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CH > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common respiratory viral infection?

A

RSV

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2
Q

What is the common organism amongst older children with Pharyngitis?

A

Usually viral

Group B haemolytic strep

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3
Q

What are the common pathogens in tonsillitis?

A

Group A Beta haemolytic Strep

EBV

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4
Q

What is the epidemiology of AOM?

A

Most children will have at least one episodes, usually at 6-12months

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5
Q

Why are infants and younger children more at risk of AOM?

A

Eustachian tube are short, horizontal and poorly functioning

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6
Q

What does the TM look like on AOM?

A

Bright red, bulging with loss of normal light reflection

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7
Q

What are the causative organisms in AOM?

A

Viral: RSV and rhinovirus
Bacterial: Pneumococcus, H.Influenza, Moraxella Cararrhalis

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8
Q

What are some serious but uncommon complications of AOM?

A
  • Mastoiditis and Meningitis

- Most cases resolve spontaneously, if recurrent can lead to otitis media with effusion

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9
Q

What is the epidemiology of AOM with effusion?

A
  • Common between 2-7yrs with peak incidence at 2.5-5years
  • It is the most common cause of conductive hearing loss in children and can interfere with normal speech development and can result in school difficulties
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10
Q

What is the tx for AOM with effusion when interference with speech development?

A

Insertion of grommets

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11
Q

Where does sinusitis tend to present in children?

A
  • Can occur with viral URTI or secondary to bacterial

- As the frontal sinus does not develop until late childhood, frontal sinusitis is uncommon in the first decade of life

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12
Q

Why are children at risk of airway narrowing with tonsillitis?

A
  • Adenoids increase in size until 8yrs then regress
  • In young children, adenoids grow proportionally faster than the airway and therefore the effect of narrowing the airway lumen is greatest between 2-8yrs
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13
Q

When is stridor heard?

A

Inspiratory wheeze

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14
Q

What sounds may be heard in laryngeal/tracheal upper airways obstruction?

A

Stridor
Hoarseness (inflammation of vocal cords)
Barking cough
Variable degree of dyspnoea

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15
Q

How can an upper airway obstruction be assessed clinically?

A
  • The degree of chest retraction (no/on crying/at rest)

- The degree of stridor (none/on crying/at rest/biphasic)

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16
Q

What is it extremely important to remember in children with upper airways obstruction?

A

Do NOT examine the throat.

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17
Q

How does croup arise?

A
  • Laryngotracheobronchitis
  • Mucosal inflammation and increased secretions affecting the airway.
  • Oedema in subglottic area may result in critical narrowing of trachea
  • 95% is viral
  • Parainfluenza virus most common
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18
Q

What is the epidemiology of croup?

A
  • From 6months to 6years
  • Peak incidence at 2yrs
  • Most common in Autumn
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19
Q

What are the typical features of croup?

A
  • Barking cough
  • Harsh stridor
  • Hoarseness
  • Preceded by fever and coryza
  • Symptoms often start and are worse at night
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20
Q

When can a child with croup be managed at home?

A
  • Airway obstruction is mild if the stridor and chest recession disappear when the child is at home.
  • Parents need to observe the child closely.
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21
Q

What factors determine where a child with croup should be managed?

A

Time of day
Ease of access to hospital
Child’s age (lower threshold for admission if <12months)

Admit any child with mod/severe croup

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22
Q

What is the tx of croup?

A

Single dose of oral dexamethasone

Decreases the severity and duration of croup and need for hospitalisation

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23
Q

What is the tx for severe croup/emergency?

A

High flow oxygen
Nebulised adrenaline
Close monitoring by anaesthetist

24
Q

What is Pseudomembranous croup and tx?

A
  • Rare, child has a high fever, appears toxic and has rapidly progressive airway obstruction with thick, copious secretions
  • Staph Aureus
  • Tx: IV Abx, intubation and ventilation if required
25
Q

What is the epidemiology of Acute Epiglottitis?

A
  • Caused by Haemophilus Influenza Type B
  • Rare due to vaccination
  • Children aged 1-6years

Intense swelling of epiglottis and surrounding tissues associated with septicaemia

26
Q

What is the presentation of acute epiglottitis?

A
  • Fever, “toxic” looking child, stridor, drooling, minimal cough
  • Intensely painful throat that prevents the child from speaking or swallowing
  • Soft inspiratory stridor, rapidly increasing respiratory difficulty
27
Q

What must you NOT do in acute epiglottis?

A

Do NOT examine the throat, do NOT lie the child down

28
Q

What is the tx of acute epiglottis?

A
  • If suspected, urgent hospital admission and tx required
  • Senior anaesthetist, paediatrician and ENT surgeon
  • Intubation, IV Abx and blood cultures
  • Prophylaxis for household contacts
29
Q

How would you describe stridor?

A

Harsh, monophonic noise from the trachea or larynx as a result of narrowing

30
Q

What is the DDx of stridor?

A 
Viral croup
Epiglottitis 
Inhaled foreign body
Acute allergic reaction
Airway burns and scalds
31
Q

What is the method of assessment in persistent/recurrent stridor?

