Respiratory Flashcards
(87 cards)
1
Q
What is the medical name for croup?
A
Laryngotracheobronchitis
2
Q
What are the negatives of antibiotic use?
A
Diarrhoea Oral thrush Nappy rash Allergic reaction Multi-resistance
3
Q
What can rhinitis be a prodrome to?
A
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
4
Q
How many times a year might a child have rhinitis?
A
5-10
5
Q
How will otitis media look on examination?
A
Erythema
Bulging drum
6
Q
How is otitis media treated in children?
A
Self-limiting
7
Q
Is otitis media viral or bacterial?
A
Primary viral infection
8
Q
What is the treatment for otitis media?
A
Analgesia
Usually antibiotics don’t help
9
Q
What are the two types of tonsillitis/pharyngitis?
A
Viral or bacterial
10
Q
What is the treatment for tonsillitis/pharyngitis?
A
Analgesia
Nothing
OR 10 days penicillin
11
Q
How to diagnose tonsillitis/pharyngitis?
A
Throat swab
12
Q
Which antibiotic don’t you give for tonsillitis/pharyngitis?
A
Amoxycillin
13
Q
What is the most common virus that causes croup?
A
Parainfluenza I
14
Q
What are the signs/symptoms of croup?
A
Coryza++
Stridor
Hoarse voice
Barking cough
15
Q
What is the treatment for croup?
A
Oral dexamethasone
16
Q
What is the most common virus that causes epiglottitis?
A
H. influenzae type B
17
Q
What are the signs/symptoms of epiglottitis?
A
Stridor
Drooling
18
Q
What is the treatment for epiglottitis?
A
Intubation
Antibiotics
19
Q
Why is epiglottitis rare these days?
A
Hib vaccine
20
Q
What is the treatment for most URTI’s in children?
A
Self-limiting, no treatment
Analgesia
21
Q
What are common bacterial agents in LRTI?
A
Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumonia Chlamydia pneumonia
22
Q
What are common viral infections that cause LRTI?
A
RSV Parainfluenzae III Influenza A & B Adenovirus Rhinovirus
23
Q
What are the principles of management of LRTI?
A
Make diagnosis
Assess patient: oxygen, hydration, nutrition
Treatment options
24
Q
What are the signs/symptoms of bronchitis?
A
Loose rattly cough
Post-tussive vomit
Chest free of wheeze/creps
25
What are the normal causes of bronchitis?
Haemophilus
| Pneumococcus
26
What is the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance
27
What is the treatment for bronchitis?
Mostly self-limiting
28
What are the red flags in bronchitis?
```
Age <6mo, >4yr
No relapse-remission
Static weight
Disrupts child's life
Associated SOB (not coughing)
Acute admission
Other co-morbities
```
29
What is the treatment for usual persistent bacterial bronchitis?
Reassure
| Don't treat!
30
What are the causes of bronchiolitis?
RSV
Paraflu III
HMPV
31
What are signs/symptoms of bronchiolitis?
```
Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze
Cough
```
32
What are the possible interventions for bronchiolitis?
Oxygenation
Supportive care: hydration, NG tube, unblock nose
No medication
33
What is the best indicator of progress for bronchiolitis?
Feeding
34
When do symptoms peak in bronchiolitis?
Days 4-5
35
How long might the cough last in bronchiolitis?
1-2 weeks
36
Is bronchiolitis usually recurrent?
No
37
At what age does bronchiolitis usually occur?
<12 mo
38
What is RSV?
Respiratory syncytial virus
39
What time of year do RSV/bronchiolitis usually present?
Winter
40
What are the signs/symptoms of LTRI?
```
48hrs
Fever
SOB
Cough
Grunting
Reduced/bronchial breath sounds
```
41
What is the management of a LRTI?
Nothing if symptoms mild
Oral amoxycillin first line
Oral macrolide second
IV if vomiting
42
When should oral antibiotic be given over IV?
Antibiotics indicated
Non-severe LRTI
Child is not vomiting
43
What are the benefits of oral antibiotics?
Shorter hospital stay
| Cheaper
44
What are the signs/symptoms of pertussis?
```
Cough >2wks
Worse at night
Inspiratory whoop
Vomiting
Colour change
```
45
How does a vaccination help pertussis?
Reduces risk
| Reduces severity
46
When should you give antibiotics for tonsillitis?
If you know it is Strep!
47
When should you give antibiotics for otitis media?
