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Paediatric rotation > Paediatric respiratory > Flashcards

Paediatric respiratory Flashcards

1
Q

What are the signs of respiratory distress?

A

Raised RR
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises

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2
Q

What are the respiratory failure red flags?

A

Drowsiness
Lethargy
Cyanosis
Tachycardia
Laboured breathing

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3
Q

What is croup also known as?

A

Acute Laryngeotracheobronchitis

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4
Q

What was croup previously caused by and what did it lead to?

A

Diptheria and lead to epiglottitis

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5
Q

What is the cough in croup due to?

A

Upper airway infection causing oedema and mucosal inflammation in the larynx

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6
Q

When does croup tend to occur?

A

6 months-6 years. Peaks at 2-3 years.

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7
Q

At what time of year is croup most common?

A

Autumn and Spring

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8
Q

Is croup more common in boys or girls?

A

Boys

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9
Q

What is the cough like in croup?

A

Barking cough

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10
Q

What is the main causative pathogen of croup?

A

Parainfluenza virus

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11
Q

Apart from parainfluenza virus, what are the other causes of croup?

A

Influenza, adenovirus and RSV (Respiratory syncytial virus), enterovirus

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12
Q

What are the main symptoms of mild croup?

A

Occasional barking cough with no audible stridor, no recession, child eating and drinking as normal

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13
Q

What are the main symptoms of moderate croup?

A

Frequent barking cough with audible stridor at rest, suprasternal recession, child not agitated

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14
Q

What are the main symptoms of severe croup?

A

Frequent barking cough, prominent stridor, marked sternal recession, agitated and distressed child potentially with tachycardia.

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15
Q

What is the examination and history for croup?

A

1-4 days history of non-specific rhinorrhea, fever and barking cough
Worse at night
stridor
decreased bilateral air entry
tachypnoea
costal recession
Hoarse voice
low grade fever

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16
Q

What might you do for diagnosis and rule out DDx for croup?

A

FBC, CRP U+E
CXR to exclude foreign body

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17
Q

How long can symptoms of croup last?

A

48 hrs-1 week

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18
Q

What is the management for most children with croup?

A

Fluid and rest at home

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19
Q

What drug do you give to treat croup?

A

Single dose of oral dexamethasone 0.15mg or nebulised budesonide/prednisolone

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20
Q

How do you treat severe croup?

A

Oral dexamethasone, oxygen, nebulised budesonide/adrenline and adrenaline, intubation and ventilation if needed (in stepwise progression)

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21
Q

What are the complications of croup?

A

Otitis media
Dehydration due to reduced fluid intake
Superinfection: Pneumonia

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22
Q

What is acute epiglottitis?

A

Acute upper airway obstruction due to swelling of the epiglottis and surrounding tissue. it is a medical emergency!

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23
Q

What pathogen causes acute epiglottitis?

A

Haemophilis influenzae B

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24
Q

What sounds will a child with acute epiglottitis be making?

A

Soft inspiratory stridor with no cough
Muffled voice

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25
Q

How might a child with acute epiglottitis present apart from sounds

A

Unable to speak or swallow (drooling).
Sitting upright with open mouth to optimise airway. (tripod position) Sore throat in septic looking child
high fever
scared and quiet child

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26
Q

What should you not do if acute epiglottitis is suspected?

A

Do not examine throat

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27
Q

What will a lateral x ray of the neck show?

A

Characteristic thumb sign

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28
Q

What drug is given to children with acute epiglottitis?

A

IV cefuroxime
And steroids (dexamethosone)

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29
Q

What is a common complication of apiglottitis?

A

Epiglottic abscess

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30
Q

What has reduced the incidence of acute epiglottitis?

A

Introduction of the HiB vaccine

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31
Q

What might an unvaccinated child presenting with a fever, sore throat and difficulty swallowing that is sitting forward and drooling have?

A

Epiglottitis

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32
Q

What is whooping cough also known as?

A

Pertussis

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33
Q

What is whooping cough?

A

Bacterial URTI

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34
Q

What pathogen causes Whooping cough?

A

Bordetella Pertussis (highly contagious)- gram negative bacillus

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35
Q
A
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36
Q

When are vaccinations given against whooping cough?

A

2,3,4 months, booster at 3 years 4 months

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37
Q

What are the sounds of whooping cough?

A

Inspiratory whoop (forced inhalation against a closed glottis)

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38
Q

When is the cough in whooping cough worse?

A

At night

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39
Q

What can the cough in whooping cough causes?

A

vomiting, cyanosis, epistaxis and subconjunctival haemorrhages.

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40
Q

How long does the paroxysmal phase of Whooping cough last?

A

3-6 weeks but can last months

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41
Q

What is the clinical presentation of whooping cough?

