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Respiratory Flashcards

1
Q

What is stridor

A

Monophonic inspiratory breathing

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2
Q

What is the typical cause of croup and what time of year does it typically present

What age is it most commonly seen in?

A
  • Viral - Parainfluenza Virus or Respiratory Syncytial Virus (RSV)
  • Spring/Autumn time
  • <6 yrs
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3
Q

How does someone with croup present

A
  • Worse at night
  • Stridor (harsh more severe disease will become softer)
  • Barking Cough
  • Hoarseness
  • Intercostal Recession
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4
Q

How do you manage croup

A

Mild illness - Dexamethasone/Prednisaslone

Severe illness -admit and careful watching for severe signs e.g cyanosis worsening stridor/recession
- Give O2, Steroids and nebulised adrenaline

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5
Q

If croup fails to improve what could it be

A

Bacterial Tracheitis - risk of occluding airway from exudate and slough which can’t be cleared by coughing
Cause: S.Aureus, Strep A
- Rx: suction of secretions and give cefotaxime and flucloxacillin

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6
Q

What causes Epiglottitis

and what age does it present

A

Haemophillus Influenzae Type B
(always bacterial)
2-7 yrs

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7
Q

How does Epiglottitis present

A
  • Continuous Stridor (softer)
  • Drooling or secretions
  • Voice muffled
  • acute onset high fever (>38)
  • Toxic appearance
  • Respiratory Distress
  • Tripod Position
  • Cough not prominent
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8
Q

How do you treat Epiglottitis

A

avoid approaching child and do NOT examine the throat!!! - may precipitate obstruction

  • Call senior help
  • Emergency Airway Management - Emergency Endotracheal Intubation (Tracheostomy if fails)
  • Abx - IV Cefotaxime
  • Propylaxis to family - Rifampicin
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9
Q

What is the commonest LRTI in infants

A

Bronchiolitis

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10
Q

What is the commonest cause of Bronchiolitis

A

Respiratory Syncytial Virus (RSV)

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11
Q

What are risk factors for Bronchiolitis

A

< 6 mths (infants)

Other underlying medical conditions

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12
Q

How does bronchiolitis present

A
  • Coryza and Rhinorrhoea
  • Dry Cough
  • Sometimes fever
  • Tachypnoea
  • Wheeze
  • Apnoea
  • Fine Inspiratory crackles
  • Irritable with poor feeding
  • Severe!!! - Respiratory Distress/Cyanosis
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13
Q

How do you manage bronchiolitis

A

Mild: manage at home with supportive treatments e.g fluids, paracetamol

Severe: signs of respiratory distress/cyanotic or high risk patients

  • Admit to hospital
  • Give O2, Fluids via NG tube, Respiratory support
  • Ribovarin only for immunocompromised
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14
Q

What are signs of respiratory distress

A
  • Tachypneoa
  • Cyanosis
  • Grunting
  • Intercostal Regression
  • Use of accessory muscles
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15
Q

What is pneumonia

A

respiratory disease characterised by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by bacteria or viruses or irritants

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16
Q

What are the 4 stages of pneumonia

A
  • Congestion - small no. neutrophils, large no. bacteria
  • Red Hepatization - (consolidation) - increased no. RBC, fibrin and neutrophils filling airspaces with exudate
  • Grey Hepatization - RBC break down, but neutrophils and fibrin still there - grey
  • Resolution - exudate is digested by enzymes and cleared by macrophages
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17
Q

What is the diagnosic presentation of pneumonia

A
  • High Temperature (39 or higher)
  • Tachypnoea
  • Dry or Productive Cough
  • Toxic Appearance (pale, lethargic, cyanotic)
  • Malaise and Poor Feeding
  • Respiratory Distress/ Cyanosis
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18
Q

How is pneumonia diagnosed

A
  • Hx
  • Auscultation: Persistently Focal and Coarse Inspiratory Crackles

Severe:

