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Paeds > Respiratory > Flashcards

Respiratory Flashcards

1
Q

∆∆ stridor

A 
Inhaled foreign body 
Anaphylaxis 
Croup 
Epiglottis 
Bacterial tracheitis 
Laryngomalacia
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2
Q

difference between stridor and wheeze

A

stridor = upper airway obstruction - monophonic
High inspiratory noise
Wheeze = lower airway obstruction - polyphonic

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3
Q

Asthma
Aetiology
Presentation
Investigations

A 
Aetiology 
Fam Hx 
Atopy 
Hygiene hypothesis 
Viral illness 
Maternal smoking 
Presentation 
Diurnal cough - worse @ night 
Dyspnoea
Wheeze 
SOB

O/E
harrison’s sulci
hyper inflated chest
Wheeze

Investigations 
FEV1/FVC - >70 
Reversibility - >12% 
FeNO >35ppb 
CXR - hyperinflation
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4
Q

Asthma management

A

SABA
+ICS
+ LRTA
Swap LRTA for LABA

SABA + MART
SABA + MART higher dose ICS
SABA + other eg theophylline

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5
Q

Asthma attack severity

A

Moderate
PEF >50%
Sats >92
Can speak in full sentences

Severe 
PEF 33-50%
Sats <92 
Struggles to speak in full sentences 
Use of accessory neck muscles 
Life threatening 
PEF <33% 
Sats <92
Symptoms 
1) Silent chest 
2) Reduced breathing effort 
3) ∆ consciousness 
4) Cyanosis
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6
Q

Asthma attack management

A 
OSHITME 
O2
Salbutamol - neb
Hydrocortisone IV 
Ipratroprium IV 
Theophylline IV
Magnesium sulphate IV 
Escalate care
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7
Q 
Cystic fibrosis 
Aetiopathophysiology 
Presentation 
Investigations 
Management
A

Aetiopath
Autosomal recessive - CFTR gene - ∆F508 mutation - –> defect in cAMP chloride channel –> decreased Chloride in lungs –> decreased water –> thicker secretions

Presentation
Neonate
- Prolonged jaundice
- Meconium ileus

Resp

  • Recurrent infections
  • Thick secretions
  • Cough/ wheeze/ dyspnoea

GI

  • Gall bladder insufficiency - decreased ADEK absorption
  • Liver - cirrhosis + portal HTN
  • Pancreatic insufficiency - malnutrition

UROGEN
- Subfertility

General

  • FTT
  • Clubbing

Investigations

  • Heel prick test - immunoreactive trypsinogen
  • Sweat test - decreased Cl
  • raised faecal elastase
  • CXR - hyperinflation, train track sign - bronchial wall thickening

Recurrent infection organisms

  • Staph A
  • Hib
  • Pseudomonas
  • Burkholderia
Management 
Resp 
Mucolytic - carbocystine 
Physio 2/3 x/day 
Vaccinations + prophylactic abx 
Remember they can have palivizumab for bronchiolitis

GI

  • 12-150% RDA
  • ADEK
  • Creol for pancreatic insufficiency

Lung transplant if Rx compliant and no burkholderia C

Isolation

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8
Q

Recurrent infections in CF

A

Staph A
Pseudomonas
Hib
Burkholderia C

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9
Q

Bronchiolitis

Aetiology
Presentation
Investigations
Management

A

Aetiology
RSV
HMV
parainfluenza

Presentation 
Coryzal symptoms 
Cough (sharp + dry)
Poor feeding 
Wheeze 
Respiratory distress symptoms

Investigations
Nasal swab/ nasopharyngeal aspirate

Management

  • Fluids/ supportive
  • NG feed if poor feeding
  • Humidified O2
  • Neb salbutamol

Palivizumab for people at risk - given IM injection monthly -

  • CF
  • Congenital heart defects
  • Immunocompromised
  • premature
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10
Q

When to admit in bronchiolitis

A 
Resp distress 
Poor feeding 
Poor fluid intake 
Cyanosis 
Apnoea 
RR >70
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11
Q

Croup

Aetiology
Presentation
Investigations
Management

A

More common in autumn

Aetiology

  • Parainfluenza - main
  • HMV
  • RSV

Presentation (initial fever/ coryza symptoms)
Stridor
Barking cough
Symptoms worse @ night

Investigations
Do not examine throat

Management

  • Fluids
  • O2
  • Dexamethasone oral
  • Nebulised budesonide
  • Neb adrenaline
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12
Q

Epiglottitis

Aetiology
Presentation
Investigations
Management

A

Aetiology
Hib

Presentation 
Tripod sign 
Lack of cough 
Soft stridor 
Drooling 
Fever
Use of accessory muscles

Investigations
Do not examine throat
Thumb sign on XR

Management

  • INTUBATION
  • IV cefuroxime
  • Rifampicin to household contacts
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13
Q

Whooping cough

Aetiology
Presentation
Investigations
Management

A

Aetiology
Bordatella pertussis

Presentation 
Catarrhal phase -->
Cough with inspiratory whooping sound 
Severe coughing bout can --> 
Vomit 
Conjunctival haemorrhage 
Apnoea

Investigations
Nasal swab

Management
Azythromycin
School exclusion

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14
Q

Rx for whooping cough

A

Azithromycin

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15
Q

Rx for bronchiolitis

A

Fluids
Supportive

Humidified O2
Neb salbutamol (less used now)
Suction if excess secretions
NG feed if poor intake

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16
Q

Rx for croup

A

Fluids + O2
Oral dex
Neb budesonide
Neb adrenaline

17
Q

Bacterial tracheitis

Aetiology
Presentation
Investigations
Management

A

Aetiology
Staph A

Presentation
Stridor
Cough
high fever

Investigations

Management

  • IV cefuroxime + clindamycin
  • Intubation
18
Q

Pneumonia causes

A

Neonates
GBS
Gram -ve enterococci
Listeria

Infant 
Strep P 
Hib 
RSV
Bordatella

Adolescent
Strep P
Chlamydia P
Mycoplasma P

19
Q

What distinguishes pneumonia from other resp infections clinically

A

if HIGH FEVER - suspect pneumonia

20
Q

Pneumonia

Investigations
Management

A

Investigations

  • Blood cultures
  • Septic screen
  • CXR
  • Sputum sample

Management

  • IV ben pen if severe
  • Amox
  • Co amox if not responding
21
Q

Otitis media

Aetiology
Presentation
Management
Complications

A

Aetiology
Strep pneumonia
Hib
RSV

Presentation 
Pulling ear/ hearing loss 
pain 
Fever 
Otorrhoea

Management
amoxicillin

Complications
OME
CSOM + TM perforation
mastoiditis –> meningitis

22
Q

Heel prick test in CF looks at

A

immunoreactive trypsinogen

23
Q

croup cause

A

parainfluenza

24
Q

bronchiolitis cause

A

RSV

25
Q

Infections in CF

A

Staph A
Pseudomonas
Hib
Burk

26
Q

Epiglottitis cause

A

Hib

Paeds (14 decks)

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