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Paediatrics > Respiratory Disease > Flashcards

Respiratory Disease Flashcards

0
Q

3 other viruses that can cause bronchiolitis and which is the most virulent?

A

Human metapneumovirus hMPV
Adenovirus - most virulent
Parainfluenza virus

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1
Q

What is the commonest cause of bronchiolitis?

A

Respiratory syncitial virus RSV

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2
Q

Risk factors for severe bronchiolitis?

A

Prematurity or low birth weight
Less than 12 weeks of age
Ongoing chronic lung disease
Congenital heart disease

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3
Q

What examination finding is characteristic of bronchiolitis?

A

Widespread (bi basilar) fine inspiratory crackles +/- high pitched expiratory wheeze

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4
Q

What findings can occur in the abdomen in severe respiratory disease due to lung hyperinflation?

A

Hepatomegaly and less commonly splenomegaly

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5
Q

What one investigation is most useful in diagnosing bronchiolitis?

A

NPA for rapid RSV testing

Viral cultures

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6
Q

How long does bronchiolitis normally last and when are kids normally asymptomatic?

A

Normally 7-10 days, 50% asymptomatic by 2 weeks

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7
Q

What may prompt admission for respiratory disease generally?

A

Signs of respiratory distress, increased work of breathing, RR>70
Poor feeding or dehydration
Lethargy or systemically unwell, high fever
Cyanosis or saturation <92/94%, apnoea

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8
Q

What 3 factors lower threshold for admission in respiratory disease?

A

Significant (lung, heart) comorbidities
Prematurity
Less than 3m old

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9
Q

What are the management options for bronchiolitis in hospital?

A

Typically supportive; O2, fluids if dehydrated
Can offer bronchodilators and antibiotics
If care needing to be escalated or consistently de saturating on 50% O 2, consider PICU humicare (like CPAP)

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10
Q

What can be a long term problem after early or bad bronchiolitis? Short term complications?

A

Subsequent reactive airways disease - asthma, viral induced wheeze
Secondary bacterial infection, pneumonia etc. Bronchiectasis if particularly bad

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11
Q

What is the RSV vaccine and under what circumstances is it given?

A

Palivizumab - for very young, premature, congenital heart disease, immunodeficient etc.

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12
Q

What is the gender distribution of incidence of asthma through childhood?

A 
Prepuberty = Boys
Adolescent = Even
Adult = Women
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13
Q

When does peak flow and spirometry testing become viable for asthma in kids?

A

Age 6 for peak flow

5 for spirometry

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14
Q

Define reversibility in relation to asthma and bronchodilators?

A

> 12% increase in lung function 10 minutes after bronchodilator administered

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15
Q

Why are spacers good for bronchodilator inhalation? (3 reasons)

A

Make inhalers easier to use and more effective
Stop medication from sticking to back of throat and causing thrush, pharyngitis
Better than a nebuliser in an emergency

16
Q

Signs of life threatening acute asthma attack?

A 
Silent chest
Cyanotic or apnoeas
Poor respiratory effort/exhaustion
Hypotensive or bradycardia 
Confused, impaired consciousness
O2 < 92, PEFR < 33%
17
Q

What is the most important early treatment of a severe asthma attack presenting in the emergency dept?

A

Oral prednisolone 20-40mg

18
Q

Step 1 of chronic asthma management?

A

PRN SABA - salbutamol blue inhaler w/spacer to use as required

19
Q

What indicates movement from step 1 to step 2 of chronic asthma ladder?

A

Using SABA more than twice a week, at night once a week or having had acute exacerbation within last 2 years

20
Q

Step 2 in chronic asthma management?

A

PRN SABA + regular preventer (brown inhaler- inhaled corticosteroid)

21
Q

Step 3 of chronic asthma management?

A

PRN SABA + regular inhaled corticosteroid + regular LABA (salmeterol)
If not controlling up corticosteroid dose to highest possible
Note: for under 5s use leukotriene antagonist instead of LABA

22
Q

Step 3/4 alternatives for chronic asthma?

A

Leukotriene antagonists
Modified release oral theophylline (aminophylline)
Oral B2 agonists if really bad

23
Q

Summary of step 4 for chronic asthma management?

A

PRN SABA
Regular highest dose inhaled corticosteroid
Regular LABA if of any benefit
One of regular inhaled leukotriene antagonist, oral theophylline or oral beta 2 agonist

24
Q

Step 5 of chronic asthma management?

A

PRN SABA
Regular high dose inhaled corticosteroid
One of the step 4 long acting bronchodilators
Regular once daily prednisolone tablets

25
Q

Worst case scenario asthma - option for those with IgE mediated asthma over age of 6 requiring regular oral steroids?

A

Omalizumab

26
Q

Alternative names for croup?

A

Laryngotracheobronchitis

Laryngotrachietis

27
Q

What viruses typically cause croup?

A

Parainfluenza viruses (PIV)

28
Q

What is the pathophysiology behind croup?

A

Inflammation and oedema of subglottic larynx and trachea near cricoid, which is the narrowest part of the paediatric airway

29
Q

What is spasmodic croup?

A

A noninfectious croup variant that occurs at night, typically recurring.
Get subglottic oedema but no inflammation
Less coryzal symptoms

30
Q

Symptoms of croup?

A

Low grade fever + coryza for 1-2 days
Then characteristic barking cough, hoarse voice and inspiratory stridor
Typically worse at night but can occur in daytime
Can precipitate respiratory distress

31
Q

How long does croup normally last for?

A

Symptoms usually last 3-7 days, can be as long as 2 weeks

32
Q

Signs of croup on exam?

A

Range from mild inspiratory stridor to airway obstruction and severe respiratory failure
Mild expiratory wheeze
Chest wall recessions
Tachycardia, tachypnoea, hypotonia, hypoxia etc.

33
Q

Management of croup?

A

Generally supportive unless severe and questions over airway patency - potentially intubation
Otherwise mask/nasal cannula O2 if necessary, fluids etc.

34
Q

Medical management of croup?

A

Corticosteroids (reduces oedema) - early single dose dexamethasone IM injection can last duration of disease
Nebulised epinephrine if severe disease (has B2 agonist activity and also resorption of laryngeal oedema)

35
Q

Most common bacterial causes of pneumonia?

A

Group B strep, enterococci in neonates
Infants/young kids - pneumococcal, Hi
Older kids - mycoplasma, pneumococcal, chlamydiae
Always consider mycobacterium TB

36
Q

Ab therapy for bacterial pneumonia?

A

amoxicillin usually suffices

Co-amoxyclav or erythromycin for complicated/unresponsive

Paediatrics (9 decks)

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