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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma pathology

A

IgE ab to allergens

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2
Q

S+S asthma

A

Cough, SOB, wheeze Worse at night + early in morning

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3
Q

Management of acute asthma attack

A

Salbutamol inhaler or nebs, high flow O2 if sats <92%

Steroids early - Oral prednisolone or IV hydrocortisone if severe

  • add iprotropium if not responding or nebulised MgSO4

If not improving: IV salbutamol and/ or aminophylline

Critical care review if not improving

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4
Q

Pathogen causing bronchiolitis + RF

A

Respiratory syncytial virus (RSV)

RF: passive smoking

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5
Q

S+S bronchiolitis

A

Coryzal symptoms, dry cough, SOB, decreased feeding Wheeze (high pitched, expiratory) Hyperinflation of chest Widespread crackles

Often following a viral URTI

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6
Q

Pathology + epidemiology of croup

A

Laryngotracheobronchitis that causes mucosal infalmmation + increases secretions Oedema of subglottic area Usually caused by parainfluenza virus

Most common between 6 months - 3 years

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7
Q

S+S croup

A

Barking cough Harsh inspiratory stridor Hoarseness, symptoms of URTIWorse at night

Takes hours - days to come on

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8
Q

Management of croup

A

Oral dexamethasone or oral prednisolone (takes longer to work)

Budesonide nebs

If severe = adrenaline nebs

Lasts 3-7 days

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9
Q

Pathology of epiglottitis

A

Intense swelling of epiglottis Caused by haemophilus influenza B

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10
Q

S+S epiglottitis

A

High fever, toxic looking child Painful throat Saliva drooling down chin Soft stridor Cough is absent

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11
Q

Management of epiglottitis

A

Intubation IV cefuroxime Rifampicin to rest of house

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12
Q

Causes of pneumonia in children

A

Newborn: group B strep Infants: RSV, strep pneumonia, haemophilus influenza Children: mycoplasma pneumoniae, strep pneumonia, chlamydia pneumonia

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13
Q

S+S pneumonia

A

Fever, difficulty breathing Cough Poor feeding Chest/ abdo pain = pleural irritation Transient pleural rub Tachypnoea

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14
Q

Management of pneumonia

A

Supportive Co-amoxiclav for newborns + severely ill Oral amoxicillin or erythromycin for older children

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15
Q

Causes of tonsillitis

A

Group A beta haemolytic strep EBV, RSV, rhino + adenovirus

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16
Q

Complications of tonsillitis

A

Quinsy - peritonsillar abscess Cervical abscess Acute nephritis (2-3 weeks later) Rheumatic fever (1-2 weeks later)

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17
Q

Management of tonsillitis

A

Penicillin V or erythromycin

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18
Q

Genetics of cystic fibrosis + epidemiology

A

Defective CFTR protein - its a cyclic AMP dependent chloride channel - controls chloride transport Gene located on chromosome 7 Most common defect is on delta F508

Autosomal recessive

Affects 1 in 2500 newborns

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19
Q

Pathology of CF

A

Impaired ciliary function Thick meconium produced Mucus secretions in pancreatic ducts Abnormal function of sweat glands

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20
Q

S+S of CF

A

Perinatal presentation: screening, meconium ileus, prolonged jaundice, haemorrhagic disease

Infancy + children presentation: Recurrent chest infections, poor growth, malabsorption, loose offensive stools, acute pancreatitis, rectal prolapse, diarrhoea, nasal polyps

Infection with staph aureus, haemophilus influenza + pseudomonas aeruginosa Hyperinflation of the chest Pancreatic insufficiency - leads to malabsorption + steatorrhoea

Signs: bilateral changes, clubbing, cough, purulent sputum, wheeze, obstructive FEV1

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21
Q

What is the investigation for CF?