<2yrs
| Bilateral OM
48
Which antibiotic for otitis media?
Oral amoxycillin
49
When should give antibiotics for LRTI/pneumonia?
2 days fever, cough, focal signs (ie one side)
50
What antibiotic for LRTI/pneumonia?
Oral amoxycillin
51
What are the things key things to help diagnosis asthma?
Wheeze
Variability
Responds to treatment
52
What are some of the causes of asthma?
Genes
Environment
Epigenetics
53
What is the treatment of asthma in children?
Watchful waiting if no QoL implications of symptoms
54
What is the test for asthma in children?
```
No diagnostic test
HOWEVER
Spirometry
BDR
FeNO
Peak Flow
```
55
What is BDR?
Bronchodilator responsiveness
56
What are the signs/symptoms of asthma?
```
PSignificant resp difficulty
Airway obstruction
SOB at rest
Looking in of ribs with wheeze
Cough - dry, nocturnal, exertion
```
57
What are other risk factors or associated symptoms of asthma?
Parent asthma
Eczema
Hayfever
Food allergies
58
What is the other factor which confirms a diagnosis of asthma?
Responds to treatment
59
What are the potential disadvantages of trial of treatment for asthma?
Cost
Hassle
Loss in height
Oral thrush
60
What are the potential advantages of trial of treatment for asthma?
Helps diagnosis
Symptoms responds
Improves QoL
Reduces risk of attacks
61
What are the options to approach wheeze?
Watch and see
| Trial of treatment
62
When is it more likely a respiratory infection than asthma?
<18 mo
63
When is it more likely asthma age-wise?
>5yrs
64
What is a DD for asthma if onset <5yrs?
```
Congenital
CF
PCD (Primary Ciliary Dyskinesia)
Bronchitis
Foreign body
```
65
What is a DD for asthma if onset >5yrs?
Dysfunctional breathing
Vocal cord dysfunction
Habitual cough
Pertussis
66
What is VIW?
Viral induced wheeze
67
What is the trial of treatment for asthma?
Inhaled steroids
68
What is the SANE mnemonic for measuring control of asthma in children?
Short acting beta agonist/wk
Absence from nursery or school/wk
Nocturnal symptoms/wk
Excertional symptoms/wk
69
If asthma is not well controlled what must be assessed before treatment is increased?
Are they taking treatment?
Are they taking treatment correctly?
Do they have asthma?
70
What is different about asthma medication in children?
```
Max dose ICS 800microg (<12)
No oral B2 tablet
LTRA first line preventer <5
No LAMAs
Only two biologicals
```
71
When would a regular preventer be prescribed in a child?
Symptomatic 3x+/wk or waking 1x/wk
72
What is the regular preventer you would start with in <5s with asthma?
Leukotriene receptor antagonists (LTRA)
73
What is the regular preventer you would start with in >5s with asthma?
Very low dose ICS
74
Why are ICS as a regular preventer in children?
Useful for diagnosis
Effective
Safe
75
What are the adverse effects of ICS?
Height suppression
?oral candidiasis
?adrenocortical suppression
76
What is the initial add on preventer in asthma?
Add LABA
77
What should you remember about long acting beta agonists (LABA)?
Do not use without ICS
| Use as fixed dose inhaler
78
What is the leukotriene receptor antagonist you would use?
Montelukast
79
What are additional add-on therapies in asthma?
Increase ICS
| LTRA
80
What are the two types of delivery systems that can be used in asthma for children?
Metered dose inhaler (MDI)/spacer
| Dry powder device
81
What advice should you give when prescribing a spacer for asthma?
Shake inhaler between puffs
| Wash spacer monthly to reduce static
82
What other management options are there for asthma in children beyond medication?
Stop tobacco smoke exposure
| Remove environmental triggers - pets
83
What factors should you consider when prescribing medicine for acute asthma in children?
```
RR
Work of breathing
HR
O2 sats
Ability to complete sentences
Confusion
Air entry
```
84
What should the response be to acute asthma?
Start treatment and reassess in 1hr
| Step up or down as appropriate
85
What is the medication for mild acute asthma?
1. SABA via spacer
| 2. SABA via spacer + pred
86
What is the medication for moderate acute asthma?
1. SABA via neb + pred
| 2. SABA + ipra via neb + pred
87
What is the medication for severe acute asthma?
```
IV salbutamol
IV aminophylline
IV magnesium
IV hydrocortisone
Intubate and ventilate
```
