Respiratory Flashcards
What is Pneumonia?
When is it most common?
Pneumonia is an infection in the lungs. It can be mild or serious.
Pneumonia is generally more common in children younger than 5 years old.
What are the most common causative organisms for pneumonia?
Streptococcus pneumoniae
Mycoplasma pneumonia. This often causes a mild form of the illness called walking pneumonia.
Group B streptococcus
Staphylococcus aureus
Respiratory syncytial virus (RSV)
What are the symptoms of pneumonia?
What is the difference between bacterial and viral pneumonia?
Cough that produces mucus
Cough pain
Vomiting or diarrhea
Loss of appetite
Tiredness (fatigue)
Fever
Difference
Bacterial happens quicker than viral
What investigations can you do for pneumonia?
Chest X-ray
Blood tests - CO2 and O2
Sputum culture - causative organism
Pulse oximetry
What are the treatment options for pneumonia?
-
Bacterial - Oral for mild to moderate cases
- Amoxicillin
- Clarithromycin, erythromcyin (pregnancy), doxycycline
-
IV if severely unwell
- Co-amoxiclav with erythromycin
- Benzylpenicillin
- Mycoplasma pneumonia - erythromycin
What is Croup?
What age is most common for croup?
Inflammation of the layrnx and trachea
6 months to 3 years
At what age is croup most common?
6 months - 3 years
What is the most common causative organism of croup?
Parainfluenza virus
Respiratory syncytial virus (RSV)
What are the symptoms of croup?
Starts with runny nose, sore throat, fever and cough
Barking seal cough
Horse voice
What are the investigations for croup?
- Mainly diagnosed clinically
-
Chest x-rays
- Tapering below the vocal chords
- Steeple sign
What is the emergency treatment for croup?
High flow oxygen
Nebulised adrenaline
What is the management for croup?
Single dose oral dexamethasone
What is Asthma?
Asthma is ongoing inflammation
What is the cause of asthma?
A reaction to an allergen or trigger
Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
Respiratory infections, such as the common cold
Physical activity
Cold air
Air pollutants and irritants, such as smoke
Certain medications, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs
Strong emotions and stress
What are the symptoms of asthma?
Cough
Wheezing, a high-pitched, whistle-like sound when exhaling
Trouble breathing or shortness of breath
A tight, uncomfortable feeling in the chest
What are the investigations for asthma?
IN PEADS
Spirometry - FEV1/FVC <70%
Bronchodilator reversibility - Show improvement
Peak expiratory flow (PEF) - Monitor variability
Chest X-ray
What is the treatment for asthma people aged 5-16?
- SABA
- SABA + paediatric low-dose ICS
- SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
- SABA + paediatric low-dose ICS + long-acting beta agonist (LABA)
- SABA + MART low-dose ICS
- SABA + MART moderate-dose ICS
- SABA + one of the following options:
- increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
- a trial of an additional drug (for example theophylline)
- seeking advice from a healthcare professional with expertise in asthma
What is the treatment for asthma people aged under 5?
1) SABA
2) SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)
3) SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
4) Stop the LTRA and refer to an paediatric asthma specialist
What is the treatment of an acute exaccerbation asthma attack in the GP?
Bronchodilator therapy
- Give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
- give 1 puff every 30-60 seconds up to a maximum of 10 puffs
- if symptoms are not controlled repeat beta-2 agonist and refer to hospital
Steroid therapy
- Should be given to all children with an asthma exacerbation
- treatment should be given for 3-5 days
What is a MART?
A form of combined ICS and LABA treatment in which a single inhaler
What are the features of a severe asthma attack?
SpO2 < 92%
PEF 33-50% best or predicted
Too breathless to talk or feed
Heart rate
>125 (>5 years)
>140 (1-5 years)
Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)
Use of accessory neck muscles
What are the features of a life-threatening asthma attack?
- SpO2 <92%
- PEF <33% best or predicted
- Silent chest
- Poor respiratory effort
- Agitation
- Altered consciousness
- Cyanosis
What is viral induced wheeze?
Viral induced wheeze is when the tubes carrying air to the lungs (airways) become irritated and inflamed by a cold virus
How is viral induced wheeze different to asthma?
viral induced wheeze does not occur when the child is otherwise well, whereas asthma is brought on when the child is well during exercise etc.
