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Pediatrics > Respiratory diseases > Flashcards

Respiratory diseases Flashcards

1
Q

Common cold (coryza) etiology, features and management

A
  • Etiology: viruses - rhinoviruses, coronaviruses, RSV
  • Features:
  • Clear or mucopurulent nasal discharge
  • Nasal blockage
  • Management: self-limiting, anti analgesics
  • Cough may persist for up to 4 weeks
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2
Q

Pharyngitis: etiology, features and management

A
  • Etiology: mostly viral infection - adenoviruses, enteroviruses, rhinoviruses. Group A beta-hemolytic streptococcus (older children). EBV (tonsillitis)
  • Features: pharynx and soft palate are inflamed, local lymphadenopathy. Tonsillitis - inflammation of the tonsils with purulent exudate
  • Management: Penicillin V for 10 days
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3
Q

When given Amoxicillin for pharyngitis, child develop widespread maculopapular rash. Why?

A

Infection with EBV (mononucleosis)

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4
Q

Etiology, features and management of scarlet fever

A
  • Etiology: Group A streptococcus
  • Features:
  • Fever precedes headache and tonsillitis by 2-3 days.
  • ‘Sandpaper-like’ maculopapular rash with flushed cheeks and perioral sparing
  • White and coated tongue, may be sore or swollen
  • Only childhood exanthema caused by a bacterium
  • Management: Penicillin V.
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5
Q

Complications of Group A beta-hemolytic streptococcus pharyngitis?

A
  • Acute glomerulonephritis

- Rheumatic fever’

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6
Q

Pathogens in acute otitis media

A
  • Viruses:
  • RSV
  • Rhinovirus
  • Bacteria:
  • Pneumococcus
  • Nontypeable Haemophilus influenza
  • Moraxella catarrhalis
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7
Q

Treatment for acute otitis media

A
  • Usually resolves spontaneously

- If child remains unwell after 2-3 days: Amoxicillin

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8
Q

Differential Dx of acute stridor (upper airway obstruction)

A
  • Most common: Viral laryngotracheobronchitis = ‘Croup’

- Rare: epiglottitis, bacterial tracheitis, foreign body, angioedema, trauma, retropharyngeal abscess

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9
Q

Pathogens in Croup

A
  • Most common: Parainfluenza

- Other: Rhinovirus, RSV, influenza

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10
Q

Typical age and features of Croupe

A
  • Occurs between 6 months - 6 years, peak at 2 years of age
  • Features:
  • Coryza (cold symptoms)
  • Fever
  • Hoarseness (inflammation of vocal cords)
  • Barking cough, like a sea lion (tracheal edema and collapse)
  • Harsh stridor
  • Variable degree of difficulty breathing with chest retraction
  • Symptoms often starts and are worse at night
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11
Q

First-line treatment for Croupe

A
  • Oral dexamethasone, Oral prednisolone, or neubilized steroids (budesonide)
  • For severe obstruction: neubilized adrenaline with oxygen by face mask
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12
Q

Pathogen in epiglottitis

A

H. influenza type B (99% reduction after immunization)

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13
Q

Clinical features of epiglottitis

A

Onset very acute

  • High fever, very ill, toxic-looking child
  • An intensely painful throat, prevents child from speaking or swallowing
  • Saliva drools down the chin
  • Soft inspiratory stridor
  • Rapidly increasing respiratory difficulty over hours
  • Child sitting immobile, upright, with an open mouth
  • Minimal or no cough
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14
Q

Pathogen of bronchiolitis

A

Most common RSV (80% of cases)

Others are parainfluenza virus, rhinovirus, adenovirus, influenza virus, human metapneumovirus

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15
Q

Clinical findings in bronchiolitis

A
  • Croyza (cold symptoms)
  • Dry wheezy cough
  • Tachypnea and tachycardia
  • Subcostal and intercostal recession
  • Hyperinflation of the chest
  • Fine end-inspiratory crackles
  • High-pitched wheezes - prolonged expiration
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16
Q

When to admit child with bronchiolitis to hospital?

