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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
Q

What are risk factors for viral induced wheeze

A

Passive smoking
Prematurity
Bronchiolitis

26
Q

How do you manage viral induced wheeze

A

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
Q

What does HIV increase the risk of

A

Bacterial pneumonia mortality
can lead to pneumocystis pneumonia caused by pneumocystis jiroveci - life threatening
TB pneumonia

28
Q

What is bronchiectitis

A

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
Q

What are causes of bronchietitis

A
  • Pneumonia
  • TB
  • Whooping cough
  • ABPA
  • Cystic Fibrosis
30
Q

What symptoms is bronchiectitis characterised by

A

Persistant cough
Copious amounts of purulent sputum
Dyspnoea

31
Q

What complications are associated with bronchiectitis

A

Increased risk of infection

Massive haemoptysis

32
Q

What is the cycle that leads to bronchiectasis

A
  1. Infection (Abx)
  2. Inflammation
  3. Airway Damage
  4. impaired Mucocillary clearance (physio)
  5. Increased risk of infection again
33
Q

How can you stop the cycle leading to bronchiectasis

A

Treat the infection with prompt Abx

Physiotherapy for impaired mucocillary clearance

34
Q

What is the definition of a wheeze

A

Polyphonic breathing sounds

35
Q

What are causes of wheeze in children

A 
Viral Induced Wheeze 
Asthma - Atopy/Airway Hyperactivity
Foreign Body 
Anaphylaxis 
Bronchiolitis 
GORD
Cystic Fibrosis
36
Q

What is cystic fibrosis

A

An autosomal Recessive disorder

Due to mutations in cystic fibrosis transmembrane conductance regulator gene (CFTR) on Chromosome 7

37
Q

What does the mutation in CFTR gene leaf to

A

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
Q

What effects does the CFTR mutation have

A

Effects Exocrine gland function - meconium illius
Lung disease - CF bronchiectitis
Pancreatic Exocrine Insufficiency
Increase in Na+ level in sweat

39
Q

What complications does CF lead to

A

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
Q

How do CF patents generally present

A
  • 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
Q

what tests can you do to investigate CF

A
  • Sweat test (increase Cl- on skin) - >60 supports diagnosis
  • FaecalElastase 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
Q

What is meconium lleus

A

Emergency!!!

- failure to pass stools (vomiting) in 1st 48hrs of life

43
Q

How do you treat meconium ileus

A

NG tube drainage
Washout Enema
Excision of gut contains meconium

44
Q

What are the respiratory problems caused by CF

A

Difficulty clearing airways leading to build go bacteria and chronic infection therefore leading to bronchiectasis

45
Q

What infections are common causes of respiratory infection in CF

A
  • 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
Q

How do you manage respiratory CF

A
  • Regular Physiotherapy
  • Abx given in acute exacerbations and prophylactically (PO or nebulised) e.g Gentamicin
  • Bronchodilators
  • Lung transplant
47
Q

How do you manage GI CF

A
  • 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
Q

how do you manage CF bone disease

A

Nutriton (Vit D and K, Ca2+)
Exercise
Physio

49
Q

What is the most common cause of death in CF

A

Pneumonia or Cor Pulmonale

50
Q

What other options are there to treat CF

A

Gene therapy

rhDNase

51
Q

What is asthma and how does it present

A 
Reversible airway obstruction
Symptoms:
Inspiratory Wheeze (polyphonic) 
Dyspnoea 
Cough
52
Q

What 3 factors cause airway naorrowing in asthma

A
  • bronchial muscle contracton
  • mucosal swelling/inflamation
  • membrane inflammation
53
Q

What triggers asthma

A

Allergic - IgE - pollen, dust mite, fur, chemical, smoke/pollution, feathers
Non Allergic - Cold Air, Exercise, Stress

54
Q

What are differentials for asthma

A 
Foreign Body 
Croup
Pneumonia/TB
Aspiration 
Anaphylaxis 
CF
55
Q

What is the management of Acute Asthma

A
  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
  6. Consider Ventilatory support and ITU
56
Q

What is the step wise management of chronic asthma

A

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
Q

What are reasons of failure to respond to treatment

A
  • faulty inhaler technique - watch patents inhaler technique
  • bad disease
  • poor adherence/ compliance
  • Incorrect diagnosis
  • Envionment
58
Q

What are the risks of long term inhaled corticosteroids

A

Adrenal Supression - Adrenal Crisis
Growth Supression but not final adult height
Maybe linked to Osteoporosis?

59
Q

What is the most common cause of tonsillitis

A

Group A Strep

60
Q

What is the cause of whooping cough

61
Q

What is stridor breathing sounds

A

Inspiratory Monophonic

Paediatrics (13 decks)

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