A 
Plot growth 
Continuous or episodic?
Hx of child trauma/CN anomalies?
Hx cardiac/thoracic trauma?
Any cutaneous haemangiomas?
Swallowing problems? (bulbar dysfunction)
32
Q

What are the investigations in persistent/recurrent stridor?

A

CXR (to asess mediastinum and cardiac size)
Flexible larygobronchoscopy
Blood test (rarely hypocalcaemia/hypomagnesaemia)

33
Q

What are some causes of persistent stridor in an older child?

A

Viral or allergic
Vocal cord dysfunction
Rare: neck mass/tumour

34
Q

What is the epidemiology of Pertussis

A
  • Whooping cough
  • Caused by Bordella Pertussis
  • Endemic, every 3-4years
35
Q

What is the clinical presentation of Pertussis?

A
  • Coryza for one week followed by spasmodic coughing ending with an inspiratory ‘whoop’.
  • Young babies may present with apnoeas
  • Spasms of cough are often worse at night and may culminate in vomiting.
  • During a paroxysm, the child goes red or blue in the face, mucus flows from the nose and mouth
36
Q

What is the course of Pertussis?

A
  • Paroxysmal phase lasts for 3-6wks

- Symptoms gradually decrease (convalescent phase) but may persist for many months.

37
Q

What are the complications of Pertussis?

A
  • Pneumonia
  • Convulsions
  • Bronchiectasis
38
Q

What are the investigations in Pertussis?

A
  • Per-nasal swab
  • Marked leucocytosis on FBC
  • Erythromycin prophylaxis for close contacts
  • If severe, admission
  • Isolate from other children
39
Q

What is the epidemiology of Bronchiolitis?

A
  • The most serious respiratory tract infection of infancy (<1yr, peaks 3-6months)
  • Winter epidemics
  • RSV causative virus in 80%
40
Q

What are the clinical features of Bronchiolitis?

A
  • Coryzal symptoms precede a dry cough and increasing breathlessness.
  • Feeding difficulties associated with increasing dyspnoea
41
Q

Which groups are at risk of severe Bronchiolitis?

A
  • Premature babies with bronchopulmonary dysplasia

- Those with underlying lung disease: CF or congenital heart disease

42
Q

What are the investigations in Bronchiolitis?

A
  • RSV identified by PCR analysis of nasopharyngeal secretions
  • Pulse oximetry: O2 sats
  • Blood gases in severe disease
43
Q

What is the tx in Bronchiolitis?

A
  • Supportive
  • Humidified O2 via headbox
  • Monitor baby for apnea
44
Q

What is the prognosis in bronchiolitis?

A
  • Most will recover from acute infection within 2wks

- Up to half will have recurrent episodes of cough and wheeze

45
Q

What are the two main categories of wheeze in children?

A

Transient early wheezing: ViW, resolves by age 5.

Recurrent wheezing.

46
Q

What are some of the causes of childhood wheezing?

A 
Transient early wheezing (ViW)
Atopic asthma
Non-atopic asthma
Recurrent aspiration of feeds
Inhaled foreign body
47
Q

What is the aetiology of asthma

A
  • Up to 40% are atopic

- Majority of exacerbations triggered by RSV

48
Q

What are the clinical features of asthma?

A
  • Wheeze described as “whistling in the chest when your child breaths out”
  • Symptoms worsen at night and early morning
  • Triggers (exercise, pets, cold air, dust, laughter)
  • Interval symptoms (between acute exacerbations)
49
Q

What are the features of a severe asthma attack?

A 
SpO2 <92%
PEF 33-50% of predicted 
Breathless to talk or feed
HR >125 (>5yrs), HR>140 (2-5yrs)
RR >30 (>5yrs), RR>40 (1-5yrs)
Use of accessory muscles
50
Q

What are the features of a life-threatening asthma attack?

A 
SpO2 <92%
PEF <33% predicted
Silent chest
Poor respiratory effort
Agitation
Altered consciousness 
Cyanosis
51
Q

What is the tx for a mild-moderate asthma attack?

A
  • Give beta2 agonist via spacer, 1 puff every 30-60s up to a max of 10 puffs
  • If not controlled, repeat and refer to hospital
52
Q

What are the causative organisms in pneumonia for:

a) Newborns
b) Infants and young children
c) >5years

A

a) Group B Strep and gram -ve enterococci
b) RSV, Strep pneumonia, H.Influenza
c) Mycoplasma pneumonia, Strep pneumonia, Chlamydia Pneumonia

53
Q

What are the clinical features of Pneumonia?

A
  • Fever, difficult breathing , preceded by URTI

- O/e: Tachypnoea, nasal flaring, chest undrawing, increased RR

54
Q

What is the diagnosis and tx of pneumonia?

A

Diagnosis: CXR
Tx: Amoxicillin

55
Q

What is the epidemiology of CF?

A
  • Autosomal recessive
  • 80% due to delta F508 on long arm of chromosome 7.
  • Organisms which may colonise: Staph Aureus, Pseudomonas, Burkholderia, Aspergillus
56
Q

How is the diagnosis of CF made?

A

High sweat chloride

57
Q

What are some of the presenting features in CF?

A

Neonatal jaundice (20%)
Recurrent chest infections
Malabsorption

If diagnosed >18yrs:
-Short stature, DM, delayed puberty, nasal polyps, male infertility

CH (7 decks)

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