Respiratory Flashcards
Forms of noisy breathing?
Stridor, wheeze, grunting, rattling, coughing, snoring
4 acute respiratory disorders in new borns?
Acute bronchiolitis, croup (epiglottitis), acute pneumoniae, acute asthma
Causative agent of acute bronchiolitis?
Viral - RSV, rhinovirus
Acute bronchiolitis starts and progresses?
URTI, head cold
Difficulty feeding, wheeze, breathless, crackles
Treatment of acute bronchiolitis?
O2, suction, NG tube/parental nutrition
What monoclonal antibody can be used to treat RSV infection?
Paliazumab
Classical symptoms of acute pneumoniae?
Tachypnoea Tachycardia Fever Cough Grunting Increased work of breathing
2 causative agents of lobar pneumoniae?
Streptococcus pneumoniae
Haemophilus influenzae
Causative agent of bronchopneumoniae?
Viral - RSV
What antibiotic is usually given for pneumoniae?
Amoxicillin (PO/IV)
Another name for croup?
Laryngotracheobronchitis
What is the causative agent of croup?
Viral - parainfluenza
3 stages of croup development?
Runny nose, barking cough, stridor
Age bracket usually effected by croup
6 months - 2 years
Treatment of mild croup? What helps it?
none
Cold air contact
Treatment of moderate croup?
Nebulised budesonide or oral dexamethasone
Treatment of very severe croup?
PICU, intubation, nebulised adrenaline beforehand
If epiglottitis is present in infant older than 2 years old what is the causative agent most likely to be?
Typical development and diff to croup?
Haemophilis influenzae B
4-6 hours, fever, sore throat, no cough, lower pitched stridor
Management of children age 2-5 experiencing acute epiglottitis?
3rd generation cephalosporin, intubate, blood cultures
Acute asthma presentation?
Wheeze
tachypnoea
Indrawing
increased work of breathing
Less severe cases of acute asthma what is given for management?
Oxygen
Salbutamol nebuliser
Oral corticosteroids 3-5 day course
More severe cases of acute asthma are given what management options?
Oxygen
IV steroids
Back to back nebulisers salbutamol and ipratropium bromide
IV salbutamol
Aminophylline
MgSO4
Symptoms of obstructive sleep apnoea syndrome?
loud snoring, episodes of apnoea, sleepy in day, bad school performance
Causes of obstructive sleep apnoea? (2 syndrome)
Obese, large tonsils or adenoids, large tongue (downs syndrome), Hunters causes craniofacial abnormalities
Cardinal sign of chronic asthma?
Wheeze (also cough)
Atopic triad?
Asthma, hayfever, eczema
How do you determine if a child has asthma or non-atopic viral induced wheeze?
When they are well they dont have wheeze and they dont have wheeze at night time
Management of chronic asthma under the age of 5?
salbutamol reliever and a inhaled corticosteroid preventer
If chronic asthma is bad what can be added and how does this change if they are above 5 or below 5?
step up ICS
add a long acting beta agonist (above 5)
or add a leukotriene antagonist (below 5)
What is the recessive gene for CF?
delta F508
What channels are effected in CF?
sodium chloride
How can they test for CF easily?
Sweat test with Chloride content above 60mmol/L
What is the most common presentation of CF?
Meconium ileus
Chronic respiratory infections
Steatorrhoea
Recurrent pneumoniae
Management options for CF?
enzyme replacement therapy
nebulised DNAase
Antibiotics
Define bronchiectasis?
When the bronchial tubes of your lungs are permanently damaged, widened and thickened
What is a chronic supparative lung disease that can lead to bronchiectasis?
CF
Symptoms and signs of bronchiectasis?
chronic wet cough, recurrent pneumoniae, finger clubbing, failure to thrive
If someone has bronchiectasis what needs to be ruled out? other causes>
CF
other causes: immune deficiency, cilia disorders, pulmonary aspiration neurodisability, GORD
Investigations into bronchiectasis?
Bronchogram, CT, xray
What equipment is found inside an emergency blue box tracheostomy change?
suction catheter and a trachestomy tube
also need gel and saline suction tube syringe and ribbon ties and oxygen bag that can fit tracheostomy
Different colour aerochambers?
less than 1 = brown
1-6 = yellow
older children = blue
MDI? powder inhaler? dry powder inhaler?
MDI = meter dose inhaler, chamber for young babies
Powder inhaler = mouth inhaler hold for 6 seconds
dry powder inhaler = turbohaler (whistles), salbutamol bronchodilator
What can powder inhalers cause?
Oral thrush
How does pneumoniae appear on CXR?
consolidation, ground glass
How does round pneumoniae appear on x-ray?
pseudotumour
How does miliary TB present on CXR?
numerous fine nodule throughout both lungs
What can bronchiolitis be seen as on CXR?
overinflation due to air trapping, horizontal ribs, flattened diaphragm domes, perihilar bronchial wall thickening
Features on x-ray of primary TB?
lymphadenopathy, cavitation, consolidation, small pleural effusions
What may be seen on xrays of bronchiectasis?
mucus plugging, areas of lung collapse, dilated bronchi
What is tram tracking on x-ray?
bronchial wall thickening and dilatation
What is pneumopericardium a complication of in infants?
ventilation support in prematurity
What is seen on xray of a child with infant respiratory distress syndrome?
air bronchogram, bilateral
2 clues into oesophageal atresia/ tracheooesophageal fistula?
difficulty passing nasogastric tube or recurrent aspirations
When does a foreign body inhalation cause collapse and when does it cause hyperinflation?
