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PAEDIATRICS > Respiratory system and Exam > Flashcards

Respiratory system and Exam Flashcards

1
Q

State two differences between respiratory systems of adults and children

A

Children have greater lung compliance hence indrawing
Children respiratory sounds are readily transmitted to the child’s thorax from the upper airway

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2
Q

State four causes of prolonged expiratory rate

A

Alveoli issues - emphysema
Bronchoconstriction - asthma
Pulmonary edema - CHF
Respiratory infection - pneumonia

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3
Q

How to make sure patient is not rotated on Xray x2

A

Medial ends of clavicle should be equal on both sides
Distance between the spinous processes should be equal

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4
Q

State 4 ways to note hyperinflation of CXR

A

Flat diaphragm
Ribs appear straight
Lowered diaphragm
Increased retrosternal space- between ascending aorta and posterior sternum

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5
Q

State 4 things lost due to over penetrated xray

A

Vascular markings
Lung fields
Fractures
Consolidation

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6
Q

Describe the pathophysiology of asthma

A

Environmental triggers > inflammation> muscle spasms of bronchioles > increased mucus production, edema> obstruction > air trapping or collapse

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7
Q

Treatment for asthma x5

A

Bronchodilators- salbutamol MDI or nebuliser
Steroids- prednisolone and dexamethasone
Aminophylline or magnesium if severe
Control allergies

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8
Q

Progression of asthma

A

Cough > wheezing> tachypnea> silent chest> lethargy> hypocapnia> Normalizing of RR> resp failure> death

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9
Q

Causes of bronchiolitis - viral x5

A

Adenovirus, influenza, parainfluenza, human metapneumovirus, RSV- respiratory syncytial viral

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10
Q

Clinical features of bronchiolitis x6

A

Hypoxemia +/-
Tachypnoea
Wheezes, wet lung
Increased effort of breathing
Coryza- inflammation of the mucous membrane in the nose

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11
Q

Describe the pathophysiology of bronchiolitis

A

Infection > inflammation > mucous production > obstruction > poor gas exchange > hypoxemia
Obstruction > air trapping and hyperinflation

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12
Q

Management of bronchiolitis x5

A

Analgesics
Hydration
Oxygen
Nebulised bronchodilators
Hypertonic solution- clears mucus plug

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13
Q

Define bronchiectasis and its cause

A

Irreversible and abnormal dilation of the bronchial tree
Caused by continuous inflammation and mucous plugging > progressive airway obstruction

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14
Q

Common causes of pneumonia x4

A

S. pneumoniae, H. influenza, S. aureus, Klebsiella

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15
Q

State signs of typical(3) and atypical(3) pneumoniae

A

Typical- sudden onset of fever malaise and productive cough
Atypical- gradual onset of productive cough, dyspnea, extrapulmonary manifestations

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16
Q

State 5 processes that result in permanent dilation of bronchial tree in bronchiectasis

A

Infection
Inflammation
Increased secretions
Airway obstruction
Impaired defense mechanisms

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17
Q

Clinical features of bronchiectasis x4

A

Couch
Hemoptysis
Rhinosinusitis
Copious mucopurulent sputum

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18
Q

Patients with features suggestive of bronchiectasis x3

A

Productive cough >8 weeks in healthy patients
Chronic cough and recurrent pulmonary infections in immunosuppressed patients
Poor control or frequent exacerbations in patients with chronic pulmonary disease

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19
Q

Describe the CXR findings of typical and atypical pneumonia

A

Typical- opacity contained in one lobe
Atypical- diffuse subtle infiltrates

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20
Q

Define empyema and state possible microbes causes x2 in the lungs

A

Loculated accumulation of pus inside the lung consolidation
S. aureus and gram negatives/anaerobes

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21
Q

State what a sail sign on CXR suggests x3

A

Thymus shadow - prominent till 5Yrs
Pneumomediastinum
Left lower lobe collapse

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22
Q

CXR findings in asthma or bronchiolitis x5

A

Barrel chest shape
Flat diaphragm
Straight ribs
Hypertranslucent lung fields
Prominent hilum bronchovascular markings

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23
Q

What worsens asthma during the night x2

A

Hormonal changes
Muscle relax > airway narrowing > increased resistance in the lungs

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24
Q

Define status asthmaticus

A

Acute exacerbation of asthma that does not respond to treatment and requires hospitalization

25
Q

Treatment of mild(1) moderate(2) and severe(3) asthma

A

Mild - salbutamol rescue inhaler
Moderate - bronchodilators and rescue inhaler
Severe - daily inhaled steroids, long acting bronchodilators, rescue inhaler

26
Q

Define wet lung and describe what causes it

A

This is when lungs are filled with fluid aka acute respiratory distress syndrome
Accompanied by SOB, hypoxemia
Caused by damage to alveoli which makes the capillaries more permeable > fluid entering alveoli > alveolar collapse > hypoxia and acidosis

27
Q

Signs of severe pneumonia x4 and treatment x3

A

Tachypnea and dyspnea
Lower chest indrawing
No danger signs
Treatment: penicillin and gentamycin, switch to amoxicillin when improved

28
Q

Complications of pneumonia

A

Pleural effusions - exudative
Pleural empyema
Lung abscess
Respiratory failure
ARDS

