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Year 4 Paediatrics > Respiratory System/ENT > Flashcards

Respiratory System/ENT Flashcards

1
Q

What commonly causes bronchiolitis?

A

Respiratory syncytial virus

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2
Q

Why does bronchiolitis occur in infants?

A

It tends to occur in infants less than 18 months due to obstruction of the small airways - they have much smaller airways than older children/adults

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3
Q

What are the clinical features of bronchiolitis? (6)

A
  1. Coryza
  2. Wheeze
  3. Cough
  4. Difficulty feeding
  5. Apnoea
  6. Subcostal/intercostal retractions
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4
Q

In an infant with bronchiolitis, what would be found on examination? (2)

A
  1. Over-expansion of the chest

2. Wheeze and crepitations

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5
Q

How is bronchiolitis diagnosed, what investigations are carried out/results seen? (2)

A
  1. CXR will reveal overinflated lungs, and collapse or consolidation
  2. Nasopharyngeal aspirate - taken to look for RSV in respiratory secretions using immunofluorescence
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6
Q

How are babies with bronchiolitis managed? Do they need to be admitted?

A

Most babies are not ill enough to require admission and provided they can take feeds well, they are managed at home. Admission is required if there is:

  1. Cyanosis
  2. Increasing respiratory distress
  3. Apnoea
  4. Poor feeding
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7
Q

When do the symptoms of bronchiolitis peak during the infection?

A

Day 3-5

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8
Q

What are the NICE guidelines for diagnosis of bronchiolitis?

A

Diagnose if the baby has had a coryzal prodrome lasting 1 to 3 days, followed by:

  1. Persistent cough AND
  2. Either tachypnoea or chest recession AND
  3. Either wheeze or crackles on auscultation
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9
Q

When would a diagnosis of pneumonia be more likely compared to bronchiolitis? (2)

A

If the child has:

  1. A high fever (over 39 degrees) and/or
  2. Persistently focal crackles
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10
Q

NICE guidelines suggest there may be impending respiratory failure in a child with bronchiolitis, if they display what signs/symptoms? (3)

A
  1. Signs of exhaustion, for example listlessness or decreased respiratory effort
  2. Recurrent apnoea
  3. Failure to maintain adequate oxygen saturation despite oxygen supplementation.
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11
Q

According to NICE guidelines, which drugs often used to treat other respiratory conditions should NOT be given to treat bronchiolitis? (7)

A
  1. Antibiotics
  2. Salbutamol
  3. Hypertonic saline
  4. Adrenaline
  5. Montelukast
  6. Ipratropium bromide
  7. Systemic/inhaled corticosteroids
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12
Q

What is the treatment for bronchiolitis? (4)

A
  1. Oxygen (if stats are persistently below 92%)
  2. CPAP - only if have impending respiratory failure
  3. Upper airway suctioning - only if indicated (e.g. apnoea, feeding difficulties)
  4. If not taking fluids by mouth, give fluids via NG or OG tube
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13
Q

Before discharging a child with bronchiolitis, what is important for them to be able to do? (3)

A
  1. Maintain sats above 92% on room air for 4 hours, including a period of sleep
  2. Is taking adequate oral fluids
  3. Clinically stable
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14
Q

What are the NICE guideline red flag symptoms, that are important to look out for, and parents should be aware of, in children with bronchiolitis? (4)

A
  1. Worsening work of breathing (for example grunting, nasal flaring, marked chest recession)
  2. Fluid intake is 50–75% of normal or no wet nappy for 12 hours
  3. Apnoea or cyanosis
  4. Exhaustion (for example, not responding normally to social cues, wakes only with prolonged stimulation).
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15
Q

What is croup and why does it occur?

A

Croup is also known as laryngotracheobronchitis, and is a common childhood respiratory disease, characterised by a sudden onset of a seal-like barking cough often accompanied by stridor, voice hoarseness and respiratory distress.
The symptoms occur as it is an upper airway obstruction caused by inflammation due to a viral infection - normally parainfluenza virus.

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16
Q

What are the signs/symptoms of croup? (6)

A
  1. Seal-like barking cough
  2. Stridor
  3. Wheeze
  4. Coryza
  5. Fever
  6. Hoarseness
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17
Q

What % of children are affected by croup each year, and which age range is it most prevalent in?

