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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the other name for croup

A

Laryngotracheobronchitis

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2
Q

What other symptoms would you see in bacterial tracheitis

A

Fever

child looks toxic

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3
Q

What are the clinical features of croup

A
  • Barking cough ‘seal-like’
  • Harsh stridor
  • Hoarseness
  • Respiratory distress and dyspnoea
  • Preceded by low grade fever and coryza
  • Chest wall/ sternal indrawing – chest recessions
  • Symptoms start and are worse at night and increased agitation
  • Central cyanosis and drowsiness indicated severe hypoxaemia = URGENT INTERVENTION
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4
Q

What is the most common cause of croup

A

Parainfluenza virus types 1 and 2

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5
Q

What is the most common cause of bronchiolitis

A

Respiratory syncytial virus

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6
Q

what is the chronological order of Bronchiolitis

A

Preceding coryzal symptoms with clear secretions (1-2 days)

Symptoms peak at 3-5 days:
• Dry cough (resolves in 90% of infants within 3 weeks)
• Increasing breathlessness
• Feeding difficulty
• Recurrent apnoea (serious complication)
• Fever (30% of cases less then 39ᵒC)
wheeze and inspiratory crackles on auscultation

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7
Q

How would you diagnose bronchiolitis

A

Mostly clinical diagnosis
• PCR analysis of nasopharyngeal secretions (swabs)
• Chest x ray may show hyperinflation of the lungs due to small airway obstruction, air trapping and focal atelectasis
• Pulse oximetry for arterial oxygen saturation
• Capillary Blood gas sample for severe cases with worsening respiratory distress (supplemental oxygen greater than 50%)

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8
Q

How to manage bronchiolitis

A
  • humidified oxygen via nasal cannula if sats less then 92%
  • monitored for apnoea
  • fluids either IV or via nasogastric tube
  • assisted ventilation via CPAP or full ventilation in small percentage of infants for those with impending respiratory failure
  • kept in separate room due to how contagious RSV is
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9
Q

What are the main causes of stridor

A

Croup- Epiglottitis- Bacterial Tracheitis - Diphtheria - Laryngomalacia - Inhaled foreign body- Angioedema / anaphylaxis

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10
Q

What are the main cause of wheeze

A

Asthma
bronchiolitis
viral induced wheeze
pneumonia

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11
Q

What are the main signs of respiratory distress

A 
cyanosis
tracheal tug
subcostal/intercostal recessions
hypoxia, tachypnoea
wheeze
stridor
head bobbing
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12
Q

How can pneumonia present

A

Cough, fever, tachypnoea, chest recession, nasal flaring, head bobbing, hypoxia, hypotension, confusion…. SHOCK!!!

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13
Q

What are the typical bugs to look out for in pneumonia and where to they occur

A

Streptococcus pneumonia is most common

Group B strep occurs in pre-vaccinated infants, NEONATES!

Staphylococcus aureus - chest x ray findings of pneumatocoeles (round air filled cavities) and consolidations in multiple lobes.

Haemophilus influenza pre-vaccinated/unvaccinated children.

Mycoplasma pneumonia, also common in children may develop erythema multiforme (red circular rash)

RSV is the most common viral cause, influenza is also an important cause… a viral cause is more common in < 2 yr olds.

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14
Q

What investigations are needed for pneumonia

A

CXR, blood culture, FBC, sputum culture, throat swabs for bacterial culture and Viral PCR, capillary blood gas

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15
Q

What is the treatment for pneumonia

A

Treatments

Neonates – IV Broadspectrum abx

Older children 1st line – Amoxicillin 2nd line erythromycin

Add co-amoxiclav if associated with influenza

Treat with erythromycin for mycoplasma pneumoniae

Macrolides will cover the atypical pneumonias.

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16
Q

How does an acute asthma attack present

A

Progressively worsening shortness of breath + Signs of respiratory distress + Tachypnoea + Expiratory wheeze + with reduced air entry… A silent chest is an ominous sign.

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17
Q

How is an acute asthma attach managed

A

1 puff every 30-60 s of salbutamol up to a max of 10 puffs…

Supplementary high flow oxygen
nebulised salbutamol 
nebulised ipratropium bromide
Oral prednisone (1mg per kg for 3 days)
IV hydrocortisone
IV Salbutamol 
IV aminophylline
IV magnesium sulphate

Call an anaesthetist and the intensive care unit.
They may need intubation and ventilation

18
Q

How is an acute asthma attack managed after admission to hospital

A

Prescribed a reducing regime of salbutamol
Finish the course of oral prednisolone (typically 3 – 5 days total)
Provide safety-net information, 1 week GP follow up
Provide an individualised written asthma action plan

19
Q

How is asthma managed in a <5 year old

A

Short-acting beta agonist – salbutamol
Add a low dose corticosteroid inhaler
Add leukotriene receptor antagonist (LTRA) - oral montelukast

20
Q

How is asthma managed in a 5-12 year old

A

Start a SABA – salbutamol as required
Add a regular low dose corticosteroid inhaler
Add a LABA inhaler - salmeterol.
Titrate up the corticosteroid inhaler to a medium dose.
Oral leukotriene receptor antagonist - montelukast
Increase the dose of the inhaled corticosteroid to a high dose.

