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Peadiatrics > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

Are respiratory infections usually viral or bacterial

A

90% viral

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2
Q

Reasons why children are more susceptible to respiratory infections

A 
Chest wall more compliant than that of adult.
Fatiguability of respiratory muscles.
Increased mucous gland concentration.
Poor collateral ventilation.
Low chest wall elastic recoil
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3
Q

4 types of upper RTI

A

Common cold - acute nasopharyngitis
Sore throat - pharyngitis and tonsillitis
Acute Otis media (+/- effusion)
Sinusitis

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4
Q

Features of common cold (coryza)

A

Clear / mucopurulent discharge

Cough, fever, malaise

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5
Q

Treatment of common cold

A

Paracetamol / ibuprofen for symptomatic relief of pain / fever

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6
Q

Sore throat usually caused by a virus (especially in

A

Group A b- haemolytic strep

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7
Q

Features of sore throat

A

Sore throat , fever, constitutional upset

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8
Q

What features might indicate a bacterial sore throat

A

Severe pain, lymphadenopathy and purulent exudate

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9
Q

Treatment of sore throat

A 
Sx relief (paracetamol / ibuprofen) 
Bacterial - penicillin
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10
Q

What abx can be given in sore throat if allergic to penicillin

A

Erythromycin

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11
Q

How long corse of abx for sore throat

A

10/7 to eradicate organism and prevent rheumatic fever

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12
Q

What abx should not be given with sore throat and why

A

Amoxicillin - can cause widespread maculopapular rash in EBV infection

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13
Q

Complications of sore throat

A

Retro pharyngeal abscess
Peritoneal are abscess (quinsy )
Rheumatic fever
Post strep glomerulonephritis

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14
Q

Causes of acute Otis media

A

Viral - RSV, influenza

Bacterial - pneumococcal, h influenzae, group b strep, maraxella catarrhatis

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15
Q

Does sinusitis usually occur on own

A

Often with viral URTIs

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16
Q

Features of sinusitis

A

2^ bacterial infection causes pain, swelling and tenderness over the cheek from infection of maxillary sinuses

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17
Q

Treatment of sinusitis

A

Abx and analgesia

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18
Q

Indications for tonsillectomy

A

Recurrent tonsillitis
Peritoneal are abscess (quinsy)
Obstructive sleep apnea

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19
Q

Why do adenoids cause obstructive sleep apnea

A

Grow proportionally faster than airway -> narrowing effect greater at 2-8 years

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20
Q

Indications for adenoidectomy

A

Obstructive sleep apnea

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21
Q

What percent of children snore / have obstructive sleep apnea

A

10%, 1%

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22
Q

Usual cause of OSA

A

Airway obstruction due to adenohyperthrophy

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23
Q

Features of OSA

A

Hx of snoring followed by 30-45 seconds of apnea with disturbed sleep and struggling for breath

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24
Q

Treatment of OSA

A

Adeno-tonsillectomy

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25
Q

Disorders which can cause sleep disordered breathing

A

Craniofacial - eg. Pierre-robin sequence
Neuromuscular eg. Muscular dystrophy
Hypotonia eg. Downs

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26
Q

Treatment of sleep disordered breathing

A

Overnight nasal mask ventilation

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27
Q

What should always be ruled out in laryngeal and tracheal infections

A

Inhaled foreign body

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28
Q

Egs of tracheal / laryngeal infections

A

Croup
Diphtheria and bacterial tracheitis
Acute epiglottitis

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29
Q

What is often caused by laryngeal / tracheal infections and why

A

Upper airway obstruction due to mucosal inflammation

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30
Q

Features of upper airway obstruction

A

Stridor
Hoarseness - due to inflammation of vocal cords
Barking cough - sea lion like
Dyspnea

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31
Q

Basic management of laryngeal / tracheal infections ? What should you not do !

A

Don’t examine throat.
Monitor for signs of decreased O2 / deterioration.
Add nebuliser adrenaline if in doubt and intubate if deterioration

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32
Q

What is croup

A

Viral laryngotracheaobronchitis

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33
Q

Most common cause of laryngotracheal infections and its cause

A

Croup - para influenza virus most common

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34
Q

Hx of croup

A

URTI for 1-2 days (coryza and fever) then barking cough and stridor

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35
Q

When are symptoms of croup worst

A

Night

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36
Q

What causes the barking cough and stridor in croup

A

Sub glottic inflammation and oedema

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37
Q

How long is management of croup symptomatic

A

3/7 as most improve spontaneously

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38
Q

When do children require hospital admission with croup

A

Young age (

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39
Q

Hospital management of croup ?