  • Blood or Sputum Cultures
  • CXR: Dense or fluffy opacity that occupies a portion or whole of lobe
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19
Q

What can cause pneumonia

A

Infants: Group B Strep or E.coli

Under 2 more likely viral: RSV, Influenza A&B

Young Children: Pneumococcus (most common), Haemophillus Type B

Others: S.Aureus, TB,

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20
Q

When should a child be admitted to hospital

A

SpO2 < 92%
Respiratory Distress
High Temperature over 38

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21
Q

What is the first line treatment of Bacterial Pneumonia

A

1st line: Amoxicillin

2nd: Co - Amoxiclav

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22
Q

How should suspected viral pneumonia be managed

A

Common in the under 2 - mild symptoms can be discharged without Abx but ensure follow up

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23
Q

What is a viral induced wheeze

A

Children with cough or wheeze that are not a LRTI/URTI and too young to be diagnosed with asthma

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24
Q

What is viral induced wheeze commonly caused by

A

Virus - RSV or Rhinovirus

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25
What are risk factors for viral induced wheeze
Passive smoking Prematurity Bronchiolitis
26
How do you manage viral induced wheeze
Likely to improve with age Inhaled B2-Agonists (bronchodilators) In severe cases may use oral steroids e.g prednisolone regular inhaled steroids no benefit!
27
What does HIV increase the risk of
Bacterial pneumonia mortality can lead to pneumocystis pneumonia caused by pneumocystis jiroveci - life threatening TB pneumonia
28
What is bronchiectitis
Permanent dilation of bronchi and bronchioles due to obstruction and and severe inflammation leading to continued insult of bronchial wall - caused by chronic infection/failure of mucocillary clearance
29
What are causes of bronchietitis
- Pneumonia - TB - Whooping cough - ABPA - Cystic Fibrosis
30
What symptoms is bronchiectitis characterised by
Persistant cough Copious amounts of purulent sputum Dyspnoea
31
What complications are associated with bronchiectitis
Increased risk of infection | Massive haemoptysis
32
What is the cycle that leads to bronchiectasis
1. Infection (Abx) 2. Inflammation 3. Airway Damage 4. impaired Mucocillary clearance (physio) 5. Increased risk of infection again
33
How can you stop the cycle leading to bronchiectasis
Treat the infection with prompt Abx | Physiotherapy for impaired mucocillary clearance
34
What is the definition of a wheeze
Polyphonic breathing sounds
35
What are causes of wheeze in children
``` Viral Induced Wheeze Asthma - Atopy/Airway Hyperactivity Foreign Body Anaphylaxis Bronchiolitis GORD Cystic Fibrosis ```
36
What is cystic fibrosis
An autosomal Recessive disorder | Due to mutations in cystic fibrosis transmembrane conductance regulator gene (CFTR) on Chromosome 7
37
What does the mutation in CFTR gene leaf to
it affects the Na+/Cl- channel so that it can't pump Cl- ions into secretions (Cl- draws water into secretions) therefore without its presence secretions are sticky and thick
38
What effects does the CFTR mutation have
Effects Exocrine gland function - meconium illius Lung disease - CF bronchiectitis Pancreatic Exocrine Insufficiency Increase in Na+ level in sweat
39
What complications does CF lead to
Neonate: Failure to thrive, meconium ileum and rectal prolapse Respiratory: Cough, Wheeze, acute, chronic infection/pneumonia, bronciectasis, haemoptyisis, pneumothorax GI: malunutriton, poor growth, weight loss, hepatic failure, DM, cholesterol gallstones, pancreatitis Urogenital: male infertility CNS: delayed puberty Others: Osteoporosis, Pain
40
How do CF patents generally present