A

3% of children each year, generally aged between 6 months and 3 years

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18
Q

When are hospital admissions of croup most common?

A

Between the months September to December

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19
Q

Croup tends to affect which gender more commonly?

A

Males

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20
Q

What is the treatment for moderate/severe croup?

A

Combination of dexamethasone and nebulised epinephrine

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21
Q

Which symptoms appear first in the croup?

A

Croup starts with coryza symptoms and fever and then proceeds to stridor and barking cough

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22
Q

If croup is very severe and respiratory failure develops, what is the management?

A

Intubation

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23
Q

What are the differential diagnoses for croup? (5)

A
  1. Epiglottitis
  2. Upper airway foreign body
  3. Retropharyngeal abscess
  4. Tonsillar abscess
  5. Allergic reaction
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24
Q

How is croup judged to be mild/moderate/severe/life-threatening?

A 
Mild = seal-like barking cough but no stridor/intercostal recession
Moderate = seal-like barking cough with stridor and sternal recession at rest ...but no agitation or lethargy 
Severe = all of the above with agitation and lethargy 
Life-threatening = all of the above with cyanosis/pallor/decreased level of consciousness
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25
Q

When is a child with croup admitted to hospital?

A

If it is moderate or worse

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26
Q

If in GP land, what is the management of a child with croup?

A

Give supplementary oxygen

Give oral dexamethasone (0.15mg/kg), if the child is too unwell to take this, then inhaled budesonide

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27
Q

Which bacteria causes epiglottitis?

A

Haemophilus influenzae B (HiB)

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28
Q

What are the common bacterial causes of pneumonia? (4)

A
  1. Streptococcus pneumoniae (especially in younger children)
  2. Mycoplasma pneumoniae
  3. Haemophilus influenzae
  4. Group B beta-haemolytic streptococcus (only in the newborn)
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29
Q

What are the viral causes of pneumonia? (5)

A
  1. Respiratory syncytial virus
  2. Influenza viruses
  3. Parainfluenza
  4. Adenovirus
  5. Coxsackie virus
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30
Q

What are the predisposing factors that can cause pneumonia in children? (6)

A
  1. Inhaled foreign body
  2. Persistent lobar collapse
  3. Aspiration
  4. Large left to right intracardiac shunt
  5. Immunocompromise
  6. Congenital abnormality of the tracheo-bronchial tree
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31
Q

What are the clinical features suggestive of pneumonia in the history? (5)

A
  1. Fever
  2. Cough
  3. Respiratory distress
  4. Shoulder tip/abdominal pain
  5. Sputum production in older children
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32
Q

What are the common presentation findings in a child with pneumonia?

A
  1. Tachypnoea
  2. Nasal flaring
  3. Intercostal/subcostal recession
  4. Grunting in infants
  5. Meningism
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33
Q

What investigations are performed in suspected pneumonia in children which can confirm the diagnosis? (2)

A
  1. CXR - focal consolidation suggests bacterial cause, diffuse consolidation often suggest viral
  2. Blood count/blood culture
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34
Q

What are the differential diagnoses for pneumonia in children? (6)

A
  1. URTI
  2. Bronchiolitis
  3. Acute bronchitis
  4. Asthma
  5. Non-specific viral infection
  6. Inhaled foreign body
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35
Q

What are the possible complications of pneumonia in children? (5)

A
  1. Lung abscess
  2. Empyema
  3. Pneumothorax
  4. Sepsis
  5. Bronchiectasis
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36
Q

What are the paediatric respiratory disorders that can cause a stridor? (3)

A
  1. Epiglottitis
  2. Inhaled foreign body
  3. Croup
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37
Q

What are the paediatric respiratory conditions that cause a wheeze? (5)

A
  1. Asthma
  2. Bronchiolitis
  3. Inhaled foreign body
  4. Cardiac failure
  5. Viral induced wheeze
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38
Q

What are the causes of a cough in infants? (4)

A
  1. Infections (URTI, bronchiolitis, pneumonia)
  2. Congenital malformations of the airway
  3. GORD
  4. Cystic fibrosis
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39
Q

What are the causes of a cough in pre-school children? (5)

