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Paed:Resp Flashcards

1
Q

3 main pathophys features of Asthma

A
  • Chronic airway inflammation
  • Bronchial Hyper reactivity
  • Reversible airway obstruction
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2
Q

Causes of asthma

A

Genetic predisposition
Atopy
Environmental triggers

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3
Q

What are the two types of wheeze?

A
  • Transient early wheezing (small airways more likely to be narrow) (episodic)
  • Persistent and recurring wheezing (Ass w/ common inhaled allergens and atopy)
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4
Q

Clinical features of asthma

A 
worse at night or early in the morning
triggering factors
interval symptoms
SOB
Cough
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5
Q

Examination features in asthma

A

barrel shaped chest
hyperinflation
wheeze
prolonged expiration

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6
Q

Investigations of asthma

A

Spirometry: PEFR<80%, FEV1/FVC<80%, 15%improvement after bronchodilator
Skin prick test
CXR: Hyperinflation, flattened hemidiaprhagm, peribronchial cuffing, atelectasis
FENO

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7
Q

Management of asthma

A

Stepwise approach:
1) Mild intermittend asthma: Inhaled SABA
2)Regular preventer therapy: Add inhaled steroid (beclometasone) or if <5 oral LTRA (montelukast)
3) >5 LABA (salmaterol)
<5 LTRA
4) increase steroids
5) Oral steroidz babyy

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8
Q

S/e of long term ICS use?

A

Adrenal suppression
Growth suppression
Osteoporosis

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9
Q

Features of acute asthma attack

A 
Wheeze
Tachypnoea
Use of accessory msucles
Pulsus pardoxus
SOB interferes with talking
Cyanosis, fatigue, drowsiness
o2 sats below 90%
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10
Q

Management of asthma attack

A

oxygen
nebulised b2 agonsit and ipatropium bromide
IV hydrocortisone

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11
Q

What viruses cause the common cold?

A

Rhinoviruses, coronaviruses, RSV

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12
Q

What viruses cause sore throat/pharyngitis?

A

Adenovirus, enterovirus, rhinovirus

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13
Q

In the older age grup, what could be a bacterial cause of sore throat

A

Group A beta-haemolytic strep

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14
Q

Tonsillitis - causes and treatment?

A

Group A beta haemolytic strep, EBV. Penicillin if severe

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15
Q

Why are kids prone to otitis media?

A

Shorter eustachian tubes

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16
Q

What would the tympanic membrane look like in OM?

A

Bright red, bulging, loss of normal light reflection

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17
Q

Causes of OM

A

RSV, rhinovirus

Pneumococcus, H.Influenzae, Moraxella Catarrhlis

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18
Q

Complications of OM

A

Mastoiditis, meningitis, OM w/effusion (glue ear) can cause hearing loss

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19
Q

What is croup?

A

Laryngotracheobronchitis is mucosal inflammation of the airway.

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20
Q

What causes Croup?

A

90% viral.

Viral: parainfulenza virus normally. also: Human metapneumovirus, RSV, influenza

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21
Q

Typical features of Croup?

A 
Barking cough
Harsh stridor
Hoarseness
Symptoms worse at night.
Preceded by fever and coryza
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22
Q

Treatment of Croup

A

Oral dexamethasone, oral prednisolone, nebulised steroids

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23
Q

What is the most common cause of Epiglottitis

A

Haemophilus Influenzae - not anymore cus of the vaccine lol!

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24
Q

What is epiglottitis?