A

Catarrhal phase: lasts 1-2 weeks: coryzal symptoms
Paroxysmal phase: occurs weeo 3-6: characteristic “inspiratory whoop”
Spasmodic coughing episodes
low grade fever
Sore throat
Convalescent phase: downgrade of cough lasting up to 3 months

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42
Q

How do you investigate whooping cough?

A

Per nasal swab culture
(FBC and antibody test)

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43
Q

What is the treatment for whooping cough lasting less than a month?

A

Azithromycin 5 days

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44
Q

What is the treatment for whooping cough lasting more than a month?

A

Azithromycin/Erythromycin 7 days

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45
Q

What are the complications of whooping cough?

A

Seizures
Pneumonia
Bronchiectasis
Encephalopathy
Otitis media

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46
Q

What is the most common LRTI in children?

A

Bronchiolitis

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47
Q

What is bronchiolitis?

A

Viral infection of the bronchioles

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48
Q

What ages are most common for bronchiolitis?

A

1-9 months

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49
Q

When does bronchiolitis peak?

A

Winter and Spring

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50
Q

What pathogen mainly causes bronchiolitis?

A

RSV (very infectious)( Respiratory Syncytial Virus)

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51
Q

What other 2 pathogens can cause bronchiolitis?

A

parainflueza virus, human metapneumovirus

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52
Q

What are the risk factors for bronchiolitis?

A

Breastfeeding<2 months
Smoke exposure
Older siblings who attend nursery/school
Chronic lung disease of prematurity

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53
Q

What are the main symptoms of bronchiolitis?

A

Symptom onset in 2-5 days Coryzal, breathlessness, poor feeding, Fine end inspiratory crackles, high pitched wheeze, cyanosis (on feeding), cough. signs of respiratory distress

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54
Q

What are the abnormal airway noises heard in bronchiolitis?

A

Wheezing (on expiration), grunting and stridor

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55
Q

What 2 investigations can you do for bronchiolitis?

A

PCR analysis of nasal secretions for RSV
FBC, Urine, Blood gas if severely unwell
CXR- not usually but shows hyperinflation, air trapping and flattened diaphragm

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56
Q

What might you see on a CXR in bronchiolitis?

A

Hyperinflation

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57
Q

What would suggest urgent hospital admission in bronchiolitis?

A

Apnoea
Resp rate >70
Central cyanosis
SpO2<92 %

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58
Q

What would suggest non-urgent admission in bronchiolitis?

A

Resp rate>60
Clinical dehydration

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59
Q

What drug can be used to prevent bronchiolitis?

A

Palivizumab

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60
Q

What kind of drug is palivizumab?

A

Monoclonal antibody

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61
Q

Which children may get palivizumab to prevent bronchiolitis?

A

CF, immunocompromised, congenital heart disease, Downs

62
Q

What is pneumonia?

A

Infection of the lower respiratory tract and lung parenchyma which leads to consolidation

63
Q

What are the characteristic chest sounds of pneumonia?

A

Bronchial breath sounds, focal coarse crackles, dullness to percussion

64
Q

What general cause of pneumonia is most common in infants?

A

Viral

65
Q

What general cause of pneumonia is more common in older children?

A

Bacterial

66
Q

Which pneumonia is more common in winter; viral or bacterial?

A

Viral

67
Q

What is the most common bacterial cause of pneumonia?

A

Streptococcus pneumonia

68
Q

What bacteria causes pneumonia in pre-vaccinated infants during birth?

A

Group B strep

69
Q

If staphylococcus aureus causes pneumonia, what might be seen on the chest x ray?

A

Pneumoceles and consolidation in multiple lobes

70
Q

Apart from streptococcus pneumonia, Group B strep and staphylococcus aureus, what can cause paediatric pneumonia?

A

Group A strep

71
Q

What is the most common viral cause of paediatric pneumonia?

A

Respiratory Syncytial virus (RSV)

72
Q

Apart from RSV, what other viral causes are there of paediatric pneumonia?

A

Parainfluenza virus and influenza virus

73
Q

What are the causes of pneumonia in neonates and which is most common (put 1st)

A

Group B strep
E.coli
Klebsiella
Staph aureus

74
Q

What is the main cause of pneumonia in infants?

A

Strep pneumoniae

75
Q

What are the causes of pneumonia in neonates and which is most common (put 1st)

A

Strep pneumoniae
Staph aureus
Group A strep
Mycoplasma pnuemoniae

76
Q

What is the clinical presentation of pneumonia?

A

Fever
SOB
Lethargy
Signs of respiratory distress
Auscultation signs: dullness to percuss, crackles, decreased breath sounds, bronchial breathing
Wheeze and hyperinflation more typical of viral infection

77
Q

What 4 investigations should you do for paediatric pneumonia?

A

CXR, Sputum cultures, blood cultures and ABG

78
Q

What is the medication management of paediatric pneumonia?

