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Respiriatory: Airway Disease > Respiratory Problems in Children > Flashcards

Respiratory Problems in Children Flashcards

1
Q

What is the neonatal period?

A

First 28 days of life

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2
Q

What classes can respiratory problems in children be split into?

A
  • Neonatal and older children

* Acute and chronic

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3
Q

In what ways are infants different from adults?

A
  • Babies respiratory rate is 60 breaths/min

* They can have periodic breathing (really fast then really slow)

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4
Q

What are signs of respiratory distress in newborns?

A
  • Sternal in-drawing
  • Tracheal tug (head bobs)
  • Grunt when struggling to breathe - essentially giving themselves CPAP
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5
Q

What is respiratory distress syndrome in newborns?

A

Relative surfactant deficiency

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6
Q

What newborns are affected with respiratory distress syndrome?

A
  • Predominately affects pre-term babies

* 1% of all births

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7
Q

What is the relationship between RDS and gestational age?

A

As gestational age increases, incidence of RDS decreases

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8
Q

What are components of surfactant?

A
  • Phospholipid

* Apoproteins

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9
Q

What does lack of surfactant result in?

A

Atelectasis and impairment of gas exchange

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10
Q

How is production of surfactant stimulated in premature infants?

A
  • If suspected pre-mature birth, mother given steroids to promote surfactant production by infant
  • Following birth, synthetic surfactant can be delivered down intubation tube into the lungs
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11
Q

What can ventilation lead to in young infants?

A

Pneumothorax

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12
Q

What are signs of a pneumothorax caused by ventilation of an infant?

A
  • Sudden deterioration requiring increased oxygen
  • No breath sounds on one side of chest
  • CXR showing black space in lung
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13
Q

What is pneumothorax?

A

Air in pleural space

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14
Q

What can increase the incidence of pneumothorax in young infants?

A
  • IPPV, CPAP and ventilation

* RDS (stiff lungs)

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15
Q

What percentage of pneumothorax cases are spontaneous?

A
  • Occurs in around 1% vaginal deliveries

* 1.5% caesarean sections

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16
Q

When would intervention be needed for pneumothorax in children?

A

Tension pneumothorax - a chest drain in required

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17
Q

What is chronic lung disease in children?

A
  • Oxygen requirement beyond 36 weeks corrected gestation
  • Evidence of pulmonary parenchymal disease (ILD) on CXR
  • Generally follows RDS
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18
Q

What can cause chronic lung disease in infants?

A

Damage caused by ventilation

  • Barotrauma (pressure trauma)
  • Volume trauma
  • High inspired oxygen
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19
Q

What are the effects of chronic lung disease in infants?

A
  • Often wheezy

* Healing stage associated with continued lung growth over 2-3 years

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20
Q

What is dextrocardia?

A

Heart points toward right side of chest instead of left side

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21
Q

What condition can mimic dextocardia in children?

A

Diaphragmatic hernia - guts in baby’s chest can push heart to right side

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22
Q

What are diaphragmatic hernias assorted with?

A

Pulmonary hypoplasia - lung hasn’t had enough space to develop

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23
Q

What are the commonest types of diaphragmatic hernia?

A
  • Posterolateral (Bochdalek), left-sided
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24
Q

Why should a bag-mask be avoided as treatment for diaphragmatic hernia?

A

Avoid bag mask as can travel down the oesophagus into bowel causing more problems

25
Q

What is the treatment for diaphragmatic hernia?

A
  • respiratory support - intubation (not bag mask)

* Surgical intervention

26
Q

What is the most likely diagnosis of a term baby who was delivered by LUSCS and is grunting shortly after delivery?

A

Transient Tachypnoea of the Newborn (TTN)

27
Q

What is Transient tachypnoea of the Newborn?

A

Lung fluid present in babies
* Occurs in babies delivered through caesarean section as in the womb, lungs are filled with amniotic fluid but the stress of labour pushes fluid out of the lungs

28
Q

What is the most likely respiratory diagnosis of a 1-year-old child who has a prolonged history of cough, loose stools and failure to thrive?

A

Cystic fibrosis

29
Q

What is the most likely diagnosis of a newborn infant with a raised immune-reactive trypsin level on neonatal screening and is also found to be homozygous for the delta-F508 deletion?

A

Cystic fibrosis

30
Q

Why is everyone in Scotland screened for CF?

A

Most common life-limiting illness in caucasians

31
Q

What is the main cause of death in cystic fibrosis?

A

Infection

32
Q

What is cystic fibrosis?

A
  • Autosomal recessive
  • Mutations in CFTR gene
  • Multisystem disorder
  • Recurrent respiratory infections
33
Q

What are differential diagnoses for cystic fibrosis?

