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PAEDIATRICS > RESPIRATORY PAEDS > Flashcards

RESPIRATORY PAEDS Flashcards

1
Q

What is Bronchiolitis and what is usual causative agent?

A

Infection of the bronchioles

Usually caused by RESPIRATORY SYNCYTIAL VIRUS (RSV)

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2
Q

BRONCHIOLITIS: Age of presentation

A

Usually infants under 1 year - most common in infants under 6 months
Can rarely be diagnosed in children up to 2 years (ex-premature babies with CLD)

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3
Q

BRONCHIOLITIS: Presentation

A
  • Coryzal symptoms
  • Signs of resp distress
  • Dyspnoea
  • Tachypnoea
  • Poor feeding
  • Apnoeas
  • Wheeze and crackles
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4
Q

BRONCHIOLITIS: Signs

A
  • Raised RR
  • Use of accessory muscles
  • Intercostal and subcostal recessions
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging
  • Cyanosis
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5
Q

Define WHEEZE

A

Whistling sound
Narrowed airways
EXPIRATION

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6
Q

Define GRUNTING

A

Caused by exhaling with the glottis partially closed due to increased positive END-EXPIRATORY pressure

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7
Q

Define STRIDOR

A

High pitched INSPIRATORY noise
Obstruction of upper airway
E.g. croup

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8
Q

BRONCHIOLITIS: Treatment

A

Most recover in 2-3 weeks, most managed at home
Supportive management:
- adequate intake
- saline nasal drops

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9
Q

BRONCHIOLITIS: Reasons for admission

A 
Aged UNDER 3 MONTHS or any pre-existing condition such a prematurity, downs, CF 
50-75% or less of normal milk intake 
Clinical dehydration 
RR >70 
O2 sats <92%
Moderate to severe respiratory distress- e.g. deep recessions, head bobbing 
Apnoeas 
Parents unable to manage at home
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10
Q

Blood gases in TYPE 2 respiratory distress

A 
Rising pCO2 
Falling pH (CO2 build up —> acidosis)
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11
Q

BRONCHIOLITIS: preventative injection

A

PALIVIZUMAB - monoclonal antibody against RSV
monthly injection
High risk babies

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12
Q

How is VIRAL INDUCED WHEEZE different to ASTHMA

A 
Caused by: RSV or rhinovirus
Prevention: Before the age of 3
No atopic history 
Occurs during viral infections 
Evidence of viral infection 1-2 days preceding onset of SOB, respiratory distress, expiration wheeze
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13
Q

ACUTE ALLERGIC ASTHMA type of hypersensitivity reaction

A

Type 1 hypersensitivity

IgE

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14
Q

Signs of SEVERE ACUTE ASTHMA

A 
Peak flow <50%
Sats <92%
unable to complete full sentences 
Signs of respiratory distress 
RR >40 (1-5 years) 
RR >30 (5 years+)
HR >140 (1-5 years)
HR >125 (5 years+)
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15
Q

Signs of LIFE THREATENING ACUTE ASTHMA

A 
Peak flow <33% predicted 
Sats <92% 
Exhaustion or poor respiratory effort 
Hypotension 
Silent chest 
Cyanosis 
Altered consciousness or confusion
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16
Q

Management of acute asthma (or viral induced wheeze!)

A

1) Supplementary oxygen if sats low
2) Bronchodilators (e.g. salbutamol, ipratropium, magnesium sulphate)
3) steroids: prednisone (oral) hydrocortisone (IV)
4) Antibiotics if bacterial infection suspected (Amoxixillin or erythromycin)

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17
Q

Stepped up management of bronchodilators

A

1) Inhaled or nebulised SALBUTAMOL (Beta-2 agonist)
2) Inhaled or nebulised IPRATROPIUM BROMIDE (anti-muscarinic)
3) IV MAGNESIUM SULPHATE
4) IV AMINOPHYLLINE

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18
Q

MODERATE to SEVERE acute asthma stepwise treatment

A

1) SALBUTAMOL inhaler via spacer device (10 puffs every 2 hours)
2) Nebulisers with SALBUTAMOL/IPRATROPIUM BROMIDE
3) oral PREDNISONE (1mg per kg weight OD for 3 days)
4) IV HYDROCORTISONE
5) IV MAGNESIUM SULPHATE
6) IV SABUTAMOL
7) IV AMINOPHYLLINE

