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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How many ribs are normal to visualise on a paediatric CXR?

A

6 anterior

9 posterior

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2
Q

Why is a caesarean a risk factor for respiratory distress syndrome?

A

Birth contractions during vaginal labour result in increased levels of glucocorticoids which aid lung maturation and surfactant distribution

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3
Q

Why is maternal diabetes mellitus a risk factor for respiratory distress syndrome?

A

Insulin inhibits surfactant production

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4
Q

What are the x-ray features of an infant with respiratory distress syndrome?

A

Reticulogranular ground-glass densities (fibrinous exudates from epithelial damage)

Air bronchograms (tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates)

Low lung volumes (airway collapse)

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5
Q

What is the main marker of foetal lung immaturity assessed by amniocentesis for respiratory distress syndrome?

A

Lecithin-sphingomyelin ratio <1.5

The amount of sphingomyelin in the amniotic fluid stays consistent during pregnancy

The lecithin concentration (the major component of surfactant) varies depending on the amount of surfactant present

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6
Q

What is the major long-term complication of prolonged mechanical ventilation and oxygen in neonates with respiratory distress syndrome?

A

Bronchopulmonary dysplasia

Chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy for neonatal RDS

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7
Q

How is neonatal respiratory distress syndrome prevented?

A

Antenatal corticosteroid therapy administered to the mother

Stimulates infant lung maturation

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8
Q

What is the most common cause of respiratory distress in term infants?

A

Transient tachypnoea of the newborn

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9
Q

What causes transient tachypnoea of the newborn?

A

Delay in the resorption of lung fluid

Mostly occurs in those born by caesarean section

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10
Q

What is the medical management for mild croup?

A

Prednisolone or oral dexamethasone

Reduces airway swelling, long-lasting

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11
Q

What is the medical management of severe croup?

A

Inhaled adrenaline (fast onset)

AND

Dexamethasone

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12
Q

Haemophilus influenzae type b typically caused which disease?

A

Epiglottitis

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13
Q

What is the management of bronchiolotis?

A

Supportive

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14
Q

What is the characteristic feature of laryngitis?

A

Hoarseness

Non-specific

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15
Q

Preterm infants suffer what due to insufficient surfactant production and/or distribution?

A

Neonatal respiratory distress syndrome

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16
Q

Why can infants with respiratory distress syndrome develop hyaline membrane disease

A

Hypoxemia and hypercapnia → vasoconstriction of the pulmonary vessels and acidotic metabolism → intrapulmonary right to left shunt → increased permeability due to alveolar epithelial damage → fibrinous exudation within the alveoli → development of hyaline membranes in the lungs (hyaline membrane disease)

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17
Q

Which type of asthma is typically triggered by allergens or environmental antigens?

A

Extrinsic (allergic)

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18
Q

Which type of asthma is typically triggered by drugs, respiratory tract infections, physical exertion and cold air?

A

Intrinsic (non-allergic)

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19
Q

What is the methacholine challenge test?

A

Used for diagnosing asthma when spirometry is unclear or diagnosis in doubt

Methacholine is administered and FEV1 is monitored for a drop

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20
Q

What is fluticasone?

A

An inhaled corticosteroid

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21
Q

What is montelukast?

A

Leukotriene-receptor antagonist

Decreases bronchoconstriction and inflammation

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22
Q

What is the MoA of omalizumab?

A

Anti-IgE antibody that binds to serum IgE

  • reduces IgE binding to basophils and mast cells
  • reduces surface expression of the IgE receptor on basophils and mast cells with long-term use
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23
Q

What is status asthmaticus?

A

An extreme asthma exacerbation that does not respond to initial treatment with bronchodilators

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24
Q

What is the definition of pulsus paradoxus?

A

Inspiratory fall in SBP > 10 mmHg

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25
Q

What normally occurs to BP during inspiration and why?

A

Decreases

Inhalation → decrease in intrathoracic pressure → blood flows into the RV + blood pools in the lungs → compression on the LV → decreased stroke volume and peripheral pulses

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26
Q

Why does asthma cause pulsus paradoxus?

A

BP normally drops with inspiration due to increased RV volume and blood in the pulmonary vasculature that compresses the LV

During epsiodes of airway resistance, negative intrathoracic pressure seen on inspiration is greater than normal so this physiological response is exaggerated

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27
Q

What is the most common cause of the common cold?

