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Respiratory Disorders Flashcards

1
Q

What is the infecting agent in acute epiglottitis?

A

Haemophilus influenzae type B

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2
Q

Name 3 causes of stridor in children

A

Croup, acute epiglottitis, inhaled foreign body, laryngomalacia

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3
Q

Is stridor inspiratory or expiratory? High pitch or low pitch?

A

Harsh high pitch

Inspiratory usually

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4
Q

Is stridor a sign of upper or lower airway obstruction?

A

Upper airway obstruction

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5
Q

Thumb print sign on head x ray

A

Epiglottitis

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6
Q

Is wheeze predominantly expiratory or inspiratory?

A

Expiratory

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7
Q

Is wheeze a sign of upper or lower airway obstruction?

A

Lower

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8
Q

What syndrome is associated with dextrocardia?

A

Kartagener’s syndrome aka primary ciliary dyskinesia

also cause bronchiectasis, recurrent sinusitis, subfertility

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9
Q

Organism in whooping cough?

A

Bordatella pertussis

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10
Q

Laryngotracheobronchitis AKA

A

Croup

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11
Q

Infecting organism in croup

A

Parainfluenza

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12
Q

Seal like barking cough

A

Croup

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13
Q

Commonest age range in bronchiolitis

A

1mth - 1yr

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14
Q

Commonest age range in croup

A

Toddlers

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15
Q

Infecting organism in bronchiolitis

A

RSV or rhinovirus

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16
Q

Name some signs of respiratory distress in children

A

Nasal flaring, grunting, subcostal / intercostal / sternal recession

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17
Q

What features in croup suggest severe and need for admission?

A

Stridor, sternal recession and lethargy

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18
Q

What is the management of croup?

A

All children with mild or severe croup get 1X PO dexamethasone
Can add NEB dexamethasone
Paracetamol

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19
Q

What is the diagnostic criteria for bronchiolitis?

A 
Persistent cough 
AND 
(tachypnoea or chest recession)
AND
wheeze/crackles on auscultation
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20
Q

When should you refer bronchiolitis via ambulance from GP?

A 
O2 <92%
RR >70
Central cyanosis
Apnoea
Grunting
Marked chest recession
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21
Q

Do all children with bronchiolitis get a CXR?

A

No - NICE says don’t routinely CXR

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22
Q

Bronchiolitis is aggravated by smoking in the home - true or false

A

True - recommend don’t smoke

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23
Q

If advising to manage bronchiolitis at home, what red flag symptoms should you safety net about?

A
  • Increased work of breathing (grunting, nasal flaring, marked chest recession)
  • Fluid intake is 50-75% of normal or no wet nappies for 12 hours
  • Apnoea or cyanosis
  • Exhaustion (no responding normally to social cues, wakes only with prolonged stimulation)
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24
Q

What is the 1st and 2nd line for non-severe bacterial pneumonia in children?

A

1st amox

2nd clarithromycin

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25
Q

What is the name of the enzyme replacement and the genetic drug for CF?

A

Creon and ivacaftor

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26
Q

What day of life is the Guthrie test done?

A

Day 5

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27
Q

What type hypersensitivity is asthma?

A

Type 1

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28
Q

What immunoglobulin mediates asthma?

A

IgE

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29
Q

Asthma + aspirin insensitivity + nasal polyps

A

Samter’s triad

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30
Q

Wheeze in asthma expiratory or inspiratory? Polyphonic?

A

Polyphonic expiratory

31
Q

What investigation in asthma is a measure of airway inflammation?

32
Q

What impairs a FeNO test accuracy?

33
Q

What type of drug is ipratropium?

34
Q

What type of drug is formoterol?

35
Q

What type of drug is salbutamol?

36
Q

What type of drug is tiotropium?

37
Q

What type of drug is salmeterol?

38
Q

What type of drug is beclometasone?

39
Q

What type of drug is budesonide?

40
Q

What type of drug is in a blue inhaler?

41
Q

What type of drug is in a brown inhaler?

