Respiratory Flashcards

1
Q

Child presents with Coryza, stridor, hoarse voice and a “barking” seal-like cough, what’s the likely diagnosis?

A

Croup

These patients tend to be systemically well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes Croup [1]
Epidemiology [1]
Tx croup [3]

A
Parainfluenza Type 1
- Peak: 6m-3y, autumn
Mx:
- Dexamethasone
- admit if moderate, severe
- Neb Adrenaline, inhaled ICS (if severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What management should be enacted for any kid with a respiratory infection?

A

Assess their oxygenation, hydration and nutritional status then attend to these if necessary
Most kids won’t need anything more than this for Respiratory infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Kid presents systemically very unwell with stridor and drooling, what do you think might be happening?

A

Epiglottitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
What cause epiglottitis? [1]
Immediate management [2]
Subsequent management [4]
Subsequent investigations [2]
Definitive management
A

H. Influenzae B for which there is a vaccine

• Initial assessment: ABCDE and urgent ENT or anaesthetic assessment

Subsequently…
• Nebulised ADRENALINE and IV DEXAMETHASONE
• Ix: blood and throat cultures
• Abx: IV PENICILLIN and CEFTRIAXONE
• IV fluids and analgesia
• Definitive mx: EUA and intubation in theatre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List at least 3 bacteria and viruses known to cause LRTIs?

A
  • Pneumococcus
  • H Influenzae
  • Morazella Catarrhalis
  • Mycoplasma Pneumoniae
  • Chlamydia Pneumoniae
  • RSV
  • Adenovirus
  • Parainfluenzae 3
  • Influenzae A & B
  • Rhinovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s the most common LRTI in infants?
Ep [2]
Name causative organisms [2]

A

Bronchiolitis

Ep: <1 yo, winter

Viral cause: mostly by RSV or sometimes parainfluenzae 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you expect bronchiolitis to present? [6]

A

One off episode of:

  • ~3day h/o progressive
  • Nasal stuffiness, coryzal symptoms
  • tachypnoea, feeding problems
  • crackles +/- wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you investigate [2] and treat [2] an infant with bronchiolitis?

A

Ix: NPA (viral swab) & O2 sats is all that’s needed

Focus on their oxygen, hydration & nutrition and most will recover on their own
(Remember it’s viral so it can’t be treated with Abx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mom brings in her son saying he’s been going through episodes all winter of a rattly cough & post-coughing vomit that’s mucousy.
Dx [1]
Clinical picture [4]
What does it sound like? Classic sign [1]
Mx

A

Bronchitis

Tend to see:

  • Mostly well kid
  • Relapsing remitting pattern
  • Post-tussive Vomit (“glut”)
  • No wheeze/creps
  • Loose rattly Cough

Mx: reassurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathogenesis of bronchitis? [4]

A

Usually a viral infection e.g. RSV [1] disturbs the mucocilliary clearance [1] leading to a secondary bacterial infection with:

  • Haemophilus Influenzae [1]
  • Pneumococcus [1]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bronchitis is generally managed with reassurance and waiting, when would we be more worried? [6]

A

Red Flags include:

  • <6months / 4yrs
  • Static or dropping weight
  • Disrupts child’s life
  • SOB when not coughing
  • Acute admission
  • Co-morbidities e.g. neuro/gastro
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Kid comes in with mum complaining of a 2 day history of Fever, SOB & Coughing, dx?
What are the 5 symptoms in the history?
What are 3 signs on examination?
Don’t call it pneumonia as it unnessarily scares parents. What are 4 signs of pneumonia?

A

A LRTI or Chest Infection

Symptoms: 48hrs of fever, sob, cough, grunting
Signs: +/- wheeze, reduced/bronchial breath sounds & creps

Focal signs
Crepitations
HIgh fever
CXR signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
LRTI/chest infection/community acquired pneumonia?
How do you investigate [1] and treat: 
Mild symptoms [2]
First line if worsening [1]
Second line rx [1]
When is iv indicated [1]
A

Generally no need for inflammatory markers, CXR or medications, if its bad you can do FBC, CRP, CXR etc.

  • Mild = no meds, always offer to review if things get worse
  • Worse? = Oral amoxycillin –> Oral Macrolide 2nd line –> IV if vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What characterizes Pertussis? [4]
Causative organism
How does vaccination effect pertussis? [2]
Management [2]

A

Whooping cough:

  • “coughing fits”, paroxysmal
  • vomiting and colour change, post-tussive vomiting
  • Conjunctival hematoma
  • May last up to 6m
  • apnoeic spells (infants)
  • inspiratory whoop

Bortadella pertussis

Vaccination reduces risk and severity but doesn’t confer life-long protection

Mx oral erythromycin only if <3w sx (this is to reduce spread antibiotic therapy has not been shown to alter the course of the illness), give home contact prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is needed to diagnose Asthma? [5]