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19
Q

MILD asthma

A

SALBUTAMOL inhaler via spacer (e.g. 4-6 puffs every 4 hours)

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20
Q

Side effects of Salbutamol

A

Hypokalaemia

Tachycardia

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21
Q

CHRONIC ASTHMA diagnosis

A

Spirometry with bronchodilator reversibility testing (FEV1 improvement by >12%)
Direct bronchial challenge test with histamine or Mehta hotline
Fractional exhaled NO (FeNO)
Peak flow variability measured by keeping a diary

22
Q

Management stepwise approach CHRONIC ASTHMA in UNDER 5s

A
  1. Short acting beta-2 agonist (e.g. salbutamol) PRN
  2. Add low dose corticosteroid inhaler or leukotriene antagonist (ie oral monteleukast)
  3. Add other option from step 2
  4. Refer to specialist
23
Q

Management CHRONIC ASTHMA in children AGED 5-12

A
  1. (Same) Salbutamol
  2. (Same) Low dose corticosteroid inhaler
  3. LONG ACTING BETA-2 AGONIST inhaler (e.g. SALMETEROL)
  4. Titration up the corticosteroid inhaler
  5. Consider adding
    oral MONTELUKAST
    THEOPHYLLINE
  6. Increase corticosteroid to high dose
  7. Refer to specialist
24
Q

CHRONIC ASTHMA management 12 years +

A

SAME AS ADULT

25
Q

Metered dose inhaler technique WITHOUT SPACER

A

Remove cap
Shake inhaler
Sit or stand up straight
Lift chin slightly
Fully exhale
Make tight seal around inhaler between lips
Press canister and take steady breath in
Continue breathing for 3-4 seconds after pressing canister
Hold breath for 10 SECONDS
Wait 30 seconds before next dose
Rinse mouth after steroid inhaler

26
Q

Metered dose inhaler WITH A SPACER

A 
Assemble spacer
Shake inhaler 
Attach inhaler
Sit/stand up straight 
List chin slightly 
Make seal with lips/mask 
Spray dose into inhaler 
Take steady breaths in and out 5 times until the mist fully inhaled
27
Q

Characteristic signs of PNEUMONIA

A

Bronchial breath sounds (harsh breath sounds equally loud on inspiration and expiration - caused by consolidation of lung tissue around airway)
Focal coarse crackles (air passing through sputum - like straw blowing into drink)
Dullness to percussion (consolidation)

28
Q

Common bacterial causes of PNEUMONIA

A 
Strep. Pneumonia 
Group A Strep (e.g. strep pyogenes)
Group B strep (pre-vaccinated infants) 
Staph. Aureus 
H. Influenza 
Mycoplasma pneumonia (atypical bacteria - extra pulmonary manifestations e.g. erthyema multiforme)
29
Q

Viral causes of PNEUMONIA

A

RSV (most common)
Parainfluenza virus
Influenza virus

30
Q

Management of pneumonia

A

AMOXICILLIN
Add macrolide (e.g. ERYTHROMYCIN, CLARITHROMYCIN or AZITHROMYCIN ) - covers atypical bacteria
Penicillin allergy - MACROLIDES AS MONOTHERAPY

31
Q

RECURRENT LRTI: Pontential underlying problems

A

Reflux, aspiration, neurological disease, heart disease, asthma, cystic fibrosis, primary ciliary dyskinesia, immune deficiency

32
Q

CROUP: causative agents

A

PARAINFLUENZA
Influenza
Adenovirus
RSV

33
Q

CROUP: age of presentation

A

6 months - 2 years

34
Q

CROUP: presentation

A

Barking cough
Hoarse voice
STRIDOR
Low grade fever

35
Q

CROUP: management

A

Can be managed at home - SUPPORTIVE

Oral DEXAMETHASONE - single dose, can be repeated after 12hrs if required 
If not improving, stepwise: 
- Oral Dex
- Oxygen 
- Nebulised budesonide 
- Nebulised adrenaline 
- intubation/ventilation
36
Q

