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Paediatrics > Difficulty Breathing > Flashcards

Difficulty Breathing Flashcards

1
Q

What is a paroxsysmal cough?

A

Frequent and violent coughing that can make it hard for a person to breathe

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2
Q

Acute severe asthma: Findings on inspection

A

Severe Recession; SC, IC, Tracheal Tug

Posture sitting forward - ‘tripod position’

(intermittent wheeze)

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3
Q

Acute severe asthma: Findings on palpation

A

Hyperexpanded chest
Symmetrical Expansion

Poor expansion if severe
Central trachea, cardiac apex in usual position

liver pushed down; edge palpable

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4
Q

Acute severe asthma:

Percussion and Auscultation

A

Resonant but equal

Air entry symmetrical
Poor entry indicates increasing severity

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5
Q

Severe pneumonia:

Findings on inspection

A

Respiratory distress with recession and tracheal tug

Wet cough; +/- grunting

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6
Q

Severe pneumonia:

Findings on palpation, percussion and auscultation

A

Asymmetrical if severe unilateral pneumonia

Dullness over consolidation

Reduced air entry

Bronchial breathing/crackles over the area of infection

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7
Q

Pneumothorax:

Findings on Inspection

A

Signs of inc resp effort - recession asymmetrical chest expansion

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8
Q

PTX:

Findings on palpation, percussion, auscultation

A

Asymmetrical chest expansion
Trachea may be deviated and cardiac apex displaced (IF TENSION)

Hyperresonant

No air entry on the affected side

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9
Q

Cardiac failure:

Findings on inspection

A

Tachypnoea with little recession

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10
Q

Cardiac failure:

palpation, percussion auscultation

A

Symmetrical expansion
Liver enlarged

Resonant, symmetrical

Creps over both lung bases
Heart murmur may be present

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11
Q

Differences in child and adult resp exams

A

Increased emphasis on looking for signs of increased respiratory effort and respiratory distress

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12
Q

What is Harrison’s Sulci?

A

Horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm

Usually caused by chronic asthma or obstructive respiratory disease

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13
Q

Organs affected by Cystic Fibrosis

A

Sinuses (sinusitis)
Lungs (mucus, bacterial infection, widened airways)
Skin (salty sweat)
Liver (blocked biliary duct )
Pancreas (blocked pancreatic ducts)
Intestines (cannot fully absorb nutrients)
Reproductive organs (male and female complications)

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14
Q

Assessing severity of wheeze or exacerbation of asthma

A

Agitation/Conciousness ?hypoxia
Exhaustion - accessory muscles, cyanosis
RR, HR, BP, O2, PEF

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15
Q

Severity of attack

A

Moderate:
- PEFR at least 50% of best, normal speech (none of below)

Severe:

  • PEFR <50% of best
  • RR >25 (12y) >30(5y) >40 (2-5y)
  • Pulse - 110, 125, 140
  • Inability to complete sentences

Life threatening:

  • PEFR <33%
  • O2 <92%
  • altered consciousness, exhaustion, cardiac arrhythmia, hypotension, cyanosis, poor respiratory effort, silent chest, confusion
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16
Q

Factors that lower threshold for hospital admission

A

Born prematurely
Significant medical history
Ability of carers to cope (experience, level of anxiety, time available)

17
Q

Treatment while awaiting hospital admission

A 
O2
Treat with β2 agonist:
- life threatening: salbutamol nebs
- use pressurised metered-dose inhaler with spacer up to 10 puffs
Monitor PEFR and O2
18
Q

Treatment if admission not required

A

SABA to relieve acute symptoms
If good response to SABA prescribe PRN
Prescribe short course oral Pred if existing/suspected asthma
Prescribe Abx (Amoxicillin)
Self care advice
Follow up child within 48 hours of presentation

19
Q

Life expectancy with CF

A

Early 50s

20
Q

What are adenoids?

A

Glands located behind the soft palate
Produce antibodies and WBC
Shrink during adolescence

21
Q

Three key problems in asthma

A

Airway obstruction
Inflammation
Smooth muscle hyperplasia

22
Q

Non atopic/Intrinsic causes of asthma

A 
Aspirin
Stress
Exercise
Cold
Occupation toxins
23
Q

Cells in the respiratory system

A

Pseudostratified columnar epitheleum

24
Q

Layers of the mucosa in the respiratory tract

A

Epitheleum
Basement membrane
Lamina Propria

(Smooth muscle
Submucosa)

25
Q

Effects of histamine in asthma

A

Results via IgE mediated allergens

Acts on smooth muscle and stimulates mucus production (cough in astma)

26
Q

Effects of CF on male reproductive system

A

Can have absent Vas deferens

Reduced fertility

27
Q

Primary immune cells involved in asthma

A

TH2

Eosinophils

28
Q

Interleukins released by TH2 in asthma

A

IL4 - causes B cells to produce IgE ->
IL5
(IL13)

29
Q

Pathophys of Asthma following initial exposure (Immediate)

A

Primed mast cells release mediators - prostaglandins, leukotrienes, interleukins

Release of ACh due to vagus stimulation (smooth muscle contraction)

Mast Cells in LP:
Produce chemoattractants, attracting neutrophils, eosinophils
Release Leukotriene C4, B4 E4 (lipooxygenase pathway) - brochoconstriction, blood vessel dilation (oedema), stimulate mucus glands
Release prostaglandins (PGD2) - bronchoconstriction, mucus production (COX pathway)

30
Q

Pathophys of Asthma (Late)

A

Further antigens are not necessary for late phase reaction
IL5 produced by B cell and mast cells activate eosinophils
Eosinophils release Major Basic Proteins (Cationic) and cause inflammation
Leads to resp epitheleal damage

31
Q

Airway Remodelling in Asthma

A

Curshmann spirals
Charcot-Leyden crystals
Lamina Propria thickening
Muscle hyperplasia

32
Q

What are Curshmann spirals?

A

Spiral-shaped mucus plugs from subepithelial mucous gland ducts of bronchi

33
Q

What are Charcot-Leyden crystals?

A

Microscopic crystals composed of eosinophil protein galectin-10 found in people who have allergic diseases such as asthma or parasitic infections such as parasitic pneumonia or ascariasis

34
Q

What is the commonest lung infection in children?

A

Acute broncheolitis

35
Q

What are the causes of acute broncheolitis?

A

Respiratory syncytial virus (RSV)

Mycoplasma
Parainfluenza
Adenoviruses

36
Q

Symptoms of acute broncheolitis

A 
Coryza precedes cough
Fever (sometimes)
Tachypnoea
Wheeze
Inspiratory crackles

Apnoea
Recession
Cyanosis

Paediatrics (19 decks)

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