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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
Q

What is stridor

A

He

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26
Q

What are signs of respiratory distress?

A 
Cyanosis
Tracheal tug 
Subcostal/intercostal recessions
Hypoxia, tachypnoea
Wheeze on auscultation
Stridor 
Head bobbing
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27
Q

Presentation of pneumonia

A 
Cough
Fever
Tachypnoea 
Chest recession
Nasal flaring 
Head bobbing
Hypoxia
Hypotension
Confusion 
Shock
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28
Q

What is the most common causative agent of pneumonia

A

Streptococcus pneumonia

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29
Q

What is the causative agent of pneumonia in pre vaccinated infants neonates

A

Group B strep

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30
Q

What causative agent of pneumonia has CXR finding of pneumatocoeles and consolidation in multiple lobes

A

Staphylococcus aureus

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31
Q

What is the causative agent of pneumonia in pre vaccinated children

A

Haemophilus influenza

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32
Q

What is the causative agent of pneumonia can children develop erythema multiforme

A

Mycoplasma pneumonia

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33
Q

What is the most causative agent of viral pneumonia

A

RSV

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34
Q

What tests do you do for pneumonia

A 
CXR
Blood cultures and sensitivities
FBC
Throat swabs for bacterial cultures and viral PCR
Capillary blood gas
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35
Q

What treatments for the pneumonia of neonates

A

IV broad spectrum abx

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36
Q

What treatment for pneumonia in older children?

A

1st line - amoxicillin

2nd line - erythromycin

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37
Q

What abx should you add with pneumonia with influenza

A

Co amoxiclav

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38
Q

What abx treatment for mycoplasma pneumonia

A

Erythromycin

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39
Q

What is the presentation of acute asthma attack

A 
Progressively worsening shortness of breath
Signs of respiratory distress
Tachypnoea
Expiratory wheeze 
Reduced air entry
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40
Q

What is the SpO2 of a moderate asthma attack

A

SpO2 > 92

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41
Q

What is the SpO2 of a severe asthma attack

A

SpO2 < 92

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42
Q

Features of a severe asthma attack

A

Too breathless to talk or feed
Heart rate > 140/min
Respiratory rate > 40/min
Use of accessory muscles

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43
Q

Features of a life threatening asthma attack

A 
SpO2< 92%
Silent chest
Poor respiratory effort
Agitation 
Altered consciousness 
Cyanosis
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44
Q

Treatment of an asthma attack

A
  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
Q

What is salbutamol?

A

short-acting, selective beta2-adrenergic receptor

46
Q

What are side effects of salbutamol?

A

Tachycardia
Hypokalaemia
Tremor

47
Q

What is the atopic triad

A

Asthma, eczema, hay fever and food allergies

48
Q

Management of chronic asthma in under 5 yrs old

A
  1. SABA - salbutamol
  2. Add lose dose corticosteroid inhaler
  3. Add leukotriene receptor antagonist- oral montelukast
49
Q

Managing chronic asthma in 5 - 12 yr olds

A
  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
Q

Signs and symptoms of anaphylaxis

A

Urticaria, itching, swelling of lips, tongue, eyes (angioedema), wheeze, stridor, shortness of breath, tachycardia, abdo pain, collapse, hypotension

51
Q

Treatment of anaphylaxis

A 
ABCDE
Oxygen
IV fluids
IM adrenaline 
Hydrocortisone IV
Antihistamines
52
Q

Presentation of viral induced wheeze

A

A 2 yr old presents with cold like symptoms
Fever
Runny nose
Expiratory wheeze

53
Q

What causes a viral induced wheeze

A

RSV, inflammation and oedema leads to narrowing and a restriction in airflow leading to a wheeze

54
Q

Key signs and symptoms of viral induced wheeze

A

Presenting < 3 years of age
No atopic history
Only occurs during viral infection

55
Q

Treatment of viral induced wheeze

A

Supplementary oxygen
Salbutamol and ICS
montelukast

56
Q

What is bronchiolitis

A

Inflammatory respiratory condition. It’s caused by a virus that affects the smallest air passages in the lungs (bronchioles).

57
Q

Most common cause of bronchiolitis

A

RSV

58
Q

Key signs and symptoms of bronchiolitis

A 
Coryzal symptoms 
Signs of respiratory distress 
Apnoea
Poor feeding 
Wheeze + inspiratory crackles = bronchiolitic
59
Q

What is the pathophysiology Of bronchiolitis

A

Mucus production and inflammation results in narrowing and alveoli collapse

60
Q

How do you diagnose bronchiolitis

A

Nasal swabs,

61
Q

What is the presentation of

Croup?

