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Paeds > Respiratory > Flashcards

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
Q

Clinical features of epiglottitis

A 
Stridor
Retractions
Tachypnoea
Sore throat
Fever
Odynophagia
Cyanosis
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26
Q

How would a child with epiglottitis behave?

A

Refuses to lie down
Tripoding
Anxious

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27
Q

What does a child’s voice sound like with epiglottitis

A

Muffled

Can’t speak (aphonia)

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28
Q

What 2 diagnostic imagings can you use for epiglottitis? And what would they show?

A

Laryngoscopy - swollen red epiglottitis

X-ray - enlarged epiglottis and ballooning of hypopharynx

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29
Q

What do lab results show for epiglottitis?`

A

Increased WBC
Increased CRP
Positive throat culture

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30
Q

What is the treatment for epiglottitis?

A

Secure airway
IV antibiotics - ceftriaxone
Supp O2
Supp dexamethasone

Once stable: oral abx - augmentin

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31
Q

Which vaccine can prevent against epiglottitis?

A

HiB

32
Q

What non-resp systems does CF affect?

A

GI (pancreas)
Reproductive
Sweat glands

33
Q

Which gene and chromosome is affected by CF?

A

CFTR gene. Chromosome 7.

34
Q

Classic triad for CF

A

Increased sweat Cl- ions
Chronic sinopulmonary disease
Pancreatic insufficiency

35
Q

What enzyme do neutrophils release due to airway inflammation in CF?

A

Elastase

36
Q

Risk factors for CF

A 
Caucasian
Family history (esp. carrier parents)
37
Q

Lung complications of CF

A 
Chronic resp infections
Hemopytsis
Bronchiectasis
Pneumothorax
Secondary pulmonary HTN
Resp failure
38
Q

Non-lung complications of CF

A 
Cirrhosis
Pancreatitis
Gallstones
Dehydration
Excess salt loss in sweat
Infertility (azoospermia)
ADEK vitamin deficiency
Anaemia
Nail clubbing
39
Q

What are clinical features of a CF patient?

A 
Chronic, productive cough
Dyspnoea
Expanded chest
Nail clubbing
Base crackles
Wheeze
Hyperesonant chest
40
Q

How is CF diagnosed antenatally?

A

Prenatal USS.

Can detect meconium peritonitis or hyperechogenic (bright) bowel.

41
Q

What does CXR show for CF?

A 
Hyperinflation
Trapped air
Atelectasis
Tram tracks (thickened bronchial walls)
Flattened diaphragm
42
Q

Aside from genetic testing, what other tests are done for CF?

A

Sweat chloride test (done with pilocarpine)
Newborn screening (immunoreactive trypsinogen)
PFT
Faecal elastase

43
Q

What drugs can be used to treat CF?

A

Inhaled hypertonic saline (to clear mucus)
Inhaled bronchodilator (salbutamol)
Inhaled mucolytic (dornase alfa)
Anti-inflammatory (NSAID, azithromycin)

44
Q

What conservative treatment is important in managing CF?

A

Chest physio

Non-invasive ventilation +/- O2

Treat underlying cause

45
Q

What surgical management can be done for CF patients?

A

Lung transplant

46
Q

What are the common pathogens for pneumonia in Newborns?

A

Group B strep (mother’s genital tract)

Gram -ve enterococci
Bacilli

47
Q

What are the common pathogens for pneumonia in infants and young children?

A

RSV

Strep pneumoniae
Haem influenzae
Bordatella pertussis
Chlamydia trachomatis

S. aureus (rare but dangerous)

48
Q

What are the common pathogens for pneumonia in children over 5 years?

A

Mycoplasma pneumoniae
Strep pneumoniae
Chlamydia pneumoniae

49
Q

Symptoms of child with pneumonia

A

Fever
Cough
Tachypnoea

Lethargy
Poor feeding
Unwell child

50
Q

What does localised chest, abdo or neck pain in pneumonia suggest?

A

Pleural irritation -> suggests bacterial infection

51
Q

What can be heard on auscultation of children with pneumonia?

A

End-inspiratory coarse crackles over affected area

52
Q

How will O2 sats appear children with pneumonia?

A

Decreased O2 sats

53
Q

What imaging can confirm pneumonia?

A

CXR. Shows consolidation.

54
Q

What can differentiate between viral and bacterial pneumonia?

A

NPA (in younger children)

55
Q

When would you admit a child with pnemonia?

A

Sats <92%
Recurrent apnoeas
Grunting
Inability to maintain fluids/feeds

56
Q

How would you manage a child with pneumonia conservatively?

A

O2 (for hypoxia)
Analgesia (for pain)
IV fluids (hydration and sodium balance)

57
Q

What antibiotics are used for pneumonia?

a) in newborns
b) infants
c) older children

A

Newborns - broad spectrum
Infants - oral amoxicillin (augmentin if not responding)
Older children - amoxicillin or erythromycin)

58
Q

How are pleural collections in pneumonia managed?

A

Chest drain + antibiotics 48h

59
Q

In pneumonia patients with lobar collapse or atelectasis, what followup should there be?

A

Repeat CXR

Otherwise, no followup needed normally

60
Q

Name 3 factors contributing to airway narrowing in asthma

A

Bronchoconstriction
Mucosal inflammation
Increased mucus

61
Q

Name 3 features of a severe asthma attack

A
  1. Inability to complete sentences or feed
  2. HR > 140bpm
  3. RR > 40
  4. Peak flow = 33-50% predicted
62
Q

Name 3 features of a life-threatening asthma attack

A
  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
Q

What allergens can trigger asthma?

A 
Air pollution
Cigarette smoke
Mold
Pollen
Dust
Pet dander
Meds (aspirin, beta blockers)
64
Q

What is extrinsic asthma?

A

Extrinsic allergens - dust mold etc.
Type 1 hypersensitivity.
Atopic triad involved.

65
Q

What is intrinsic asthma?

A

Non-immune

Viral infections, stress, exercise, smoking

66
Q

Clinical features of asthma

A 
Cough
Tight chest
Dyspnoea/DIB
Wheeze
Whistling in expiration
Hyper inflated chest
Harrison's sulci
*Atopic triad*
67
Q

Investigations for asthma

A

PEF
Spirometry
Bronchodilator reversibility test
Trigger test (metacholine challenge)

68
Q

How would you conservatively manage asthma?

A

Avoid triggers

69
Q

After giving a SABA and ICS for asthma, what is the next line?

A

Add LTRA (montelukast)

Add LABA

70
Q

What can be given in an acute asthma attack on admission to hospital?

A

Oral corticosteroids (prednisolone)

71
Q

How does asthma severity vary throughout the day?

A

Worse on waking and at night.

72
Q

What age does VIW resolve by usually?

A

5 years old

73
Q

Risk factors for VIW

A

Maternal smoking during/after pregnancy

Family history of early viral wheezing

74
Q

Why does viral episodic wheeze usually resolve early in life?

A

Due to narrow airways becoming larger with growth and less susceptible to viral inflammation.

75
Q

Questions to ask a patient with asthma to judge severity?

A
  1. Using inhaler more often?
  2. Stopping you from doing daily activities?
  3. Wake up at night, disrupting sleep from asthma symptoms?

Paeds (8 decks)

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