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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is croup and how does it occur?

A

Laryngotracheobronchitis:

  • Upper respiratory tract infection caused by viral infection - normally parainfluenza, influenza and RSV
  • Leads to swelling of the larynx, trachea and bronchi causing some degree of upper airway obstruction
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2
Q

Presentation of croup…

A
  • Barking cough
  • Stridor
  • Hoarse voice
  • Coryzal symptoms - nasal congestion
  • Low grade fever
  • Normally seen in 6mths- 6 yrs
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3
Q

Management of croup…

A

Mild -moderate:
- Dexamethasone (0.15mg/kg PO STAT) or Prednisolone (1-2mg/kg STAT) - can be sent home if good response

Severe:

  • Nebulised adrenaline
  • ITU admission if worsening
  • Oxygen may be needed if SpO2 <92%
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4
Q

What causes epiglottitis?

A

Normally caused by haemophilus influenzae type B

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5
Q

How does epiglottitis present?

A
  • Sudden onset with continuous stridor
  • Drooling secretions
  • No barking cough
  • Toxic and feverish
  • Swollen, cherry red epiglottis will be seen
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6
Q

Treatment of epiglottitis?

A

Cefotaxime

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7
Q

Key features of viral induced wheeze…

A
  • Normally occur between 12 mths - 5 yrs
  • Wheeze only during viral illness
  • Rapid onset of wheeze
  • Responsive to beta agonists e.g. salbutomol
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8
Q

Management of viral induced wheeze…

A

Moderate (able to talk, mild recessions, RR<40):
- Salbutomol inhaler - 6-10 puffs via spacer and mask

Severe (difficulty talking, use of neck muscles, RR >40):

  • Salbutomol inhaler - 10 puffs via spacer, then 2 more doses of 10 if required
  • May need secondary care if no improvement

Life threatening (low GCS, cyanosis, silent chest):

  • Nebulised salbutomol
  • Emergency care required
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9
Q

What is the commonest cause of bronchiolitis?

A

RSV infection

Can also be caused by adenovirus, rhinovirus, parainfluenza

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10
Q

Presentation of bronchiolitis…

A
  • Normally seen in <1 year olds
  • Coryzal symptoms seen first
  • Sharp, non-productive cough
  • Difficulty feeding due to breathlessness
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11
Q

Examination findings for bronchiolitis…

A
  • Fine-end inspiratory crackles
  • Expiratory wheeze
  • Intercostal recessions
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12
Q

Management of bronchiolitis…

A

In the community:

  • Saline nasal drops
  • Nasal suctioning
  • Baby sleeps propped up
  • Feed little and often

Secondary care required if ; <50% normal food intake, RR>50, dehydrated, exhaustion

  • Humidified oxygen
  • NG feeding
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13
Q

Why do beta agonists not help in bronchiolits?

A

Beta receptors have not yet developed therefore beta agonists cannot work effectively.

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14
Q

Pathophysiology of asthma…

A
  • Bronchial hyperactivity and smooth muscle hypertrophy
  • Causes chronic inflammation of airways
  • Widespread reversible bronchospasm
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15
Q

Risk factors for childhood asthma…

A
  • Family history
  • Low birth weight
  • Bottle fed
  • Atopy
  • Prematurity
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16
Q

What are the symptoms of moderate asthma attack, and where are they managed?

A
  • Able to talk in sentences
  • Peak flow >50% of best/ predicted
  • HR<140 and RR<40 in 2-5 y/o
  • Normal skin colour
  • No chest sounds/ slight wheeze

Management = admitted, or watchful waiting then go home

17
Q

What are the symptoms of severe asthma attack, and where are they managed?

A
  • Only speaks few words/ unable to feed
  • Peak flow = 33-55% of best/predicted
  • HR >140 and RR >40 in 2-5 y/o
  • Pallor
  • Wheeze is heard

Management= admitted to hospital

18
Q

What are the symptoms of life-threatening asthma attack, and where are they managed?