What else can be used

A

Small dose of oral dexamethasone (0.15mg/kg), oral prednisolone and nebulised steroids (budesonide)

Nebulised adrenaline can be used

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40
Q

What causes diphtheria

A

Corynebacterium diptheriae

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41
Q

What is bacterial tracheitis also called

A

Pseudomembranous croup

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42
Q

What causes bacterial tracheitis

A

Staph aureus / h influenzae

Rare but serious

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43
Q

Features od bacterial tracheitis

A

Similar to viral croup but with high fever, toxic apperance and rapidly progressing airway obstruction

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44
Q

Why do you get rapidly progressing airway obstruction in bacterial tracheitis

A

Copious thick airway secretions

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45
Q

Treatment of bacterial tracheitis

A

Abx eg IV flucoxacilin

Intubation (if required)

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46
Q

How serious is acute bacterial epiglottitis and what causes

A

Life threatening

Haemophilus influenza type B (HiB) - rare due to immunisation

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47
Q

Onset of acute bacterial epiglottitis

A

Rapid onset (hrs) after intesely painful throat

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48
Q

Features of acute bacterial epiglottitis ?

A

Ill, toxic, febrile child who is unable to speak or swallow with soft inspiratory stridor

Tend to sit upright with open mouth to maximise airway and might drool saliva

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49
Q

What does acute epiglottitis need to be distinguished from ? How?

A

Croup as different management

Fast onset, no coryza, little or no cough, drooling saliva, >38.5 fever

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50
Q

How do you confirm diagnosis of acute epiglottitis and management

A

Examination under anaesthetic followed by intubation to secure airway

3rd gen ceflasporin eg. CEFUROXIME

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51
Q

Why should you not examine throat in acute epiglottitis

A

May cause complete airway obstruction

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52
Q

3 common types of LRTI

A

Pneumonia
Bronchiolitis
Pertussis (whooping cough)

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53
Q

What is characterised by pneumonia

A

Inflammation of the parenchyma and consolidation of the alveoli

54
Q

Causative organisms by age of pneumonia

A

Neonates - group b strep, E. coli, chalmydia (from mother genital tract)

Infants - respiratory viruses eg RSV, adenoviruses, strep pneumonae, h influenzae, bordetella pertussis

Child - strep pneumoniae, h influenza, group A strep, mycoplasma pneumonia

55
Q

Symptoms of pneumonia? When else should it be considered?

A

Fever and difficulty breathing usually preceded by URTI symptoms. Cough, lethargy, poor feeding.
Chest / neck pain / acute abdomen

56
Q

What does localised chest / neck pain imply in pneumonia

A

Pleural irritation and bacterial infection

57
Q

Signs of pneumonia

A

Respiratory distress - flaring, tracheal tug, sub / intercostal recession
Crepitations/ wheeze +/- bronchial breathing (darth Vader)
Decreased SaO2

58
Q

Investigations for pneumonia and results ?

A

CXR - lobar consolidation -> bacterial pneumonia
FBC - neutropenia -> bacterial
USS - distinguish between effusions and empyema

59
Q

Management of pneumonia

A

Close SaO2 monitoring (

60
Q

Abx in bacterial pneumonia ? If severe? If mycoplasma ?

A

1st line - penicillin
Cefuroxime / flucloxacillin in severe
Macrolide eg. Erythromycin if mycoplasma

61
Q

What is the commonest sever respiratory infection in infants

A

Broncholitis (90% occurs in 1-9 months)

62
Q

Commonest cause of bronchiolitis ? Others?

A 
RSV - 80% 
Human metapneumovirus (MPV) and other respiratory viruses eg adenoviruses, parainfluenza
63
Q

Features of bronchiolitis ? What may small infants develop?