A

Rhinovirus

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28
Q

Vesicles on the posterior pharynx are characteristic of which disease?

A

Herpangina (coxsackie)

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29
Q

An amoxicillin-induced rash is characteristic of which disease?

A

EBV/infectious mononucleosis

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30
Q

What does a monophonic wheezes suggest?

A

Fixed obstruction e.g. foreign body, tumour

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31
Q

List 4 potential complications of sinusitis

A
  1. Periorbital/orbital cellulitis
  2. Meningitis
  3. Encephalitis
  4. Cavernous sinus thrombosis
  5. Cerebral/subdural/epidural abscess
  6. Osteomyelitis of the frontal bone
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32
Q

What anitbiotic is given for sinusitis when indicated?

A

Amoxycillin

Only in severe or protracted illness

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33
Q

Which 3 agents are most commonly responsible for acute bacterial rhinosinusitis?

A
  • Streptococcus pneumoniae*
  • Haemophilus influenzae*
  • Moraxella catarrhalis*
34
Q

Why is a normal or high PaCO2 during an asthma attack concerning?

A

Normally: hyperventilation → low PaCO2

The PaCO2 will increase if the patient’s respiratory muscles are fatiguing → respiratory failure

35
Q

What is the clinical course of bronchiolitis?

A

Begins with upper respiratory tract symptoms

Lower respiratory symptoms and signs develop on days 2-3

Symptoms peak on days 3-5

Resolve over the next 2-3 weeks

36
Q

What are the three best ways of assessing disease severity in a child with bronchiolitis?

A
  1. O2 saturations
  2. Work of breathing
  3. Feeding
37
Q

What is the salbutamol dose for children having an acute asthma attack?

A

0-5 years/<20kg: 6 puffs

6+ years/>20kg: 12 puffs

38
Q

What is the monoclonal antibody that binds IgE?

A

Omalizumab

39
Q

What is the definition of good asthma control?

A

All of

Daytime symptoms ≤2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator)

No limitation of activities

No symptoms during night or when wakes up

Need for reliever ≤2 days per week

40
Q

What is the definition of partial asthma control?

A

Any of

Daytime symptoms >2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator)

Any limitation of activities

Any symptoms during night or when wakes up

Need for reliever >2 days per week

41
Q

What is the definition of poor asthma control?

A

Either of

Daytime symptoms >2 days per week (lasting from minutes to hours or recurring, and partially or fully relieved by rapid-acting bronchodilator)

≥3 features of partial control within the same week

42
Q

What is the stepwise escalation of asthma medications in children?

A
  1. SABA as needed (all children)
  2. ICS (low dose)
  3. ICS/LABA (low dose)
  4. ICS/LABA (high dose)
  5. Referral
43
Q

What is the most notable adverse effect of montelukast?

A

Aggressive behaviour

44
Q

What is the MoA of cromoglycate?

A

Inhibits release of inflammatory mediators from mast cells

45
Q

How does adrenaline work to relieve airway obstruction in patients with croup?

A

Constricts precapillary arterioles + decreases capillary hydrostatic pressure → fluid reabsorption → improvement of airway oedema

46
Q

What O2 saturations correspond with mild, moderate and severe asthma?

A

Mild: >94%

Moderate: 90-94%

Severe: < 90%

47
Q

A low-pitched, continuous wheeze which usually clears after coughing is characteristic of which adventitial sound?

A

Rhonchi

Often resembles snoring

https://www.youtube.com/watch?v=nokZ5sNt3fA

48
Q

What is the second most common cause of bronchiolitis in children?

A

Rhinovirus

49
Q

What is the mechanism of sodium cromoglycate?

A

Inhibits release of inflammatory mediators from mast cells

50
Q

What is the difference between aminophylline and theophylline?

A

Aminophylline = managing asthma exacerbations

Theophylline = preventor

51
Q

When is aminophylline used during asthma exacerbation management?

A

Inadequate response to salbutamol

Evidence is limited for children and non-existent for adults

52
Q

What is the major adverse effect of aminophylline?

A

Vomiting

Also giddiness and cardiac arrythmias

53
Q

When is tiotropium used for asthma?

A

Alongside ICS + LABA when asthma remains moderate/severe

In consultation with a specialist

54
Q

What is the role of azithromycin for asthma?