29
Q

Differential diagnosis for wheezing x5

A

Asthma
Bronchiolitis
Foreign body
Bacterial tracheitis
Atypical infection eg myecoplasma

30
Q

Differential diagnoses for chronic wheezing x5 -STRUCTURAL

A

Tracheal stenosis
Vascular rings
Cystic masses
Lymphadenopathy
Cardiac failure

31
Q

Functional Differential diagnosis of chronic wheezing x5

A

GERD
Asthma
Cystic fibrosis
Immunodeficiency
Recurrent aspiration
Vocal cord dysfunction

32
Q

Treatment of otitis media x2

A

Amoxicillin
Ear wicking- removing wax with candles

33
Q

Complications of otitis media x5

A

Local- hearing impairment and mastoiditis
Intracranial- meningitis, dura and brain abscesses, encephalitis

34
Q

State 3 causes of nasal congestion with obstruction in the first year of life

A

Bacterial and viral infections
Enlarged adenoids
Tongue

35
Q

Treatment of nasal congestion in infants x3

A

Normal saline drops
Topical nasal decongestants
Antibiotics

36
Q

CT purpose and findings in choanal atresia x2

A

Purpose- to show the location and extent of thickening + bony involvement
Hypoplastic nasal cavities
Bony and mucosal choanal atresia

37
Q

Symptoms of enlarged tonsils and adenoids x5

A

Chronic mouth breather
Poor school performance
Hyponasal speech and hyposmia
Loss of appetite
Loud snoring

38
Q

Describe Heimlichs maneuver and when its done

A

Done on children after 5 failed back blows
Go behind the child
Make a fist and place it on childs sternum, put the other hand over fist and pull upwards into the abdomen. Repeat 5 times

39
Q

Features of foreign body obstruction of upper airway x3

A

Acute onset of cyanosis
Cough, stridor and drooling

40
Q

Management of foreign body aspiration x3

A

Adrenalin nebulizations - promotes relaxation of muscles
Removal by rigid bronchoscopy
Physiotherapy

41
Q

State the viral cause of epiglottitis and the clinical signs x5

A

Haemophilus influenza B
Sore throat, cough
High fever and drooling
Pain when swallowing
Difficulty breathing relieved by leaning forward

42
Q

State the radiological signs for croup and epiglottitis

A

Croup- steeple sign
Epiglottitis- thumb print

43
Q

Define croup and its causative agent

A

Inflammation of the trachea and larynx caused by parainfluenza virus

44
Q

Causative agents of retropharyngeal abscess x3

A

Strep group A and staph species
Haemophillus influenza

45
Q

Clinical features of retropharyngeal abscess x5

A

Difficulty swallowing
Pain when swallowing > drooling
Unwillingness to look up
Snoring, stridor, respiratory distress

46
Q

Management of retropharyngeal abscess x4

A

Ampicillin/sulbactam
Clindamycin
Steroids if there is acute airway obstruction
Surgical incision and drainage plus culture

47
Q

Management of croup x2

A

Adrenalin nebulizations
Brief steroid use

48
Q

Clinical presentation of recurrent respiratory papillomas x3

A

Chronic and progressive hoarseness
Communication difficulties
Respiratory distress
Obstructive sleep apnea

49
Q

Congenital causes of airway obstruction x5

A

Laryngomalacia
Subglottic stenosis
Subglottic hemangioma
Vocal cord paralysis
Laryngeal atresia and webs

50
Q

Define laryngomalacia and main symptom

A

Immature cartilage resulting in collapsing of epiglottic folds into airway during inspiration
Stridor exacerbated by crying, agitation, feeding

51
Q

Define pulsis paradoxus

A

An exaggerated fall in patient’s blood pressure during inspiration by greater than 10mm hg

52
Q

Asthma Exacerbation treatment x4

A

Dexamethasone 0.6mg/kg
Salbutamol nebulizer 2.5mg over 20min
Magnesium sulphate ie bronchodilator
Oxygen therapy

53
Q

Explain why CPAP is preferred over BIPAP in asthma respiratory support

A

BIPAP delivers higher pressure on inspiration and lower pressure on expiration
Cpap delivers equal pressure

54
Q

Medications used for severe asthma exacerbations x 4

A

Adrenaline
Ketamine- anesthetic
Terbutaline- reliever inhaler ie relieves wheezing and SOB
Heliox- treatment for breathing difficulties

55
Q

Asthma patient discharge requirements x3

A

Able to eat and drink
No longer requiring oxygen
Able to go 4hrs inbetween salbutamol treatments

56
Q

Pathophysiology of croup and it’s x-ray characteristics

A

Inflammation> edema> epithelial necrosis and shedding > narrowing of subglottic region
Inverted v sign ie conical shape

57
Q

Indications of CPAP x5

A

RDS
Lung collapse
Tracheomalacia
Pulmonary edema
Apnea of prematurity

58
Q

Contraindications of CPAP x5

A

Pneumonia
Hypotension
Meconium aspirate syndrome
Cardiac or respiratory distress

59
Q

Define cystic fibrosis and it’s manifestations x2

A

Cystic fibrosis is a disease of exocrine gland function that involves multiple organ systems but chiefly results in chronic respiratory infections, pancreatic enzyme insufficiency

PAEDIATRICS (20 decks)

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