42
Q

What is the role of specific IgE tests in asthma investigations?

A

Done after Dx to identify triggers

43
Q

What is the role of aeroallergen skin prick tests in asthma investigations?

A

Done after Dx to identify triggers

44
Q

What is the role of CXR in asthma investigations?

A

In an adult for exclusion diagnosis

45
Q

How is asthma diagnosed in under 5ys?

A

Can’t do investigations - just treat symptoms based on clinical judgement and do investigations when age 5

46
Q

What is the first line investigation in asthma if aged 5-16yr?

A

Spirometry

47
Q

What investigation is a measure of lung function in asthma?

A

Spirometry

48
Q

What is the first line investigation in asthma if aged 17+?

A

FeNO exhaled nitric oxide test

49
Q

What pattern is seen on spirometry in asthma?

A

Obstructive

FEV1/FVC ratio <70%

50
Q

What does bronchodilator reversibility mean? How is it tested for?

A

Reversible airflow obstruction

12% improvement in FEV1

51
Q

In asthma, how long is peak flow variability monitored for? What is a positive test?

A

2-4wk

Diurnal variability >20%

52
Q

Investigating asthma age 17+ after FeNO test, what is done next?

A

Spirometry, then bronchodilator reversibility

53
Q

What is required for a diagnosed of asthma in those age 5-16yr?

A

Obstructive spirometry + bronchodilator reversibility

54
Q

After start / adjusting a new asthma medicine, how soon should the patient be reviewed?

55
Q

What is the 1st line Mx of asthma?

A

Infrequent, short-lived wheeze, normal lung function: SABA reliever alone
S+S 3X/wk or causing waking at night: low dose ICS maintenance

56
Q

What is the next step in the management of asthma is uncontrolled on SABA alone?

A

Low dose ICS

57
Q

What is the next step in asthma Mx if uncontrolled on SABA + ICS?

58
Q

What is the next step in asthma Mx if no benefit from adding LTRA with SABA + ICS?

A

If 17+ stop LTRA
If 5-16 continue LTRA if it gave any benefit
Use ICS-LABA combo (purple Fostair)

59
Q

What is the next step in asthma Mx if uncontrolled on SABA + ICS/LABA combo?

A

Switch ICS:LABA to MART regimen

60
Q

What is the next step in asthma Mx if uncontrolled on SABA + MART regimen?

A

Increase ICS dose

61
Q

What is the next step in asthma Mx if uncontrolled on SABA + MART regimen at upped dose?

A

Increase dose or trial theophylline

+ If 5-16 yr seek advice

62
Q

What peak flow is moderate / severe / life threatening asthma?

A

Mod 50-75%
Severe 33-50%
Life threatening <33%

63
Q

What are the features of a severe asthma exacerbation?

A

Any 1 of: PF 33-50%, inability to complete sentence in one breath, RR>25, HR>110

64
Q

What grade of acute asthma is a silent chest?

A

Life threatening

65
Q

What is the feature of near fatal asthma?

A

Raised PaCO2 >6

66
Q

What is the PaCO2 in life threatening asthma?

67
Q

When should you alert ITU in acute asthma?

A

If severe features

Transfer if life-threatening

68
Q

What is the role of cardiac monitoring in acute asthma?

A

Salbutamol arrhythmias

69
Q

What is the Mx of acute asthma?

A 
NEB SABA + 
NEB ipratropium + 
PO prednisolone 40mg for 5 days + 
ABG + 
O2
70
Q

What is the dose, delivery method and rate for salbutamol in acute asthma?

A

5mg salbutamol via oxygen driven nebulizer at rate 6-8 liters

71
Q

What drug should be given first in the Mx of acute asthma?

72
Q

If you can’t give oral pred in the Mx of acute asthma, what is given instead?

A

IV hydrocortisone

73
Q

In acute asthma, if a PTx is deteriorating after been given NEB SABA + PO pred + NEB iptratropium - what drug is given next?

A

IV magnesium sulfate

then after IV aminophylline

Y4 Child Health (6 decks)

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