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Paediatrics RIA > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Taking a history about poor feeding (5)

A
  • 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
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2
Q

volume recorded as

A

mls/kg/day

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3
Q

minimum milk requirement for 1st month of life

A

150mls/kg/day

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4
Q

antenatal history questions to ask

A

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
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5
Q

when does routine immunisations start?

A

at 2 months

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6
Q

high risk for TB are given TB vaccination when?

A

@ birth

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7
Q

signs of increased work of breathing in a baby

A
  • tracheal tug
  • nasal flaring
  • head bobbing
  • sternal recession
  • intercostal and subcostal recession
  • paradoxical breathing
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8
Q

6 causes of increasing sleepiness in a child

A
  • hypoglycaemic
  • exhaustion due to work of breathing + feeding
  • encephalopathic (e.g. viral/bacterial infection)
  • neurological 2. to head injury: NAI, poor cerebral perfusion
  • hypoxia
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9
Q

most common pathogen causing Bronchiolitis

A

Respiratory syncytial virus

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10
Q

features of bronchiolitis

A
  • coryzl symptoms
  • dry cough
  • increasing breathlessness
  • wheezing, fine inspiratory crackles
  • feeding difficulties in association with increasing dyspnoea
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11
Q

immediate referral to hospital if any of following, bronchiolitis

A
  • 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
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12
Q

what to exclude from examination when suspecting airway obstruction

A

throat

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13
Q

signs of respiratory distress

A
  • tracheal tug
  • posture
  • pre arrest findings due to failure of compensatory mechanisms: low RR and diminished breath sounds
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14
Q

ddx for respiratory distress in a young child

A
  • viral croup
  • epiglottis
  • foreign body aspiration
  • anaphylaxis
  • bacterial trachitis
  • laryngomalacia
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15
Q

natural course of growth of hemangiomas and how can it affect the airways

A

enlarge steadily over 12-24 months

can grow in the airways: laryngeal capillary hemangioma

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16
Q

intermittent distress following feeds and lying flat

A

GORD

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17
Q

what is GORD

A

regurgitation of feeds

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18
Q

when to advise parents to return with child with GORD

A
  • 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
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19
Q

complications of GORD in infants

A
  • oesophagitis
  • recurrent aspiration pneumonia
  • frequent otitis media
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20
Q

risk factors for GORD

A
  • premature birth
  • parental heartburn
  • obesity
  • hiatus hernia
  • neurodisaiblity
  • hx oesophageal atresia
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21
Q

1st and 2nd treatment of GORD in infants

A

1st 4 week trial of H2RA/PPI

2nd refer to a specialist if symptoms do not resolve or recur after stopping treatment

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22
Q

symptoms and signs of anaphylaxis

A
  • pallor and sweating
  • wheeze
  • stridor
  • hypotension
  • bronchoconstriction
  • airway compromise
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23
Q

features of allergic reactions

A
  • itching
  • pallor
  • sweating
  • stridor
  • facialk swelling
  • erythema
  • uticarial rash
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24
Q

what type of hypersensitivity reaction is a food allergy

A

Type 1

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25
Q

what is sensitisation

A

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

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26
Q

effects of histamine

A
  • Bronchoconstriction –> wheeze
  • localised swelling + uticarial rash
  • vasodilation –> hypotension
  • itching due to localised irritation of nerve ending
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27
Q

criteria for prescribing an adrenaline pen

A
  • 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
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28
Q

when is cyanosis often seen?

A

sats < 85%

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29
Q

5 causes of tachycardia

A
  • pyrexia
  • pain
  • increased WoB
  • shock 2ndary to sepsis
  • cardiac failure
30
Q

3 causes of abnormal respiration

A
  • cardiac disease causing pulmonary oedema
  • DKA: kussmaul breathing
  • diaphragmatic herniation
31
Q

3 cause of sleepiness

A
  • hypoglycaemia
  • neurological: poor cerebral perfusion
  • hypoxia
32
Q

findings on inspection in acute severe asthma attach

A
  • subcostal recession
  • intercostal recession
  • tracheal tug
  • tripod sitting position
33
Q

findings on palpation in acute severe asthma attack

A
  • hyperexpanded chest
  • symmetrical expansion
  • central trachea
  • displaced apex beat
  • liver displaced downwards + palpable edge
34
Q

examination findings in severe pneumonia

A
  • respiratory distress: recession + tracheal tug
  • wet cough and grunting
  • expansion may be assymetrical
  • dullness over consolidation
  • reduced air entry on auscultation/crackles
35
Q

what is HARRISONS SULCI

A

bony chest wall deformity, suggests ongoing increased activity of intercostal and diaphragmatic muscles OR chronic increased work of breathing