A
  • Unable to speak or cry
  • Exhausted
  • Drowsy/ confused
  • Peak flow <33% of best/ predicted
  • Cyanotic
  • Silent chest

Management = escalation to ITU

19
Q

Management of acute asthma attack…

A

O SHIT ME (not in that order!)

  1. High flow oxygen if sats <94% - aiming for 94-98%
  2. SABA back to back nebs - may add Ipratropium Bromide if poor response to SABA alone
  3. Nebulised magnesium sulphate can be added
  4. Oral prednisolone 40-50mg - continued for up to 3 days
  5. Consider escalation to PICU
  6. First line IV treatment= IV magnesium sulfate
  7. IV aminophylline
20
Q

Follow up after acute asthma attack…

A
  • Take detailed history to identify cause of asthma attack
  • Review asthma medications and inhaler technique
  • Create asthma action plan
  • GP review within 2 working days
  • Seen in clinic in 4 weeks
  • Should not be discharged until PEFR >75%
21
Q

Name some common inhalers and the drug included in them…

A 
Salbutomol = blue inhaler - SABA 
Beclomethasone = brown inhaler - ICS
Symbicort = red inhaler - ICS + SABA
Seretide = purple inhaler - ICS +LABA
Spiriva = green inhaler - LABA
22
Q

Long term management of paediatric asthma…

A
  1. SABA as intermittent reliever therapy
  2. Very low dose ICS = regular preventer
  3. Initial add on = LABA or LTRA with ICS in combination inhaler e.g. seretide
  4. Increase ICS to low dose
  5. Referral to specialist care
23
Q

What is cystic fibrosis ?

A

Autosomal recessive disease caused by mutations in CFTR gene.
This causes exocrine gland dysfunction - which has a variety of clinical manifestations.

24
Q

Presentation of cystic fibrosis…

A

Exocrine gland dysfunction:

  • Meconium ileus in neonates
  • Lung disease similar to bronchiectasis, leading to reccurent pneumonia, wet cough (due to mucus)
  • Biliary disease - neonatal jaundice, gallstones
  • Pancreatic insufficiency - diabetes, steatorrhoea (due to malabsorption), pancreatitis
  • Failure to thrive
25
Q

How is cystic fibrosis diagnosed?

A
  • Heel prick test at birth - genetic testing

- Sweat test = >60mmol/L of Cl- in sweat sample

26
Q

Management of cystic fibrosis…

A
  • Meconium ileus = nasogastric drainage, enema washout
  • Chest physiotherapy - taught to parents for percussion and postural drainage, forced expiration techniques in older children
  • Oral antibiotics for recurrent infections
  • Inhaled corticosteroids
  • CREON for pancreatic insufficency
  • Diabetes management
27
Q

What causes respiratory distress syndrome in infants?

A
  • Deficiency of surfactant in premature babies means the alveoli are less able to stay open during ventilation
  • First breath is very important as it opens the terminal airways but without surfactant this becomes very difficult and so infant will have difficulty with breathing
28
Q

Presentation of respiratory distress syndrome…

A

First 4 hours of birth:

  • Intercostal recessions
  • Tachypnoea
  • Nasal flaring
  • Grunting
29
Q

Risk factors for respiratory distress syndrome…

A
  • Premature birth
  • Maternal diabetes
  • C-section
30
Q

Investigations for respiratory distress syndrome…

A

Chest x-ray shows:

  • Widespread opacification
  • Air bronchograms
31
Q

Management of respiratory distress syndrome…

A
  • Oxygen
  • Intubate if <26 weeks
  • Prophylactic surfactant
  • Fluids
  • Normally self resolves when endogenous surfactant is eventually produced (within 1 week of age)
32
Q

What is transient tachypnoea of newborn, and who is at risk?

A

When the fluid in the lungs is not reabsorbed naturally it leads to a transient episode of tachypnoea as lung function is reduced.

Risk factors = male, SGA and LGA, prematurity

33
Q

What is the treatment for meconium aspiration syndrome?

A

Baby takes forceful gasps during birth leading meconium aspiration which may cause pneumonitis.

  • Antibiotics are given for pneumonitis
  • Assistance for breathing is required

Paediatrics (12 decks)

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