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Respiratory Flashcards

1
Q

Main pathogen responsible for bronchiolitis

A

RSV. Others adenovirus, human metapneumovirus. Mycloplasma pneumonia

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2
Q

Risk factors for bronchiolitis

A 
Young age (<2 yo)
Previous infection
Decreased immunity
Neuromuscular disorders
Premature birth
Cardiovascular malformation
Airway malformation
Smoking exposure
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3
Q

Complications for bronchiolitis

A

Hypoxemia, Sepsis

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4
Q

What are some common features of bronchiolitis?

A 
Congestion/coryza
Sore throat
Wheezing
Cough
Poor feeding
Decreased activity
Hypoxia -> tacycardia, tachypnoea, exhaustion
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5
Q

Severe features of bronchiolitis

A 
Dyspnoea
Apnoea
Increased WOB
Cyanosis
Fever
Lethargic
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6
Q

Key imaging for bronchiolitis? What does it show?

A

X-ray. Shows patchy infiltrates and atelectasis.

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7
Q

Key lab test for bronchiolitis?

A

NP swab. RT-PCR for viral testing

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8
Q

Main management for bronchiolitis

A

Supportive. Fluids, O2, mechanical ventilation if needed.

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9
Q

What medication can be used to treat bronchiolitis and in what patients is this used?

A

Ribavirin. Immunocompromised, premature or children with lung/heart disease.

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10
Q

Prophylaxis against bronchiolitis

A

Palivizumab. Especially in winter months.

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11
Q

Which part of the airways does croup affect?

A

Larynx and trachea. (upper airway)

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12
Q

Main pathogen responsible for croup

A

RSV. Also parainfluenza, adenoviruses. Used to also be diptheria before vaccines.

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13
Q

Which age group does croup appear in commonly?

A

<6 years old children

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14
Q

Complications of croup

A

Respiratory failure
Hypoxia
Secondary bacterial infections

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15
Q

Clinical features of croup?

A 
Barking cough
Sore throat
Hoarse voice
Tachypnoea
Grunting
Inspiratory stridor
Cyanosis (if resp failure)
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16
Q

Stridor or wheeze in croup?

A

Stridor (inspiratory)

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17
Q

Diagnostic imaging for croup? And what does it show?

A

CXR. Shows “steeple sign” - narrowing below epiglottis.

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18
Q

Which medications for croup? And if it gets severe?

A

Dexamethasone. If severe, nebulised adrenaline (+consider intubation if impending resp failure)

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19
Q

Supportive treatment for croup

A

Humidified O2, fluids, antipyretics

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20
Q

Main pathogen for epiglottitis in children?

A

Haemophilus influenzae. Others: strep pneumoniae, staph aureus

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21
Q

Risk factors for epiglottitis

A

No immunisations

Mucusal trauma

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22
Q

Which age group does epiglottitis commonly appear in?

A

6-12 year old children

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23
Q

Complications of epiglottitis

A

Obstructed airways
Aspiration of secretions
Cardiopulmonary arrest
Death

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24
Q

What are the 3D’s of epiglottitis?