A

Amoxicillin and a macrolide

79
Q

Why is a macrolide adding to treatment of paediatric pneumonia?

A

To cover atypical pneumonia

80
Q

Give three examples of macrolides

A

Erythromycin, clarithromycin and azithromycin

81
Q

What is the medication treatment for paediatric pneumonia when the patient has a penicillin allergy?

A

Macrolides as monotherapy

82
Q

What is the medical treatment of neonates with pneumonia?

A

Broad spectrum IV Abx

83
Q

What is the medical management of infants with pneumonia?

A

Amoxicillin/ co-amoxiclav

84
Q

What is the medical management of over 5s with pneumonia?

A

Amoxicllin/Erythromycin

85
Q

What are the complications of pneumonia?

A

Risk of parapneumonic collapse and empyema

86
Q

If a patient is getting recurrent LRTIs, what conditions do you want to check for?

A

Reflux, aspiration, neurological disease, heart disease, asthma, CF, primary ciliary dyskinesia and immune deficiency.

87
Q

What immunoglobulin do you test to check for immunoglobulin class-switch recombination therapy?

A

G

88
Q

What is immunoglobulin class-switch recombination therapy?

A

Where a patient is unable to convert IgM to IgG and therefore cannot form long term immunity to that bug.

89
Q

A patient comes in with cough, high fever, tachypnoea, tachycardia, increased work of breathing, lethargy and delirium. What could this be?

A

Pneumonia

90
Q

A patient comes in with increased work of breathing, barking cough, hoarse voice, stridor and a low grade fever. What could this be?

A

Croup

91
Q

A patient comes in with progressively worsening SOB, signs of respiratory distress, tachypnoea and expiratory wheeze. What could this most likely be?

A

Acute exacerbation of asthma

92
Q

A patient comes in with episodic symptoms of dry cough with wheeze and SOB. Has diurnal variability with widespread polyphonic wheeze. What could this most likely be?

A

Chronic Asthma

93
Q

A patient comes in with coryzal symptoms, signs of respiratory distress, dyspnoea, tahcypnoea, mild fever and wheeze and crackles on ascultation. What could this most likely be?

A

Bronchiolitis

94
Q

An unvaccinated child comes in with a sore throat and stridor, drooling, tripod positioning, high fever and a muffled voice. What could this most likely be?

A

Epiglottitis

95
Q

What can asthma be triggered by?

A

Infection, exercise or cold weather

96
Q

What is the most chronic condition in children?

A

Asthma

97
Q

What is asthma?

A

Reversible paroxysmal constriction of the airways with inflammatory exudate and followed by airway remodelling

98
Q

Do people with asthma have an inspiratory wheeze or expiratory wheeze?

A

Expiratory wheeze

99
Q

What are the levels of severity of acute asthma?

A

Moderate, Severe and life threatening

100
Q

If a patient has peak flow > 50% predicted and normal speech, how severe is the acute episode of asthma?

A

Moderate

101
Q

If a patient has a peak flow < 50% predicted and is unable to complete sentences in 1 breath, how severe is the acute episode of asthma?

A

Severe

102
Q

What percentage of predicted peak flow rate is considered to be life threatening?

A

<33%

103
Q

What RR in a child aged 3 is considered to be severe in asthma?

A

> 40

104
Q

What RR in a child aged 7 is considered to be severe in asthma?

A

> 30

105
Q

What HR in a child aged 4 is considered to be severe in asthma?

A

> 140

106
Q

What HR in a child aged 8 is considered to be severe in asthma?

A

> 125

107
Q

What is the aetiology of asthma?

A

Genetic
Prematurity
Low birth weight
Parental smoking
Viral bronchiolitis in early life
Cold air
Allergen exposure

108
Q

What are the clinical presentations of asthma?

A

Episodic wheeze which is infrequent
Dry cough often worse at night
SOB
Wheeze
Reduced peak flow

109
Q

What type of bronchodilator is salbutamol?

A

Beta-2 agonist

110
Q

What type of bronchodilator is ipratropium bromide?

A

Anti-muscarinic

111
Q

What bronchodilators can you give in an acute asthma attack?

A

Salbutamol, ipratropium bromide, IV magnesium sulphate, IV aminophylline

112
Q

What are the steps for a moderate/severe asthma attack?

A
  1. Salbutamol inhaler
  2. nebuliser with salbutamol/ipratropium bromide
  3. oral prednisolone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline
113
Q

What side effects can salbutamol causes?

A

Tachycardia and Tremor

114
Q

What are the 4 investigations for asthma?

A

Spirometry with reversibility testing- highly suggestive of asthma
Direct bronchial challenge test with histamine or methacholine
Fractional exhaled nitric oxide- ENO levels of nitric oxide correlate to inflammation
Peak flow variability- FEV1 is significantly reduced, FVC normal, FEV1:FVC may be <70 % if poorly controlled

115
Q

What is the first step for the management of all children with asthma?

