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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Forms of noisy breathing?

A

Stridor, wheeze, grunting, rattling, coughing, snoring

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2
Q

4 acute respiratory disorders in new borns?

A

Acute bronchiolitis, croup (epiglottitis), acute pneumoniae, acute asthma

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3
Q

Causative agent of acute bronchiolitis?

A

Viral - RSV, rhinovirus

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4
Q

Acute bronchiolitis starts and progresses?

A

URTI, head cold

Difficulty feeding, wheeze, breathless, crackles

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5
Q

Treatment of acute bronchiolitis?

A

O2, suction, NG tube/parental nutrition

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6
Q

What monoclonal antibody can be used to treat RSV infection?

A

Paliazumab

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7
Q

Classical symptoms of acute pneumoniae?

A 
Tachypnoea
Tachycardia
Fever
Cough
Grunting 
Increased work of breathing
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8
Q

2 causative agents of lobar pneumoniae?

A

Streptococcus pneumoniae

Haemophilus influenzae

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9
Q

Causative agent of bronchopneumoniae?

A

Viral - RSV

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10
Q

What antibiotic is usually given for pneumoniae?

A

Amoxicillin (PO/IV)

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11
Q

Another name for croup?

A

Laryngotracheobronchitis

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12
Q

What is the causative agent of croup?

A

Viral - parainfluenza

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13
Q

3 stages of croup development?

A

Runny nose, barking cough, stridor

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14
Q

Age bracket usually effected by croup

A

6 months - 2 years

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15
Q

Treatment of mild croup? What helps it?

A

none

Cold air contact

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16
Q

Treatment of moderate croup?

A

Nebulised budesonide or oral dexamethasone

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17
Q

Treatment of very severe croup?

A

PICU, intubation, nebulised adrenaline beforehand

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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

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19
Q

Management of children age 2-5 experiencing acute epiglottitis?

A

3rd generation cephalosporin, intubate, blood cultures

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20
Q

Acute asthma presentation?

A

Wheeze
tachypnoea
Indrawing
increased work of breathing

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21
Q

Less severe cases of acute asthma what is given for management?

A

Oxygen
Salbutamol nebuliser
Oral corticosteroids 3-5 day course

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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

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23
Q

Symptoms of obstructive sleep apnoea syndrome?

A

loud snoring, episodes of apnoea, sleepy in day, bad school performance

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24
Q

Causes of obstructive sleep apnoea? (2 syndrome)

A

Obese, large tonsils or adenoids, large tongue (downs syndrome), Hunters causes craniofacial abnormalities

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25
Q

Cardinal sign of chronic asthma?

A

Wheeze (also cough)

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26
Q

Atopic triad?

A

Asthma, hayfever, eczema

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27
Q

How do you determine if a child has asthma or non-atopic viral induced wheeze?

A

When they are well they dont have wheeze and they dont have wheeze at night time

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28
Q

Management of chronic asthma under the age of 5?

A

salbutamol reliever and a inhaled corticosteroid preventer

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29
Q

If chronic asthma is bad what can be added and how does this change if they are above 5 or below 5?

A

step up ICS
add a long acting beta agonist (above 5)
or add a leukotriene antagonist (below 5)

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30
Q

What is the recessive gene for CF?

A

delta F508

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31
Q

What channels are effected in CF?

A

sodium chloride

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32
Q

How can they test for CF easily?

A

Sweat test with Chloride content above 60mmol/L

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33
Q

What is the most common presentation of CF?

A

Meconium ileus
Chronic respiratory infections
Steatorrhoea
Recurrent pneumoniae

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34
Q

Management options for CF?

A

enzyme replacement therapy
nebulised DNAase
Antibiotics

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35
Q

Define bronchiectasis?

A

When the bronchial tubes of your lungs are permanently damaged, widened and thickened

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36
Q

What is a chronic supparative lung disease that can lead to bronchiectasis?

A

CF

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37
Q

Symptoms and signs of bronchiectasis?

A

chronic wet cough, recurrent pneumoniae, finger clubbing, failure to thrive

38
Q

If someone has bronchiectasis what needs to be ruled out? other causes>

A

CF

other causes: immune deficiency, cilia disorders, pulmonary aspiration neurodisability, GORD

39
Q

Investigations into bronchiectasis?

A

Bronchogram, CT, xray

40
Q

What equipment is found inside an emergency blue box tracheostomy change?

A

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
Q

Different colour aerochambers?

A

less than 1 = brown
1-6 = yellow
older children = blue

42
Q

MDI? powder inhaler? dry powder inhaler?

A

MDI = meter dose inhaler, chamber for young babies
Powder inhaler = mouth inhaler hold for 6 seconds
dry powder inhaler = turbohaler (whistles), salbutamol bronchodilator

43
Q

What can powder inhalers cause?

A

Oral thrush

44
Q

How does pneumoniae appear on CXR?

A

consolidation, ground glass

45
Q

How does round pneumoniae appear on x-ray?

A

pseudotumour

46
Q

How does miliary TB present on CXR?

A

numerous fine nodule throughout both lungs

47
Q

What can bronchiolitis be seen as on CXR?

A

overinflation due to air trapping, horizontal ribs, flattened diaphragm domes, perihilar bronchial wall thickening

48
Q

Features on x-ray of primary TB?

A

lymphadenopathy, cavitation, consolidation, small pleural effusions

49
Q

What may be seen on xrays of bronchiectasis?

A

mucus plugging, areas of lung collapse, dilated bronchi

50
Q

What is tram tracking on x-ray?

