Respiratory disease in childhood Flashcards
What is the cause of respiratory distress syndrome? Who does this predominantly affect?
- relative surfactant deficiency causing atelectasis and impairment of gas exchange
- preterm babies
What stimulates the production of surfactant?
-steroids
What does IPPV, CPAP, ventilation and respiratory distress syndrome all increase the risk of?
-pneumothorax
RDS bc stiff lungs
What is chronic lung disease in children?
Oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease on CXR
What is chronic lung disease generally associated with?
Generally follows RDS
Barotrauma, volume trauma, high inspired oxygen
What is the prognosis of chronic lung disease in children?
Healing stage associated with continued lung growth over 2-3 years – often wheezy
What does a diaphragmatic hernia cause in the lungs for babies? what is the treatment?
- pulmonary hypoplasia
- respiratory support
- surgical treatment
What are the clinical features (7) that increase the probability of asthma?
One or more : wheeze, cough, chest tightness, difficulty breathing
Atopy(personal or family history)
Widespread wheeze on auscultation
Response to Rx
What is the management of children with a high/intermediate/low probability of asthma?
High Probability – diagnosis of asthma likely
(trial of Rx – further Ix if poor response)
Low Probability – consider Ix & ? Referral
Intermediate Probability: ?watchful waiting ?spirometry(response)
? Rx & evaluate
What are the risks of smoking in pregnancy/passive smoking in children? (7)
Reduces birthweight by 250g 4500 pregnancy losses p.a. 30% increase in Perinatal Mortality Teratogenic : airways, cleft lip/palate Glue ear Carcinogenic Increase likelihood of asthma attack
What is the treatment for an asthma attack in children?
Oxygen Nebulised bronchodilator Oral prednisolone IV salbutamol IV aminophylline IV magnesium Ventilatory support
What is the diagnosis:
6 week old presented with increased work of breathing and possible apnoes
URTI symptoms over last 2 days
bronchiolitis
What causes bronchiolitis?
What aged children does it affect?
what three clinical features does it cause and how is this different in smaller babies?
Viral infection – RSV
Usually under 18 months old
More severe in younger babies, ex prem, family of smokers
Tachypnoea, poor feeding, irritating cough
Apnoea in small babies
What is the treatment for bronchiolitis?
-supportive
What are the organisms that cause pneumonia in:
Neonates (4)
Infants (2)
School age (6)
Neonates: GBS, E.coli, Klebsiella, Staph aureus
Infants: Strep pneumoniae, Chlamydia
School age: Strep pneumoniae, Staph aureus, Gr A strep, Bordetella, Mycoplasma, Legionella
What are the 5 differential diagnoses for stridor?
Inhaled foreign body Laryngomalacia Epiglottitis and bacterial tracheitis Allergy Croup
What is croup? what is it caused by? what does it present with? what is treatment?
Viral laryngotracheobronchitis
Parainfluenza virus
Stridor, barking cough
Treatment is oral steroid to reduce inflammation
Epiglottitis:
What does it cause?
What is it caused by?
What is the treatment?
severe croup
haemophilus influenzae
treatment: ICU and ceftriaxone
Pertussis:
what does it cause?
what is it caused by?
Acute tracheobronchitis
cold like symptoms for two weeks
paroxysmal coughing (2 weeks)
repeated violent exhalations with severe inspiratory whoop, vomiting common
residual cough for month or more
Bordatella pertussis
What is the diagnosis and treatment for whooping cough?
Diagnosis:
pernasal swab (charcoal blood agar/ Bordet-Gengou medium)
PCR
serology
clinical ( by the stage of paroxysmal coughing organism numbers much reduced)
Treatment: most effective in the first 10 days of illness, also reduces spread to susceptible contacts
Vaccination