A
  • Apnea
  • Persistent SpO2 <90% on room air
  • Inadequate oral fluid intake
  • Severe respiratory distress - grunting, marked chest recession, RR >70 breaths/minute
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17
Q

Causes of acute respiratory distress in an infant

A
  • Bronchiolitis
  • Viral episodic wheeze
  • Pneumonia
  • HF
  • Foreign body
  • Anaphylaxis
  • Pneumothorax, pleural effusion
  • Metabolic acidosis
  • Severe anemia
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18
Q

What are the three patterns of wheezing?

A
  1. Viral episodic wheezing - only in response to viral infection
  2. Multiple trigger wheeze - in response to multiple triggers and which is more likely to develop into asthma over time
  3. Asthma
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19
Q

Pathophysiology of asthma

A 
Bronchial inflammation:
* Edema
* Excessive mucus production
* Infiltration with cells (eosinophils, mast cells, neutrophils, lymphocytes)
Bronchial hyperresponsiveness:
* Exaggerated "twitchiness" to inhaled stimuli
Airway narrowing:
* Reversible airflow obstruction
20
Q

Clinical features in asthma

A

Should be suspected in a child with:
- Wheezing in more than one occasion
- More common in children with a personal or family history of atopy
Features:
- Symptoms worse at night and in the early morgning
- Nonviral triggers
- Interval symptoms, i.e. symptoms between acute exacerbations
- Positive response to asthma therapy

21
Q

4 major symptoms in asthma

A
  1. Wheeze
  2. Dry cough
  3. Breathlessness
  4. Chest tightness
22
Q

What does Harrison’s sulci indicate?

A
  • Depressions at the base of the thorax.

- Associated with chronic obstructive airways disease such as asthma, from chronic increased work of breathing

23
Q

How much must the FEV1 improve after bronchodilators, to be diagnosed as asthma?

A

Improvement of 12% or more –> bronchodilator reversibility

24
Q

Short-acting beta2-agonists

A
  • Called relievers
  • Salbutamol, Terbutaline
  • Rapid onset of action - maximum effect after 10-15 min
  • Effective for 2-4 hours
  • Used “as required” for increased symptoms
25
Q

Long-acting beta2-agonist (LABAs)

A
  • Salmeterol or Formoterol
  • Effective for 12 hours
  • Should not be used without an inhaled corticosteroid
26
Q

First-line treatment in asthma

A

Relievers:
- Short-acting beta2-agonist (Salbutamole)
Preventers:
- Inhaled corticosteroids (Budesonide, Fluticasone)
- Add-on therapy:
* >5 y.o. - LABA (Salmeterol)
* <5 y.o. - Oral leukotriene receptor antagonist/LTRA (Montelukast)

27
Q

Management in asthma attacks

A
  1. High-dose inhaled bronchodilators, steroids and oxygen. (goal SpO2 >92%)
  2. Addition of neutralized Ipratropium
  3. Short course of oral prednisolone
  4. To children who fails to respond adequately to inhaled therapy:
    * Magnesium sulphate I.V.
    * Aminophylline I.V.
    * Salbutamol I.V.
28
Q

What type of pneumonia can cause wheezing?

A

Atypical pneumonia caused by:

  • Mycoplasma
  • Chlamydia
  • Adenovirs
29
Q

Clinical features of whooping cough (Pertussis)

A

Catarrhal phase (1 week):
- Coryza
Paroxysmal phase (up to 3 months):
- Paroxysmal or spasmodic cough followed by a characteristic inspiratory whoop
Convalescent phase (may persist for many months):
- Symptoms gradually decrease

  • Spasm often worse at night, may culminate in vomiting
  • During paroxysm - child goes red or blue in face, mucous flows from the nose and mouth.
  • Woop may be absent in infant - then apnea
  • Epistaxis and subconjunctival hemorrhages
30
Q