A

Coryzal precede dry cough and progressive breathlessness

Apnoeic episodes (

64
Q

Physical signs of bronchiolitis

A

Tachypnea with respiratory distress
Chest hyperinflation (prominent sternum / downward displaced liver)
Fine end inspiratory crackles and high pitches wheeze

65
Q

Is the wheeze in bronchiolitis louder inspiratory or expiratory

A

Expiratory

66
Q

Risk factors for bronchiolitis

A

Preterm infants

Infants with CHD / chronic lung disease (eg. CF, bronchiopulmlnary displasia)

67
Q

What is given to preterm infants to prevent bronchiolitis

A

RSV monoclonal antibody (PALIVIZUMAB)

68
Q

How do you detect RSV

A

Nasopharyngeal swabs -> detect by immunofluorescence

69
Q

What investigation for bronchiolitis

A

Swabs

CXR - hyperinflation with air trapping and focal atelectasis (collapse)

70
Q

Management of bronchiolitis

A

Supportive

oxygen for hypoxia, maintain hydration

71
Q

Cause of whooping cough

A

Bordetella pertussis

72
Q

Features of whooping cough (pertussis)

A

Catarrhal stage - 1/52 of coryza
Paroxysmal stage - cough with inspiratory whoop (worse at night & child may go blue).
Convalescent stage -(recovery)

73
Q

How long does whooping cough last

A

3-6/52

74
Q

What can occur after vigourous coughing

A

Subconjunctival haemorrhage and epistaxes (nose bleed)

75
Q

Diagnosis of pertussis

A

Lymohocytosis characteristic

Perinasal swab cultures

76
Q

Treatment of whooping cough

A

Erythromycin

77
Q

Define asthma

A

Chronic inflammatory disorder of the airways associated with widespread REVERSIBLE AIRWAY OBSTURCTION

78
Q

3 types of wheezing

A

Transient early wheeze
Non atopic wheeze
IgE mediated wheeze (atopic asthma)

79
Q

How to distinguish viral induced wheeze from asthma

A

No interval symptoms (main feature is symptoms only with infection)
No excess of atopy
Likely to improve with age (however lots of asthma does too)
No benefit from regular inhaled steroids

80
Q

What’s affected in transient early wheezing

A

Small airways (often during viral infections)

81
Q

Risk factor for transient early wheeze

A

Maternal smoking during pregnancy

82
Q

Prognosis of transient early wheezing

A

Most resolve by 5 years of age (probably due to increased airway calibre)

83
Q

What is non atopic wheezing and usual cause

A

Normal lung function in early life but a LRTI due to virus (usually RSV) leading to increased wheezing in first 10 years

84
Q

Prognosis of non atopic wheeze

A

Usually improves as progresses to adolescence

85
Q

Pathogenesis of IgE mediated (atopic) asthma

A

Genetic predisposition & environmental factors

  • > bronchial inflammation
  • > bronchial hyper reactivity
  • > triggers
  • > mucosal oedema, mucosal secretions, bronchoconstriction
  • > airway narrowing
  • > cough, wheeze, chest tightness, breathlessness
86
Q

Trigger factors for asthma

A

Smoking, cold air, RTIs, allergens (house dust mite / pollens), exercise, emotional upset / excitement

87
Q

5 stages of asthma management

A

Inhaled short acting b2 agonist (salbutamol / terbutaline)
Regular inhaled steroid 200-400mg/day (beclamethasone, budesonide, fluticasone)
Add long acting b2 agonist (salmeterol, formeterol)
Increase steroid to 800mg/day
Continuous / frequent use of oral steroids and refer to paediatric respiratory physician

88
Q

Two outcomes of adding LABAs that don’t fix asthma

A

Benefit but not adequate -> increase steroid to 400mg/day

No response to LABA -> stop, increase steroid (400mg/day) and trial other therapies

89
Q

What other therapies can be trailed if LABA is ineffective

A

Leukotriene receptor antagonists (MONTELUKAST), theophylline (slow release)

90
Q

What is the usual continuous oral steroid used in asthma stage 5 treatment

A

Prednisolone

91
Q

Complications with inhaled steroids

A

Adrenal suppression

Brief slowing of growth (no evidence saying affects final adult height)

92
Q

How do b2 agonists work

A

Relax smooth muscle

93
Q

Side effects of b2 agonists

A

Tachycardia
Hypokalaemia
Restlessness

94
Q

How does theophylline work

A

Phosphodiesterase inhibitor

95
Q

Side effects of theophylline

A

Restlessness, arrythmias, diuresis

96
Q

Eg of anticholinergic for asthma

A

Ipratropium bromide (“atrovent”)