EPIGLOTTITIS: Infective agents

A

HAEMOPHILIUS INFLUENZA TYPE B

- rare now due to vaccination

37
Q

EPIGLOTTITIS: X-ray signs

A

Lateral X-ray of neck: THUMB SIGNS - soft tissue shakedown that looks like thumb pressed against trachea caused by oedematous swollen epiglottis

38
Q

EPIGOTITTIS: management

A 
Medical emergency!!
Do not distress child 
Secure airway - most don’t need intubation but there is a risk of sudden airway closure, so prepare for intubation or tracheostomy 
IV antibiotics (e.g. CEFTRIAXONE)
Steroids (DEXAMETHASONE)
39
Q

Laryngomalacia characteristics

A

CHRONIC STRIDOR - during inspiration (larynx flops across airway as child breaths in) - harsh whistling sound
- intermittent, more prominent when feeding, upset, during URTI
Peak presentation at 6MONTHS

40
Q

WHOOPING COUGH: causative agents

A

Bordetella Pertussis (gram neg bacteria)

41
Q

WHOOPING COUGH: presentation

A

Initially: Coryzal symptoms, low grade fever, mild dry cough
A week +: More severe coughing fits, PAROXYSMAL cough
Loud inspiratory WHOOP when coughing ends as out of breath
Can cough so hard they faint, vomit, develop pneumothorax
+/- apnoeas
NOTIFIABLE DISEASE

42
Q

WHOOPING COUGH: management

A

Notify public health!
Simple supportive care
Macrolide antibiotics: AZITHROMYCIN, ERYTHROMYCIN, CLARITHROMYCIN (within first 21 day)
Alternative: Co-trimoxazole

Close contacts: Prophylactic antibiotics

43
Q

CYSTIC FIBROSIS: genetic mutation

A

Cystic fibrosis transmembrane conductance regulatory gene
Chromosome 7
Codes for a type of chloride channel

44
Q

CYSTIC FIBROSIS: prevalence

A

1 in 2500 children have CF

1 in 25 are carriers for the mutation

45
Q

CYSTIC FIBROSIS: key consequences

A

1) THICK PANCREATIC and BILIARY secretions - block ducts, lack of digestive enzymes such as pancreatic lipase in the digestive tract
2) Low volume THICK AIRWAY SECRETIONS - reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections
3) Congenital bilateral absence of the VAS DEFERENS in males - male infertility as sperm have no way of getting from the testis to ejaculate

46
Q

CYSTIC FIBROSIS: Diagnosis

A

Screening: Newborn bloodspot test (shows high immune reactive trypsinogen levels)
SWEAT TEST - gold standard for diagnosis (high conc. of chloride ions >60mmol/L)
GENETIC SCREENING - for the GFTR gene can be performed during pregnancy by amniocentesis or chorionic villous sampling or blood test after birth

47
Q

CYSTIC FIBROSIS: the sweat test

A

PILOCARPINE applied to skin
Electrodes placed wither side of the patch and small current passed between electrodes - causing skin to sweat
Sweat absorbed by gauze/filter paper and a analysed for chloride ion concentration

48
Q

CYSTIC FIBROSIS: microbial colonisers

A 
Most common:
Staph Aureus 
H. Influenza 
Pseudomonas aeruginosa (BAD - often becomes resistant and increases mortality) 
Other: 
Klebsiella pneumoniae 
E Coli
49
Q

CYSTIC FIBROSIS: Management

A

Chest PHYSIOTHERAPY
Exercise
High Calorie diet
CREON tablets - to digest fats due to pancreatic insufficency
Prophylactic FLUCLOXACILLIN tablets
Bronchodilators
Nebulised DNase - can breakdown DNA material in respiratory secretions - making secretions less viscous and easier to clear
vaccinations: PNEUMOCOCCAL, INFLUENZA and VARICELLA

50
Q

CYSTIC FIBROSIS: Monitoring

A

Follow up every 6 months
Regular monitoring for colonisation of bacteria in sputum (e.g. pseudomonas)
Screening for: diabetes, osteoporosis, VitD deficiency, liver failure

51
Q

PRIMARY CILIARY DYSKINESIA: also known as?

A

Kartagner’s syndrome

52
Q

KARTAGNER’S TRIAD

A

Paranasal sinusitis
Bronchiectasis
Situs Inversus

(Not all patients will have all 3)

PAEDIATRICS (18 decks)

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