Respiratory Flashcards
Taking a history about poor feeding (5)
- volume of milk taken before and now -bottles/breast
- timescale of the decline in feeding
- reasons for why he stops feeding due to SoB?
- sleepiness? - during feeds?
- ICE
volume recorded as
mls/kg/day
minimum milk requirement for 1st month of life
150mls/kg/day
antenatal history questions to ask
Maternal health
- congenital infections
- vascular episodes following antenatal bleeds
- trauma
- medication
- teratogenic agents including high sugars
Delivery: increased risk of infection with prolonged rupture of membranes
Gestation, mode of delivery, weight
Post delivery
- any time on antenatal unit
- hypoglycaemic screening
- concerns around sepsis
when does routine immunisations start?
at 2 months
high risk for TB are given TB vaccination when?
@ birth
signs of increased work of breathing in a baby
- tracheal tug
- nasal flaring
- head bobbing
- sternal recession
- intercostal and subcostal recession
- paradoxical breathing
6 causes of increasing sleepiness in a child
- hypoglycaemic
- exhaustion due to work of breathing + feeding
- encephalopathic (e.g. viral/bacterial infection)
- neurological 2. to head injury: NAI, poor cerebral perfusion
- hypoxia
most common pathogen causing Bronchiolitis
Respiratory syncytial virus
features of bronchiolitis
- coryzl symptoms
- dry cough
- increasing breathlessness
- wheezing, fine inspiratory crackles
- feeding difficulties in association with increasing dyspnoea
immediate referral to hospital if any of following, bronchiolitis
- apnoea
- child looks seriously unwell
- severe respiratory distress e.g. grunting, chest recession, resp rate over 70 breaths/min
- central cyanosis
- persistent oxygen sats < 92% when breathing air
what to exclude from examination when suspecting airway obstruction
throat
signs of respiratory distress
- tracheal tug
- posture
- pre arrest findings due to failure of compensatory mechanisms: low RR and diminished breath sounds
ddx for respiratory distress in a young child
- viral croup
- epiglottis
- foreign body aspiration
- anaphylaxis
- bacterial trachitis
- laryngomalacia
natural course of growth of hemangiomas and how can it affect the airways
enlarge steadily over 12-24 months
can grow in the airways: laryngeal capillary hemangioma
intermittent distress following feeds and lying flat
GORD
what is GORD
regurgitation of feeds
when to advise parents to return with child with GORD
- regurgitation becomes persistently projectile
- bile stained vomiting/haematemesis
- new concerns: marked distress, feeding diff, faltering growth
- frequent regurg beyond age 1
- chronic cough
- hoarseness
- single episode of pneumonia
complications of GORD in infants
- oesophagitis
- recurrent aspiration pneumonia
- frequent otitis media
risk factors for GORD
- premature birth
- parental heartburn
- obesity
- hiatus hernia
- neurodisaiblity
- hx oesophageal atresia
1st and 2nd treatment of GORD in infants
1st 4 week trial of H2RA/PPI
2nd refer to a specialist if symptoms do not resolve or recur after stopping treatment
symptoms and signs of anaphylaxis
- pallor and sweating
- wheeze
- stridor
- hypotension
- bronchoconstriction
- airway compromise
features of allergic reactions
- itching
- pallor
- sweating
- stridor
- facialk swelling
- erythema
- uticarial rash
what type of hypersensitivity reaction is a food allergy
Type 1
what is sensitisation
initial exposure to allergen results in cross binding of 2 bound IgE molecules on the mast cell or basophil surface, resulting in degranulation of the mass cell to release histamine
effects of histamine
- Bronchoconstriction –> wheeze
- localised swelling + uticarial rash
- vasodilation –> hypotension
- itching due to localised irritation of nerve ending
criteria for prescribing an adrenaline pen
- Hx anaphylaxis
- previous cv/resp involvement
- evidence of airway obstruction
- poorly controlled asthma requiring inhaled corticosteroids
- reaction to small amounts of allergen
- ease of allergen avoidance
when is cyanosis often seen?
