What are the clinical features of asthma in children?

A
  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
Q

What are the possible triggers for exacerbations of asthma?

A 
−	Exercise
−	Allergen exposure
−	Cold air
−	Viral infection
−	Emotions and laughter
93
Q

What are the IX for asthma?

A

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
Q

What is complete control of asthma defined as?

A 
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
Q

Describe the Rx algorithm for children 5-16yrs newly diagnosed w asthma

A
  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
Q

Give an example of SABA

A

Salbutamol

97
Q

Give an example of LABA

A

Salmeterol

98
Q

give an example of ICS

A

budenoside

99
Q

give an example of LRTA and the administration

A

montelukast

oral tablet

100
Q

What is MART?

A

Combination inhaler used as both preventer and reliever

101
Q

Explain the treatment algorithm for children <5 years

A
  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
  4. Stop LTRA, refer to paediatric asthma specialist
102
Q

What is low dose ICS?

A

≤200microgams budenoside or equivalent

103
Q

what is mod dose ICS

A

200-400micrograms budenoside or equivalent

104
Q

what is high dose ICS

A

> 400microgram budenoside or equivalent

105
Q

Give the management of severe asthma exacerbation

A
  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
Q

What is type 1 brittle asthma?

A

wide variability in PEFR despite intensive therapy

107
Q

what is type 2 brittle asthma?

A

sudden severe attacks despite apparently well controlled asthma

108
Q

What are the features of life threatening asthma?

A

Sats <92%

Silent chest, cyanosis, bradycardia, dysrhythmia, hypotension, confusion, coma

109
Q

what are the features of acute severe asthma?

A

inability to complete sentences

use of accessory muscles

110
Q

What are the different classifications of pre-school wheeze that children can be divided into?

A
  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
Q

which type of wheeze is associated w increased risk of asthma?

A

multiple trigger wheeze

112
Q

What is the treatment of episodic viral wheeze?

A

symptomatic
1st line - SABA or anticholinergic via a spacer
2nd - LRA (montelukast) or ICS

113
Q

What is rx of multiple trigger wheeze?

A

ICS or leukotriene receptor antagonist (montelukast)

114
Q

what is general management of viral induced wheeze?

A

mother stop smoking

115
Q

what is a big RF of viral induced wheeze?

A

smoking during pregnancy

116
Q

what should be investigated in very early onset wheeze and how?

A

CF w sweat test (especially if failure to thrive. and loose stools)

117
Q

If cough is a chronic problem what causes should be excluded?

A

TB
Asthma
foreign body

118
Q

What is otitis media?

A

acute infection of the middle ear

119
Q

What is the peak age of otitis media”

A

6-12m

120
Q

Why are children more prone to getting otitis media?

A

eustachian tubes are short, horizontal and function poorly

121
Q

What is an important part of the examine to do and why in a child w fever?

A

examine the tympanic membrane!!!

122
Q

What are causative organisms of otitis media?

A

RSV
Rhinovirus
H. influenza
mortadella catarrhalis

123
Q

How can the tympanic membrane appear in otitis media?

A

red, bulging w loss of normal light reflection

pus visible in the external canal and acute perforation

124
Q

What are possible complications of otitis media?

A

meningitis

mastoiditis

125
Q

what is the rx of otitis media?

A

analgesics
most resolve spontaneously
abx shorten duration of pain but don’t reduce irisk of hearing loss (amoxicillin)

126
Q

What is otitis media w effusion also known as?

A

glue ear

127
Q

what age is OME commonly seen

A

2-7yr

128
Q

why is OME important?

A

commonest cause of conductive hearing loss

129
Q

how can OME affect a Childs development?

A

interfere w normal speech development and disrupt learning at school

130
Q

Why does OME occur?

A

recurrent ear infections

131
Q

How does the tympanic membrane appear in OME?

A

dull retracted w fluid level visible

132
Q

how is a diagnosis of OME made?

A

flat trace on tympanometry

pure tone audiometry - evidence of conductive hearing loss

133
Q

How can OME present?

A

asymptomatic, hearin gloss

134
Q

Give the possible management options of OME

A

Usually resolve spontaneously
Ventilation tubes (Grommets) if recurrent URTIs and chronic OME that don’t resolve w conservative measures
Adenoidectomy

135
Q

How long are grommets used for in rx of OME?

A

6-12 m then fall out

136
Q

How do grommets work in OME?

A

allow air to pass through keep the pressure on either side equal

137
Q

What are the causes of otitis externa?

A 
Infection: staph. aureus, pseudomonas aeruginosa, fungal
Seborrhoeic dermatitis
Contact dermatitis (allergic and irritant)
138
Q

What are the features of otitis external?

A

ear pain, itch, discharge

red, swollen or eczematous canal

139
Q

What is the management of otitis externa?

A

topical abx +/- steroid
if perforated membrane, aminoglycosides not usually used
removal of canal debris
ear wick if swollen

Paeds (15 decks)

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