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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What age group is most affected by bronchiolitis

A

infants, 1-9 months

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2
Q

When is bronchiolitis most common?

A

during annual winter epidemics

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3
Q

What is the most common pathogen causing bronchiolitis?

A

Respiratory syncytial virus

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4
Q

what other viruses cause bronchiolitis

A

parainfluenza
rhinovirus
adenovirus
influenza

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5
Q

What are the symptoms and signs of bronchiolitis

A 
symptoms
coryzal symptoms
dry wheezy cough
high pitched wheeze
temporarily stop breathing
breathlessness
signs
tachypnoea and tachychardia
subcostal and intercostal recession
hyperinflation of chest
fine inspiratory crackles
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6
Q

What investigations would you do for bronchiolitis?

A

Pulse oximetry

if respiratory failure - ABG, CXR

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7
Q

when do you admit infants with bronchiolitis?

A

if apnoea
sats less than 90
inadequate oral intake (50-70% of usual)
severe resp distress

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8
Q

what is the management for bronchiolitis?

A
  • humidified oxygen
  • fluids NG or IV
  • non invasive resp support - CPAP
  • good infection control measures as RSV is highly contagious
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9
Q

how soon do children with bronchiolitis recover and what are the possible complications?

A
  • most recover within 2 weeks

complications
- rarely - adenovirus infection, can go on to cause Bronchiolitis Obliterans

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10
Q

Which group of children are considered high risk for bronchiolitis?

A

premature babies with

  • bronchopulmonary dysplasia
  • congenital heart disease
  • CF
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11
Q

What can be given to prevent Bronchiolitis? Who is it for?

A

monoclonal antibody to RSV
palvizumab - monthly via IM injection
for high risk preterm babies, reduces hospital admissions

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12
Q

Which bacterium causes whooping cough?

A

Bordatella pertussis

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13
Q

what are the three phases of whooping cough?

A

Coryzal (catarrhal phase)

Paroxysmal phase (paroxysmal cough followed by inspiratory whoop)

Concalescent phase (symptoms decrease)

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14
Q

When are symptoms of whooping cough worse and what can they cause?

A

Symptoms are worse at night,

can cause vomiting

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15
Q

What are the symptoms of whooping cough?

A
  • during paroxysm- child goes red or blue
  • in infants, whoops can be absent, apnoea may occur
  • epistaxis and subconjuntival haemorrhage after significant coughing
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16
Q

What are some uncommon complications of whooping cough

A

Pneumonia

Seizures

Bronchiectasis

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17
Q

What investigations should you do for whooping cough?

A

Prenasal swab culture
PCR is more sensitive

Blood count - marked lymphocytosis

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18
Q

What is the management for whooping cough?

A

Macrolide antibiotic - eradicate organism and decrease symptoms (clarithromycin

Close contacts - macrolide prophylaxis

unimmunised infant contacts - immunise!

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19
Q

List some of the causes of recurrent/persistent cough in children?

A
  1. recurrent respiratory infections (or following RSV, Mycoplasma or Pertussis)
  2. Asthma
  3. Persistent lobar collapse following pneumonia
  4. recurrent aspiration
  5. suppurative conditions e.g CF, cilliary dyskinesia, immune deficiency
  6. persistant bacterial bronchitis
  7. inhaled foreign body
  8. cigarette smoke - active or passive
  9. TB
  10. airway anomalies e.g trachea-bronchomalacia, trachea-oesophageal fistula
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20
Q

Define Pneumoniae

A

Disease characterised by inflammation of lung parachyma with congestion caused by viruses or bacteria or irritants

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21
Q

What are the causes of Pneumonia ?

A

Newborns: organisms from mothers genital tract - esp. GBS but also gram negative enteroccoci and bacilli

most common viral: RSV

most common bacterial cause:pneumococcus

Also
Hib, 
S.aureius
K.pneumoniae 
mycobacterium Tuberculosis
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22
Q

Which age range is viral causes of pneumoniae more common?

A

viral causes more common in younger children

bacterial in older children

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23
Q

Symptoms of pneumoniae?

A

fever, cough and rapid breathing usually precede URTI

lethargy, poor feeding, unwell child

  • localised chest, abdominal and neck pain suggests ????
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24
Q

what does localised chest, abdominal and neck pain suggest in pneumoniae?

A

bacterial infection!

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25
Q

what are some of the signs of penumoniae?

A
  • Tachypnoea
  • nasal flaring
  • chest indrawing
  • high RR - most sensitive sign
    end-inspiratory coarse crackles over the affected areas (consolidation - dull to percussion)
  • decreased breath sounds
  • bronchial breathing
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26
Q

How do you diagnose pneumoniae in a child?

