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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the classical triad seen in asthma?

A

Cough, shortness of breath, wheeze

Symptoms tend to be worse at night and in early morning

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2
Q

What test should be used to aid diagnosis of asthma in children?

A

Spirometry with improvement in FEV1 of 12% following bronchodilator (e.g. salbutamol) therapy

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3
Q

What is the first step in asthma management in kids?

A

Salbutamol (Short acting b2 agonist) prn

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4
Q

What is the second step in asthma management in kids 5 or over?

A

Add on very low dose inhaled corticosteroid (e.g. beclametasone)

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5
Q

What is the second step in asthma management in kids under 5?

A

Add on a leukotriene receptor anatgonist (e.g. montelukast)

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6
Q

What is the third step in asthma management in kids 5 or over?

A

In addition to the salbutamol and v. low dose ICS, add on Long Acting B2 agonist (e.g. Salmeterol)

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7
Q

What is the third step in asthma management in kids under 5?

A

In addition to the salbutamol and montelukast, add on a very low dose inhaled corticosteroid (e.g. beclametasone)

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8
Q

What is the fourth step in asthma management in children?

A

If no response to LABA, stop this and increase ICS dose
If some response to LABA but control still inadequate, continue but consider increasing dose of ICS and trialling a LRTA.

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9
Q

What is the fifth step in asthma management in children?

A

Increase dose of ICS again

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10
Q

What is the fifth step in asthma management in children?

A

Daily low dose steroid tablet

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11
Q

When is asthma control deemed inadequate and therefore consideration given to moving up the asthma management ladder?

A

If requiring reliever inhaler more than twice a week.

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12
Q

What should all children receive to aid delivery of inhaled drugs?

A

A spacer

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13
Q

Which age group is most commonly affected by bronchiolitis and when is the peak incidence?

A

0-2 year olds.

Peak incidence: 3-6 months

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14
Q

What organism is most commonly causative of bronchiolitis?

A

Respiratory syncytial virus (RSV) is the pathogen in ~80% of cases.

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15
Q

How may bronchiolitis present?

A

Coryzal Sx preced a sharp, dry cough with SOB. Subcostal and intercostal recession. Feeding difficulty. High pitched wheeze. Hyperinflated chest. Fine end inspiratory crackles.

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16
Q

What structures become inflamed in Croup?

A

Larynx, trachea, bronchi

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17
Q

Which age group is most commonly affected by croup and when is the peak incidence?

A

6 months - 6 years.

Peak incidence: 1-3 years

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18
Q

What organism is most commonly causative of croup?

A

Parainfluenza virus

19
Q

How may croup present?

A

Stridor, barking cough (worse at night), fever, coryzal symptoms. There may be intercostal and sternal recession

20
Q

How is croup managed?

A

Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity. In emergency situation, high flow O2 and nebulised adrenaline

21
Q

What organism most commonly causes epiglottitis?

A

Haemophilus influenza B (hence low incidence now due to vaccine)

22
Q

What symptoms may be seen in someone with epiglottitis?

A

Stridor, drooling, ‘hot potato voice’, sudden onset, very unwell child, fever.

23
Q

What scoring system helps determine severity and guides management of croup?

A

Westley Croup score
=< 3: ok, send home, parents to monitor progress
4-7: steroids and admit
>= 8: Resus

24
Q

What are the most common causative organisms of pneumonia in neonates?

A

Group B strep, E.coli, gram -ve bacilli, chlamydia trochamatis

25
Q

What are the most common causative organisms of pneumonia in pre-school children?

A

Viral: parainfluenza, influenza, RSV, adenovirus
Bacterial: Strep. pneumonia (90%), H. influenza, bordatella pertussis.

26
Q

Sputum is often described as yellow-greeny in pneumonia, what might be the appearance of the sputum in pneumonia due to strep. pneumoniae?

A

Rusty

27
Q

What are common causative organisms of tonsillitis?

A

Group A beta-haemolytic streptococci

Epstein-Barr virus

28
Q

What forms the modified Centor criteria for bacterial tonsillitis?

A
  1. Absence of cough
  2. Fever > 38 degrees
  3. Anterior cervical lymphadenopathy
  4. Tonsillar exudates
    Score of 3 or more suggests Group A strep may be the cause and therefore antibiotics may be of benefit
29
Q

What is the first choice antibiotic in tonsillits?

A

Phenoxymethylpenicillin aka Penicillin V

30
Q

How common is cystic fibrosis?

A

Commonest life-limiting autosomal recessive condition in Caucasians.
Incidence: 1 in 2500
1 in 25 are carriers

31
Q

What is the defective protein in Cystic Fibrosis and where is the gene for this protein located?

A

Cystic Fibrosis Transmembrane conductance Regulator (CFTR) - a chloride channel in cell membranes. The gene is located on chromosome 7.

32
Q

What is the most common mutation that leads to Cystic Fibrosis?

A

Delta F508

33
Q

What are the cardinal symptoms of CF?

A

Recurrent chest infections, loose, offensive stool and FTT

34
Q

How may someone present with CF?

A

Mostly picked up via Guthrie screen on day 5 of life - results ~3 weeks.
15-20% will get meconium ileus, presenting on day 1-2 of life with failure to pass meconium and billious vomiting - managed with gastrograffin enema or bowel surgery +/- stoma.
Babies have to be above 3/4kg to have diagnostic sweat test.

35
Q

In CF patients, infection with what organism causes a doubling in the rate of lung function decline?

A

Pseudomonas aeringuosa

36
Q

Presence of which bacteria in the lungs of patients with CF prevents lung transplantation and how is it deteceted?

A

Non-tuberculosis mycobacterium

Alcohol and acid fast bacilli (AAFB) test

37
Q

What will be seen on CT chest of a CF patient if there is bronchiectasis?

A

Signet ring sign

38
Q

How is CF managed?

A

Chest physio. Prophylactic antibiotics. Mucolytics (inc. DNAase). Inhalers. Likely need long-term IV access (PICC line or Port-a-cath). Lung transplant.
For the gut, high fat/high protein/high calorie diet. Creon (pancreatic enzyme replacement therapy). Vitamin replacements. Insulin often required as diabetes likely to develop.

39
Q

What is the name of the test that diagnoses Tuberculosis?

A

Mantoux test

40
Q

What is the management of tuberculosis?

A

Quadruple therapy with rifampicin, isoniazid, pyrazinamide, ethambutol. Reduced to just rifampicin and isoniazid after 2 months. Treatment often needed for 6 months, longer if disseminated disease.

41
Q

What is the causative organism of whooping cough?

A

Bordatella pertussis

42
Q

How may whooping cough present?

A

Typically, week long catarrhal phase then characteristic paroxysmal/spaspmodic coughing stage with inspiratory whoop noise. Coughing spasms worse at night and may culminate with vomiting. Paroxysmal phase lasts 3-6 weeks.

43
Q

How is whooping cough managed?

A

Although erythromycin eradicates the organism, it is only effective if started during the catarrhal phase. Immunisation reduces risk of the condition.

Paediatrics (16 decks)

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