A

bronchial wall thickening and dilatation

51
Q

What is pneumopericardium a complication of in infants?

A

ventilation support in prematurity

52
Q

What is seen on xray of a child with infant respiratory distress syndrome?

A

air bronchogram, bilateral

53
Q

2 clues into oesophageal atresia/ tracheooesophageal fistula?

A

difficulty passing nasogastric tube or recurrent aspirations

54
Q

When does a foreign body inhalation cause collapse and when does it cause hyperinflation?

A

Collapse - complete obstruction

Hyperinflation - ball valve effect

55
Q

how much weight do babies initially lose and how long does it take to regain?

A

10% body weight regained in 2 weeks

56
Q

What does IRT stand for and what does an elevated level usually indicate?

A

immunoreactive trypsin level indicative of CF

57
Q

If IRT is positive on day 5 heel prick, when is it repeated?

A

Day 21

58
Q

If a child had 2 positive IRT scores, how can you confirm CF? what result is confirmatory?

A

Sweat test above 60mmol/l

59
Q

How are mutations classed in CF and what chromosome are they found on?

A

chromosome 7, classed 1-5 in severity (4/5 are mild)

60
Q

What organs are mainly effected by CF?

A

liver, lungs, gut, pancreas, vas deferens

61
Q

Why do babies with CF fail to thrive?

A

pancreas cannot secrete and therefore can’t break down and absorb

62
Q

How do you test for pancreatic insufficiency?

A

Stool - faecal elastase

Severe has less than 100mcg/g in a stool

63
Q

What is used to combat pancreatic insufficiency in children with CF?

A

enzyme replacement therapy (Creon)

64
Q

How many units of lipase/kg are needed for pancreativ insufficiency caused by CF

A

infant and young children = 15,000 U

Older children = 10,000 U

65
Q

What vitamins are fat soluble and therefore needed replacing in CF?

A

A, D, E, K

66
Q

What prophylaxis is given to CF patients? (2)

A

flucloxicillin, airway clearance

67
Q

Why is positioning used in young babies with CF?

A

to enhance ventilation and drain central secretions

68
Q

What methods can be used to dislodge secretions in the respiratory systems of young babies with CF?

A 
Positioning
Clapping
vibrations 
Bouncing at 3-6 months
Muscles from the upper body encouraged t beused from 3-6 months
69
Q

Why is prophylactic flucloxicillin given to babies with CF?

A

prevent staph aureus infection during lung maturation

70
Q

What does pulmozyme/dornase alpha do for CF patients?

A

When they have ongoing chronic inflammation and thick secretions
DNA from neutrophils creates stickiness
Pulmozyme cleaves the DNA and leaves secretions less viscous

71
Q

When swabbing the airway of someone with CF, which bacteria presence warrants aggressive treatment?

A

Pseudomas aeruginosa

72
Q

What is the treatment for pseudomonas aeruginosa?

A

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
Q

How early in pregnancy can couples know whether their child has CF?

A

Amniocentesis at 16 week (CVS at 10 weeks but high miscarriage)

74
Q

What are two key features on xray of bronchiectasis?

A

tram lines and ring shadows

75
Q

What is a major condition that 50% of CF patients develop by the age of 30?

A

CF related diabetes (CFRD)

76
Q

In CF patients who have developed diabetes, how often is their HbA1c, renal and eyes checked?

A

HbA1c measured every 3 months
Eyes checked every year in over 12s
Renal function checked yearly

77
Q

Why are CF patients encouraged not to mix with each other

A

Cross infection

78
Q

Ivacaftor is a CF drug reserved for what mutation?

A

G551D

79
Q

History taking in asthma clinic?

A 
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
Q

What should you ask about in PMH of asthma?

A 
Other conditions
Any atopic conditions?
URTI?
Obstetric history
Birthweight, gestation, perinatal problems
immunisations up to date
development milestones?
81
Q

Questions to ask about in social history of asthma?

A

whos at home
any pets
anyone smoke

82
Q

When examining the respiratory system what are you looking at about the child with asthma and about the system itself?

A

RR, work of breathing, wheeze, cyanosis, finger clubbing, chest deformities, accessory muscles, oxygen sats, trachea central, expansions, percussion, auscultation, apex beat location

83
Q

What is chlorphenamine?

A

antihistamine

84
Q

Name the commonly used leukotriene receptor antagonist in Asthma and dosage?

A

Montelukast 4mg OD

85
Q

Management plan to parents of children with asthma

A

clear written plan, good technique, they know what asthma is, triggers, symptom diary

86
Q

transient cardiac side effect of salbutamol?

A

Tachycardia

87
Q

When a child is admitted after an asthma attack, when must they be followed up after discharge? What else must be prepared before discharge?

A 
4 weeks
updated asthma plan
inhaler technique
asthma nurse review
review medications
88
Q

What is laryngomalacia? symptoms? treatment?

A

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
Q

What factors would make you worried about laryngomalacia?

A

Difficulty feeding
Collapse of chest wall
Blue spells
failure to gain weight

90
Q

How is laryngomalacia diagnosis confirmed?

A

fibre-optic laryngoscope

91
Q

How are mild, moderate and severe laryngomalacia managed? what procedure can be performed?

A

Mild moderate = observation in OP
severe = home monitoring
procedure = CO2 laser supraglottoplasty

92
Q

Vallecular cyst?

A

Cystic fullness at the back of the tongue and the epiglottis needing CO2 laser supraglottoplasty

Paediatrics (20 decks)

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