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Phase 3A - Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What age do children normally get bronchiolitis?

A

Younger than 18 months

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2
Q

What is RSV?

A

Respiratory syncytial virus

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3
Q

RSV can lead to a…

A

Small airway obstruction

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4
Q

Symptoms of bronchiolitis

A 
Wheeze 
Harsh cough
Fever
High HR and RR
Nasal flaring
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5
Q

Signs of bronchiolitis

A

Fine inspiratory crackles and expiratory wheeze

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6
Q

How long does bronchiolitis last?

A

Normally 9 days - 3 stable, 3 worse, 3 better - resolved

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7
Q

What individuals are at risk of bronchiolitis

A

Prem, chronic resp conditions, CHD

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8
Q

What is given to children at high risk of bronchiolitis

A

Pavalizumab monoclonal antibody

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9
Q

What investigations are needed for bronchiolitis

A

Capillary blood gas, CXR, nasopharyngeal aspirate

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10
Q

Mild bronchiolitis and management

A

Feeding well, minimal RD, no RFs, no oxygen needed - home with advice on when to return

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11
Q

Moderate bronchiolitis and management

A

Increased work of breathing, poor feeding, low sats, RFs - admit for feeding support +/- O2

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12
Q

Severe bronchiolitis and management

A

Worsening RD, respiratory acidosis, apnoea, dehydration, RFs -HDU, CPAP, ventilation, IV fluids

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13
Q

Viral pneumonia can be caused by

A

RSV, parainfluenza, adenovirus, rhinovirus

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14
Q

Signs of pneumonia

A

Signs
• Derangement in basic observation, which can be indicate of sepsis secondary to the pneumonia
• Tachypnoea (raised RR)
• Tachycardia (raised HR)
• Hypoxia
• Hypotension
• Fever
• Confusion
Chest signs
Bronchial breath sounds – these are harsh breath sounds that are equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway
Focal coarse crackles – causes by air passing through sputum similar to using a straw to blow into a drink
Dullness to percussion – due to lung tissue collapse and/or consolidation

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15
Q

Symptoms of pneumonia

A

G

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16
Q

Treatment of mild pneumonia

A

Home with oral Abs and advice

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17
Q

Treatment of moderate to severe pneumonia

A

Admit oxygen and IV Abs/fluids

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18
Q

What is croup

A

Acute viral laryngotracheobronchitis

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19
Q

Features of croup

A

Hoarse voice
Barking cough
Harsh stridor
Possible RD

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20
Q

Age group for croup

A

6 months to 6 years

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21
Q

Causative agent for croup

A

Parainfluenza virus

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22
Q

What causes wheeze?

A

Asthma
Bronchiolitis
Viral induced wheeze
Pneumonia

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23
Q

What causes stridor

A 
Croup
Epiglottitis 
Bacterial tracheitis
Diphtheria
Laryngomalacia
Inhaled foreign body
Angioedema/ anaphylaxis
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24
Q

What is wheeze?