A
  1. short-acting beta 2 agonist inhaler (salbutamol)
116
Q

What is the second step for the management of children under 5 with asthma?

A

SABA + trial ICS (belclomethasone)

117
Q

What is the second step of the management of children with asthma?

A

ICS- Beclomethasone

118
Q

What is the third and fourth step in the management of children over 5 with asthma?

A
  1. Long-acting beta 2 agonist inhaler (salmeterol)
  2. Titrate up corticosteroid and consider adding oral leukotriene receptor antagonist ( montelukast) or oral theophylline
119
Q

Is cystic fibrosis autosomal dominant or recessive?

A

Recessive

120
Q

What glands does cystic fibrosis affect?

A

Mucous glands

121
Q

What is cystic fibrosis caused by?

A

A genetic mutation on the cystic fibrosis transmembrane conductions regulatory gene on chromosome 7

122
Q

What is the most common variant of cystic fibrosis mutations?

A

Delta-F508

123
Q

What does the delta-F508 gene code for?

A

cellular channels particularly chloride channels

124
Q

What percentage of people are carriers of CF?

A

1 in 25

125
Q

What percentage of children have CF?

A

1 in 2500

126
Q

What are the three main consequences of CF?

A

Thick pancreatic and biliary secretions
Low volume thick airway secretions
Congenital bilateral absence of the vas deferens

127
Q

What is the test at birth that screens for CF?

A

Newborn bloodspot test

128
Q

What is often the first sign of CF?

A

Meconium Ileus

129
Q

What are the common presentation signs of CF?

A

Chronic cough, recurrent RTIs, steatorrhoea, failure to thrive, abdominal pain and bloating

130
Q

What signs might a child show on their hands if they have CF?

A

clubbing

131
Q

What are the causes of clubbing in children?

A

Hereditary, Infective endocarditis, TB, liver cirrhosis, cyanotic heart disease, CF, IBD

132
Q

What is the gold standard test for diagnosing CF?

A

Sweat test

133
Q

How do you test for CF during pregnancy?

A

Amniocentesis or chronic villous sampling

134
Q

What common bacteria is often resistant to abx and can cause morbidity and mortality in CF?

A

Paseudomonas aeruginosa

135
Q

How do you prevent staphylococcus aureus infection in CF patients?

A

Prophylactic flucloxacillin

136
Q

What medical treatment can you give for patients with CF?

A

Prophylactic flucloxacillin and CREON tablets

137
Q

What is viral induced wheeze?

A

Episodic wheeze- a symptom of viral URTI and symptom free between events.

138
Q

In what age does viral wheeze tend to present?

A

Before 3 years old

139
Q

What is the management of viral induced wheeze?

A

SABA inhaler via spacer max 10 puffs/4 hourly
LTRA and ICS via spacer

140
Q

Who does respiratory distress syndrome affect?

A

premature neonates, before the lungs start producing adequate surfactant, common in below 32 week babies.

141
Q

What is the pathophysiology of respiratory distress syndrome

A

Inadequate surfactant leads to high surface tension within alveoli leading to atelectasis (lung collapse) as it is more difficult for the alveoli and the lungs to expand leading to inadequate gaseous exchange and hypoxia, hypercapnia and respiratory ditress.

142
Q

What is the management of respiratory distress syndrome?

A

Dexamethasone is given to mothers with suspected or confirmed preterm labour to increase production of surfactant and reduce incidence of respiratory distress syndrome
Intubation and ventilation may be needed
Endotracheal surfactant (artificial) delivered into the lungs via an endotracheal tube
CPAP
Supplementary oxygen to maintain sats 91-95%

143
Q

Short term complications of respiratory distress syndrome?

A

Pneumothorax
Infection
Apnoea
Intraventricular haemorrhage
Pulmonary Haemorrhage
Necrotising Enterocolitis

144
Q

Long term complications of respiratory distress syndrome?

A

Chronic lung disease of prematurity
Retinopathy of prematurity
Neurological, hearing and visual impairment

145
Q

What is bronchopulmonary dysplasia?

A

Infants who still require oxygen at a postmenstrual age of 36 weeks are described as having BPD.

146
Q

What is the pathophysiology of BPD?

A

The lung damage comes from pressure and volume trauma of artificial ventilation, oxygen toxicity and infection

147
Q

What is the choice of investigation in BPD?

A

CXR

148
Q

What does a CXR show in BPD?

A

Widespread areas of opacification and sometimes cystic changes, fibrosis and even lung collapse

149
Q

What is the management of BPD?

A

Infants are weaned onto CPAP and potentially corticosteroids however there is risk of neurodevelopment with these

150
Q

What are the major complications of BPD?

A

Intercurrent infection leading to death or pulmonary hypertension

Paediatric rotation (14 decks)

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