Respiratory Flashcards
1
Q
Forms of noisy breathing?
A
Stridor, wheeze, grunting, rattling, coughing, snoring
2
Q
4 acute respiratory disorders in new borns?
A
Acute bronchiolitis, croup (epiglottitis), acute pneumoniae, acute asthma
3
Q
Causative agent of acute bronchiolitis?
A
Viral - RSV, rhinovirus
4
Q
Acute bronchiolitis starts and progresses?
A
URTI, head cold
Difficulty feeding, wheeze, breathless, crackles
5
Q
Treatment of acute bronchiolitis?
A
O2, suction, NG tube/parental nutrition
6
Q
What monoclonal antibody can be used to treat RSV infection?
A
Paliazumab
7
Q
Classical symptoms of acute pneumoniae?
A
Tachypnoea Tachycardia Fever Cough Grunting Increased work of breathing
8
Q
2 causative agents of lobar pneumoniae?
A
Streptococcus pneumoniae
Haemophilus influenzae
9
Q
Causative agent of bronchopneumoniae?
A
Viral - RSV
10
Q
What antibiotic is usually given for pneumoniae?
A
Amoxicillin (PO/IV)
11
Q
Another name for croup?
A
Laryngotracheobronchitis
12
Q
What is the causative agent of croup?
A
Viral - parainfluenza
13
Q
3 stages of croup development?
A
Runny nose, barking cough, stridor
14
Q
Age bracket usually effected by croup
A
6 months - 2 years
15
Q
Treatment of mild croup? What helps it?
A
none
Cold air contact
16
Q
Treatment of moderate croup?
A
Nebulised budesonide or oral dexamethasone
17
Q
Treatment of very severe croup?
A
PICU, intubation, nebulised adrenaline beforehand
18
Q
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?
A
Haemophilis influenzae B
4-6 hours, fever, sore throat, no cough, lower pitched stridor
19
Q
Management of children age 2-5 experiencing acute epiglottitis?
A
3rd generation cephalosporin, intubate, blood cultures
20
Q
Acute asthma presentation?
A
Wheeze
tachypnoea
Indrawing
increased work of breathing
21
Q
Less severe cases of acute asthma what is given for management?
A
Oxygen
Salbutamol nebuliser
Oral corticosteroids 3-5 day course
22
Q
More severe cases of acute asthma are given what management options?
A
Oxygen
IV steroids
Back to back nebulisers salbutamol and ipratropium bromide
IV salbutamol
Aminophylline
MgSO4
23
Q
Symptoms of obstructive sleep apnoea syndrome?
A
loud snoring, episodes of apnoea, sleepy in day, bad school performance
24
Q
Causes of obstructive sleep apnoea? (2 syndrome)
A
Obese, large tonsils or adenoids, large tongue (downs syndrome), Hunters causes craniofacial abnormalities
25
Cardinal sign of chronic asthma?
Wheeze (also cough)
26
Atopic triad?
Asthma, hayfever, eczema
27
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
28
Management of chronic asthma under the age of 5?
salbutamol reliever and a inhaled corticosteroid preventer
29
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)
30
What is the recessive gene for CF?
delta F508
31
What channels are effected in CF?
sodium chloride
32
How can they test for CF easily?
Sweat test with Chloride content above 60mmol/L
33
What is the most common presentation of CF?
Meconium ileus
Chronic respiratory infections
Steatorrhoea
Recurrent pneumoniae
34
Management options for CF?
enzyme replacement therapy
nebulised DNAase
Antibiotics
35
Define bronchiectasis?
When the bronchial tubes of your lungs are permanently damaged, widened and thickened
36
What is a chronic supparative lung disease that can lead to bronchiectasis?
CF
37
Symptoms and signs of bronchiectasis?
chronic wet cough, recurrent pneumoniae, finger clubbing, failure to thrive
38
If someone has bronchiectasis what needs to be ruled out? other causes>
CF
| other causes: immune deficiency, cilia disorders, pulmonary aspiration neurodisability, GORD
39
Investigations into bronchiectasis?
