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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the signs of increased work of breathing?

A
  • Head bobbing
  • Nasal flaring
  • Tracheal tug
  • Sternal recession
  • Intercostal/subcostal recession
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2
Q

What is the most common group of pathogens which cause croup?

A

Parainfluenza viruses

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3
Q

Describe the clinical features of croup

A

Typical features are coryza and fever, followed by:

  • Hoarse voice/cry
  • “Barking” cough
  • Stridor
  • Increased work of breathing
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4
Q

Describe the investigation of croup

A
  • Not routinely investigated, it is a clinical diagnosis
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5
Q

Describe the management of croup

A
  • Oral dexamethasone
  • Oxygen
  • Nebulised budesonide
  • Nebulised adrenaline if severe
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6
Q

What is the most common causative pathogen of acute epiglottitis?

A

Haemophilus influenzae type B (Hib)

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7
Q

Describe the clinical features of acute epiglottitis

A
  • High fever
  • Stridor
  • Very ill, toxic-looking child
  • Drooling
  • “Tripod” position
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8
Q

Describe the investigation and management of acute epiglottitis

A

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
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9
Q

What treatment may you provide to close contacts of children with acute epiglottitis caused by Hib infection?

A

Rifampicin

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10
Q

What is bronchiololitis?

Who does it most commonly affect?

A

Bronchiolitis is inflammation of the bronchioles caused by a viral infection

90% of cases are in infants under 9 months

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11
Q

What is the most common pathogen responsible for causing bronchiolitis?

A

Respiratory syncitial virus (RSV)

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12
Q

Describe the clinical features of bronchiolitis

A
  • Coryza
  • Dry cough
  • Wheeze
  • Signs of respiratory distress
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13
Q

Describe the investigation of bronchiolitis

A
  • Pulse oximetry should be performed on all children with suspected bronchiolitis
  • No other investigations are routinely recommended
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14
Q

Give some examples of criteria for admission to hospital with bronchiolitis

A
  • Oxygen saturations < 92% on air
  • Inadequate oral fluid intake (50-75% of usual volume)
  • Severe respiratory distress
  • Apnoea (observed or reported)
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15
Q

Describe the management of bronchiolitis

A

Supportive management:

  • Oxygen
  • Fluids
  • Assisted ventilation e.g. Airvo, CPAP
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16
Q

Is there any way to prevent bronchiolitis?

A

Monoclonal antibody to RSV (palivizumab, given monthly by IM injection) reduces number of hospital admissions in high risk infants

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17
Q

What are the most common causative organisms of pneumonia?

A

Viral:

  • RSV
  • Influenza

Bacterial:

  • Neonates: Group B streptococcus
  • Older children: Streptococcus pneumoniae (most common)
18
Q

What are the clinical features of pneumonia?

A
  • Fever
  • Cough
  • Pleuritic chest pain
  • Signs of respiratory distress
19
Q

Describe the investigation of pneumonia

A

CXR (but this is not routinely required)

20
Q

Describe the management of pneumonia

A
  • Antibiotics (amoxicillin is usually first line + a macrolide, e.g. clarithromycin)

General supportive measures if required:

  • Oxygen
  • Fluids
  • Assisted ventilation, e.g. Airvo, CPAP
21
Q

Give some examples of criteria for admission to hospital with pneumonia

A
  • Oxygen saturations < 92% on air
  • Inadequate oral fluid intake (50-75% of usual volume)
  • Severe respiratory distress
  • Apnoea (observed or reported)
22
Q

What are the clinical features of asthma?

A
  • Wheeze
  • Dry cough
  • Dyspnoea
  • Diurnal variation in symptoms
23
Q

Describe the management of an asthma attack (immediate management and follow-up)

A

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
24
Q

What are the side effects of salbutamol?

A
  • Tremor
  • Tachycardia
  • Hypokalaemia
25
Q

How is asthma diagnosed?

A
  • Clinical diagnosis (history and examination)
  • Positive response to asthma therapy
  • Serial peak flow measurements (peak flow diary)
26
Q

Describe the management of chronic asthma in infants and children

A

1) SABA (salbutamol)
2) Add low dose corticosteroid inhaler (e.g. beclometasone)
3) Add leukotriene receptor antagonist (LTRA) - montelukast

27
Q

What is meant by viral-induced wheeze?

A

Wheeze triggered by viral infection (there are no symptoms between viral infections)

28
Q

Describe the pathophysiology of laryngomalacia

A

‘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

29
Q

Describe the investigation of suspected laryngomalacia

A

Bronchoscopy (characteristic ‘omega’ sign)

30
Q

Describe the management of laryngomalacia

A

Usually resolves naturally within 18 months

31
Q

Which organism causes whooping cough?

A

Bordetella pertussis (gram negative cocobacilli)

32
Q

What are the clinical features of whooping cough?

A
  • Coryza
  • Paroxysmal cough, followed by inspiratory whoop and vomiting (in infants, apnoea rather than whoop)
  • Symptoms worse at night
33
Q

Describe the investigation of whooping cough

A

Nasopharyngeal swab and culture identifying Bordetella pertussis

34
Q

Describe the management of whooping cough

A

Macrolide antibiotics, e.g. azithromycin, clarithromycin

35
Q

Describe the aetiology and pathophysiology of cystic fibrosis

A
  • 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
36
Q

Give examples of clinical presentations of cystic fibrosis in…

  • Neonate
  • Infants and children
A

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)
37
Q

Describe the investigation of cystic fibrosis

A
  • 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
38
Q

Describe the management of cystic fibrosis (respiratory, nutritional and fertility)

A

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
39
Q

Give some examples of potential complications of cystic fibrosis

A
  • Diabetes

- Infertility

40
Q

Primary ciliary dyskinesia is inherited in a (…?) pattern

A

Autosomal recessive

41
Q

Primary ciliary dyskinesia is more common in populations where there is…

A

Consanguinity

42
Q

There is a strong link between primary ciliary dyskinesia and which anatomical abnormality?

A

Situs inversus

Paediatrics (17 decks)

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