What is the most causative organism for viral induced wheeze?
Respitory sncytial viral or rhinovirus
What are the symptoms of viral induced wheeze?
Shortness of breath
Signs of respiratory distress
Expiratory wheeze throughout the chest
What is the treatment for viral induced wheeze?
Episodic viral wheeze
Treatment is symptomatic only
- First-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
- Next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both
Multiple trigger wheeze
- Trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks
What is bronchiolitis?
Acute bronchiolar inflammation
What age group does bronchiolitis affect?
Less than 1 year old
What is the most common causative organism for bronchiolitis?
Respiratory syncytial virus
What are the symptoms of bronchiloitis?
- Runny nose
- Cough
- Slight fever (not always present)
- After this, there may be a week or more of difficulty breathing or a whistling noise when the child breathes out (wheezing)
- Grunting = immediate referral
What is a condition which makes bronchiolitis more severe when it occurs?
Ventricular septal defect is the most common
It’s also a risk factor for an increased complication rate.
What are the investigations for bronchioloitis?
Largely Clinical
- Nasopharyngeal aspirate (NPA)
- O2 sats <92%
- Throat/sputum swab - Immunofluorescence of nasopharyngeal secretions may show RSV
What is the management plan for bronchiolitis?
-
Supportive
- Home management
- Secondary management
- Oxygen
-
Consider hospital referral if:
- >60 breaths/min
- 50-75% oral intake
- Clinical dehydration
When should you consider an alternative diagnosis with bronchiolitis?
Temp >39 degrees
What is cystic fibrosis?
Autosomal recessive disorder
Increased viscosity of secretions (e.g. lungs and pancreas)
It is due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR)
Which codes a cAMP-regulated chloride channel
What gene is there a defect in cystic fibrosis?
- Autosomal recessive disorder cystic fibrosis transmembrane conductance regulator gene (CFTR),
- Most cases are delta F508 on the long arm of chromosome 7
What organism are cystic fibrosis patients suseptable to?
Burkholderia cepacia complex (B. cepacia)
What are the symptoms of cystic fibrosis?
salty-tasting skin
persistent coughing
shortness of breath
wheezing
poor weight gain in spite of excessive appetite
greasy, bulky stools
nasal polyps, or small, fleshy growths found in the nose
Increases the risk of bronchitis and pneumonia
blockage of the vas deferens
What are the treatment options for cystic fibrosis?
Airway clearance e.g. postural drainage + percussion
Nebulisers to help clearance and give antibiotics
What is epiglottitis?
Epiglottitis is a potentially life-threatening condition that occurs when the epiglottis swells, blocking the flow of air into your lungs.
At what age does epilglottis develop?
2 and 6 years
What is the most common causative organism for epiglottitis?
Haemophilus influenzae type b, also known as Hib
What are the symptoms of epiglottitis?
- Rapid onset
- High temperature, generally unwell
- Stridor
- Drooling of saliva
- ‘Tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
What are the investigations for epiglottitis?
- Diagnosis is made by direct visualisation
-
X-rays can also be used
- A lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
- In contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the ‘steeple sign’
What is the treatment for epiglottits?
FAST TREATMENT
- Admission!
- Oxygen mask
- Potential intubation
- IV fluids for nutrition and hydration until you’re able to swallow again
- Antibiotics to treat a known or suspected bacterial infection Chloramphenicol, or Cefotaxime
- Anti-inflammatory medication, such as corticosteroids, to reduce the swelling in your throat
What is laryngomalacia?
Floppy epiglottis which folds into the airway on inspiration
What are the symptoms of laryngomalacia?
- Stridor
- Low weight
When do children with laryngomalacia commonly present?
4 weeks after birth
What are the normal ranges for heart and respiratory rate?
Age Heart rate Respiratory rate
< 1 110 - 160 / 30 - 40
1-2 100 - 150 / 25 - 35
2-5 90 - 140 / 25 - 30
5-12 80 - 120 / 20 - 25
> 12 60 - 100 / 15 - 20
WHAT ARE THE CAUSES FOR PULMONARY HYPOPLASIA?
- Oligohydramnios
- Congenital diaphragmatic hernia
WHAT IS THE MOST COMMON CAUSE FOR A CHILD TO BECOME UNRESPONSIVE?
Hypoxia from choking