Bronchogram, CT, xray
40
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
41
Different colour aerochambers?
less than 1 = brown
1-6 = yellow
older children = blue
42
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
43
What can powder inhalers cause?
Oral thrush
44
How does pneumoniae appear on CXR?
consolidation, ground glass
45
How does round pneumoniae appear on x-ray?
pseudotumour
46
How does miliary TB present on CXR?
numerous fine nodule throughout both lungs
47
What can bronchiolitis be seen as on CXR?
overinflation due to air trapping, horizontal ribs, flattened diaphragm domes, perihilar bronchial wall thickening
48
Features on x-ray of primary TB?
lymphadenopathy, cavitation, consolidation, small pleural effusions
49
What may be seen on xrays of bronchiectasis?
mucus plugging, areas of lung collapse, dilated bronchi
50
What is tram tracking on x-ray?
bronchial wall thickening and dilatation
51
What is pneumopericardium a complication of in infants?
ventilation support in prematurity
52
What is seen on xray of a child with infant respiratory distress syndrome?
air bronchogram, bilateral
53
2 clues into oesophageal atresia/ tracheooesophageal fistula?
difficulty passing nasogastric tube or recurrent aspirations
54
When does a foreign body inhalation cause collapse and when does it cause hyperinflation?
Collapse - complete obstruction
| Hyperinflation - ball valve effect
55
how much weight do babies initially lose and how long does it take to regain?
10% body weight regained in 2 weeks
56
What does IRT stand for and what does an elevated level usually indicate?
immunoreactive trypsin level indicative of CF
57
If IRT is positive on day 5 heel prick, when is it repeated?
Day 21
58
If a child had 2 positive IRT scores, how can you confirm CF? what result is confirmatory?
Sweat test above 60mmol/l
59
How are mutations classed in CF and what chromosome are they found on?
chromosome 7, classed 1-5 in severity (4/5 are mild)
60
What organs are mainly effected by CF?
liver, lungs, gut, pancreas, vas deferens
61
Why do babies with CF fail to thrive?
pancreas cannot secrete and therefore can't break down and absorb
62
How do you test for pancreatic insufficiency?
Stool - faecal elastase
| Severe has less than 100mcg/g in a stool
63
What is used to combat pancreatic insufficiency in children with CF?
enzyme replacement therapy (Creon)
64
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
65
What vitamins are fat soluble and therefore needed replacing in CF?
A, D, E, K
66
What prophylaxis is given to CF patients? (2)
flucloxicillin, airway clearance
67
Why is positioning used in young babies with CF?
to enhance ventilation and drain central secretions
68
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
```
69
Why is prophylactic flucloxicillin given to babies with CF?
prevent staph aureus infection during lung maturation
70
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
71
When swabbing the airway of someone with CF, which bacteria presence warrants aggressive treatment?
Pseudomas aeruginosa
72
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
73
How early in pregnancy can couples know whether their child has CF?
Amniocentesis at 16 week (CVS at 10 weeks but high miscarriage)
74
What are two key features on xray of bronchiectasis?
tram lines and ring shadows
75
What is a major condition that 50% of CF patients develop by the age of 30?
CF related diabetes (CFRD)
76
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
77
Why are CF patients encouraged not to mix with each other
Cross infection
78
Ivacaftor is a CF drug reserved for what mutation?
G551D
79
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?
```
80
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?
```
81
Questions to ask about in social history of asthma?
whos at home
any pets
anyone smoke
82
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
83
What is chlorphenamine?
antihistamine
84
Name the commonly used leukotriene receptor antagonist in Asthma and dosage?
Montelukast 4mg OD
85
Management plan to parents of children with asthma
clear written plan, good technique, they know what asthma is, triggers, symptom diary
86
transient cardiac side effect of salbutamol?
Tachycardia
87
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
```
88
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
89
What factors would make you worried about laryngomalacia?
Difficulty feeding
Collapse of chest wall
Blue spells
failure to gain weight
90
How is laryngomalacia diagnosis confirmed?
fibre-optic laryngoscope
91
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
92
Vallecular cyst?
Cystic fullness at the back of the tongue and the epiglottis needing CO2 laser supraglottoplasty
