Respiratory Flashcards
1
Q
Where are all the infections (resp tract)?
A
2
Q
Rhinitis
Where?
Features?
Prodrome to what other illnesses?
A
The nose
Self-limiting condition that occurs in the winter months.
Runny nose normally lasts 16 days
- Pneumonia, bronchiolitis
- Meningitis
- Septicaemia
3
Q
How does otitis media erythema appear?
A
Bulging tympanic membrane
Normally lasts 9 days
4
Q
Features of Otitis Media?
Causation?
What are complications?
Rx?
A
- Common, self-limiting
- Not “a bit pink”
- Primary viral infection
- Secondary infection with Pneumococcus/ H’flu
- Spontaneous rupture of drum
- Rx: Antibiotic treatment usually does not help so give analgesics and wait it out
5
Q
How do we Dx Tonsillitis/pharyngitis?
A
- Sore throat
- Normally lasts 7 days
- Viral or bacterial?
- Do a throat swab
6
Q
Tonsillitis/pharyngitis
Rx if viral?
Rx if bacterial?
A
- Either nothing (viral) or 10 days penicillin (bacterial)
- Don’t give amoxycillin
7
Q
Which two URTI are very similar and must be differntiated?
A
Croup and Epiglottitis
8
Q
How can we differentiate between croup (LTB) and epiglottitis?
A
Croup:
- Para’flu 1
- Common
- Child is well
- Coryza++, stridor, hoarse voice, “barking” cough
- Normally lasts 3 days
Epiglottitis:
- H. influenzae
- Rare
- Toxic
- Stridor + drooling
9
Q
Rx for croup?
Rx for epiglottitis?
A
- Croup = oral dexamethasone
- Epiglottitis = intubation and antibs
10
Q
What are common agents for bacterial LRTI?
A
- Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae
11
Q
What are common agents for viral LRTI?
A
- RSV, parainfluenza III, influenza A and B, adenovirus, rhinovirus
12
Q
How do we assess a patient with LRTI?
A
- Make a diagnosis (easy)
- Assess the patient (easy)
- Oxygenation, hydration, nutritional
- To treat or not to treat (grey area)
13
Q
What is bronchitis?
A
Infection of the main airways of the lung - the bronchi.
14
Q
SSx of bronchitis?
A
- Common ++++
- Loose rattly cough
- Post-tussive vomit - “glut”
- Chest free of wheeze/creps
- Haemophilus/Pneumococcus
- Mostly self-limiting
- Child VERY well, parent worried
15
Q
Mechanism of bacterial bronchitis?
A
- Disturbed mucociliary clearance
- Minor airway malacia
- RSV/adenovirus
- Bacterial overgrowth is secondary
16
Q
What are red flags for LRTI?
A
- Age <6 mo, >4yr
- Static weight
- Disrupts child’s life
- Associated SOB (when not coughing)
- Acute admission
17
Q
Rx for persistent bacterial bronchitis?
A
- Reasure parents
- Do not treat
18
Q
Bronchiolitis: What is it?
A
Infection of the smal airways of the lungs - bronchioles
19
Q
Bronchiolitis: features? SSx?
A
- Affects 30-40% of all infants
- Usually RSV, others include paraflu III, HMPV
- Nasal stuffiness, tachypnoea, poor feeding
- Crackles +/- wheeze
- Normally lasts 16 days!
20
Q
Who does bronchiolitis occur in?
A
- <12 months
- One off (not recurring)
21
Q
Rx for bronchiolitis?
A
- Maximal observation
- Minimal intervention - there is no proven medications to work
22
Q
Ix for bronchiolitis?
A
- Naspharyngeal aspirate (NPA)
- Oxygen saturations (severity)
23
Q
What is pneumonia?
A
Lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid
24
Q
SSx for pneumonia?
A
- Fever
- SOB
- Grunting
- Cough
- Reduced breath sounds
- Consolidation/fluid on xray
Also only refer to it as pneumonia if signs are focal, creps and high fever. Otherwise refer to it as LRTI.
25
Rx for **pneumonia**?
* Investigations
* CXR and inflammatory makers NOT “routine”
* Management
* Nothing if symptoms are mild
* (always offer to review if things get worse!)
* **Oral Amoxycillin first line**
* **Oral Macrolide second choice**
* **Only for IV if vomiting**
26
When is IV vs oral antibiotics used in pneumonia?
