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Medicine, Year 4, Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common cause of Bronchiolitis? What type of micro-organism is it?

A

Respiratory Syncytial Virus, negative-strand RNA

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2
Q

In what age group does Bronchiolitis occur? What time of year does it occur in? What are other risk factors?

A

Babies under the age of 1, more commonly if under 6 months old. Occurs in Winter. Other risk factors include ex-premature babies, those with congenital heart problems or Cystic Fibrosis

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3
Q

What is the Pathophysiology of Bronchiolitis?

A

Usually begins as an URTI, of which half will migrate downwards and inflame / infect the smaller airways (bronchioles). Mucus plugs can cause atelectasis (lung collapse) or air-trapping

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4
Q

What patients with Bronchiolitis should be admitted to hospital?

A
  • If they are < 3 months old
  • Pre-existing conditions i.e. CF, prematurity, Down’s
  • Dehydration
  • RR > 70 bpm, O2 sats < 92%
  • Moderate to severe respiratory distress
  • 50-75% less of normal intake
  • Apnoeas
  • Parents not feeling confident to take care of baby
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5
Q

What is the management for Bronchiolitis?

A

Mainly supportive

  • Ensure adequate intake
  • Saline drops / nasal suction
  • Supplementary oxygen
  • Ventilatory support
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6
Q

What is Palivizumab? Which patient group is it given to?

A

Monthly Injection monoclonal antibody targeting RSV, for prevention of Bronchiolitis. Prescribed for premature babies and those with congenital heart diseases

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7
Q

What is the presentation of Bronchiolitis?

A
  • LOW grade fever < 39 C
  • Coryzal symptoms
  • Wheeze / crackles
  • Poor feeding
  • Tachypnoea / Bradypnoea
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8
Q

What is the most common cause of Viral Induced Wheeze?

A

Respiratory Syncytial Virus

Rhinovirus

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9
Q

What is the difference between:

  • Episodic Viral Wheeze
  • Multiple Trigger Wheeze
A
  • Episodic Viral Wheeze: Only wheezes when has a viral URTI and is symptom free in between episodes
  • Multiple Trigger Wheeze: As well as viral URTIs, other factors appear to trigger the wheeze i.e. exercise, allergens and cigarette smoke
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10
Q

Why does Bronchiolitis affect young children more so than adults?

A

Smaller airways in young children being narrowed have a larger effect due to Poiseuille’s Law (Flow rate is proportional to the radius of a tube^4)

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11
Q

What does a focal wheeze typically suggest?

A

Inhaled foreign body or tumour

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12
Q

How is an Episodic Viral Wheeze treated?

A
  • Salbutamol + Spacer

- Intermittent LKTRa, ICS

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13
Q

How is a Multiple Trigger Wheeze treated?

A
  • LKTRa or ICS trial for 4-8 weeks
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14
Q

What is the effect of Inhaled Corticosteroids on growth?

A

A year of ICS stunts growth by approximately 1cm, however ICS improves control / prevent future asthma attacks, reducing need for further ICS. Child will have regular asthma reviews to ensure growth is well

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15
Q

Croup is most commonly caused by..?

A

Parainfluenza

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16
Q

What are the symptoms of Croup?

A

Harsh, barking cough
Stridor
Low grade fever

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17
Q

What is the epidemiology of Croup? What season is it most common in?

A

Commonly affects children aged 6 months - 2 years
More common in males
More common in Autumn

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18
Q

What is the best management of Croup?

A

Single dose Dexamethasone 150 mcg/kg (can be repeated after 12 hours)

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19
Q

What is the prognosis for Croup?

A

Majority improves within 48 hours

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20
Q

What is Croup?

A

URTI characterised by stridor and laryngo-oedema

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21
Q

Why should doctors not perform a throat exam on patients with Croup or Epiglottitis?

A

Risk of obstruction / asphyxiation

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22
Q

What is the pathophysiology of Laryngomalacia?

A

Supraglottic larynx is abnormally structured, where the Aryepiglottic folds are shorter and softer, pulling on the epiglottis to form an Omega shape. This means the larynx has less tone and can flop during inspiration

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23
Q

When does Laryngomalacia typically present?