97
Q

How do anticholinergics work in asthma

A

Inhibit choline rigid brinchoconstriction

98
Q

Side effects of anticholinergics

A

Dry mouth, urinary retention

99
Q

How do steroids work in asthma

A

Inhibit synthesis of inflammatory mediators (cytokines, leukotrines, prostaglandins)
-> decreased airway hyperresponsiveness

100
Q

Local side effects of steroids? How to reduce

A

Oral candidiasis

Wash mouth with dry powder inhaler / use spacer with metered dose inhalers

101
Q

Features of acute asthma attack

A

Respiratory rate >50bpm in under 5 (>30 in over 5)
Pulse >140bpm in under 5 (>120 in over 5)
Use of accessory muscles
Too breathless to talk

102
Q

Feature of life threatening asthma

A

Central cyanosis
Silent chest (insufficient air flow to generate wheeze)
Exhaustion / poor respiratory effort
Agitation & diminished conciousness (severe hypoxia )

103
Q

What is CFTR

A

Camp dependent chloride channel

ATP-binding cassette transporter

104
Q

What is carrier rate of CF

A

1 in 25

105
Q

How many affected by CF

A

1:2500

106
Q

Cause of cf

A

Deletion of d-F508 of CFTR gene on chromosome 7

107
Q

What do mutations in CFTR gene cause ? Especially where?

A

Defective chloride ion transport across epithelial cells &
Increased viscosity of secretions

Respiratory tract and exocrine pancreas

108
Q

What is the diagnostic test for cf and why

A

Sweat test

Abnormal transport in sweat glands -> increased NaCl in sweat

109
Q

Features of cf

A

Recurrent RTI and failure to thrive
Cough with purulent sputum, hyperinflation, Crepitations, wheeze, finger clubbing
Deficient pancreatic enzymes -> Steatorrhoea, failure to thrive and malnutrition

110
Q

Pancreatic enzymes deficient in cf

A

Protease, amylase, lipase

111
Q

What can be first sign of cf

A

10% get meconium ileus

112
Q

Systems affected by cf

A 
Airway and GI 
Pancreas / endocrine 
Reproductive 
Joints
Vascular
Hepatic 
Psychological
113
Q

Cf in Airway and Gi

A

Nasal polyps, distal ileal obstruction syndrome

114
Q

Cf in pancreas / endocrine

A

Diabetes, poor growth, osteoporosis

115
Q

Cf in reproductive

A

Infertility in males - absent vas deferens

116
Q

Cf in joints

A

Athropathy

117
Q

Cf in vessels

A

Vasculitis

118
Q

Cf in hepatic

A

Portal hypertension -> ascities, varicies, hepatic encephalopathy

119
Q

Sweat test result needed for cf diagnosis ?

What’s used to test?

A

Two tests showing chloride of >60mmol/L

Pilocarpine iontoploresis

120
Q

Management of cf 2 aims

A

Prevent progression of lung disease

Promote adequate nutrition and growth

121
Q

Members of cf MDT

A

Parents, specialist paediatrician, specialist nurse, physiotherapist, dietician

122
Q

Most important part of resp management in cf ? What’s involved ?

A

Physiotherapist - 2x/day

Chest percussion with postural drainage, breathing exercises, positive expiratory pressure masks

123
Q

What is monitored in cf ? What are used to hell with symptoms ?

A

Fev1 - declines with disease progression

Mucolytics eg nebulised DNase & hypertonic saline (aid mucocilary clearance )

124
Q

What is given to many cf patients ? Why?

A

Prophylactic Abx eg flucoxacilin.

Need additional cover against common resp pathogens (s aureus, h influenzae, pseudomonas aeurgnosa)

125
Q

What’s given for nutritional management of cf

A

High calorie
Vitamin supplements
Pancreatic enzymes supplements

126
Q

Which vitamins are essential to be given as supplements in cf

A

Fat soluble (ADEK )

127
Q

Eg of pancreatic enzymes supplement and effect

A

Crean

Improve Steatorrhoea and allow catch up growth

128
Q

What is the genetic screen for cf ? What else does it screen for ?

A

Guthrie test

Cf, phemylketanuria, congential hypothyroidism, MOAD deficiency, sickle cell, thalassaemia

129
Q

Specifically looked for in genetic test of cf

A

Immunoreactive trypsin

130
Q

Specifically looked for in genetic test of phenylketonuria

A

Phenylalanine

131
Q

Specifically looked for in genetic test of congential hypothyroidism

A

TSH

Peadiatrics (14 decks)

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