36
Q

3 causes of finger clubbing

A
  • IBD
  • CF
  • cyanotic congenital heart disease
37
Q

treatment of asthma attack whilst awaiting hospital admission

A
  • controlled supplementary oxygen to all children with hypoxia using face mask with aim of 94-98%
  • nebulised salbutamol
38
Q

PEFR in moderate asthma attack?

A

greater than or equal to 50%

39
Q

PEFR in acute severe asthma attack

A

less than or equal to 50%

40
Q

PEFR in life threatening asthma attack

A

< 33%

41
Q

respiratory rate in acute severe asthma attack

A

greater than or equal to 25 breath per min

42
Q

inability to pass NG tube down in a newborn?

A

tracheo-oesophageal fistula

43
Q

condition that can cause night time cough due to pus/secretions dripping down throat

A

adenoid diseas

44
Q

viral cause of Croup?

A

Parainfluenza virus

45
Q

age affected in croup?

A

6 months to 3 years

46
Q

what bacteria causes epiglottitis?

A

Haemophilus influenza type B

47
Q

presentation of epiglottitis

A
  • sore throa
  • stridor
  • drooling
  • high fever
  • painfull swallowing
  • muffled voice
48
Q

lateral x ray showing thumbprint sign - diagnosis & why?

A

epiglottitis

oedematous epiglottitis

49
Q

management of epiglottitis§

A
  • Ensure airway is secure
  • IV abx (ceftriaxone)
  • Steroids
50
Q

pathophysiology of VIRAL INDUCED WHEEZE

A

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

51
Q

3 specific features of viral induced wheeze over asthma

A
  1. Presenting before age of 3 years
  2. No hx of atopy
  3. Only occurs during viral infections
52
Q

2 causes of focal wheeze

A
  • inhaled foreign body

- tumour

53
Q

cause of whooping cough

A

Bordetella pertusis (gram neg bacteria)

54
Q

how is whooping cough diagnosed?

A

Nasopharyngeal swab with PCR testing/bacterial culture within 2-3 weeks of onset of symptoms

55
Q

what causes STRIDOR?

A

it is a harsh whistling sound caused by air being forced through an obstructed upper airway

56
Q

how can chronic lung disease of prematurity be prevented?

A

Giving corticosteroids to mothers showing signs of premature labour at less than 36 weeks

57
Q

what can babies with Chronic lung Disease of Prematurity be given long term and why?

A

monthly injections of monoclonal antibody Palivizumab - to protect against RSV

58
Q

Kartagner’s syndrome also called?

A

primary ciliary dyskinesia

59
Q

Kartagner’s triad

A
  • Paranasal sinusitis
  • Bronchiectasis
  • Situs inversus
60
Q

salbutamol inhaler advice for out of hospital acute asthma

A

4-6 pufffs every 4 hours

61
Q

type of cough in pneumonia

A

wet & productive

62
Q

most common organism causing pneumonia

A

streptococcus pneuomnia

63
Q

most common cause of Bronchiolitis

A

RSV (respiratory synctyial virus)

64
Q

name 3 abnormal breathing sounds heard in bronchiolitis

A

1) wheezing
2) Grunting
3) stridor

65
Q

most common cause of lower respiratory tract infection in children under age of 2?

A

Acute Bronchiolitis

66
Q

auscultation findings in bronchiolitis

A

fine end-inspiratory crepitations +/- wheeze with prolonged expiration

67
Q

inheritance of cystic fibrosis

A

autosomal recessive

68
Q

what is often the first sign of cystic fibrosis

A

Meconium ileus

69
Q

gold standard for Cystic fibrosis diagnosis

A

Sweat test - chloride concentration > 60mmol/L

70
Q

bacteria that if causes a resp infection worsens prognosis for patients with CF

A

pseudonomas

Paediatrics RIA (12 decks)

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