A

Barking cough in autumn

children between six months to 6 years old stridor

62
Q

What is the cause of croup

A

Para influenza virus and an upper respiratory tract infection oedema in the larynx

63
Q

What is the presentation of a epiglottitis

A 
Very unwell 
Drooling
Inspiratory stridor 
Made better by sitting upright and leaning forward
Dysphagia 
Beefy red stuff oedematous epiglottis
Thumb sign
64
Q

Treatment of epiglottitis

A

ENT immediately
IV cefotriaxone and dexamethasone
Blood culture and close contact prophylaxis with rifampicin

65
Q

What is bronchitis

A

Inflammation of the Bronchi

66
Q

What is the presentation of bronchitis

A

Cough
Fever
Wheeze

67
Q

How long does bronchitis last

A

2 weeks

68
Q

What is whopping cough

A

A highly infectious form of bronchitis with bordetella pertussis

69
Q

What form of inheritance the cystic fibrosis have

A

Autosomal recessive inheritance gene on chromosome seven codes for CFTR

70
Q

How many people in the UK are carriers of cystic fibrosis

A

One in 25

71
Q

What is the pathophysiology of cystic fibrosis

A

mutation leading to abnormal ion transportation causes thick secretions

72
Q

When is asthma diagnosed

A

Over the age of four

73
Q

What kind of a condition as asthma

A

Reversible airway disease

74
Q

What kind of variation does asthma have

A

Diurnal variation

75
Q

What are asthma trigger symptoms

A

Exercise allergens cold weather stress emotion

76
Q

What is atopy

A

Triad of asthma eczema and rhinitis

77
Q

What changes do you get on a chest x-ray with asthma

A

Hyper inflated lung

78
Q

What are the rules of 3 in regards to asthma

A

1/3 grow out of it
1/3 Improve on teens for it to return in adulthood
One third have asthma throughout life

79
Q

What is the acute management of asthma

A 
Oxygen 
nebulised salbutamol 
Ipratroprium
 IV hydrocortisone
IV magnesium sulphate
80
Q

What is the chronic management of asthma

A

Avoid allergens, peak flow and symptom diary

81
Q

What is stridor?

A

high-pitched, wheezing sound caused by disrupted airflow

82
Q

What are the causes of stridor?

A

Croup, epiglottitis, anaphylaxis, laryngomalacia, foreign body inhalation, bacterial tracheitis, smoke inhalation, obstructive malignancy

83
Q

What chest movement do you get with bronchiolitis

A

Laboured breathing, hyper inflated chest and chest recession

84
Q

What do you get on percussion of bronchiolitis

A

Hyper resonant

85
Q

What do you get on auscultation of bronchiolitis

A

Fine crackles and all zones

Wheeze may be present

86
Q

What causes a wheeze?

A

Asthma
Bronchiolitis
Viral induced wheeze
Pneumonia

87
Q

What causes stridor

A 
Croup
Epiglottitis 
Bacterial tracheitis
Diphtheria
Laryngomalacia 
Inhaled foreign body
Angioedema/ anaphylaxis
88
Q

What are signs of respiratory distress?

A 
Cyanosis 
Tracheal tug
Subcostal/ intercostal recession
Hypoxia
Tachypnoea 
Wheeze on auscultation 
Stridor 
Head bobbing
89
Q

Presentation of pneumonia

A 
Cough
Fever
Tachypnoea 
Chest recession
Nasal flaring 
Head bobbing 
Hypoxia 
Hypotension 
Confusion 
Shock
90
Q

What is the most common cause of pneumonia

A

Streptococcus pneumonia

91
Q

What do you see on a CXR for bronchiolitis

A

Broken ribs, flattened diaphragm and atelectasis

92
Q

What is the treatment of croup ( laryngotraceo bronchitis)

A

Oral dexamethasone 0.15 mg/kg
Oxygen
Nebulised budesonide
Nebulised Adrenalin

93
Q

What is Nebulised budesonide

Nebulised Adrenalin

A

glucocorticoid, which exerts significant local anti-inflammatory effects.

94
Q

What is laryngomalacia

A

larynx is soft and floppy and collapses during breathing due to abnormalities of the laryngeal cartilages.

95
Q

What is the presentation of the laryngomalacia

A

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
Q

What are the causes of laryngomalacia

A

Part of the larynx above the vocal cords (supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction

97
Q

What is the diagnostic test for laryngomalacia

A

Characteristic omega shape epiglottis on bronchoscopy

98
Q

What is the management of laryngomalacia

A

Naturally resolved within 18 months

99
Q

What is the presentation of whooping cough?

A

Child is coryzal
Violently coughing so bad that it vomits and gasps for breath sometimes stops breathing turning blue
Inspiratory whoop

100
Q

What causes whooping cough

A

URTI
100 day cough
Gram -ve coccobacilli Bordetella Pertussis

101
Q

What is the diagnostic test for whooping cough?

A

Nasal pharynx swab

Anti pertussis immunoglobulin g

102
Q

What is the treatment for whooping cough

A

Macrolides -azithromycin, erythromycin or clarithromycin

Complications bronchiectasis or pneumothorax

103
Q

What causes CF

A

Autosomal recessive -CF transmembrane conductance regulatory gene on chromosome 7
Delta-F508 mutation
Chloride channels

104
Q

What are key signs and symptoms of CF

A

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
Q

Diagnosis of CF

A

Sweat test is golden standard

High chloride higher than 60mm/l

106
Q

What bacteria are CF susceptible?

A

Staph aureus and pseudomanas

107
Q

What drugs are indicated for a pseudomonas infection in CF?

A

Nebulised antibiotics

Tobramycin/oral ciprofloxacin

108
Q

What drugs are indicated for a staph aureus infection in CF?

A

Prophylactic flucloxacillin

109
Q

Management of CF

A

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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