A
  1. Infections (URTI, croup, acute bronchitis, pneumonia)
  2. Foreign body
  3. Asthma
  4. Cystic fibrosis
  5. Passive smoking
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40
Q

What are the causes of a cough in school children to adolescence? (6)

A
  1. Asthma
  2. Infections (URTI)
  3. Cigarette smoking
  4. Postnasal drip
  5. Psychogenic
  6. Cystic fibrosis
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41
Q

What are the symptoms of a chronic lower respiratory tract disease in children? (5)

A
  1. Productive cough which improves with antibiotics but quickly recurs
  2. Restriction of activity
  3. Failure to thrive/gain weight
  4. Clubbing
  5. Persistent tachypnoea
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42
Q

In a paediatric history for a cough, what questions are important to ask? (7)

A
  1. What does the cough sound like? (e.g. wheezy, dry, rattling due to mucus)
  2. What is the sputum like?
  3. When is the coughing worse?
  4. Is the cough acute, persistent or recurrent?
  5. Is the child systemically unwell?
  6. Associated symptoms/precipitating factors?
  7. Anyone in the family smoke?
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43
Q

Which respiratory condition frequently causes a nocturnal cough?

A

Asthma

44
Q

When a child presents with stridor, what questions are important to ask?

A
  1. Any coryza or fever?
  2. Aspiration?
  3. Features of onset?
45
Q

What is the most common cause of stridor, and which is the most worrying differential?

A

Most common cause is croup, which is self-limiting and therefore not too concerning, however the differential is epiglottitis which can be life-threatening

46
Q

In what age range is epiglottitis most common to occur in?

A

Age 2 - 7

47
Q

What % of children are affected by asthma?

A

20%

48
Q

Why are the symptoms of asthma worse in infants?

A

Because their airways are so small, any narrowing or contribution of secretions/mucosal oedema has a bigger consequence and there is often a poor response to bronchodilators

49
Q

How do children with asthma initially present?

A

Most children with asthma become symptomatic in infancy or school years. The diagnosis is made on a clinical basis of persistent or recurrent cough or wheeze, which is responsive to medication.

50
Q

What is the step by step treatment of asthma in children under the age of 5? (4 steps)

A

Step 1. Prescribe an inhaled short-acting beta-agonist PRN (SABA)
Step 2. Add inhaled steroids 200-400 ug/day
Step 3. (if older than 6 months) Add leukotriene receptor antagonists
Step 4. Refer to respiratory paediatrician

51
Q

What is the step by step treatment of asthma in children between the ages of 5-12 years? (5 steps)

A

Step 1. Prescribe a SABA prn
Step 2. Add inhaled corticosteroids 200-400ug/day
Step 3. Add LABA and consider leukotriene receptor antagonist or oral theophylline
Step 4. Increase dose of inhaled steroids 800ug/day
Step 5. Add oral low-dose prednisolone.
Refer to respiratory paediatrician

52
Q

What type of rash does measles cause, and where does it start/spread? What are the other features associated with measles? (5)

A 
Maculopapular - begins on the face and spreads downwards. 
Other features of measles include:
1. Koplik spots
2. Coryza
3. Cough
4. Conjunctivitis
5. Systemically unwell.
53
Q

What type of rash does rubella cause? What are the other features of rubella?

A

Macular rash - tiny pink macules on the face and trunk, works downwards
Other features of rubella:
1. lymphadenopathy
2. Normally a well child

54
Q

What type of rash does scarlet fever cause? and what are the other features of this infection? (3)

A 
Maculopapular - fine punctuate red rash with sandpapery feel, followed by peeling of the hands/feet
Other features of scarlet fever include:
1. Strawberry tongue
2. Perioral pallor
3. Tonsillitis
55
Q

What type of rash occurs with Fifth disease, and how does it appear?

A

Maculopapular, ‘slapped cheek’ appearance, lace-like rash on the arms, trunk and thighs

56
Q

Which virus causes Fifth disease?

A

Parvovirus B19

57
Q

What type of rash does chicken pox cause?

A

Vesicular - papules, vesicles and crusts are present

58
Q

What type of rash does meningococcaemia cause?

A

Purpuric - morbiliform (resembling measles), petechial or purpuric

59
Q

What does petechiae refer to?

