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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define Bronchiolitis

A

Infection and inflammation of the Bronchioles
Most common infection is respiratory syncytial virus
may also be parainfluenzae III
Most affects babies and infants <12 months
Peak during autumn and spring months`

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2
Q

Bronchiolitis Symptoms

A

Dry and persistent cough
Fever (low grade <39 degrees)
Coryza - Cold symptoms

Typically a 9 day illness
3 days prodrome with harsh cough and cold
3 days Ill with fever, high itched wheeze and
breathlessness
3 days recovery

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3
Q

Signs of Bronchiolitis

A

Increase Respiratory effort
Tachypnoea, Tracheal Tug, Subcostal/intercostal
Recession, head bobbig and grunting

Hypoxia –> cyanosis

ON AUSCULTATION –> coarse creps

Expiratory wheeze

Downward displaced Liver - Hyperinflated lungs

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4
Q

Investigation of Bronchiolitis

A 
Test for signs of Dehydration
   Dipped fontanelle 
   Dry mouth and skin
   Drowsiness
   Oliguria

Nasopharyngeal aspiration for viruses
CAPILLARY blood gas would show respiratory acidosis if severe
Urine or blood tests
CXR would show hyperinflated lungs
Though Bloods Xray and cultures not routinely required

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5
Q

What children are at risk of severe bronchiolitis?

A

Premature babies (<35wks) until the age of 6mo
chronic lung disease within the 1st2 years (CF)
Significant Congenital Heart disease within 1st 2 years

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6
Q

Treatment of Bronchiolitis

A

Supportive: - keep child upright with plenty fluids, keep air moist to ease respiration, smoke free environment, antipyrexials and saline nasal drops

Palavizumab (RSV monoclonal Antibody) given MONTHLY to at risk babies for 6 months during RSV season as prophylaxis

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7
Q

Definition of Croup

A

Acute laryngotracheobronchitis (LTB)
Viral Infection
Inflammation of the upper respiratory tract

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8
Q

Pathology of Croup

A

Subglottic oedema, inflammation - causes narrowing of the tract

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9
Q

Signs and Symptoms of Croup

A

‘Barking’ cough
Hoarse voice from obstruction in larynx region
Stridor - worse on exertion
increased effort of respiration - use of accessory muscles - tachypnoea, sub-costal recessions

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10
Q

Investigations for Croup

A

SaO2/Pulse oximetry - < 95% indicates severe respiratory impairment.
FBC - White cell count and viral pattern
CXR - exclude inhaled foreign body etc.

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11
Q

Management of Croup

A

Oral Corticosteriods - Pred or Dexa - this will reduce swelling in the throat
Fain Relief - Ibuprofen or paracetamol
DO NOT USE COUGH MEDICATIONS - they do not help with croup symptoms and can cause drowsiness which is not good in a child with respiratory issues

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12
Q

Prevention of Croup

A

Sin1 Vaccination with Pre-school booster

Pregnant women are offered the vaccine.

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13
Q

Definition of Epiglottitis

A

Bacterial infection resulting in inflammation of the epiglottis. Now rare with the introduction of the Hib vaccination (haemophilius influenzae B)

Less common cause may be strep Pneumonaie

1-6 year olds most commonly - medical emergency

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14
Q

Clinical presentation of epiglottitis

A 
Fever
Toxic Looking child
Dysphagia
Sore throat 
Stridor - may be improved by leaning forward
Irritability or restlessness
Drooling
Minimal cough
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15
Q

Investigation and treatment of epiglottitis

A

NOTHING IS TO BE DONE UNTIL AIRWAY IS SECURE
avoid interventions and CXR - anything that might precipitate airway obstruction

ENT/Anaesthetic review to secure airway
Rx infection with broad spectrum Abx.
WBC count
CT to check for level of swelling

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16
Q

Prevention of Epiglottitis

A

Children should receive 5 in 1 vaccine DTaP/IVP/HIB which also prevents against diphtheria, tetanus, whooping cough and polio
Receive at 2, 3 and 4 months with a booster at 12
months

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17
Q

Definition of Whooping cough (pertussis)

A

Highly contagious bacterial infection of the lungs and airways
Bordetella pertussis

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18
Q

Clinical features of Whooping Cough

A

Clod like symptoms for 2-3 days followed by spasmodic coughing and an inspiratory whoop.
Runny nose, temperature, vomiting after coughing.
Young babies may present with apnoea
systems may persist for 10 - 12 weeks (the 100 day cough)

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19
Q

Investigations for whooping cough

A

Blood tests for Bordatella and increased WBC

Pre-nasal Swab

20
Q

Management of Whooping cough

A

Supportive - Rest Fluids and analgesia
Admit if cyanotic or presenting with apnoea
May need IV Abx and steroids to reduce the swelling
Young babies may present much worse - O2 mask/ventilation support

21
Q

Definition of Cystic Fibrosis

A

Serious autosomal recessive condition
multi-system disease characterised by increased mucus viscosity, resulting in
Frequent RTIs
Pancreatic Insufficiency

22
Q

Pathology

A

Autosomal ressecive disorder affecting the CysticFibrosis Transmembrane regulator gene (CFTR) - Ch7
Na-Cl channel dysfunction = thick mucosal secretions - mainly lungs and pancreas
Most common mutation is deltaF508