A
  • Immune deficiency
  • Ciliary dyskinesia (cilia not moving correctly, build-up of mucous in RT)
  • Asthma
  • Kartagener’s/immotile cilia syndrome
34
Q

Why is flucloxacillin given to all kids with CF when they are born?

A

To prevent staph aureus infection (killer)

35
Q

What are members of the cystic fibrosis team?

A
  • Clinician
  • Specialist nurse
  • Clinical psychologist (difficult to have CF)
  • Social worker
  • Physiotherapist
  • Dietician – abnormal pancreas funtion (must gain weight with cystic fibrosis – insulin, CREON)
36
Q

Why are support groups consisting of many cystic fibrosis sufferers not plausible?

A

CF sufferers cannot be placed in a room with other CF suffers (e.g. in the case of support groups) as they spread their colonised pathogens to each other

37
Q

What is the most likely diagnosis of a 7 y/o old child who has a 3-month history of a cough that is worse at night or during active play?

A

Asthma

38
Q

What are clinical features that increase probability of asthma diagnosis?

A
  • One or more : wheeze, cough, chest tightness, difficulty breathing
  • Atopy (personal or family history)
  • Widespread wheeze on auscultation
  • Response to Rx
39
Q

What is the appearance of a flow volume loop in a child with asthma?

A

(pic)

40
Q

What is the appearance of a flow volume loop in a restrictive lung disease?

A

(pic)

41
Q

What is the appearance of a flow volume loop in restrictive + obstructive pulmonary disease?

A

(pic)

42
Q

What does the management of asthma in children include?

A
  • Stage 1: Treat with inhaled beta-agonists when needed
  • Stage 2: Treat with regular inhaled steroids
  • Stage 3A: Regular inhaled steroids + Long acting beta agonists
  • Stage 3B: Stage 3A + Leukotriene antagonists
  • Stage 4: High dose steroids
43
Q

What inhalers are used by children?

A
  • Inhaler + spacer

* For older children, breath-activated inhalers are an option

44
Q

What are the consequences of passive smoking in children?

A
  • Reduces birthweight by 250g
  • 4500 pregnancy losses per annum
  • 30% increase in Perinatal Mortality
  • Teratogenic : airways, cleft lip/palate
  • Glue ear
  • Carcinogenic
  • Increases likelihood of asthma attack
45
Q

What are the symptoms of acute asthma?

A

Cough and wheeze worsening over hours or days

46
Q

What is the treatment for acute asthma?

A
  • Oxygen
  • Nebulised bronchodilator
  • Oral prednisolone – reduces inflammation
  • IV salbutamol
  • IV aminophylline
  • IV magnesium
  • Ventilatory support
47
Q

What is the most likely diagnosis of a 6-week old who presents with increased work of breathing, possible apnoeas, and URTI symptoms over the last 2 days?

A

Bronchiolitis

48
Q

What is bronchiolitis?

A

A viral infection caused by RSV (respiratory syncytial virus)

49
Q

What children are at risk of more severe bronchiolitis?

A
  • Younger babies
  • Premature
  • Family of smokers
50
Q

What are the symptoms of bronchiolitis in infants?

A
  • Tachypnoea
  • Poor feeding
  • Irritating cough
  • Apnoea in small babies
51
Q

What is the treatment for bronchiolitis?

A

Treatment is supportive

52
Q

What is the most likely diagnosis of a 10 y/o girl who presents with high fever, cough and sputum production? On examination, she showed dullness on percussion, increased vocal resonance and bronchial breathing

A

Pneumonia

53
Q

What microorganisms are responsible for pneumonia in neonates?

A

Group B strep, E.coli, Klebsiella, Staph aureus

54
Q

What microorganisms are responsible for pneumonia in infants?

A

Strep pneumoniae, chlamydia

55
Q

What microorganisms are responsible for pneumonia in school children?

A

Strep pneumoniae, Staph aureus, Group A strep, Bordetella, Mycoplasma, Legionella

56
Q

What is croup?

A

Viral laryngotracheobronchitis

57
Q

What are the symptoms of croup?

A
  • Stridor

* Barking cough

58
Q

What is the treatment for croup?

A

Treatment is oral steroid to reduce inflammation

59
Q

What are common respiratory problems in children?

A
  • Infant respiratory distress syndrome
  • CLD
  • Congenital diaphragmatic hernia
  • Cystic fibrosis
  • Asthma
  • Bronchiolitis
  • Childhood pneumonias
  • Croup

Respiriatory: Airway Disease (10 decks)

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