A

Red, brown or purple spots on the skin that are caused by bleeding beneath the skin

60
Q

When a child presents with pyrexia of an unknown origin, what questions are important to ask in the history? (4)

A
  1. Review of systems
  2. Contact with infectious diseases
  3. Travel abroad?
  4. Exposure to animals?
61
Q

How may a child with tonsillitis present? (4)

A
  1. Fever
  2. Sore throat
  3. Abdominal pain (due to mesenteric adenitis)
  4. Reduced fluid/food intake
62
Q

What in the clinical examination would indicate a bacterial tonsillitis rather than a viral one?

A

A white exudate and tender enlarged cervical lymph glands

63
Q

What is the usual treatment for children with tonsillitis which is most likely viral, and what about bacterial?

A

Gargles with saline and paracetamol - viral

The above and with antibiotics for bacterial - usually penicillin based

64
Q

What are the complications of tonsillitis? (4)

A
  1. Otitis media
  2. Chronic tonsillitis
  3. Quinsy
  4. Post-streptococcal allergic disorders (acute glomerulonephritis)
65
Q

What are the most common bacterial organisms that cause otitis media? (2)

A
  1. Streptococcus pneumoniae

2. Haemophilus influenzae

66
Q

What ENT problem is commonly associated with otitis media?

A

Eustachian tube dysfunction

67
Q

How does otitis media often present? (7)

A
  1. Fever
  2. Painful ear
  3. Hearing loss
  4. Often preceded by URTI
    The following are often present in young children and are not obvious symptoms for otitis media, making it harder to identify the ear as the source of infection:
  5. Anorexia
  6. Vomiting
  7. Diarrhoea
68
Q

On examination of the ear, how does otitis media present?

A

Tympanic membrane is inflamed and bulging, with loss of the light reflex
Perforation of the tympanic membrane may occur - in which case pus will be present

69
Q

What is the management of otitis media?

A

Most cases are caused by a virus, but if the child has had symptoms for more than 48 hours, then antibiotics will be prescribed - often amoxicillin

70
Q

Which group of bacteria causes cervical adenitis?

A

Group A beta-haemolytic streptococcus

71
Q

Which virus causes infectious mononucleosis (glandular fever)?

A

Epstein-Barr virus

72
Q

What is the inheritance pattern for cystic fibrosis?

A

Autosomal recessive

73
Q

Which protein receptor is affected in cystic fibrosis?

A

CFTR - CF transmembrane receptor

74
Q

What is the result of the defect in the CFTR protein?

A

Ion transport in exocrine glands is defective - in the lung this means abnormal sodium and chloride ion transport leading to thickening of respiratory mucus

75
Q

What happens in the lungs in someone with CF due to the thickening of respiratory mucus?

A

The lung is prone to inadequate mucociliary clearance, chronic bacterial colonisation and lung injury. Similar affects are had on other organs including pancreatic insufficiency, liver disease and male infertility.

76
Q

Which is the most common mutation in the CFTR gene in cystic fibrosis? (even though there are over 1000 mutations)

A

F508 deletion

77
Q

How is cystic fibrosis (CF) screened for and diagnosed in the UK?

A

Using the Guthrie card - CF can be identified by newborn screening for abnormally raised immunoreactive trypsinogen (IRT) and CFTR F508 deletion from blood-spot analysis

78
Q

What in a history/presenting complaint can indicate CF?

A
  1. Cough and wheeze
  2. Shortness of breath
  3. Sputum production
  4. Haemoptysis
  5. Weight loss
  6. Steatorrhoea
79
Q

Approximately 20% of CF patients present in the neonatal period with what?

A

Meconium ileus (an obstruction of the bowel caused by thick, abnormal meconium)

80
Q

Other than meconium ileus, how else can children present with CF?

A
  1. Malabsorption
  2. Faltering growth
  3. Recurrent chest infection
81
Q

What investigations are carried out in someone with suspected CF and what do they show?