A

P

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25
What is stridor
He
26
What are signs of respiratory distress?
``` Cyanosis Tracheal tug Subcostal/intercostal recessions Hypoxia, tachypnoea Wheeze on auscultation Stridor Head bobbing ```
27
Presentation of pneumonia
``` Cough Fever Tachypnoea Chest recession Nasal flaring Head bobbing Hypoxia Hypotension Confusion Shock ```
28
What is the most common causative agent of pneumonia
Streptococcus pneumonia
29
What is the causative agent of pneumonia in pre vaccinated infants neonates
Group B strep
30
What causative agent of pneumonia has CXR finding of pneumatocoeles and consolidation in multiple lobes
Staphylococcus aureus
31
What is the causative agent of pneumonia in pre vaccinated children
Haemophilus influenza
32
What is the causative agent of pneumonia can children develop erythema multiforme
Mycoplasma pneumonia
33
What is the most causative agent of viral pneumonia
RSV
34
What tests do you do for pneumonia
``` CXR Blood cultures and sensitivities FBC Throat swabs for bacterial cultures and viral PCR Capillary blood gas ```
35
What treatments for the pneumonia of neonates
IV broad spectrum abx
36
What treatment for pneumonia in older children?
1st line - amoxicillin | 2nd line - erythromycin
37
What abx should you add with pneumonia with influenza
Co amoxiclav
38
What abx treatment for mycoplasma pneumonia
Erythromycin
39
What is the presentation of acute asthma attack
``` Progressively worsening shortness of breath Signs of respiratory distress Tachypnoea Expiratory wheeze Reduced air entry ```
40
What is the SpO2 of a moderate asthma attack
SpO2 > 92
41
What is the SpO2 of a severe asthma attack
SpO2 < 92
42
Features of a severe asthma attack
Too breathless to talk or feed Heart rate > 140/min Respiratory rate > 40/min Use of accessory muscles
43
Features of a life threatening asthma attack
``` SpO2< 92% Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis ```
44
Treatment of an asthma attack
1. High flow oxygen 2. Nebulised salbutamol 3. Nebulised ipratropium bromide 4. Oral prednisone 5. IV hydrocortisone 6. IV salbutamol 7. IV aminophylline 8. IV magnesium sulphate
45
What is salbutamol?
short-acting, selective beta2-adrenergic receptor
46
What are side effects of salbutamol?
Tachycardia Hypokalaemia Tremor
47
What is the atopic triad
Asthma, eczema, hay fever and food allergies
48
Management of chronic asthma in under 5 yrs old
1. SABA - salbutamol 2. Add lose dose corticosteroid inhaler 3. Add leukotriene receptor antagonist- oral montelukast
49
Managing chronic asthma in 5 - 12 yr olds
1. Start a SABA - salbutamol 2. Add a regular low dose corticosteroid inhaler 3. Add a LABA - salmeterol 4. Titrate up the corticosteroid inhaler to a medium dose 5. Oral leukotriene receptor antagonist - montelukast 6. Increase the dose of the inhaled corticosteroids to a high dose
50
Signs and symptoms of anaphylaxis
Urticaria, itching, swelling of lips, tongue, eyes (angioedema), wheeze, stridor, shortness of breath, tachycardia, abdo pain, collapse, hypotension
51
Treatment of anaphylaxis
``` ABCDE Oxygen IV fluids IM adrenaline Hydrocortisone IV Antihistamines ```
52
Presentation of viral induced wheeze
A 2 yr old presents with cold like symptoms Fever Runny nose Expiratory wheeze
53
What causes a viral induced wheeze
RSV, inflammation and oedema leads to narrowing and a restriction in airflow leading to a wheeze
54
Key signs and symptoms of viral induced wheeze
Presenting < 3 years of age No atopic history Only occurs during viral infection
55
Treatment of viral induced wheeze
Supplementary oxygen Salbutamol and ICS montelukast
56
What is bronchiolitis
Inflammatory respiratory condition. It’s caused by a virus that affects the smallest air passages in the lungs (bronchioles).
57
Most common cause of bronchiolitis
RSV
58
Key signs and symptoms of bronchiolitis
``` Coryzal symptoms Signs of respiratory distress Apnoea Poor feeding Wheeze + inspiratory crackles = bronchiolitic ```
59
What is the pathophysiology Of bronchiolitis
Mucus production and inflammation results in narrowing and alveoli collapse
60
How do you diagnose bronchiolitis
Nasal swabs,
61
What is the presentation of | Croup?
Barking cough in autumn | children between six months to 6 years old stridor
62
What is the cause of croup
Para influenza virus and an upper respiratory tract infection oedema in the larynx
63
What is the presentation of a epiglottitis
``` Very unwell Drooling Inspiratory stridor Made better by sitting upright and leaning forward Dysphagia Beefy red stuff oedematous epiglottis Thumb sign ```
64
Treatment of epiglottitis
ENT immediately IV cefotriaxone and dexamethasone Blood culture and close contact prophylaxis with rifampicin
65
What is bronchitis
Inflammation of the Bronchi
66
What is the presentation of bronchitis
Cough Fever Wheeze
67
How long does bronchitis last
2 weeks
68
What is whopping cough
A highly infectious form of bronchitis with bordetella pertussis
69
What form of inheritance the cystic fibrosis have