- Neonates may present with meconium lilius - Recurrent Pneumonia +/- clubbing - Bronchiectitis which leads to haemoptysis - Failure to thrive due to blockage of pancreatic duct - pancreatitis - Slow growth - Fatty, oily, pale stools - steatorrhoea - due to fat not being absorbed (lack of pancreatic enzymes)
41
what tests can you do to investigate CF
- Sweat test (increase Cl- on skin) - >60 supports diagnosis - Faecal`Elastase `Test - exocrine pancreatic disfunction - Newborn Heal Prick Blood spot Test Others: - CXR - bronchiole dilation - Abdo US - fatty liver, pancreatitis - Malabsorption screen - Vit A, D and E - Random Glucose - Spirometry - Sputum culture
42
What is meconium lleus
Emergency!!! | - failure to pass stools (vomiting) in 1st 48hrs of life
43
How do you treat meconium ileus
NG tube drainage Washout Enema Excision of gut contains meconium
44
What are the respiratory problems caused by CF
Difficulty clearing airways leading to build go bacteria and chronic infection therefore leading to bronchiectasis
45
What infections are common causes of respiratory infection in CF
- In young Staph. Aureus most common followed by H. influenzas and S. Pneumoniae - Later in life most are chronically infected with pseudomonas aeruginosa - promotes significant decline and increase mortality (resistant)
46
How do you manage respiratory CF
- Regular Physiotherapy - Abx given in acute exacerbations and prophylactically (PO or nebulised) e.g Gentamicin - Bronchodilators - Lung transplant
47
How do you manage GI CF
- Pancreatic Enzyme Replacement - Fat soluble Vit Supplements (A,D,E,K) - Omeprazole and Renitidine can help absorption - Liver (biliary cirrhosis 2nd cause of death) give ursodeoxycholic acid to improve live function, may need liver transplant - Diabetes - Screen yearly, insulin
48
how do you manage CF bone disease
Nutriton (Vit D and K, Ca2+) Exercise Physio
49
What is the most common cause of death in CF
Pneumonia or Cor Pulmonale
50
What other options are there to treat CF
Gene therapy | rhDNase
51
What is asthma and how does it present
``` Reversible airway obstruction Symptoms: Inspiratory Wheeze (polyphonic) Dyspnoea Cough ```
52
What 3 factors cause airway naorrowing in asthma
- bronchial muscle contracton - mucosal swelling/inflamation - membrane inflammation
53
What triggers asthma
Allergic - IgE - pollen, dust mite, fur, chemical, smoke/pollution, feathers Non Allergic - Cold Air, Exercise, Stress
54
What are differentials for asthma
``` Foreign Body Croup Pneumonia/TB Aspiration Anaphylaxis CF ```
55
What is the management of Acute Asthma
1. ABCDE and set up high Flow 100% O2 2. Salbutamol nebulised with O2 3. Prednisolone or IV Hydrocortisone 4. Poor Response? Give IV Salbutamol Bolus or salbutamol nebulisers every 15 mins PLUS iprotropium bromide 5. Give Single dose Magnesium Sulphate or Theophylline 7. Consider Ventilatory support and ITU
56
What is the step wise management of chronic asthma
Don't forget environmental management e.g elimination of triggers Step 1. Inhaled short acting Beta Agonist e.g Salbutamol Step 2. Add inhaled corticosteroid e.g Beclometasone Step 3. Add Leukotreine Receptor Atagonist e.g Montelukast Step 4. Add long acting Beta Agonist e.g Salmetarol +/- Montelukast Step 5. Mart Regime Step 5. Refer to Specialist and add prednisolone
57
What are reasons of failure to respond to treatment
- faulty inhaler technique - watch patents inhaler technique - bad disease - poor adherence/ compliance - Incorrect diagnosis - Envionment
58
What are the risks of long term inhaled corticosteroids
Adrenal Supression - Adrenal Crisis Growth Supression but not final adult height Maybe linked to Osteoporosis?
59
What is the most common cause of tonsillitis
Group A Strep
60
What is the cause of whooping cough
Pertussis
61
What is stridor breathing sounds
Inspiratory Monophonic

Paediatrics (13 decks)

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