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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
Treatment of mild(1) moderate(2) and severe(3) asthma
Mild - salbutamol rescue inhaler Moderate - bronchodilators and rescue inhaler Severe - daily inhaled steroids, long acting bronchodilators, rescue inhaler
26
Define wet lung and describe what causes it
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
Signs of severe pneumonia x4 and treatment x3
Tachypnea and dyspnea Lower chest indrawing No danger signs Treatment: penicillin and gentamycin, switch to amoxicillin when improved
28
Complications of pneumonia
Pleural effusions - exudative Pleural empyema Lung abscess Respiratory failure ARDS
29
Differential diagnosis for wheezing x5
Asthma Bronchiolitis Foreign body Bacterial tracheitis Atypical infection eg myecoplasma
30
Differential diagnoses for chronic wheezing x5 -STRUCTURAL
Tracheal stenosis Vascular rings Cystic masses Lymphadenopathy Cardiac failure
31
Functional Differential diagnosis of chronic wheezing x5
GERD Asthma Cystic fibrosis Immunodeficiency Recurrent aspiration Vocal cord dysfunction
32
Treatment of otitis media x2
Amoxicillin Ear wicking- removing wax with candles
33
Complications of otitis media x5
Local- hearing impairment and mastoiditis Intracranial- meningitis, dura and brain abscesses, encephalitis
34
State 3 causes of nasal congestion with obstruction in the first year of life
Bacterial and viral infections Enlarged adenoids Tongue
35
Treatment of nasal congestion in infants x3
Normal saline drops Topical nasal decongestants Antibiotics
36
CT purpose and findings in choanal atresia x2
Purpose- to show the location and extent of thickening + bony involvement Hypoplastic nasal cavities Bony and mucosal choanal atresia
37
Symptoms of enlarged tonsils and adenoids x5
Chronic mouth breather Poor school performance Hyponasal speech and hyposmia Loss of appetite Loud snoring
38
Describe Heimlichs maneuver and when its done
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
Features of foreign body obstruction of upper airway x3
Acute onset of cyanosis Cough, stridor and drooling
40
Management of foreign body aspiration x3
Adrenalin nebulizations - promotes relaxation of muscles Removal by rigid bronchoscopy Physiotherapy
41
State the viral cause of epiglottitis and the clinical signs x5
Haemophilus influenza B Sore throat, cough High fever and drooling Pain when swallowing Difficulty breathing relieved by leaning forward
42
State the radiological signs for croup and epiglottitis
Croup- steeple sign Epiglottitis- thumb print
43
Define croup and its causative agent
Inflammation of the trachea and larynx caused by parainfluenza virus
44
Causative agents of retropharyngeal abscess x3
Strep group A and staph species Haemophillus influenza
45
Clinical features of retropharyngeal abscess x5
Difficulty swallowing Pain when swallowing > drooling Unwillingness to look up Snoring, stridor, respiratory distress
46
Management of retropharyngeal abscess x4
Ampicillin/sulbactam Clindamycin Steroids if there is acute airway obstruction Surgical incision and drainage plus culture
47
Management of croup x2
Adrenalin nebulizations Brief steroid use
48
Clinical presentation of recurrent respiratory papillomas x3
Chronic and progressive hoarseness Communication difficulties Respiratory distress Obstructive sleep apnea
49
Congenital causes of airway obstruction x5
Laryngomalacia Subglottic stenosis Subglottic hemangioma Vocal cord paralysis Laryngeal atresia and webs
50
Define laryngomalacia and main symptom
Immature cartilage resulting in collapsing of epiglottic folds into airway during inspiration Stridor exacerbated by crying, agitation, feeding
51
Define pulsis paradoxus
An exaggerated fall in patient’s blood pressure during inspiration by greater than 10mm hg
52
Asthma Exacerbation treatment x4
Dexamethasone 0.6mg/kg Salbutamol nebulizer 2.5mg over 20min Magnesium sulphate ie bronchodilator Oxygen therapy
53
Explain why CPAP is preferred over BIPAP in asthma respiratory support
BIPAP delivers higher pressure on inspiration and lower pressure on expiration Cpap delivers equal pressure
54
Medications used for severe asthma exacerbations x 4
Adrenaline Ketamine- anesthetic Terbutaline- reliever inhaler ie relieves wheezing and SOB Heliox- treatment for breathing difficulties
55
Asthma patient discharge requirements x3
Able to eat and drink No longer requiring oxygen Able to go 4hrs inbetween salbutamol treatments
56
Pathophysiology of croup and it's x-ray characteristics
Inflammation> edema> epithelial necrosis and shedding > narrowing of subglottic region Inverted v sign ie conical shape
57
Indications of CPAP x5
RDS Lung collapse Tracheomalacia Pulmonary edema Apnea of prematurity
58
Contraindications of CPAP x5
Pneumonia Hypotension Meconium aspirate syndrome Cardiac or respiratory distress
59
Define cystic fibrosis and it’s manifestations x2
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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