Autosomal recessive inheritance gene on chromosome seven codes for CFTR
70
How many people in the UK are carriers of cystic fibrosis
One in 25
71
What is the pathophysiology of cystic fibrosis
mutation leading to abnormal ion transportation causes thick secretions
72
When is asthma diagnosed
Over the age of four
73
What kind of a condition as asthma
Reversible airway disease
74
What kind of variation does asthma have
Diurnal variation
75
What are asthma trigger symptoms
Exercise allergens cold weather stress emotion
76
What is atopy
Triad of asthma eczema and rhinitis
77
What changes do you get on a chest x-ray with asthma
Hyper inflated lung
78
What are the rules of 3 in regards to asthma
1/3 grow out of it 1/3 Improve on teens for it to return in adulthood One third have asthma throughout life
79
What is the acute management of asthma
``` Oxygen nebulised salbutamol Ipratroprium IV hydrocortisone IV magnesium sulphate ```
80
What is the chronic management of asthma
Avoid allergens, peak flow and symptom diary
81
What is stridor?
high-pitched, wheezing sound caused by disrupted airflow
82
What are the causes of stridor?
Croup, epiglottitis, anaphylaxis, laryngomalacia, foreign body inhalation, bacterial tracheitis, smoke inhalation, obstructive malignancy
83
What chest movement do you get with bronchiolitis
Laboured breathing, hyper inflated chest and chest recession
84
What do you get on percussion of bronchiolitis
Hyper resonant
85
What do you get on auscultation of bronchiolitis
Fine crackles and all zones | Wheeze may be present
86
What causes a wheeze?
Asthma Bronchiolitis Viral induced wheeze Pneumonia
87
What causes stridor
``` Croup Epiglottitis Bacterial tracheitis Diphtheria Laryngomalacia Inhaled foreign body Angioedema/ anaphylaxis ```
88
What are signs of respiratory distress?
``` Cyanosis Tracheal tug Subcostal/ intercostal recession Hypoxia Tachypnoea Wheeze on auscultation Stridor Head bobbing ```
89
Presentation of pneumonia
``` Cough Fever Tachypnoea Chest recession Nasal flaring Head bobbing Hypoxia Hypotension Confusion Shock ```
90
What is the most common cause of pneumonia
Streptococcus pneumonia
91
What do you see on a CXR for bronchiolitis
Broken ribs, flattened diaphragm and atelectasis
92
What is the treatment of croup ( laryngotraceo bronchitis)
Oral dexamethasone 0.15 mg/kg Oxygen Nebulised budesonide Nebulised Adrenalin
93
What is Nebulised budesonide | Nebulised Adrenalin
glucocorticoid, which exerts significant local anti-inflammatory effects.
94
What is laryngomalacia
larynx is soft and floppy and collapses during breathing due to abnormalities of the laryngeal cartilages.
95
What is the presentation of the laryngomalacia
6 month old infant had intermittent chronic stridor (when the larynx flops across the airway as the infant breathed in) which is made worse on feeding or crying . There are no other signs of respiratory distress
96
What are the causes of laryngomalacia
Part of the larynx above the vocal cords (supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction
97
What is the diagnostic test for laryngomalacia
Characteristic omega shape epiglottis on bronchoscopy
98
What is the management of laryngomalacia
Naturally resolved within 18 months
99
What is the presentation of whooping cough?
Child is coryzal Violently coughing so bad that it vomits and gasps for breath sometimes stops breathing turning blue Inspiratory whoop
100
What causes whooping cough
URTI 100 day cough Gram -ve coccobacilli Bordetella Pertussis
101
What is the diagnostic test for whooping cough?
Nasal pharynx swab | Anti pertussis immunoglobulin g
102
What is the treatment for whooping cough
Macrolides -azithromycin, erythromycin or clarithromycin | Complications bronchiectasis or pneumothorax
103
What causes CF
Autosomal recessive -CF transmembrane conductance regulatory gene on chromosome 7 Delta-F508 mutation Chloride channels
104
What are key signs and symptoms of CF
Thick pancreatic and biliary secretions - blockage of the ducts resulting in a lack of pancreatic enzymes Thick airway secretions - reduce clearance = bacterial colonisation Congenital bilateral absence of the vans deferens Meconium ileus Salty tasting baby Nasal polyps Finger clubbing Failure to thrive Foul smelling floating stools
105
Diagnosis of CF
Sweat test is golden standard | High chloride higher than 60mm/l
106
What bacteria are CF susceptible?
Staph aureus and pseudomanas
107
What drugs are indicated for a pseudomonas infection in CF?
Nebulised antibiotics | Tobramycin/oral ciprofloxacin
108
What drugs are indicated for a staph aureus infection in CF?
Prophylactic flucloxacillin
109
Management of CF
Chest physiotherapist/exercise, high calorie diet + CREON tablets, prophylactic flucloxacillin Vaccinations Bronchodilators Nebulised DNase dornase Alfa - breakdown DNA material in respiratory secretions, making secretions less viscous and easier to clear Nebulised hypertonic saline Fertility treatment involving testicular sperm extraction Genetic counselling

Phase 3A - Paediatrics (11 decks)

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