Respiratory Flashcards
What are the signs of increased work of breathing?
- Head bobbing
- Nasal flaring
- Tracheal tug
- Sternal recession
- Intercostal/subcostal recession
What is the most common group of pathogens which cause croup?
Parainfluenza viruses
Describe the clinical features of croup
Typical features are coryza and fever, followed by:
- Hoarse voice/cry
- “Barking” cough
- Stridor
- Increased work of breathing
Describe the investigation of croup
- Not routinely investigated, it is a clinical diagnosis
Describe the management of croup
- Oral dexamethasone
- Oxygen
- Nebulised budesonide
- Nebulised adrenaline if severe
What is the most common causative pathogen of acute epiglottitis?
Haemophilus influenzae type B (Hib)
Describe the clinical features of acute epiglottitis
- High fever
- Stridor
- Very ill, toxic-looking child
- Drooling
- “Tripod” position
Describe the investigation and management of acute epiglottitis
DO NOT examine the throat, as this may precipitate total airway obstruction
Management:
- Arrange urgent hospital admission and treatment
- IV antibiotics (e.g. ceftriaxone) and dexamethasone
- Tracheal intubation may be necessary to secure airway
What treatment may you provide to close contacts of children with acute epiglottitis caused by Hib infection?
Rifampicin
What is bronchiololitis?
Who does it most commonly affect?
Bronchiolitis is inflammation of the bronchioles caused by a viral infection
90% of cases are in infants under 9 months
What is the most common pathogen responsible for causing bronchiolitis?
Respiratory syncitial virus (RSV)
Describe the clinical features of bronchiolitis
- Coryza
- Dry cough
- Wheeze
- Signs of respiratory distress
Describe the investigation of bronchiolitis
- Pulse oximetry should be performed on all children with suspected bronchiolitis
- No other investigations are routinely recommended
Give some examples of criteria for admission to hospital with bronchiolitis
- Oxygen saturations < 92% on air
- Inadequate oral fluid intake (50-75% of usual volume)
- Severe respiratory distress
- Apnoea (observed or reported)
Describe the management of bronchiolitis
Supportive management:
- Oxygen
- Fluids
- Assisted ventilation e.g. Airvo, CPAP
Is there any way to prevent bronchiolitis?
Monoclonal antibody to RSV (palivizumab, given monthly by IM injection) reduces number of hospital admissions in high risk infants
What are the most common causative organisms of pneumonia?
Viral:
- RSV
- Influenza
Bacterial:
- Neonates: Group B streptococcus
- Older children: Streptococcus pneumoniae (most common)
What are the clinical features of pneumonia?
- Fever
- Cough
- Pleuritic chest pain
- Signs of respiratory distress
Describe the investigation of pneumonia
CXR (but this is not routinely required)
Describe the management of pneumonia
- Antibiotics (amoxicillin is usually first line + a macrolide, e.g. clarithromycin)
General supportive measures if required:
- Oxygen
- Fluids
- Assisted ventilation, e.g. Airvo, CPAP
Give some examples of criteria for admission to hospital with pneumonia
- Oxygen saturations < 92% on air
- Inadequate oral fluid intake (50-75% of usual volume)
- Severe respiratory distress
- Apnoea (observed or reported)
What are the clinical features of asthma?
- Wheeze
- Dry cough
- Dyspnoea
- Diurnal variation in symptoms
Describe the management of an asthma attack (immediate management and follow-up)
Immediate management:
1) Salbutamol via spacer - 1 puff every 30-60 seconds up to maximum of 10 puffs
2) High flow oxygen
3) Nebulised salbutamol
4) Oral prednisolone or IV hydrocortisone
5) IV salbutamol or IV magnesium sulphate or IV aminophylline
6) Transfer to PICU (airway management and ventilation)
Follow-up:
- Reducing regime salbutamol
- Finish course oral prednisolone (usually 3-5 days)
- Safety netting and 1 week GP follow up
What are the side effects of salbutamol?
- Tremor
- Tachycardia
- Hypokalaemia
How is asthma diagnosed?
- Clinical diagnosis (history and examination)
- Positive response to asthma therapy
- Serial peak flow measurements (peak flow diary)
Describe the management of chronic asthma in infants and children
1) SABA (salbutamol)
2) Add low dose corticosteroid inhaler (e.g. beclometasone)
3) Add leukotriene receptor antagonist (LTRA) - montelukast
What is meant by viral-induced wheeze?
Wheeze triggered by viral infection (there are no symptoms between viral infections)
Describe the pathophysiology of laryngomalacia
‘Floppy larynx’ - part of the larynx above the vocal cords (supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction during inspiration
Describe the investigation of suspected laryngomalacia
Bronchoscopy (characteristic ‘omega’ sign)
Describe the management of laryngomalacia
Usually resolves naturally within 18 months
Which organism causes whooping cough?
Bordetella pertussis (gram negative cocobacilli)
What are the clinical features of whooping cough?
- Coryza
- Paroxysmal cough, followed by inspiratory whoop and vomiting (in infants, apnoea rather than whoop)
- Symptoms worse at night
Describe the investigation of whooping cough
Nasopharyngeal swab and culture identifying Bordetella pertussis
Describe the management of whooping cough
Macrolide antibiotics, e.g. azithromycin, clarithromycin
Describe the aetiology and pathophysiology of cystic fibrosis
- Autosomal recessive condition
- Mutation in the CFTR gene which is located on chromosome 7
- Most common mutation is the delta-F508 mutation, which results in production of defective chloride ion channels
- Abnormal chloride ion transport across epithelial cells results in thicker, more viscous mucus secretions
Give examples of clinical presentations of cystic fibrosis in…
- Neonate
- Infants and children
Neonate:
- Diagnosed through newborn screening
- Meconium ileus (failure to pass meconium in first 24 hours of life)
Infants/children:
- Steatorrhoea and faltering growth (thick mucus secretions block the pancreatic duct, resulting in exocrine pancreas insufficiency and malabsorption)
- Recurrent chest infections (thick mucus secretions in the lungs impair ciliary function, leading to retention of mucopurulent secretions/allowing bacteria to colonise the airways)
Describe the investigation of cystic fibrosis
- Majority of babies with CF are diagnosed through newborn screening, which identifies raised IRT (immunoreactive trypsinogen)
- Patients who present later, e.g. with faltering growth, recurrent chest infections etc., are diagnosed using the sweat test (which shows elevated chloride ions in the sweat) and genetic testing
Describe the management of cystic fibrosis (respiratory, nutritional and fertility)
Respiratory management:
- Chest physiotherapy
- Nebulised hypertonic saline to thin mucus secretions
- Bronchodilators, e.g. salbutamol
- Prophylactic antibiotics (usually flucloxacillin) and vaccinations (pneumococcal, flu and varicella)
Nutritional management:
- Pancreatic insufficiency is managed using pancreatic enzyme replacement therapy e.g. CREON
- High calorie diet (150% of normal is recommended) - in order to achieve this overnight feeding with gastrostomy may be required
Other:
- Fertility treatment, e.g. testicular sperm extraction for infertile males
- Genetic counselling
Give some examples of potential complications of cystic fibrosis
- Diabetes
- Infertility
Primary ciliary dyskinesia is inherited in a (…?) pattern
Autosomal recessive
Primary ciliary dyskinesia is more common in populations where there is…
Consanguinity
There is a strong link between primary ciliary dyskinesia and which anatomical abnormality?
Situs inversus
