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paediatrics > respiratory > Flashcards

respiratory Flashcards

1
Q

asthma signs and symptoms

A

polyphonic wheeze
coughing
SoB
diurnal rhythm

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2
Q

asthma DD

A

foreign body
croup
pneumonia
TB

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3
Q

asthma investigations

A

spiro - FEV1:FVC < 70%

CXR

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4
Q

asthma managment 5 step process

A

1 - inhaled short acting B2 agonist as required (salbutamol)
2 - add inhaled corticosteroid (beclamethasone)
3 - try inhaled long acting B2 agonist (salmeterol)
4 - increase steroid dose and try leukotriene receptor antagonist (montelukast)
5 - add oral prednisolone

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5
Q

acute asthma managment

A

O2 if needed
nebulised salbutamol (with ipratropium bromide)
hydrocortisone IV
magnesium sulfate IV
aminophylline IV (with ondasetron as causes vomitting)

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6
Q

viral induced wheeze common cause

A

respiratory syncytial virus (RSV)

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7
Q

recurrent and persistent wheeze caused by

A

IgE

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8
Q

reasons of failure to respond to treatment

A

Adherence (Compliance)
medication technique
Bad disease
Choice of drugs/devices

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9
Q

POSSIBLE RISKS OF LONG TERM Inhaled corticosteroids

A

slows short/medium term growth (doesnt effect adult height)

adrenal crisis

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10
Q

pneumonia aetiology new born

A

group B streptococcus (maternal) - Streptococcus agalactiae

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11
Q

pneumonia aetiology infants and young

A

streptococcus pneumoniae
haemophilus influenza B
RSV

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12
Q

pneumonia aetiology atypical

A

mycoplasma pneumoniae

use macrolide - Erythromycin

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13
Q

pneumonia aetiology considerations

A

viruses commoner in younger children, bacteria in older

consider mycobacterium tuberculosis in all ages

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14
Q

pneumonia signs

A

cough
fever
poor feeding
respiratory distress (tachyponea, cyanosis, grunting)
older children may get end respiratory crackles / bronchial breathing

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15
Q

pneumonia managment

A 
O2 if signs of resp distress - admit
oral amoxicillin (1st line) - IV for newborns
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16
Q

bacterial pneumonia diagnosis

A

<3years
fever >38.5
chest recessions
RR >50

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17
Q

pneumonia investigations

A

CXR - opacity throughout lobe or lung

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18
Q

croup (laryngotracheobronchitis) cause

A

95% viral
parainfluenza virus (1,2,3)
respiratory syncytical virus

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19
Q

croup (laryngotracheobronchitis) epidemiology

A

autum, <6 years

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20
Q

croup (laryngotracheobronchitis) signs

A 
onset over a few days
barking cough
harsh stridor
voice hoarseness
worse at night
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21
Q

croup (laryngotracheobronchitis) management

A

mild - dexamethasone / prednisolone
cyanosed - ABC +/- O2
nebulised adrenaline if severe

22
Q

bacterial tracheitis what is it

A

consider if croup does not improve with treatment
tracheal bacterial infection
thick mucopurulent exudate and tracheal mucosal sloughing not cleared by coughing

23
Q

bacterial tracheitis cause

A

staph. aureus

24
Q

bacterial tracheitis management

A

IV third-generation cephalosporin (eg, cefotaxime, ceftriaxone) and a penicillinase-resistant penicillin (eg, oxacillin, nafcillin)

25
Q

bronchiolitis cause

A

RSV (80%)

also parainfluenza, adenovirus

26
Q

bronchiolitis presentation

A 
coryza
dry cough
wheezing
inspiratory crackles
tachypnoea
27
Q

bronchiolitis RF

A

congenital heart defects make more severe

28
Q

bronchiolitis management

A

O2 if SATS <92%
prophylaxis - ribavirin (for immunocompromised / heart defect)
Palivizumab - for immunocompromised, CCF

29
Q

epiglottitis cause

A

haemophilus influenza B (99% reduction since vaccine)

30
Q

epiglottitis presentation

A 
DO NOT EXAMINE
acute
toxic fever >39
continuous soft inspiratory stridor
drooling
minimal / absent cough
31
Q

epiglottitis management

A

cefotaxime IV

32
Q

cystic fibrosis cause

A

CFTR mutation on chromosome 7
decreases chloride excretion into lumen with increased reabsorption of sodium into epithelial cells
less water excreted = less viscousity

33
Q

CF presentation

A

recurrent respiratory infections
meconium ileus
failure to thrive
raised sodium sweat level

34
Q

CF complications

A

90% chronically infected by pseudomonas aeruginosa

commonly infected by staph.aureus

35
Q

CF management

A

physio
pancreatic enzyme replacement therapy
inhaled corticosteroids / B2 agonists

36
Q

common cold (coryza) causes

A

rhinovirus
RSV
coronavirus

37
Q

pharyngitis causes

A 
usually viral:
rhinovirus
RSV
coronavirus
adenovirus

bacterial: group A b haemolytic strep

38
Q

FeverPAIN score (/5) - higher score more likely to be bacterial URTI

A

Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)

39
Q

centor criteria

A

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough

3+ = likely bacterial

40
Q

sinusitis viral or bacterial

A

viral - symptoms <10days

bacterial - symptoms worse after 5 days or >10days

41
Q

Chronic lung disease of prematurity

A 
breathing machine injures babys lung 
Officially needing oxygen at 36 weeks corrected age
Reduced lung volume
Reduced alveolar surface area
Diffusion defect
42
Q

Apnoea of prematurity treatments

A

stimulation

caffeine

43
Q

Periorbital cellulitis

A

Medical emergency
Staphylococcus aureus, Streptococcus pneumoniae
URTI followed by painful swollen eye
Proptosis - abnormal protrusion or displacement of an eye
Red colour vision: sign of optic nerve compromise
IV Abx
Incision and drainage of abscess – open or endoscopic

44
Q

respiratory distress syndrome cause

A

deficiency in alveolar surfactant

prematurity major risk factor

45
Q

respiratory distress syndrome prevention

A

maternal corticosteroids (beclamethasone / dexamthasone) to promote fetal lung maturation

46
Q

respiratory distress syndrome management

A

O2

exogenous surfactant

47
Q

bronchopulmonary dysplasia cause

A

complication of ventilation used for respiratory distress syndrome
lungs damaged by mechanical ventilation and long term O2 use

48
Q

bronchopulmonary dysplasia presentation and sequale

A

persistant hypoxia

feeding problems. cerebral palsy

49
Q

sinusitis cause

A

step. pneumoniae
h. influenza
moraxella catarrhallis

50
Q

meconium aspiration syndrome

A

meconium stained amniotic fluid and respiratory distress

51
Q

asthma management if under 5

A

1 - try SABA
2 - add low dose ICS
3 - add leukotriene receptor antagonist (montelukast)
4 - if still unresolved stop LTRA and refer to specialist

paediatrics (13 decks)

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