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?
0-12 months. It is rare after 3 year.
Which organism causes over 50% 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 are the classical symptoms of croup?
and age group?
Barking cough Stridor URI (LOW - grade fever) worse at night 3 months - 6 years
Which virus causes croup?
Parainfluenza virus
True / False: A throat examination should be performed on a child with epiglottis to check for exudates on the tonsils
FALSE - It’s important not to distress a child with epiglottisitis as this can make it much worse so NEVER look in their throat
What is the management of croup?
all croup?
mild and moderate?
All croup - Corticosteriods (one dose IV or PO)
(dexamethasone)
Mild = no stridor at rest –> outpatient
Moderate = stridor at rest –> hospital
- Humidified oxygen
- Nebulised budesonide
- Nebulised adrenaline may be required
- Intubation in extremis (about 2% of children)
Which organism causes acute epiglottitis?
Haemophilus influenza B
streptococci, pneumonic
True / False: Whooping cough (pertussis) is highly infectious
True
What age group are affected by croup?
3 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
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
In asthmatics, are peak flow values generally lower in the morning or in the evening?
Morning
Give an example of a long-acting beta-2 agonist added in at Step 3 of asthma management in children
Salmeterol
What might be heard on auscultation of the chest in bronchiolitis?
Fine end-inspiratory crackles
Expiratory wheeze
Which infants are particularly at risk of severe bronchiolitis?
Premature
Chronic lung disease
Passive smokers
True / False: Steroids are not indicated in bronchiolitis, but bronchodilators are
FALSE - Neither of these have been shown to improve outcomes in bronchiolitis so NEITHER are indicated
What is the underlying pathology in bronchiolitis?
Inflammation of the small airways (bronchioles)
What is the underlying pathology in croup?
Inflammation of the upper airway and increased secretions causing upper airway obstruction
What causes the stridor in croup?
Subglottis edema causing tracheal narrowing
True / Flase: Epiglottitis is common in the UK
False - Children are vaccinated against HiB so it’s uncommon
What are some clinical features of epiglottis?
Very acute onset
HIGH Fever, toxic looking child - they look unwell!
Child is open mouthed to help open the away
Drooling
Intensely painful throat - child cannot speak or swallow
Inspiratory stridor, respiratory distress
NO cough
What is the management of epiglottis?
- Sit child upright, do not examine throat, do not distress
- Alert senior paediatrician, ENT surgeon, anaesthetist
- ITU admission and intubation
- Antibiotics: Ceftriaxone or cefataxime…usually a 3-5 day course
- Extubation usually after 24 hours
Give some key clinical features of cystic fibrosis in neonates and children
Faltering growth Meconium ileus Recurrent infections Bronchiectasis Clubbing Diabetes mellitus Steatorrhoea
What is the goal standard test for diagnosis of cystic fibrosis?
Sweat test looking for raised chloride ion levels
pilocarpine iontophoresis sweat test
What is a key infective organism which affects patients with cystic fibrosis?
Pseudomonas
What is the causative organism in whooping cough?
Bordetella pertussis
Can the pertussis vaccination be given to pregnant women?
Yes - It is an inactivated vaccine
What is the incubation period of pertussis?
10-14 days
What are the clinical features of whooping cough?
Coryza
‘Whooping’ cough (caused by inspiration against closed glottis) worse at night
Vomiting after coughs
Epistaxis and subconjunctival haemorrhage may result from vigorous coughing
Apnoeas in neonates
What investigations might be carried out in pertussis?
Pernasal swab
Lymphocytosis on WCC
What are the key differences in features between epiglottitis and croup?
Croup: Harsh loud cough, hoarse voice, child will appear more ‘well’
Epiglottitis: NO cough, muffled voice, toxic looking child
S&S of bronchiolitis?
URI symptoms
moderate fever
tachypnea, wheezing, restlessness, retracting
hyperinflated lungs on CXR - not needed
