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Paediatrics for Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Name some differentials for a wheeze

A

bronchiolitis
toddler wheeze
asthma
foreign body

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2
Q

Name some differentials for stridor

A 
croup
epiglottitis 
laryngomalacia 
foreign body
anaphylaxis 
peritonsillar abscess
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3
Q

Name some differentials for a cough

A 
asthma 
infective 
post-nasal drip
GORD
habit 
CF
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4
Q

How does obstructive sleep apnoea present?

A
  • snoring
  • daytime sleepiness
  • headaches
  • dry, cracked lips

+/- repeated ENT infections if due to adenotonsilar hypertrophy

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5
Q

What are the causes of OSA and therefore the management?

A

Obesity = weight loss
Adenotonsilar hypertrophy = remove them
Craniofacial abnormalities = orthodontic/ maxillary surgery

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6
Q

How would CF present in a neonate?

A

Meconium ileus

  • delayed meconium
  • distension
  • bilious vomiting

Prolonged jaundice

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7
Q

What is distal intestinal obstruction syndrome?

A

Insufficient pancreatic enzymes + thick mucous leads to faecal obstruction in ileocecum

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8
Q

What are some signs and symptoms of CF?

A
  • nasal polyps
  • recurrent sinusitis
  • recurrent chest infections
  • DIOS
  • steatorhhoea
  • failure to thrive
  • osteoporosis
  • infertility in males
  • diabetes
  • liver disease and gallstones
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9
Q

Neonatal heel spot will be positive for what in CF?

A

immunoreactive trypsinogen

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10
Q

What can cause a false +ve sweat test?

A
  • malnutrition
  • G6PD
  • hypothyroid
  • adrenal insufficiency
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11
Q

What organisms commonly infect CF patients?

A
  • staph aureus
  • pseudomonas aeruginosa
  • burkholderia cepacia
  • aspergillus
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12
Q

What would the CXR of a CF patient show?

A
  • hyperinflated with flat diaphragm
  • nodules
  • bronchiectasis
  • pulmonary artery dilation
  • RV hypertrophy
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13
Q

How is CF managed?

A
  • chest physiotherapy
  • annual influenza vaccine
  • avoidance of other CF patients
  • mucolytics
  • fat soluble vitamins ADEK
  • creon (enzyme replacement)
  • high calorie intake
  • screening for diabetes and osteoporosis
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14
Q

How is asthma diagnosed under 5s?

A

clinical diagnosis

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15
Q

How is asthma diagnosed in 5-16 y/o?

What constitutes a positive result for these investigations?

A
  1. spirometry with bronchodilator reversibility giving >12% FEV1 improvement

If spirometry is normal or obstructive but <12% reversibility then….

  1. FeNO which is +ve if >35ppb
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16
Q

How is asthma managed in under 5s?

A
  1. SABA
  2. 8 week trial of moderate dose inhaled ICS
  • if no improvement then consider alternate diagnosis
  • if improves with trial but symptoms return on stopping then….
  1. SABA + low dose inhaled ICS
  2. SABA + low dose inhaled ICS + LTRA
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17
Q

How is asthma managed in 5-16 y/o?

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA (ditch LTRA)
  5. SABA + MART
  6. SABA + MART with moderate ICS
  7. Refer or theophylline or high dose ICS
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18
Q

Describe the features of a moderate asthma attack

A

Can talk
Sats >92%
Peak flow >50% predicted

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19
Q

Describe the features of a severe asthma attack

A 
Can't complete sentences 
Sats <92% 
Peak flow 33-50% predicted 
HR
>140 in 2-5 y/o
>125 in 5-16 y/o
RR
>40 in 2-5 y/o
>30 in 5-16 y/o
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20
Q

Describe the features of a life-threatening asthma attack

A 
Sats <92%
Peak flow <33% predicted
Silent chest 
Cyanosis 
Poor respiratory effort 
Hypotensive
21
Q

Describe the management of an acute asthma attack

A

SABA (can be via spacer if mild/moderate)
Prednisolone

+/- ipratropium bromide
+/- magnesium sulphate

22
Q

What investigations might you do to investigate pneumonia?