23
Q

Clinical Features of CF

A 
New Born infants - Meconium ileus (see later)
Young children
   Failure to thrive
   Recurrent RTI - Staph A. HIB, Pseudomonas 
   persistent cough
   steatorrhoea
   malabsorption
   rectal prolapse
24
Q

Investigations of CF

A

Heel prick (Guthrie) test - immunoreactive trypsinogen increased in newborns with CF - routine now

Sweat test - measures Na and Cl in sweat - GOLD STANDARD - 2 abnormal tests = diagnostic
CXR - shadows and exaggerated bronchial marking - Bronchiectasis

25
Q

management of CF

A 
MDT approach 
Respiratory care
   IV Abx, bronchiodilators/inhaled steroids and 
   physiotherapy
Nutrition
   Pancreatic enzyme supplementation
   high-calorie diet
Liver Disease
  UDC acid may reduce progression
Lungs
   Bilateral transplant may be indicated
26
Q

Meconium Ileus

A

Meconium is thicker and stickier than usual - causes obstruction of ilium at birth
90% of babies with Meconium ileus will have DF

27
Q

Symptoms of meconium ileus

A

Delay in passing meconium (normally within 24 hours of birth)
Poor Feeding - May get bilious vomiting
irritable
distended abdomen

28
Q

Investigation of meconium ileus

A

X-ray abdomen

29
Q

management of meconium Iieus

A

may be possible to dissolve by injecting enema
NG tub to drain collected bile
IV fluids
Abx for possible infection

30
Q

Take home points on Croup

A

para’ Flu I
Common
Coryza ++, stridor, Hoarse voice ‘barking cough’
Oral Dexa/Pred

31
Q

Take home points on Epiglottits

A 
H. Influenzae type B
Rare
Toxic Child
Stridor and Drooling
Intubate and Abx
Medical Emergency.
32
Q

Asthma

A

Chronic inflammatory disorder characterised by reversible obstruction of the airways.
hard to Dx under 3 years old - overlap with VIW
typically assoc. with Hx of atopy

33
Q

Clinical Assessment of asthma (PROPS)

A 
P - Peak Flow
R - Respiratory Rate
O - Oxygen saturation
P - Pulse rates
S - Sentences
34
Q

Asthma is severe if a child >5 years old presents with any of…

A 
P - Les than 50% of Best/Predicted  
R - more than 30/min
O - less than 92% (life threatening 
P - >125/min
S - Too breathless to talk or has to use accessory mm.
35
Q

Life threatening Features of Asthma - 33, 92 chest

A 
RR - >33
O2 sats <92%
C - Cyanosis
H - Hypotension 
E - Exhaustion with poor reps effort
S - Silent Chest
T - Tired and Confused i.e.  reduced consciousness
36
Q

Management of Asthma

A

Mild/Moderate
Often Manages in Community
Inhaled Beta-2 agonist (salbutamol) via spacer
up to 10 puffs, 30s apart - repeat every 4 hours
Oral pred for 3 days (10mg for <2, 20 2-5, 30mg >5
Admit if not responding

Severe
Transfer to Hospital
High flow O2
Beta - 2 agonist Neb - 2.5mg <5, 5mg >5
BURST THERAPY - every 20-30 minutes checking
PFR
+ Ipratropium Neb 250 micrograms if not
responding
IV hydrocortisone - 4mg/kg every 4 hours

If not responding or life threatening 
   PICU
   Above Rx + magnesium sulphate
   Aminophylline or Salbutamol by infusion if still no 
   improvement
37
Q

O SHIT ME it asthma

A

O2 - increase to 94 - 98%

S - Salbutamol Neb
H - Hydrocortisone/Prednisolone
I - ipratropium
T - Theophylline

M - Magnesium Sulphate
E - Esalate Care

38
Q

Know your inhalers

A

Blue inhaler - Salbutamol
Yellow/Brown Cap - Low Does Steroid (2x per day)
Pink inhaler - Seretide (B-agonist + steroid)

39
Q

Viral induced Wheeze

A

Wheezing episode with Viral URTI
<5 years old
Absence of strong atopic Hx (diff. From Asthma)
NO INTERVAL SYMPTOMS - no SOB/Cough when cold or running (also Diff. From Asthma)

40
Q

DDx for Asthma

A

Onset under 5 Onset over 5
Congenital Dysfunctional Breathing
CF Vocal cord dysfunction
PCD Habitual Cough
Bronchitis Pertussis
Foreign Body

41
Q

What are the goals of asthma Rx?

A

Limited symptoms during day and night
minimal need for reliever medication
no attacks/exacerbation
No limitation to physical activity

42
Q

How do we Measure Asthma Control

A

SANE

SABA/week
Absence from school
Nocturnal symptoms/week
Excertional symptoms/week

43
Q

when do we use a regular preventer of asthma in children? and what is it?

A

When using B2 agonist > 2 x a week
if symptomatic 3 times a week or more, waking up at night once a week

What - Start with very low dose ICS

44
Q

What is the initial add on preventer of asthma

A

Add on LABA or LTRA

increase ICS dose

45
Q

2 things to reember about B2 agonist

A

DO NOT use without ICS (in children)

Use as a fixed dose inhaler

46
Q

When should spacers and Dry Powder devices be used

A

Children of primary school age should use a spacer

Those of secondary school age should be given a dry powder device

Paediatrics (19 decks)

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