A

Guithre test - screening of newborn Diagnosed with sweat test >60mmol Cl+

CT head + thorax, genetic testing after diagnosis

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22
Q

Management of meconium ileus in CF

A

Gastrografin enema but may need surgery

23
Q

Respiratory management of CF

A

Physio twice a day Continuous abx (flucloxacillin + azithromycin) Nebulised saline, regular sputum samples

24
Q

Nutritional management of CF

A

Oral enteric coated pancreatic replacement therapy (Creon)

High calorie diet Overnight feeding via gastrostomy

Vitamin supplements (K, A, D, E)

25
Q

Complications of CF

A

DM Liver disease Bowel obstruction Chest infections Infertility due to absence of vas deferens in males

Survival 40-50 years

26
Q

Screening for CF

A

Screen for immunoreactive trypsinogen in heel-prick test in newborns

27
Q

Bacterial + viral causes of otitis media

A

RSV, rhinovirus Pneumococcus, H influenza, moraxella catarrhalis

28
Q

Complications of glue ear

A

Mastoiditis Meningitis Sinus thrombosis Cerebral abscess

29
Q

Management of otitis media

A

Symptomatic Amoxicillin if needed Grommet insertion if persistent

30
Q

Causes of stridor

A

Croup, foreign body, epiglottitis Abscess, anaphylaxis

31
Q

S+S TB

A

Prolonged fever Malaise, anorexia Weight loss Tuberculous meningitis Cervical adenopathy

32
Q

Management of TB

A

Rifampicin, isoniazid, pyrazinamide, ethambutol

33
Q

Incubation period for whooping cough + causative organism

A

Bordetella pertussis 7-14 days

34
Q

S+S whooping cough

A

Coryzal symptoms initially Paroxysmal/ spasmodic cough then inspiratory whoop Worse at night, may culminate in vomiting During cough, child goes red/ blue in the face Lasts 3-6 weeks, up to 12 weeks

35
Q

Management of whooping cough

A

Erythromycin only works if given if catarrhal phase

36
Q

Complications of whooping cough

A

Pneumonia Lobal collapse Convulsions due to hypoxia Haemorrhage (nose, eyes, brain)

37
Q

Investigations + management of bronchiolitis

A

Nasal viral swab

Most managed at home but hospital admission if:

<50% feeding, lethargy, significant tachypnoea, grunting, cyanosis, sats <94%

Supportive management: O2 + NG feeds

38
Q

When is bronchiolitis most common, and how many kids get it?

A

Most common between 2-6 months

80% kids have it by age 2

39
Q

Ways to give oxygen to babies?

A

High flow O2 therapy (humidified + warmed, nasal cannula) - can give up to 40L a min

Oxygen box over head

40
Q

Prognosis for bronchiolitis

A

Usually lasts 7-10 days, mortality is higher with underlying heart + lung disease

Immunoprophylaxis is available for high risk groups: congenital cardiac or lung disease (ex-prems) + congenital immunodeficiencies. Injections over winter period, once a month for 4/5 months

41
Q

What score is used to assess croup, and when should a child be hospitalised?

A

Westley score for croup: assesses chest wall retractions, stridor, cyanosis, consciousness, air entry

Aged <6 months

Poor oral intake

Severe obstruction

Immunocompromised

42
Q

Differentials for CF (when a child is FTT, RTI, wheezy)?

A

Immunodeficiencies + PCD

43
Q

When is a port-a-cath used?

A

CF

44
Q

When do peak flows become useful?

A

Over 5-7 to get a good reading

45
Q

Management of asthma in >5 y/o

A

Low dose ICS

+ LABA. If not working, remove + increase ICS. If working but not well, increase ICS and + LTRA

+ theophylline

REFER

+ daily oral prednisolone

46
Q

Management of asthma in <5 y/o

A

SABA + ICS/ LTRA (tablet)

REFER

47
Q

Criteria for acute severe asthma

A

Sp02 <92%

PEF 33-50%

Can’t complete sentences in 1 breath

HR >125 in kids >5 years; >140 in kids 1–5 years

RR >30 in kids aged >5 years; >40 in kids aged 1–5 years

48
Q

Criteria for acute life-threatening asthma

A

SpO2 <92%

PEF <33%

Silent chest, cyanosis, poor resp effort, hypotension, exhaustion, confusion

49
Q

SE of inhaled steroids

A

Stunted growth + oral thrush

50
Q

How much O2 can be delivered in a non- rebreathe mask?

A

80%

51
Q

S+S of inhaled foreign body + most common location

A

Right main bronchus

Wheeze, cough, stridor, absent/ decreased resp sounds

52
Q

Management of tension pneumothorax

A

Thoracocentesis

53
Q

Typically what is the age range for croup + bronchiolitis?

A

Bronchiolitis = 2-6 mths

Croup = 6 mths - 3 years

54
Q

Describe PCD

A

Primary ciliary dyskinesia

50% also have situs inversus

Hearing problems

Paediatrics (19 decks)

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