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Y4 Paeds > Lower resp > Flashcards

Lower resp Flashcards

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1
Q

what are common lower resp conditions in children?

A 
asthma 
bronchitis 
bronchiolitis 
bronchiectasis 
cystic fibrosis
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2
Q

what are common upper resp conditions in children?

A

croup
whooping cough

epiglottitis

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3
Q

what cells mediate allergic asthma?

A

Th2 T cells

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4
Q

what cells do activate Th2 T cells when allergens bind to them?

A

dendritic cells

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5
Q

what cytokine is involved in the inflammatory process of asthma?

A

leukotriene C4

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6
Q

what environmental factors are involved with asthma?

A 
low birth weight 
prematurity 
parental smoking 
atopy 
cold air and exercise 
atmospheric pollution 
NSAIDs 
B blockers
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7
Q

what viruses most commonly cause viral chest infections in children?

A

rhinovirus

respiratory syncytial virus

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8
Q

state two clinical patterns of wheeze?

A

episodic viral wheeze

multiple trigger wheeze

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9
Q

what resp conditions could finger clubbing suggest?

A

CF and bronchiectasis

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10
Q

what signs on examination may be present for asthma?

A

wheeze

use of accessory muscles

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11
Q

what investigations can be done for asthma?

A

spirometry (FEV1:FVC <70% if poor control)

peak expiratory flow rate 
bronchial provocation tests 
exercise testing 
skin prick testing 
exhaled nitric oxide (NO production in bronchial epithelial cells is increased with Th2 driven eosinophilic inflammation
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12
Q

what investigation can be done to diagnosis CF?

A

chloride sweat test

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13
Q

what investigation can be done to rule out GORD?

A

oesophageal pH testing

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14
Q

what investigation can be done to exclude bronchiectasis ?

A

high resolution CT

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15
Q

what gene is associated with asthma?

A

ADAM33

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16
Q

what are the aims of good control of asthma?

A 
full school attendance 
no sleep disturbance 
<2/week daytime symptoms no limitations of daily living 
no exacerbations 
using salbutamol <2/week
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17
Q

if asthma is suspected what treatment should be started?

A

inhaled corticosteroid

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18
Q

what are the 5 step wise management of asthma ?

A

as required SABA (short acting b-2 agonist - salbutamol)

regular inhaled corticosteroid

add on therapy

  • LABA (salmeterol/formeterol)
  • increase ICS dose
  • stop LABA and start leukotriene receptor antagonist

increase ICS dose

regular oral steroids and refer to paediatrician

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19
Q

state the name of a leukotriene receptor antagonist

A

montelukast

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20
Q

if no treatment works for asthma was specialist medication can be used?

A

Omalizumab

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21
Q

what is the action of Omalizumab for asthma?

A

reduces free IgE in the blood. This reduces IgE mediated inflammatory response

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22
Q

what should LABA be prescribed with?

A

ICS

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23
Q

what ICS is used in children?

A

beclometasone

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24
Q

what should all children diagnosed with asthma have?