A
  1. history of cough +/- difficulty breathing (<14 days) with increased RR - age dependant

> 2 months: > 60 / min
2 - 11 months: > 50 / min
11 months: > 40 / min

  1. CXR dense or fluffy opacity over a portion or entire lobe. can contain air bronchogram
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27
Q

what investigations would you do for pneumoniae?

A

CXR - can show pleural effusion or empyema

Nasopharyngeal aspirate

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28
Q

when should you admit a child with pneumonia and what is the management?

A

admit if: <92% sats, recurrent apnoea, grunting, inability to maintain adequate fluid/feed intake. (supportive care - oxygen and analgesia. + iv fluids)

IV benzylpenicillin
or oral co-amoxiclav - 7-14 days

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29
Q

what does persistent fever despite 48h abx in children with pneumoniae suggest and what should you do?

A

suggests pleural collection

requires drainage

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30
Q

what are complications of pneumoniae?

what should you do?

A

Lobar collapse, atelectasis

repeat CXR after 4-6 weeks

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31
Q

what are the four stages of pneumoniae?

A
  1. consolidation
  2. red hepatization
  3. grey hepatization
  4. resolution
32
Q

Which is the most common causative organism of lobar pneumonia?

A

streptococcus pneumoniae

33
Q

What does Streptococcus pneumoniae look like under the microscope?

A

Gram +ve cocci, in pairs

34
Q

Which organisms might cause pneumonia in a HIV-positive child?

A
  • Mycobacterium tuberculosis

Others

  • Pneumocystis jiroveci
  • Mycoplasma pneumoniae
35
Q

what is the genetics of CF

A
  • autosomal recessive
  • defective CFTR on chromosome 7
  • commonest in caucasions
36
Q

What is the pathphysiology of CF?

A
  • abnormal ion transport across epithelial cells (reduced cl- out of cells, increased Na+ reabsorption)
  • thicker mucus secretions
  • chronic pseudomonias auerugonosia infecion
37
Q

Clinical features of CF?

typical, newborn, infancy, young child and older children/adults

A
  • persistent wet cough, purulent sputum
  • newborn - meconium ileus
  • infancy - prolonged neonatal jaundice,
    growth faltering, recurrent chest infections, malapsorption, steatorrhoea

young child - bronchiectasis, rectal prolapse, sinusitis and nasal polyps

  • older children and adults
    • Allergic bronchopulmonary aspergillosis, DM, Cirrhosis and portal HTN, Pneumothorax, recurrent haemoptysis, Distal intestinal obstruction, sterility in males
38
Q

What are the signs of CF?

A
  • hyperinflation of chest due to air trapping
  • coarse inspiratory crepitations and/or expiratory wheeze
  • Finger clubbing
39
Q

Diagnosis of CF?

A

abnormally raised immunoreactive trypsinogen on heel prick test

CFTR mutations on genetic tests

confirmed with sweat test - >60mmol/L Cl ions supports the diagnosis

CXR: hyperinflation, cysts, bronchial dilation (+)

40
Q

what can cause false positives and negatives in the sweat test?

A

False Positive

  • Atopic eczma
  • Adrenal insufficiency
  • hypothyroidism
  • dehydration
  • malnutrition

False negative
oedema

41
Q

How is CF managed? - Resp

A
  • regular lung function measurement using spirometry
  • physio 3x daily to clear airway secretions
  • percussion and postural drainage
  • continuous abx prophylaxis (flucloxacillin)
  • rescue abx -Ticarcillin (>1 month) + gentamicin
  • bilateral lung transplant in end stage CF disease
42
Q

How is CF managed - gastro and nutrition?

A
  • enteric coated pancreatic replacement enzymes
  • high calorie diet - may need overnight gastrostomy feeding
  • fat soluble vitamin supplements
43
Q

What are the phases of TB?

A

Primary phase:
- Latent phase - asymptomatic, uninfectious - treat with chemoprophylaxis to prevent disease

  • Active phase - symptomatic/ clinical evidence e.g x-ray, lymph nodes

Dormancy and dissemination
Reactivation
Post-primary TB

44
Q

What is the stain for Mycobacterium tuberculosis?

A

Ziehl-Neelsen stain

45
Q

Why may a mantoux test be positive other than in TB?

A

Due to BCG vaccine

Interferon gamma release assay does not have false positives (looks for antigens only on mycoplasma tubeculosis) but does not rule out false negatives

46
Q

What are the symptoms of TB

A

fever
sweats
weight loss
cough

47
Q

What are the tests you can do for TB?

A 
Sputum
CXR
Tissue
Mantoux
interferon gamma release assay
48
Q

What do you have to do for TB ?

A

Contact tracing

test with IGRA and mantoux

49
Q

Treatment for TB?