sats < 85%
5 causes of tachycardia
- pyrexia
- pain
- increased WoB
- shock 2ndary to sepsis
- cardiac failure
3 causes of abnormal respiration
- cardiac disease causing pulmonary oedema
- DKA: kussmaul breathing
- diaphragmatic herniation
3 cause of sleepiness
- hypoglycaemia
- neurological: poor cerebral perfusion
- hypoxia
findings on inspection in acute severe asthma attach
- subcostal recession
- intercostal recession
- tracheal tug
- tripod sitting position
findings on palpation in acute severe asthma attack
- hyperexpanded chest
- symmetrical expansion
- central trachea
- displaced apex beat
- liver displaced downwards + palpable edge
examination findings in severe pneumonia
- respiratory distress: recession + tracheal tug
- wet cough and grunting
- expansion may be assymetrical
- dullness over consolidation
- reduced air entry on auscultation/crackles
what is HARRISONS SULCI
bony chest wall deformity, suggests ongoing increased activity of intercostal and diaphragmatic muscles OR chronic increased work of breathing
3 causes of finger clubbing
- IBD
- CF
- cyanotic congenital heart disease
treatment of asthma attack whilst awaiting hospital admission
- controlled supplementary oxygen to all children with hypoxia using face mask with aim of 94-98%
- nebulised salbutamol
PEFR in moderate asthma attack?
greater than or equal to 50%
PEFR in acute severe asthma attack
less than or equal to 50%
PEFR in life threatening asthma attack
< 33%
respiratory rate in acute severe asthma attack
greater than or equal to 25 breath per min
inability to pass NG tube down in a newborn?
tracheo-oesophageal fistula
condition that can cause night time cough due to pus/secretions dripping down throat
adenoid diseas
viral cause of Croup?
Parainfluenza virus
age affected in croup?
6 months to 3 years
what bacteria causes epiglottitis?
Haemophilus influenza type B
presentation of epiglottitis
- sore throa
- stridor
- drooling
- high fever
- painfull swallowing
- muffled voice
lateral x ray showing thumbprint sign - diagnosis & why?
epiglottitis
oedematous epiglottitis
management of epiglottitis§
- Ensure airway is secure
- IV abx (ceftriaxone)
- Steroids
pathophysiology of VIRAL INDUCED WHEEZE
as small children have small airways, when the airways encounter a virus which as RSV or rhinovirus, they develop a small amount of inflammation and oedema, swelling the walls of the airway and restricting the flow of air
& inflammation triggers the smooth muscles of the airways to constrict
3 specific features of viral induced wheeze over asthma
- Presenting before age of 3 years
- No hx of atopy
- Only occurs during viral infections
2 causes of focal wheeze
- inhaled foreign body
- tumour
cause of whooping cough
Bordetella pertusis (gram neg bacteria)
how is whooping cough diagnosed?
Nasopharyngeal swab with PCR testing/bacterial culture within 2-3 weeks of onset of symptoms
what causes STRIDOR?
it is a harsh whistling sound caused by air being forced through an obstructed upper airway
how can chronic lung disease of prematurity be prevented?
Giving corticosteroids to mothers showing signs of premature labour at less than 36 weeks
what can babies with Chronic lung Disease of Prematurity be given long term and why?
monthly injections of monoclonal antibody Palivizumab - to protect against RSV
Kartagner’s syndrome also called?
primary ciliary dyskinesia
Kartagner’s triad
- Paranasal sinusitis
- Bronchiectasis
- Situs inversus
salbutamol inhaler advice for out of hospital acute asthma
4-6 pufffs every 4 hours
type of cough in pneumonia
wet & productive
most common organism causing pneumonia
streptococcus pneuomnia
most common cause of Bronchiolitis
RSV (respiratory synctyial virus)
name 3 abnormal breathing sounds heard in bronchiolitis
1) wheezing
2) Grunting
3) stridor
most common cause of lower respiratory tract infection in children under age of 2?
Acute Bronchiolitis
auscultation findings in bronchiolitis
fine end-inspiratory crepitations +/- wheeze with prolonged expiration
inheritance of cystic fibrosis
autosomal recessive
what is often the first sign of cystic fibrosis
Meconium ileus
gold standard for Cystic fibrosis diagnosis
Sweat test - chloride concentration > 60mmol/L
bacteria that if causes a resp infection worsens prognosis for patients with CF
pseudonomas