A

First few weeks of life to 6 months

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24
Q

What is the treatment of Laryngomalacia?

A

Usually self-resolving, larynx will mature over time by 12-18 months

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25
Q

What is Epiglottitis? What is it most commonly caused by?

A

Inflammation / infection of Epiglottis, commonly caused by Haemophilus Influenzae B (Gram negative)

26
Q

What is the presentation of Epiglottitis?

A
  • Drooling
  • Tripod position
  • Dysphagia
  • Sore throat
  • Stridor
  • High fever >39C
  • Muffled voice
27
Q

What age group is Epiglottitis most common in? Other risk factors?

A

Ages 2 - 7 years old

Common in those unvaccinated

28
Q

What is the triad of Epiglottitis? (3 D’s)

A

Dysphagia,
Distress (respiratory),
Drooling

29
Q

What is the best investigation to do for Epiglottitis?

A
  • Do NOT perform throat examination

- Lateral X-Ray of neck: “thumb printing” due to swelling

30
Q

What is the significance of inspiratory and expiratory stridor?

A

Inspiratory stridor - Occurs above level of vocal cord

Expiratory stridor - Occurs below level of vocal cord

31
Q

What is the best management for Epiglottitis and why?

A

Ceftriaxone, because it is a 3rd generation Cephalosporin with good Gram negative coverage (For Haemophilus Influenzae B)

32
Q

What is the inheritance pattern and genetic mutation of Cystic Fibrosis? What affect does this have?

A

Autosomal recessive
Mutation of ΔF508 on Chromosome 7, affecting the CTFR gene / protein. Generates a faulty CTFR channel which otherwise pumps out Cl ions and make secretions more watery

33
Q

What is pathognomonic for Cystic Fibrosis in neonates?

A

Meconium Ileus, failure to pass Meconium within 24 hours

34
Q

What are the presenting features of Cystic Fibrosis?

What are features also associated with Cystic Fibrosis?

A

Meconium Ileus, Pancreatic insufficiency (malabsorption, FTT, poor weight gain, steatorrhoea), Frequent LRTIs, Salty skin

Other features: Delayed puberty, Short stature, Diabetes Mellitus, Infertility / Subfertility, Nasal polyps, Clubbing

35
Q

What is detected on a neonatal heel-prick test for Cystic Fibrosis?

A

Immunoreactive Trypsinogen

36
Q

What is the gold standard for diagnosing Cystic Fibrosis and what are the values for diagnosis?

A

Sweat test, where Chloride levels >60 mEq = diagnostic, <40 mEq = normal

37
Q

What are the two most common microbial colonisers in Cystic Fibrosis patients? What are other ones?

A

Staphylococcus Aureus
Pseudomonas aeruginosa

Others: Haemophilus influenzae, Kleibsiella pneumonia, E. Coli, Burkholderia cepacia

38
Q

What is the significance of Staphylococcus Aureus as a microbial coloniser in Cystic Fibrosis patients?

A

Patients must take prophylactic Flucoxacillin

39
Q

What is the significance of Pseudomonas aeruginosa as a microbial coloniser in Cystic Fibrosis patients?

How is a Pseudomonas aeruginosa infection treated?

A

Quickly becomes ABX resistant, hence CF patients must avoid contact with other CF patients.

Treat with Tobramycin and Ciprofloxacin

40
Q

Outline some management options for patients with Cystic Fibrosis

A
  • Chest physiotherapy
  • High calorie, high fat diet
  • CREON tablets for pancreatic insufficiency
  • Prophylactic Flucoxacillin
  • Salbutamol bronchodilators
  • Nebulised DNAse
  • Pneumococcal / Influenza / Varicella vaccine
  • Lumacaftor / Ivacaftor (Orkambi)
41
Q

What is Whooping Cough?

A

An URTI caused by Bordetella Pertussis, a Gram negative bacteria

42
Q

What is in the 6-in-1 vaccine?

A

“Parents will immunise toddlers because death”

  • Polio
  • Whooping Cough
  • Haemophilus Influenza Type B
  • Tetanus
  • Hepatitis B
  • Diptheria
43
Q

When are pregnant women offered vaccinations against Whooping Cough?