Describe cough in asthma [3]

A

Chronic
Episodes of wheeze, cough & SOB at rest
Variable/Reversible
Responds to asthma meds

It can help to look for a h/o or FH/o asthma & atopic conditions e.g. hayfever, eczema or food allergy

Cough: dry, nocturnal, exertional

17
Q

How do we test for asthma? [2]

A

Trial for 2 months with low dose ICS

Spirometry and FeNO

18
Q

What mnemonic can you use to assess how well the child’s asthma is controlled? [4]

A

SANE:

  • SABA /wk
  • Absence from school/nursery
  • Nocturnal symptoms /wk
  • Exertional symptoms /wk
19
Q

Lifestyle modifications for asthma management [3]

A

Stopping smoke exposure
Removing environmental triggers e.g. cat or dog
Diet, humidity, wt & hypoallergic duvets etc don’t help

20
Q

How do you deliver inhaled drugs in kids? [2]

A

MDI Spacer increases lung deposition

Dry powder inhaler, only start using it properly when they’re about 8

21
Q

Asthma management 5-16 year olds [7]

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA (stop LTRA)
  5. SABA + MART (combined ICS and LABA within single inhaler)
  6. SABA + MART (moderate dose ICS)
    • theophylline
22
Q

Asthma management <5yo

BTS 2019 + NICE 2017

A

SABA as adjunct

Step 1: Very low (paediatric) dose ICS or LTRA
Step 2: Very low dose ICS + LTRA
Step 3: Low dose ICS + LTRA
Step 4: Specialist referral

23
Q

Acute exacerbations: moderate
Clinical definition [2]
Management [3]

A
SpO2 >92%, PEF >50% predicted
Mx:
SABA (spacer)
Consider oral prednisolone
Review in 1h
24
Q

Acute exacerbations: severe
Clinical definition [3]
Management [2]

A

SpO2 <92%, too SOB to talk or eat, use of accessory muscles, PEF 33-50% predicted
Mx:
- SABA (spacer) or neb
- Neb ipatropium

25
Acute exacerbations: life threatening Clinical definition [2] Management [5]
``` SpO2 <92% and ANY of: - silent chest, poor respiratory effort, agitation, reduced GCS or cyanosis (increased PCO2) Mx: - Intubation & ventilation - Neb SABA + Ipratropium - Oral prednisolone (IV hydrocortisone if vomiting) 3-5 days - IV Mg sulfate - IV theophylline, salbutamol ```
26
Inhaled foreign body presentation [4] Management [1] Mx for total upper airway obstruction Mx for partial upper airway obstruction [2] Mx for obstruction lower than main bronchus [3]
Coughing Choking, vomiting Stridor, LOC Cardiorespiratory arrest Mx: - ABCDE • Total upper airway obstruction (can’t speak): BLS choking algorithm (or cardiac arrest algorithm) • Partial upper airway obstruction (can speak): get child in upright comfortable position and arrange for urgent removal in theatre • Obstruction lower than main bronchus: inspiratory and expiratory CXR - put in upright comfortable position and arrange for urgent removal in theatre
27
Signs that inhaled FB is lower than main bronchus [5]
- unexplained fever, cough - SOB, recurrent or persistent pneumonia - assymetrical chest movement - tracheal deviation - chest signs e.g. wheeze, bronchial breath sounds
28
Chronic asthma management in young person 6-12 years old
SABA as adjunct ``` Step 1: Very low dose ICS Step 2: Very low dose ICS + LTRA/LABA Step 3: - If no response to add-on, stop it - Low dose ICS + LTRA/LABA Step 4: moderate dose ICS (as part of fixed dose or MART) Step 5: choose one - high dose ICS - Add theophylline - Specialist referral ```
29
Causes of stridor [4]
Croup Acute epiglotitis Inhaled FB Laryngomalacia
30
What prompts immediate referrals in bronchiolitis? [5]
- apnoea (observed or reported) - child looks seriously unwell to a healthcare professional, severe respiratory distress eg: > grunting, marked chest recession > respiratory rate of over 70 breaths/minute - central cyanosis persistent oxygen saturation of less than 92% when breathing air.
31
Whooping cough Investigations [3] Management [2]
Ix: nasal swab culture, PCR, serology Mx: - Infants under 6m admit - macrolide
32
Pre-school wheeze in children types [4]
Episodic viral induced wheeze - only wheezes when viral URTI - symptom-free in between episodes Multiple trigger wheeze - viral induced wheeze + - other factors exercise, allergens, cigarette smoke
33
Management of episodic viral wheeze [4]
Stop smoking - parents Treat when symptomatic First line is tx with SABA via spacer Intermittent LTRA and/or intermittent ICS
34
Management of multiple trigger wheeze [2]
Trial of inhaled ICS or trial of LTRA For 4-8 weeks