A

Sputum sample
Nasopharyngeal aspirate
Blood cultures
CXR

23
Q

How is pneumonia managed? How is this different if mycoplasma or chlamydia are the suspected causative organism?

A

Amoxicillin

Erythromycin

24
Q

What causes bronchiolitis?

A

RSV leading to increased mucous production and bronchiolar inflammation and obstruction

25
Q

At what age and how does bronchiolitis present?

A

<2 but commonly 3-6 months

  • Few days of coryza
  • Dry cough
  • Wheeze and crackles
  • Tachypnoea
  • Recession
26
Q

How is bronchiolitis managed?

A

Supportive management

  • oxygen
  • NG feeds

+/- Ribavirin

+ prophylactic Palivizumab in at risk

27
Q

How is pre-school wheeze managed?

A

SABA 10 puffs 30 seconds apart

28
Q

What causes croup?

A

Parainfluenza leads to subglottal inflammation and oedema

29
Q

How does croup present?

A 
Few days of coryzal 
Symptoms worse at night: 
- Barking cough
- Hoarse voice 
- Stridor
30
Q

How is croup managed?

A

Single dose of oral dexamethasone
O2
Nebulised adrenaline

31
Q

What causes epiglottitis?

A

Haemophilus influenza B

32
Q

How does epiglottitis present?

A
  • Sore throat
  • Drooling
  • Hot potato voice
  • Systemically unwell
  • Neck hyperextended to open airway
33
Q

Compare an effective vs an ineffective cough

A

Effective: loud, breath in between, responsive and alert

Ineffective: quite/silent cough, no breaths in between, unable to vocalise, cyanosed

34
Q

What could you see on a CXR of a child who inhaled a foreign body?

A
  • Visualise the FB (often R main bronchus)
  • Hyperinflated lung on expiratory CXR (trapped air can’t escape)
  • Lobar collapse
35
Q

What is laryngomalacia and how does it present?

A

Cartilage problem leading to a soft, floppy larynx

  • Stridor worse when supine
  • Noisy breathing
36
Q

What is subglottic stenosis and how does it present?

A

Narrowing of the subglottic airway due to malformed cricoid cartilage
Presentation depends on severity
- Biphasic stridor
- Hoarse weak voice

37
Q

What organism commonly causes tonsilitis?

A

EBV

Streptococcus pyogenes

38
Q

When would you give abx in tonsillitis?

What abx would you give?

A 
>3 Centor criteria fulfilled: 
Tonsillar exudate
No cough
Fever >38
Tender anterior cervical lymphadenopathy

Phenoxymethylpenicillin

39
Q

What are the indications for a tonsillectomy?

A

7 in 1 year
5 in 2 years
3 in 3 years
Each episode should be disabling and prevent normal functioning

40
Q

What organism causes whooping cough?

A

Bordetella pertussis

41
Q

How does whooping cough present?

A 
Few days of coryzal prodrome 
Characteristic cough lasting >14 days
- Dry hacking coughing bout 
- Inhalational whoop
- post cough vomit 
- can gasp, flail arms, go red, eyes water etc
42
Q

How can whooping cough present in infants?

A

Apnoea

43
Q

When would you give abx in whooping cough and what abx would you give?

A

If present within 21 days of cough

Give Azithromycin to whole family

44
Q

What are the complications of whooping cough?

A 
Conjunctival haemorrhage 
Pneumonia 
Hernias and prolapse (high intra-abdo pressure)
Apnoea 
Seizures
45
Q

What are the school exclusion criteria surrounding whooping cough?

A

48 hours after starting abx

46
Q

What is transient tachypnoea of the newborn?

A

increased fluid in the lungs due to reduced mechanical squeeze and reduced lymphatic removal

47
Q

How does TTN present?

A

Within hours of birth:

  • Tachypnoea
  • Distress
  • Increased O2 requirements
48
Q

What does the CXR of TTN show?

A

Peri-hilar streaking indicating interstitial oedema
Prominent pulmonary vasculature
Fluid in horizontal fissure
Hyperexpanded

Paediatrics for Finals (11 decks)

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