Oral antibiotics “win” 2:1
√Shorter hospital stay
√Cheaper
XFever for a few more hours
27
What is **pertussis**?
WhoOping cough
28
What can prevent **pertussis**?
* Vaccination reduces risk
* Vaccination reduces severity
29
SSx of **pertussis**?
* “Coughing fits”
* Vomiting and colour change
30
Give a run through of all the resp tract infections and how they are managed:
31
What is **asthma**?
Clinical syndrome characterised by increased responsiveness of the tracheobronchial tree to a variety of stimuli - causing dyspnoea, wheezing and cough, which may vary from mild and almost undetectable to severe and unremitting.
32
SSx for **asthma**?
* Chronic
* Wheeze, cough and SOB
* Multiple triggers
* URTI, exercise, allergen, cold weather, etc
33
Dx for **asthma**?
* Wheeze
* Variability
* Respond to treatment
34
What are multiple hits causing **asthma**?
1. Genes
2. Inherently abnormal lungs
3. Early onset atopy
4. Later (env) exposures
Rhinovirus
Exercise
Smoking
35
Ix for **asthma**?
* **All in the history!**
* Examination unhelpful
* Unlikely to be wheezing
* Stethoscope never important (often unhelpful)
* •No asthma test in children
* Peak flow random number generator
* Allergy tests irrelevant
* Spirometry lacks specificity
* Exhaled nitric oxide unproven
36
What are important SSx for **asthma**?
**Wheeze**
**SOB at rest**
•Significant resp difficulty
–\<30% lung function
* Airway obstruction
* “Sooking” in of ribs with wheeze
**Cough**
* Dry
* Nocturnal (just after falling asleep)
* Exertional
37
What is the approach to wheeze?
1. Assess if genuine: if not it's stridor/rattle
2. If genuine: Watch and see OR trial treatment, if responds to treatment
3. Asthma.
38
DDx for asthma? (onset under 5, onset over 5)
Under 5
* Congenital
* CF
* PCD
* Bronchitis
* Foreign body
Over 5
* Dysfunctional breathing
* Vocal cord dysfunction
* Habitual cough
* Pertussis
39
When is it not asthma?
* Under 18 months, most likely infection
* Over 5 years, most likely asthma
40
What should be the approach for pre-school cough?
41
What are the goals of asthma treatment?
* “minimal” symptoms during day and night
* minimal need for reliever medication
* no attacks (exacerbations)
* no limitation of physical activity
42
How can we measure control of asthma symptoms?
* Closed questions
* SANE
* Short acting beta agonist/week
* Absence school/nursery
* Nocturnal symptoms/week
* Excertional symptoms/week
43
What is the step up step down approach to asthma treatment?
* Start on low dose ICS
* Severe may respond to minimal treatment
* Review after 2mo
* No routine test to monitor progress (?)
* Stepping up easier than down
44
What are classes of asthma medications?
* Short acting beta agonists
* Inhaled corticosteroids (ICS)
* Long acting beta agonists\*
* Leukotriene receptor antagonists\*
* Theophyllines\*
* Oral steroids
* \* “add ons”
45
What is asthma ladder of treatment?
1. Regular preventer - ICS
2. Initial add on: preventer + LABA (if over 5) or LTRA (under 5)
3. Additional add on therapies: if not respond to laba increase dose of ICS, if do respond to laba can also increase ICS, if not enough consider adding LTRA
4. High dose ICS + SR theophylline
5. Continuous use of oral steroids
46
How does asthma management in paeds differ from adults?
* Max dose ICS 800 microg (\<12 yo)
* No oral B2 tablet
* LTRA first line preventer in \<5s
* No LAMAs
* Only two biologicals
47
At what point do we start regular preventer?
* B2 agonists \>two days a week
* Symptomatic three times a week or more, or waking one night a week.
48
What are adverse effects of ICS?
* Height suppression (0.5-1cm)
* ?Oral candidiasis
* ?Adrenocortical suppression\*
* XHypertension
* XCataracts
49
What are two things to rmb about long acting beta agonist?
* Do not use without ICS
* Use as fixed dose inhaler
50
How can we make it easier for children to inhale these medications?
* MDI/spacer
* Dry powder device
51
Don’t use nebulisers
cool beans
52
Other management for asthma?
* Stop tobacco smoke exposure
* Remove environmental triggers
* Cat, Dog