Collapse - complete obstruction
Hyperinflation - ball valve effect
how much weight do babies initially lose and how long does it take to regain?
10% body weight regained in 2 weeks
What does IRT stand for and what does an elevated level usually indicate?
immunoreactive trypsin level indicative of CF
If IRT is positive on day 5 heel prick, when is it repeated?
Day 21
If a child had 2 positive IRT scores, how can you confirm CF? what result is confirmatory?
Sweat test above 60mmol/l
How are mutations classed in CF and what chromosome are they found on?
chromosome 7, classed 1-5 in severity (4/5 are mild)
What organs are mainly effected by CF?
liver, lungs, gut, pancreas, vas deferens
Why do babies with CF fail to thrive?
pancreas cannot secrete and therefore can’t break down and absorb
How do you test for pancreatic insufficiency?
Stool - faecal elastase
Severe has less than 100mcg/g in a stool
What is used to combat pancreatic insufficiency in children with CF?
enzyme replacement therapy (Creon)
How many units of lipase/kg are needed for pancreativ insufficiency caused by CF
infant and young children = 15,000 U
Older children = 10,000 U
What vitamins are fat soluble and therefore needed replacing in CF?
A, D, E, K
What prophylaxis is given to CF patients? (2)
flucloxicillin, airway clearance
Why is positioning used in young babies with CF?
to enhance ventilation and drain central secretions
What methods can be used to dislodge secretions in the respiratory systems of young babies with CF?
Positioning Clapping vibrations Bouncing at 3-6 months Muscles from the upper body encouraged t beused from 3-6 months
Why is prophylactic flucloxicillin given to babies with CF?
prevent staph aureus infection during lung maturation
What does pulmozyme/dornase alpha do for CF patients?
When they have ongoing chronic inflammation and thick secretions
DNA from neutrophils creates stickiness
Pulmozyme cleaves the DNA and leaves secretions less viscous
When swabbing the airway of someone with CF, which bacteria presence warrants aggressive treatment?
Pseudomas aeruginosa
What is the treatment for pseudomonas aeruginosa?
Oral Ciproxin BD 40mg/kg/day plus nebulised colomycin (under 12 years old 1MU BD, over 12 years old 2MU BD) for 3 months
Nebulized Tobramycin 300mg BD for 1-2 months
How early in pregnancy can couples know whether their child has CF?
Amniocentesis at 16 week (CVS at 10 weeks but high miscarriage)
What are two key features on xray of bronchiectasis?
tram lines and ring shadows
What is a major condition that 50% of CF patients develop by the age of 30?
CF related diabetes (CFRD)
In CF patients who have developed diabetes, how often is their HbA1c, renal and eyes checked?
HbA1c measured every 3 months
Eyes checked every year in over 12s
Renal function checked yearly
Why are CF patients encouraged not to mix with each other
Cross infection
Ivacaftor is a CF drug reserved for what mutation?
G551D
History taking in asthma clinic?
What symptoms are troubling? How frequently are you getting these symptoms? Any SOB/ wheeze/ cough? Exercise tolerance? Taking medication correctly how often using reliever? triggers for asthma? Control of asthma recently? any hospital admissions? Night symptoms? Any recent antibiotics? steroids?
What should you ask about in PMH of asthma?
Other conditions Any atopic conditions? URTI? Obstetric history Birthweight, gestation, perinatal problems immunisations up to date development milestones?
Questions to ask about in social history of asthma?
whos at home
any pets
anyone smoke
When examining the respiratory system what are you looking at about the child with asthma and about the system itself?
RR, work of breathing, wheeze, cyanosis, finger clubbing, chest deformities, accessory muscles, oxygen sats, trachea central, expansions, percussion, auscultation, apex beat location
What is chlorphenamine?
antihistamine
Name the commonly used leukotriene receptor antagonist in Asthma and dosage?
Montelukast 4mg OD
Management plan to parents of children with asthma
clear written plan, good technique, they know what asthma is, triggers, symptom diary
transient cardiac side effect of salbutamol?
Tachycardia
When a child is admitted after an asthma attack, when must they be followed up after discharge? What else must be prepared before discharge?
4 weeks updated asthma plan inhaler technique asthma nurse review review medications
What is laryngomalacia? symptoms? treatment?
Laryngomalacia = softening of the larynx tissues
squeaky inspiratory breathing worse lying down, feeding in first few weeks of life and becomes increasingly louder to peak at 3-6 months
Resolves spontaneously at 12-18 months
What factors would make you worried about laryngomalacia?
Difficulty feeding
Collapse of chest wall
Blue spells
failure to gain weight
How is laryngomalacia diagnosis confirmed?
fibre-optic laryngoscope
How are mild, moderate and severe laryngomalacia managed? what procedure can be performed?
Mild moderate = observation in OP
severe = home monitoring
procedure = CO2 laser supraglottoplasty
Vallecular cyst?
Cystic fullness at the back of the tongue and the epiglottis needing CO2 laser supraglottoplasty
