Respiratory Conditions Flashcards
Which gene is defective in cystic fibrosis?
The cystic fibrosis transmembrane regulator gene on chromosome 7
How common is cystic fibrosis in Caucasians?
1 in 2500 live births, carrier rate 1 in 25
True / False - Testing for cystic fibrosis is routinely done as part of the newborn heel-prick test?
True
Which age group is most commonly affected by bronchiolitis?
0-9 months. It is rare after 1 year.
Which organism causes over 80% of cases of bronchiolitis?
Respiratory syncytial virus
What is the treatment for bronchiolitis?
Supportive - keep hydrated and maintain saturations with humidified oxygen. CPAP or ventilation only required in a very small number of severe cases.
What might be given to high-risk, pre-term infants to reduce their risk of hospital admission from bronchiolitis?
Monoclonal antibody to RSV (palivizumab) given monthly by IM injection
What are the classical symptoms of croup?
Barking cough
Stridor
Which virus causes croup?
Parainfluenza virus
True / False: A throat examination should be performed on a child with croup to check for exudates on the tonsils
FALSE - It’s important not to distress a child with croup as this can make it much worse so NEVER look in their throat
What is the management of croup?
- Do not distress the child
- Humidified oxygen
- Oral steroids (dexamethasone)
- Nebulised budesonide
- Nebulised adrenaline may be required
- Intubation in extremis (about 2% of children)
Which organism causes acute epiglottitis?
Haemophilus influenza B
True / False: Whooping cough (pertussis) is highly infectious
True
What age group are affected by croup?
6 months to 6 years
Which organisms are responsible for causing pneumonia throughout childhood?
Neonate = Group B streptococcus Infancy = Viral infection especially RSV Childhood = Strep. pneumoniae, mycoplasma pnemonia, haemophilus influenza
True / False: Asthma causes clubbing
False
When should a patient with chronic asthma be advised to check their peak flow?
At least morning and evening, and preferably again during the day as well
What sort of picture on a peak flow diary would indicate an asthmatic patient?
Variability of >20% between morning and evening readings on 3 or more days of the week for 2 weeks
What is the most common chronic respiratory disorder in children?
Asthma
What is the nature of the wheeze in asthma?
Widespread, polyphonic
In asthmatics, are peak flow values generally lower in the morning or in the evening?
Morning
What is the step-wise approach to asthma management in children?
1) Short-acting beta-2 agonist
2) Add inhaled steroid e.g. beclametasone 200ug daily
* **Before proceeding to step 3, check inhaler technique and ensure correct diagnosis
3) Add long-acting beta-2 agonist e.g. Salmeterol…if this works but still symptomatic, continue LABA but increase steroid to 400ug daily. If no response from LABA, stop it, increase steroid to 400ug and consider trial of Motelukast or theophylline
4) Increase dose of inhaled steroid to 800ug
5) Add daily oral steroid e.g. prednisolone, and continue high dose inhaled steroid…refer to paediatrician!
Give an example of a long-acting beta-2 agonist added in at Step 3 of asthma management in children
Salmeterol
What is theophylline and what is it’s mechanism of action?
A methylxanthine - Normally, adenosine binds to it’s receptor and causes smooth muscle contraction due to inhibition of cAMP by phosphodiesterases…Methyxanthines block the adenosine receptor, thus increasing the amount of cAMP and causing muscle relaxation