A

Can be used as a preventer when asthma remains moderate/severe despite treatment with ICS + LABA

Anti-inflammatory and anti-microbial

55
Q

What is the role of magnesium sulfate in asthma management?

A

Can be used acutely when response to a SABA is inadequate

56
Q

What is the role of adrenaline in acute asthma management?

A

Not routinely used

Only when salbutamol cannot be given to a patient with respiratory arrest or when anaphylaxis is suspected

57
Q

What is the difference between CPAP and BiPAP?

A

CPAP = PEEP only (keeps airways open to reduce respiratory effort)

BiPAP = PEEP + PIP (breathing for infant)

58
Q

What is a Harrison’s sulcus?

A

Horisontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm

Associated with chronic lung disease e.g., severe asthma

59
Q

What is bronchomalacia?

A

Collapsable airways

Causes: congenital absense of cartilage, extrinsic airway compression, acquired narrowing after infection or lung/heart transplant

60
Q

What are the clinical features of bronchomalacia?

A

Fixed expiratory wheeze

Chronic cough

Recurrent infections

Exercise intolerance

Respiratory distress

Apnoeas

61
Q

When should oxygen therapy be given to children with bronchiolitis?

A

SpO2 persistently < 90%

62
Q

At what rate do you give oxygen for bronchiolitis?

A

1L/kg/minute

63
Q

What effect can ventolin have on BGLs?

A

Hyperglycaemia

64
Q

What electrolyte abnormality may occur with salbutamol?

A

Hypokalaemia

65
Q

A patient is given ventolin and their RR increases. Why?

A

Side effect of the medication

66
Q

A patient is given ventolin and their SpO2 decreases. Why?

A

Shunts open → areas of poor perfusion are opened

67
Q

What is chronic suppurative lung disease?

A

Children clinically appear to have bronchiectasis but without consistent radiographic features

Chronic wet cough, recurrent chest infections, clubbing, growth failure, chest wall deformity, chronic hypoxemia, pulmonary hypertension

68
Q

What is the most common cause of pneumonia in children < 5 years?

A

RSV (commonly an extension of bronchiolitis)

More commonly viruses than bacteria

  • Influenza A + B*
  • Human metapneumovirus*
  • Parainfluenza virus*
69
Q

Which organisms cause aspiration pneumonia?

A

Anaerobic oral flora

  • Peptostreptococcus* + other anaerobic streptococci
  • Fusobacterium* spp
  • Bacteroides* spp
  • Prevotella melaninogenica*
70
Q

What dose of prednisone is given in acute asthma?

A

1mg/kg (max 50mg) for 3-5 days

Begin within 1st hour

Use hydrocortisone or methylprednisolone is oral is unable to be tolerated

71
Q

What is Cheyne-Stokes respiration?

A

A breathing pattern that cycles between apnoea and hyperpnoea

A type of central sleep apnoea

72
Q

What are the types of apnoea?

A

Central

Obstructive

Mixed

73
Q

What are some of the extra-pulmonary manifestations of myoplasma pneumonia?

A

Erythema multiforme

Fatigue

Headache

Sore throat

Myalgia

74
Q

How is mycoplasma pneumonia treated?

A

Tetracycline (doxycycline)

Or a macrolide (azithromycin, clarithromycin)

75
Q

How is pertussis treated?

A

Azithromycin/clarithromycin

Within 3 weeks of cough onset

76
Q

What CXR findings are suggestive of mycoplasma/chlamydia pneumonia?

A

Unilateral lower lobe interstitial pneumonia

Looks worse than presentation

77
Q

What is infrequent intermittent asthma?

A

Symptom-free for at least 6 weeks at a time

Flare-ups up to once every 6 weeks on average but no symptoms between flare-ups

78
Q

What is frequent intermittent asthma?

A

Flare-ups more than once every 6 weeks on average but no symptoms between flare-ups

79
Q

What is persistent asthma?

A

Asthma that has symptoms between flare ups

Can be mild, moderate or severe

80
Q

During an asthma exacerbation, when should a child see a doctor/come to hospital?

A

3-4 hourly Ventolin: see a GP
< 3 hourly Ventolin: come to hospital

81
Q

On spirometry, what result demonstrates reversibility with bronchodilators?

A

FEV1 increases > 12% 10-15 minutes after a bronchodilator

Paediatrics (24 decks)

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