Most common causes for a persistent cough

A
  • Most common caused by series of respiratory tract infections
  • Other: Pertussis, RSV, Mycoplasma
31
Q

Most common pathogens causing pneumonia

A 
Newborn:
* Group B streptococcus
* Gram-negative enterococci (E. coli) and bacilli
Infants and young children:
* RSV - most common
* Streptococcus pneumonia
* H. influenza (marked reduction after immunization)
* Bordetella pertussis
* Chlamydia trachomatis
* Staph. aureus
Children >5 y.o.
* Mycoplasma pneumonia
* Streptococcus pneumonia
* Chlamydia pneumonia
All ages:
* Mycobacterium tuberculosis
32
Q

Most common symptoms of pneumonia

A
  1. Fever
  2. Cough
  3. Tachypnea

Other: Lethargy, poor feeding, an ‘unwell’ child
Bacterial infection: Localized chest, abdominal or neck pain –> pleural irritation

33
Q

Clinical findings in pneumonia

A
  1. Tachypnea - most sensitive clinical sign
  2. Nasal flaring
  3. Chest indrawing
  4. End-inspiratory coarse crackles
34
Q

Causes of generalized bronchiectasis

A
  • Cystic fibrosis
  • Primary ciliary dyskinesia
  • Immunodeficiency
  • Chronic aspiration
35
Q

Causes of localized bronchiectasis

A
  • Previous severe pneumonia
  • Congenital lung abnormality
  • Obstruction by a foreign body
36
Q

What is defect in CF?

A

CF transmembrane conductance regulator (CFTR)

- A cyclic AMP-dependent chloride channel

37
Q

On which chromosome is the gene for CFTR found?

A

Chromosome 7

38
Q

What is the most frequent mutation in CF?

A

F508 –> Class II mutation

* Incorrect folding - cannot traffic to membrane

39
Q

Pathophysiology of CF

A

Abnormal ion transport across epithelial cells

  • Airways:
  • Reduction in airway surface liquid layer
  • Impaired ciliary function
  • Retention of mucopurulent secretions
  • Dysregulation of inflammation and defence against infection
  • Intestine:
  • Thick viscid meconium - meconium ileus
  • Pancreas:
  • Blocked pancreatic ducts - pancreatic enzyme deficiency and malabsorption
  • Sweat glands:
  • Excessive concentrations of sodium and chloride in sweat
40
Q

Which factor do you look for in CF screening?

A

Immunoreactive trypsinogen (IRT) is raised in newborns with CF

41
Q

Clinical features in CF

A 
Newborn:
- Meconium ileus
Infant:
- Jaundice
- Growth faltering
- Recurrent chest infections
- Malabsorption, steatorrhea
Young child:
- Bronchiectasis
- Rectal prolapse
- Nasal polyps
- Sinusitis
Older child:
- Allergic bronchopulmonary aspergillosis 
- DM
- Cirrhosis and portal HTN
- Distal intestinal obstruction
- Pneumothorax or recurrent hemoptysis
- Sterility in males
42
Q

What is the main cause of death in CF?

A

95 % die of respiratory failure

43
Q

How to diagnose CF?

A

Sweat test:

- Increased chloride in sweat - 60-125 mmol/L (normal = 10-40 mmol/L)

44
Q

Which pathogens causes lung infections in CF?

A
  • Staph. aureus
  • H. influenza
  • Pseudomonas
  • Burkholderia cepacia
45
Q

Cause of ciliary dyskinesia

A

Congenital abnormality in the structure or function of cilia ling the respiratory tract.
Lead to impaired mucociliary clearance

46
Q

Primary ciliary dyskinesia, symptoms

A
  • Recurrent productive cough
  • Purulent nasal discharge
  • Chronic ear infections
47
Q

What i Kartagener syndrome?

A

Situs inversus - major organs are in mirror position of normal

Pediatrics (9 decks)

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