A

Between 20 and 32 weeks

44
Q

When are Children immunised against Whooping Cough?

A

At 2, 3, 4 months and 3-5 years

45
Q

What is the diagnostic criteria for Whooping Cough?

A

Cough for 14 days with no identifiable cause plus one of the following:

  1. Paroxysmal cough
  2. Inspiratory whoop
  3. Post-tussive vomiting
  4. Apnoeic attacks
46
Q

How is Whooping Cough diagnosed?

A

Nasopharyngeal / nasal swab, with PCR / bacterial culture. If cough was >2 weeks, then Anti-Pertussis Toxin IgG

47
Q

How is Whooping Cough managed?

A
  1. Notifiable disease, contact Public Health England
  2. If < 6 months, admit to hospital
  3. Oral macrolides (Erythromycin, Clarithomycin, Azithromycin) if cough was 21 days or less onset. Co-trimaxozole is an alternative
  4. Close contacts given prophylactic ABX
48
Q

What is the rule regarding school exclusion for Whooping Cough?

A

2 days after ABX has commenced. If no ABX has been commenced, then 21 days from symptom onset

49
Q

What is Primary Ciliary Dyskinesia? What is the triad?

A

Also known as Kartagener’s Syndrome, an autosomal recessive condition of impaired cilia motility. Common in consanguineous populations

Triad: Paranasal sinusitis, Situs Inversus, Bronchiectasis

50
Q

What is Chronic Lung Disease of Prematurity also known as? What patients are at risk?

A

Also known as Bronchopulmonary Dysplasia. Occurs in babies born before 28 weeks gestation

51
Q

What way can we prevent Chronic Lung Disease of Prematurity?

A

Give corticosteroids to mothers showing signs of premature labour

52
Q

What way can we manage Chronic Lung Disease of Prematurity?

A
  1. Sleep studies to measure O2 sats during sleep
  2. Low dose O2 via nasal cannulae
  3. Palivizumab against RSV
53
Q

What is the biggest risk factor for Transient Tachypnoea of the Newborn and why?

A

Caesarean section

Babies have not experienced pressure effects of a vaginal delivery, so lung fluid cannot be squeezed out

54
Q

What is seen on a CXR of a baby with Transient Tachypnoea of the Newborn?

A

Fluid in the horizontal fissure, hyperinflation

55
Q

What is seen on a CXR of a baby with Surfactant Deficient Lung Disease?

A

Ground-glass appearance, indistinct heart borders

56
Q

How is Surfactant Lung Disease prevented?

A

Maternal corticosteroids

57
Q

What is the most common bacterial and viral cause of Pneumonia in children?

A

Bacterial: Strep pneumoniae
Viral: RSV

58
Q

What is the first-line management of Bacterial Pneumonia?

A
  • Amoxicillin
    (+ Macrolide i.e. Erythomycin, Clarithromycin, Azithromycin for atypical coverage)
  • O2 if < 92%
59
Q

What are the readings for Moderate, Severe and Life-threatening Peak Flows in asthmatic patients?

A

Moderate: >50% PEFR of predicted
Severe: <50% PEFR of predicted
Life threatening: <33% PEFR of predicted

60
Q

What electrolyte abnormality is associated with Salbutamol use? What are other side-effects?

A

Hypokalaemia

Tachycardia and tremor

61
Q

What is the stepwise management of a child with an acute asthma attack?

A
  1. Salbutamol, plus spacer (10 puffs every two hours)
  2. Nebulisers with Salbutamol / Ipratropium
  3. Oral prednisolone
  4. IV Hydrocortisone
  5. IV Mg sulphate
  6. IV salbutamol
  7. IV Aminophylline
62
Q

What are some investigations in diagnosing chronic asthma in children?

A
  1. Spirometry with reversibility testing
  2. FeNo testing
  3. Peak flow variability diary for 2-4 weeks
  4. Direct bronchial challenge with histamine / methacholine

Medicine, Year 4, Paediatrics (16 decks)

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