A

written asthma management plan

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25
what are the signs of life threatening asthma exacerbation ?
``` O2 sats <92% PEFR <33% predicted silent chest altered GCS confusion exhaustion cyanosis ```
26
what is the immediate management of asthma exacerbation ?
oxygen bronchodilators (inhaled SABA - if severe nebulised) ipatropium bromide (anti-muscuranic) corticosteroids (prednisolone)
27
what is the second line treatment for asthma exacerbation?
IV salbutamol | magnesium sulphate
28
what condition is exhaled nitric oxide raised in?
hay fever
29
what is bronchiolitis commonly caused by?
respiratory syncytial virus
30
what pathophysiology occurs during bronchiolitis
proliferation of goblet cells causing excess mucus IgE mediated type 1 allergic reaction causing inflammation bronchiolar constriction infiltration of lymphocytes causing submucosal oedema infiltration of cytokines and chemokines
31
what would be seen on examination of bronchiolitis ?
``` tachypnoea grunting intercostal, subcostal recessions inspiratory crackles expiratory wheeze hyper inflated chest cyanosis ```
32
what are DD for bronchiolitis ?
``` pneumonia croup CF heart failure bronchitis ```
33
what should the management of bronchiolitis be in hospital ?
oxygen if sats <92% give fluids via NG tube consider CPAP if resp failure perform upper airway suctioning
34
should antibiotics be used for bronchiolitis ?
no | - caused by parainfluenza virus
35
what are some complications of bronchiolitis ?
``` hypoxia dehydration fatigue persistent cough/wheeze bronchiolitis obliterans ```
36
how long does bronchiolitis usually last?
7-10days
37
what LRTI organisms can lead to bronchial damage and bronchiectasis ?
``` strep pneumonia staph aureus adenovirus measles influenza Bordetella pertussis Mycobacterium tuberculosis ```
38
what is the hereditary of primary ciliary dyskinesia ?
autosomal recessive
39
what is young syndrome ?
A rare condition associated with bronchiectasis, reduced fertility and rhinosinusitis.
40
what is yellow nail syndrome ?
rare syndrome associated with pleural effusions, lymphoedema and dystrophic nails. Bronchiectasis occurs in around 40% of patients.
41
what condition is suggested by Bilateral upper lobe bronchiectasis?
CF
42
what condition is suggested by unilateral upper lobe bronchiectasis?
post TB infection
43
what condition is suggested by Focal bronchiectasis (lower lobe) ?
foreign body inhalation
44
what are some complications of bronchiectasis?
``` Recurrent infection Life-threatening haemoptysis Lung abscess Pneumothorax Poor growth and development ```
45
what is the key symptom of bronchiolitis ?
chronic productive cough
46
what will a CXR of bronchiectasis
bronchial wall thickening and airway dilation
47
which spirometry pattern does severe bronchiectasis have?
mixed obstructive/restrictive
48
what gene is associated with CF?
CF transmembrane conductance regulator gene
49
what GI complications does CF have?
bowel obstruction in utero can cause meconium ileus CF related liver disease - causes cholestasis and can result in neonatal jaundice distal intestinal obstruction syndrome
50
what reproductive complication does CF have?
98% of males are infertile due to the absence of vas deferens
51
what are signs of CF in children?
``` failure to thrive recurrent chest infections Rectal prolapse Nasal polyps (N.B. strongly suspect CF in children presenting with nasal polyps) Sinusitis ```
52
what specific mutation is the most common for CF in the UK?
ΔF508
53
what changes does CF cause to the pancreas?
the pancreatic duct is usually occluded in utero causing permanent damage to the exocrine pancreas
54
what are signs of CF in infants?
meconium ileus failure to thrive prolonged neonatal jaundice
55
how is CF screened in neonates?
part of the Guthrie test
56
what are the two key aims of CF management?
early treatment of infection | optimisation of nutrition
57
on examination what may be seen on the hands, face, chest and abdo?
Hands: finger clubbing Face: nasal polyps Chest: hyperinflated, crepitiations, portacath (indwelling vascular access device) Abdomen: faecal mass (if constipated/DIOS), may have a scar from ileostomy (meconium ileus)
58
what two things are required for a diagnosis of CF?
fitting clinical history | positive chloride sweat test
59
what investigations can be done for CF?
CXR (hyperinflation, bronchial thickening) Chloride sweat test sputum sample ``` annually- glucose tolerance test liver function and coagulation bone profile lung function testing ``` ``` faecal elastase (pancreatic function) Chest CT (for bronchiectasis) genetic analysis ```
60
how is a sweat sample collected for chloride testing?
pilocarpine iontophoresis
61
what are signs of CF in a young adult?
Pancreatic insufficiency: diabetes mellitus Chronic lung disease DIOS, gallstones, liver cirrhosis
62
is a single sweat test sufficient to diagnosis CF?
no | - require a second test or genetic testing
63
what level of chloride is required for a sweat test?
>60mmol/L | 40-60 is borderline and should be repeated
64
what MDT would be involved in the treatment of CF?
patient’s GP, a respiratory paediatrician, a specialist CF nurse, a dietician, physiotherapist, psychologist and social worker.
65
state what the management of CF would be ?
patient and family education twice daily physiotherapy mucolytics and DNase (reduces viscosity) hypertonic saline pancreatic enzyme supplements fat soluble vitamins (ADEK) ensure for weight gain prophylactic antibiotics infections should be treated for 2 weeks Regular azithromycin has been shown to reduce exacerbations and improve lung function even in those not chronically infected with Pseudomonas aeruginosa. annual follow up
66
what complications can occur in the resp tract for CF patients?
``` allergic bronchopulmonary aspergillosis (ABPA) bronchiectasis pulmonary HTN pneumothorax nasal polyps ```
67
what complications can occur in the GI tract for CF patients?
``` rectal prolapse (Tx = laxatives) distal intestinal obstruction syndrome (DIOS) ```
68
do CF patients have early or delayed puberty ?
delayed puberty | - delay of 2 years
69
What bacteria's chronic infection is associated with worsening lung function and must be treated aggressively in CF patients?
pseudomonas aeruginosa
70
The CTFR gene encodes the CFTR protein, what channel ion does this form?
chloride channel

Y4 Paeds (15 decks)

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