A

Dysphagia
Drooling
Distress

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25
Clinical features of epiglottitis
``` Stridor Retractions Tachypnoea Sore throat Fever Odynophagia Cyanosis ```
26
How would a child with epiglottitis behave?
Refuses to lie down Tripoding Anxious
27
What does a child's voice sound like with epiglottitis
Muffled | Can't speak (aphonia)
28
What 2 diagnostic imagings can you use for epiglottitis? And what would they show?
Laryngoscopy - swollen red epiglottitis | X-ray - enlarged epiglottis and ballooning of hypopharynx
29
What do lab results show for epiglottitis?`
Increased WBC Increased CRP Positive throat culture
30
What is the treatment for epiglottitis?
Secure airway IV antibiotics - ceftriaxone Supp O2 Supp dexamethasone Once stable: oral abx - augmentin
31
Which vaccine can prevent against epiglottitis?
HiB
32
What non-resp systems does CF affect?
GI (pancreas) Reproductive Sweat glands
33
Which gene and chromosome is affected by CF?
CFTR gene. Chromosome 7.
34
Classic triad for CF
Increased sweat Cl- ions Chronic sinopulmonary disease Pancreatic insufficiency
35
What enzyme do neutrophils release due to airway inflammation in CF?
Elastase
36
Risk factors for CF
``` Caucasian Family history (esp. carrier parents) ```
37
Lung complications of CF
``` Chronic resp infections Hemopytsis Bronchiectasis Pneumothorax Secondary pulmonary HTN Resp failure ```
38
Non-lung complications of CF
``` Cirrhosis Pancreatitis Gallstones Dehydration Excess salt loss in sweat Infertility (azoospermia) ADEK vitamin deficiency Anaemia Nail clubbing ```
39
What are clinical features of a CF patient?
``` Chronic, productive cough Dyspnoea Expanded chest Nail clubbing Base crackles Wheeze Hyperesonant chest ```
40
How is CF diagnosed antenatally?
Prenatal USS. Can detect meconium peritonitis or hyperechogenic (bright) bowel.
41
What does CXR show for CF?
``` Hyperinflation Trapped air Atelectasis Tram tracks (thickened bronchial walls) Flattened diaphragm ```
42
Aside from genetic testing, what other tests are done for CF?
Sweat chloride test (done with pilocarpine) Newborn screening (immunoreactive trypsinogen) PFT Faecal elastase
43
What drugs can be used to treat CF?
Inhaled hypertonic saline (to clear mucus) Inhaled bronchodilator (salbutamol) Inhaled mucolytic (dornase alfa) Anti-inflammatory (NSAID, azithromycin)
44
What conservative treatment is important in managing CF?
Chest physio Non-invasive ventilation +/- O2 Treat underlying cause
45
What surgical management can be done for CF patients?
Lung transplant
46
What are the common pathogens for pneumonia in Newborns?
Group B strep (mother's genital tract) Gram -ve enterococci Bacilli
47
What are the common pathogens for pneumonia in infants and young children?
RSV Strep pneumoniae Haem influenzae Bordatella pertussis Chlamydia trachomatis S. aureus (rare but dangerous)
48
What are the common pathogens for pneumonia in children over 5 years?
Mycoplasma pneumoniae Strep pneumoniae Chlamydia pneumoniae
49
Symptoms of child with pneumonia
Fever Cough Tachypnoea Lethargy Poor feeding Unwell child
50
What does localised chest, abdo or neck pain in pneumonia suggest?
Pleural irritation -> suggests bacterial infection
51
What can be heard on auscultation of children with pneumonia?
End-inspiratory coarse crackles over affected area
52
How will O2 sats appear children with pneumonia?
Decreased O2 sats
53
What imaging can confirm pneumonia?
CXR. Shows consolidation.
54
What can differentiate between viral and bacterial pneumonia?
NPA (in younger children)
55
When would you admit a child with pnemonia?
Sats <92% Recurrent apnoeas Grunting Inability to maintain fluids/feeds
56
How would you manage a child with pneumonia conservatively?
O2 (for hypoxia) Analgesia (for pain) IV fluids (hydration and sodium balance)
57
What antibiotics are used for pneumonia? a) in newborns b) infants c) older children
Newborns - broad spectrum Infants - oral amoxicillin (augmentin if not responding) Older children - amoxicillin or erythromycin)
58
How are pleural collections in pneumonia managed?
Chest drain + antibiotics 48h
59
In pneumonia patients with lobar collapse or atelectasis, what followup should there be?
Repeat CXR Otherwise, no followup needed normally
60
Name 3 factors contributing to airway narrowing in asthma
Bronchoconstriction Mucosal inflammation Increased mucus
61
Name 3 features of a severe asthma attack
1. Inability to complete sentences or feed 2. HR > 140bpm 3. RR > 40 4. Peak flow = 33-50% predicted
62
Name 3 features of a life-threatening asthma attack
1. Silent chest 2. Fatigue/exhaustion/confusion/LOC/coma 3. Cyanosis 4. Peak flow <33% predicted 5. Poor respiratory effort Near fatal attack means PaCO2 rises dramatically
63
What allergens can trigger asthma?
``` Air pollution Cigarette smoke Mold Pollen Dust Pet dander Meds (aspirin, beta blockers) ```
64
What is extrinsic asthma?
Extrinsic allergens - dust mold etc. Type 1 hypersensitivity. Atopic triad involved.
65
What is intrinsic asthma?
Non-immune | Viral infections, stress, exercise, smoking
66
Clinical features of asthma
``` Cough Tight chest Dyspnoea/DIB Wheeze Whistling in expiration Hyper inflated chest Harrison's sulci *Atopic triad* ```
67
Investigations for asthma
PEF Spirometry Bronchodilator reversibility test Trigger test (metacholine challenge)
68
How would you conservatively manage asthma?
Avoid triggers
69
After giving a SABA and ICS for asthma, what is the next line?
Add LTRA (montelukast) Add LABA
70
What can be given in an acute asthma attack on admission to hospital?
Oral corticosteroids (prednisolone)
71
How does asthma severity vary throughout the day?
Worse on waking and at night.
72
What age does VIW resolve by usually?
5 years old
73
Risk factors for VIW
Maternal smoking during/after pregnancy | Family history of early viral wheezing
74
Why does viral episodic wheeze usually resolve early in life?
Due to narrow airways becoming larger with growth and less susceptible to viral inflammation.
75
Questions to ask a patient with asthma to judge severity?
1. Using inhaler more often? 2. Stopping you from doing daily activities? 3. Wake up at night, disrupting sleep from asthma symptoms?

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