21
Q

What is the presentation of anaphylaxis

A

Urticaria, Itching, Swelling of lips, tongue, eyes (angioedema), Wheeze, Stridor (laryngeal involvement), Shortness of breath, Tachycardia, Abdominal pain, Collapse, hypotension.

22
Q

What is the immediate management of anaphylaxis

A

ABCDE, oxygen, IV fluids, IM adrenaline, hydrocortisone IV and antihistamines oral.

Adrenaline can be repeated in 5 mins

Measure tryptase

Give epi pen

+ 2 further doses ofPrednisolone.

23
Q

What is the presentation of viral induced wheeze

A

fever, coryzal symptoms, expiratory wheeze, <3 years old

24
Q

What are the common causes of viral induced wheeze

A

Commonly RSV or rhinovirus, a small amount of inflammation and oedema, this slight narrowing leads to a proportionally larger restriction in airflow… Leading to a wheeze.

25
Q

What is the treatment for viral induced wheeze

A

supplementary oxygen
salbutamol and inhaled corticosteroids
Montelukast

26
Q

What is the treatment for croup

A 
oral dexamethasone
oxygen
nebulised budesonide
nebulised adrenalin
DONT EXAMINE AIRWAY
27
Q

What is the main cause of epiglottitis

A

Haemophilus influenza B

28
Q

What are the key signs and symptoms of epiglottitis

A

Drooling, sore throat, dysphagia, stridor, fever, looking septic.
Laryngoscopy - Beefy-Red-Stiff oedematous epiglottis
lateral x-ray of the neck shows a characteristic “thumb sign”

29
Q

What is the treatment/management of acute epiglottitis

A

Get ITU - Need to protect the airway - Nasotracheal intubation
IV cefotriaxone + dexamethasone

blood culture + close contact prophylaxis with Rifampicin, because they probably aren’t vaccinated either.

30
Q

What is the presentation of laryngomalacia

A

intermittent chronic stridor, made worse with feeding and crying

31
Q

What is the cause of laryngomalacia

A

This is congenital stridor.

Part of the larynx above the vocal cords (the supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction.

Chronic stridor on inhalation, when the larynx flops across the airway as the infant breathes in.

A characteristic “omega” shape epiglottis on Bronchoscopy.

32
Q

What is the treatment of laryngomalacia

A

no treatment, should resolved in 18 months

33
Q

What is the presentation of pertussis

A

coryzal, violent coughing that brings on vomiting and gasping for air, inspiratory whoop of air

34
Q

What is the cause of pertussis

A

an upper respiratory tract infection - the “100-day cough”

Gram –ve cocobacilli - Bordetella Pertussis

35
Q

How is pertussis diagnosed

A

Per nasal-pharynx swabs and culture for pertussis

anti-pertussis toxin immunoglobulin G

36
Q

What is the treatment of pertussis

A

Part of the 6 in 1 vaccine given at 2, 3, 4 months and 3-5 yrs.
*it is also important to vaccinated mother between 20 – 32 weeks.

Macrolides - azithromycin, erythromycin or clarithromycin (< 1 month)
Complications – bronchiectasis, pneumothorax

37
Q

What is the cause of CF

A

autosomal recessive - cystic fibrosis transmembrane conductance regulatory gene on chromosome 7.

Most common is the delta-F508 mutation.

Codes for chloride channels.

38
Q

What are the key signs and symptoms of CF

A

Thick pancreatic and biliary secretions - blockage of the ducts, resulting in a lack of pancreatic enzymes.

Thick airway secretions - reduce clearance = bacterial colonisation.

Congenital bilateral absence of the vas deferens

Meconium ileus - not passing meconium within 24 hours, abdominal distention and vomiting.

39
Q

How is CF diagnosed

A

Newborn blood spot testing
The sweat test is the gold standard for diagnosis
Genetic testing for CFTR gene by amniocentesis or CVS

40
Q

How is CF managed

A

Particularly susceptible to staph aureus and pseudomonas.

Pseudomonas - nebulised antibiotics tobramycin / Oral ciprofloxacin
staph aureus – prophylactic flucloxacillin
Chest physiotherapy/exercise is essential to clear mucus

High calorie diet + CREON tablets to replace pancreatic enzymes

Prophylactic flucloxacillin + Vaccinations (pneumococcal, flu and varicella)

Bronchodilators such as salbutamol inhalers

Nebulised DNase (dornase alfa) - break down DNA material in respiratory secretions, making secretions less viscous and easier to clear

Nebulised hypertonic saline

Fertility treatment involving testicular sperm extraction for infertile males

Genetic counselling (average life expectancy is almost 50 yrs now)

Other complications – pancreatic insufficiency & diabetes

Paediatrics (10 decks)

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