A
  1. Sweat test showing increased chloride levels (>60mmol/L)
  2. Chest X-ray: hyperinflation, increased antero-posterior diameter, bronchial dilatation, cysts, linear shadows and infiltrates
  3. Lung function: obstructive pattern with decreased FVC and increased lung volumes
82
Q

What are the problems/complications that arise due to CF in the neonatal period? (2)

A
  1. Meconium ileus

2. Jaundice

83
Q

What are the complications that arise due to CF in early childhood? (4)

A
  1. Bronchiectasis
  2. Rectal prolapse
  3. Nasal polyps
  4. Sinusitis
84
Q

What are the complications that arise due to CF in adolescence? (8)

A
  1. Diabetes
  2. Cirrhosis and portal hypertension
  3. Distal intestinal obstruction
  4. Pneumothorax
  5. Haemoptysis
  6. Aspergillosis
  7. Male sterility
  8. Psychological problems
85
Q

What physiotherapy is given to children with CF and how often is it performed?

A

Pulmonary physiotherapy - twice daily

  • Chest percussion
  • Postural drainage
  • Self-percussion
  • Deep breathing exercises
86
Q

What prophylactic treatment are they given to prevent respiratory infections?

A

Oral antibiotics - protect against staph. aureus and haemophilus influenzae

87
Q

What will many children have with CF if they have recurrent chest infections?

A

An indwelling/permanent form of IV access to give antibiotics e.g. indwelling Portacath

88
Q

What are medications are given to help children with CF in addition to antibiotics? (3)

A
  1. Annual influenzae/pneumoccocal vaccination
  2. Bronchodilators
  3. Mucolytics - nebulized acetylcystine
89
Q

What treatment is given/recommended in terms of nutrition and help with this for children with CF? (4)

A
  1. Pancreatic insufficiency is treated with oral enteric-coated pancreatic supplements + ranitidine
  2. High calorie diet (require 150% more than normal)
  3. Salt supplements
  4. Fat-soluble vitamin supplements - Dalivit drops 1mL/day, vitamin E, vitamin K
90
Q

What are the differences between croup and epiglottitis?

A 
Croup = days, prodromal coryza, barking cough, can drink, hoarse voice, rasping stridor 
Epiglottitis = hours onset, no prodromal symptoms, slight cough if any, drooling saliva, cannot feed, weak or silent voice
91
Q

In CF, the defective protein causes which ion transport channel to be affected?

A

Sodium and chloride transport across the membrane of secretory epithelial cells

92
Q

What is the sweat test looking for when diagnosing CF?

A

High levels of sodium and chloride concentration

93
Q

What are the stools like of someone with CF?

A

Fatty/greasy - due to malabsorption caused by pancreatic insufficiency

94
Q

What are the muco-active agents used to help treat CF?

A
  1. rhDNase
    • hypertonic sodium chloride nebs
  3. Mannitol dry powder for inhalation if intolerant to rhDNase and HSC nebs
95
Q

What treatment can you give for chronic pseudomonas aeruginosa infection in CF?

A

C nebs (powerpoint from Umamah)

96
Q

What treatment improves bile flow in someone with CF?

A

Ursodeoxycholic acid treatment

97
Q

What % of adolescents with CF will develop diabetes?

A

19% - will require insulin therapy

98
Q

What length of time is stopping breathing is classed as apnoea?

A

20 seconds (though more than 10 is worrying)

99
Q

What is RSV palivizumab?

A

It is a prophylactic injection to prevent RSV bronchiolitis. It needs to be given monthly through the winter months and is given to premature babies going home on oxygen, or other high risk babies.

100
Q

Which age is the peak incidence for the croup?

A

2 years

101
Q

Whats the Westley Croup score?

A

Mild, moderate and severe classifications of croup based upon level of consciousness, cyanosis, stridor, air entry and intercostal recession - useful for monitoring improvement and indicating which treatment to use

102
Q

What investigations are going to be performed for croup?

A

Check oxygen sats and auscultation as do not want to cause any distress to the child due to risk of airway obstruction

103
Q

What is epiglottitis?

A

Oedema/inflammation of the epiglottis and surrounding area, typically occurs at 2 - 5 years of age

104
Q

How is the stridor different between epiglottitis and croup?

A

In croup the stridor is harsh whereas with epiglottis the stridor is soft (also they will appear very unwell, drooling, lethargic)

105
Q

What is the first line investigation for epiglottitis?

A

Fibre-optic laryngoscopy

106
Q

What are the causes of epiglottitis?

A
  1. Hib
  2. Staph. aureus
  3. Strep.

Year 4 Paediatrics (18 decks)

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