Respiratory Disorders Flashcards by Imogen Smedley

What is the infecting agent in acute epiglottitis?

Haemophilus influenzae type B

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Name 3 causes of stridor in children

Croup, acute epiglottitis, inhaled foreign body, laryngomalacia

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

Harsh high pitch

Inspiratory usually

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Is stridor a sign of upper or lower airway obstruction?

Upper airway obstruction

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Thumb print sign on head x ray

Epiglottitis

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Is wheeze predominantly expiratory or inspiratory?

Expiratory

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Is wheeze a sign of upper or lower airway obstruction?

Lower

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What syndrome is associated with dextrocardia?

Kartagener’s syndrome aka primary ciliary dyskinesia

also cause bronchiectasis, recurrent sinusitis, subfertility

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Organism in whooping cough?

Bordatella pertussis

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Laryngotracheobronchitis AKA

Croup

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Infecting organism in croup

Parainfluenza

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Seal like barking cough

Croup

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Commonest age range in bronchiolitis

1mth - 1yr

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Commonest age range in croup

Toddlers

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Infecting organism in bronchiolitis

RSV or rhinovirus

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Name some signs of respiratory distress in children

Nasal flaring, grunting, subcostal / intercostal / sternal recession

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What features in croup suggest severe and need for admission?

Stridor, sternal recession and lethargy

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What is the management of croup?

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

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What is the diagnostic criteria for bronchiolitis?

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

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When should you refer bronchiolitis via ambulance from GP?

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

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Do all children with bronchiolitis get a CXR?

No - NICE says don’t routinely CXR

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

True - recommend don’t smoke

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

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

1st amox

2nd clarithromycin

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

Creon and ivacaftor

What day of life is the Guthrie test done?

Day 5

What type hypersensitivity is asthma?

Type 1

What immunoglobulin mediates asthma?

IgE

Asthma + aspirin insensitivity + nasal polyps

Samter's triad

Wheeze in asthma expiratory or inspiratory? Polyphonic?

Polyphonic expiratory

What investigation in asthma is a measure of airway inflammation?

FeNO

What impairs a FeNO test accuracy?

Smoking

What type of drug is ipratropium?

SAMA

What type of drug is formoterol?

LABA

What type of drug is salbutamol?

SABA

What type of drug is tiotropium?

LAMA

What type of drug is salmeterol?

LABA

What type of drug is beclometasone?

ICS

What type of drug is budesonide?

ICS

What type of drug is in a blue inhaler?

SABA

What type of drug is in a brown inhaler?

ICS

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

Done after Dx to identify triggers

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

Done after Dx to identify triggers

What is the role of CXR in asthma investigations?

In an adult for exclusion diagnosis

How is asthma diagnosed in under 5ys?

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

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

Spirometry

What investigation is a measure of lung function in asthma?

Spirometry

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

FeNO exhaled nitric oxide test

What pattern is seen on spirometry in asthma?

Obstructive | FEV1/FVC ratio <70%

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

Reversible airflow obstruction | 12% improvement in FEV1

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

2-4wk | Diurnal variability >20%

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

Spirometry, then bronchodilator reversibility

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

Obstructive spirometry + bronchodilator reversibility

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

4 - 8 wk

What is the 1st line Mx of asthma?

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

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

Low dose ICS

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

Add LTRA

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

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

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

Switch ICS:LABA to MART regimen

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

Increase ICS dose

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

Increase dose or trial theophylline | + If 5-16 yr seek advice

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

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

What are the features of a severe asthma exacerbation?

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

What grade of acute asthma is a silent chest?

Life threatening

What is the feature of near fatal asthma?

Raised PaCO2 >6

What is the PaCO2 in life threatening asthma?

Normal

When should you alert ITU in acute asthma?

If severe features | Transfer if life-threatening

What is the role of cardiac monitoring in acute asthma?

Salbutamol arrhythmias

What is the Mx of acute asthma?

``` NEB SABA + NEB ipratropium + PO prednisolone 40mg for 5 days + ABG + O2 ```

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

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

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

NEB SABA

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

IV hydrocortisone

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

IV magnesium sulfate | then after IV aminophylline