+ side effects

A

Active phase

  • Rifampicin - 6 months (hepatitis - raised bilirubin)
  • Isoniazid - 6 months (neuropathy)
  • Pyrazinamide - 2 months

Latent phase

  • Rifampicin - 3 months
  • Isoniazid - 3 months
50
Q

What should you do with children <2 years who have been in contact with someone with a +ve sputum sample

A
  • start on prophylactic isoniazid

- if mantoux and IGRA negative 6 weeks later give BCG vaccine

51
Q

who provides additional support in TB

A

community TB nursing team

52
Q

What is primary ciliary dyskinesia?

A

impaired mucociliary clearance

53
Q

What does primary ciliary dyskinesia lead to?

A
  • recurrent URTI and LRTI - can lead to bronchiectasis

- recurrent productive cough, purulent nasal discharge, chronic ear infection

54
Q

What is primary ciliary dyskenia associated with?

A

dextrocardia and situs invernus

kartagener syndrome - when they have both PCD + ^

55
Q

How is Primary Ciliary Dyskinesia diagnosed?

A

examination of nasal epithelial cells brushed from nose

56
Q

How do you manage primary ciliary dyskinesia?

A
  • daily physiotherapy
  • treatment of infections with abx
  • ENT follow up
57
Q

what is otitis media?

A

infection of the middle ear inflammation and build up of fluid behind ear drum

58
Q

Which age range is acute otitis media most common in and why?

A

6-12 months

- risk due to short eustachian tubes that are horizontal and function poorly

59
Q

What are the signs and symptoms of AOM

A
  • bright red and bulging tympanic mebrane
  • with loss of normal light reflection
  • may be acute perforation of eardrum + pus
60
Q

which pathogens cause AOM?

A
  • Viruses - RSV, Norovirus

- Bacterial - pneumococcus, H.influenza, moraxella etc

61
Q

What are the complications of AOM?

A

mastoiditis

meningitis

62
Q

Treatment of otitis media?

A
  • Analgesia for pain

- Amoxicillin if unwell after 2-3 days

63
Q

What can recurrent ear infections lead to? what are the risks?

A
  • otitis media with effusion
  • can cause conductive hearing loss
  • manage by: ventilation tubes + adenoidectomy
64
Q

Define Pharyngitis and what is it usually due to?

A

When pharynx and soft tissue are inflamed, local lymph noeds enlarged and tender

Usually due to viral infection (adenovirus, enterovirus, rhinovirus)

older children also get group A beta haemolytic strep

65
Q

Define Tonsilitis and what is the most common cause?

A

form of pharyngitis where there is intense inflammation of tonsils often with purulent exudate

common pathogens =

  • Group A beta haemolytic strep
  • Ebstein Barr Virus
66
Q

Although it is difficult to tell the difference clinically between bacterial and viral tonsilitis, what is more commonly seen in bacterial?

A
  • headache
  • apathy
  • abdo pain
  • white tonsiller exudate
  • cervical lymphadenopathy
67
Q

How do you treat tonsilitis?

A
  • Pencillin V or Eryhtomycin (if allergic)

- 10 days

68
Q

Why do you treat tonsillitis for 10 days?

A

eradicate and prevent rheumatic fever

69
Q

What else can Group A Beta haemolytic strep also cause besides tonsillitis that is a possible complication?

A

Scarlet fever

Rheumatic fever

70
Q

What are the signs of Scarlet fever as a complication of tonsillitis and what is a further complication?

What is the Tx?

A
  • fever 2-3 days before tonsillitis and headache
  • sandpaper like maculopapular rash
  • flushed cheeks, perioral sparing
  • tongue often white and coated, may be swollen

Tx - Abx

further complications = acute glomerulonephritis + rheumatic fever

71
Q

What is epiglottitis

A

Swelling of epiglottis and surrounding tissue, associated with septicaemia

72
Q

Why is acute epiglottitis considered a life threatening condition?

A

Due to the risk of respiratory obstruction

73
Q

What is the most common cause of acute epiglottitis?

A

Haemophilus influenza b

74
Q

When do you vaccinate for Hib?

A

2, 3 and 4 months

75
Q

What do you expect to see in a child with acute epiglottitis?

A

o High fever
o Child appears toxic
o Painful throat making it difficult to swallow or talk
o Child sits still and upright with open mouth (drooling) to optimize airway
o Soft inspiratory stridor, increasing resp distress
o Cough minimal or absent

76
Q

How do you manage acute epiglottitis?

A

o Senior anaesthetist, paeds and ENT – all
o Intubate under GA
o Urgent tracheostomy may be needed
o After airway secured – blood culture, IV abx
o Prophylaxis with rifampicin for close household contacts

Paediatrics (9 decks)

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