A

Intense swelling of epiglottis and nearby tissues

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25
features of epiglottitis?
Acute onset of high fever, painful throat with drooling/not speaking child. Stridor. Child often upright with open mouth. Unwell.
26
Treatment of epiglottitis
Tracheal intubation | Cefuroxime
27
Main symptoms of bronchitis
cough and fever
28
What causes Whooping Cough?
Bordetella Pertussis
29
What is the key feature of whooping cough?
Characteristic cough followed by characteristic inspiratory whoop. Worse at night and can be followed by vomiting
30
Investigations for whooping cough
Culture nasal swab, PCR, lymphocytosis on FBC
31
Management of WhoopCough
Clarithromycin. Give Erythromycin if pregnant woman. Close contacts get erythromycin
32
What is the main cause of Bronchiolitis?
Respiratory syncytial virus. | Other causes: Parainfluenza, rhinoviruses, adenoviruses and more
33
What does bronchiolitis cause?
Pulmonary hyperinflation and atelctasis
34
Signs and sx of bronchiolitis
``` Sharp dry cough tachypnoea intercostal recession hyperinflation fine end inspiratory crackles high pitched wheeze tachycardia cyanosis/ pallor ```
35
Investigations for bronchiolitis
Pulse Oximetry ABG CXR (often not needed) shows Hyperinflation, air trapping, focal atelectasis PCR of Nasoharyngeal swabs
36
Management of bronchiolitis
OXygen NGT Bronchodilators
37
Prophylaxis of bronchiolitis
Palivizumab
38
What are the causative organisms for pneumonia by age group?
Neonates: Group B strep, E Coli, Klebsiella, Staph Aureus Infants: Strep Pneumoniae, Chlamydia Children >5: Strep Pneumoniae, staph aureus, group A strep, bordetella pertussis, Viral causes: RSV, influenza A or B
39
Clinical features of pneumonia
Fever >38.5 SOB Cough w/ sputum
40
Examination features of penumonia
Tachypnoea grunting use of accessory muscles Desaturation and cyanosis
41
Auscultation of pneumonia reveals
``` dull to percussion crackles decreased breath sounds tactile vocal fremitus bronchial breathing ```
42
investigations for pneumonia
``` Sputum culture nasopharyngeal aspirate blood culture CXR Viral titres ```
43
Treatment of pneumonia
oral abx: <5: Amox, co-amox, cefaclor | >5: amox or fluclox
44
What is cystic fibrosis?
CF is an autosomal recessive disorder casuing a defect in the CFTR protein leading to defective ion transport in exocrine glands.
45
Clinical features of CF
Persistent loose cough, purulent sputum, sob, haemoptyis, weight loss, fatty stools, FtT, prolonged neonatal jaundice, DM
46
What is a common reccurent infection in CF?
Pseudomonas Auergionsa
47
Diagnosis of CF
Sweat test - Chloride ions above 60mmol/L Gene abnormalities on CFTR protein on Chromosome 7 Faecal testing shows decreased elastase
48
management of CF
Abx (for infections and prophylaxis) - oral fluclox and nebulised ciprofloxacin Physiotherapy - chest percussion, postural drainage Nebulised DNAse Pancreatic replacement etc
49
How is TB spread?
Usually by resp route, droplet spread.
50
Clinical presentation of TB
Fever Anorexia + w loss Malaise Cough
51
Diagnosis of TB
Sputum sample -> gastric washings mantoux test Interferon gamma release assays Also: Urine, CXR, CSF
52
Treatment of TB
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol. First 2 for 6 months baby. Pyridoxine after puberty to prevent peripheral neuropathy
53
What is Periorobital cellulitis?
URTI followed by painful swollen eye Proptosis Red colour vision --> optic nerve compromise
54
Mangagement of Perioribital cellulits
Abx | Incision and drain of abcess
55
What is strabismus?
Misalignment of the visual axes.
56
What is meant by latent strabismus?
Eyes are straight when both eyes open, but a deviation of the visual axes can be elicited when each eye is covered.
57
What is Hypertropia?
Upward eye
58
What is Hypotropia?
Downward eye
59
What is esotropia?
Inwards eye
60
What is exotropia?
Outwards eye
61
Causes of strabismus?
``` Hereditary Refractive errors Neurological deficit eg. CP Craniofacial synostosis Febrile illness can precede onset. Secondary to loss of vision ```
62
Investigations of strabismus?
Corneal reflection.?Symettrical Cover test: - Exotropia for distance - Exophoria for close.
63
What is ambylopia?
defective visual activity which persists after the correction of refractive error and removal of any pathology
64
Treatment of ambylopia?
Refractive adaptation Occlusion of the better seeing eye Atropine drops (dilates pupil and paralyses accom so blurry vision in good eye so the bad eye must sort it's self out)
65
management of strabismus?
Conservative: Glasses, prisms, orthoptic exercises Pharm: Botox under ketamine anaesthesia. Injected into medial rectus if esotropia and lateral rectus if exotropia. Surgery
66
What are grommets?
Ventilation tubes that can help with otitis media w/effusion
67
What are some causes of sensorineural deafness?
Inherited:Treacher-Collins syndrome, Waardenburg syndrome Antenatal/Perinatal: Congenital infection eg. rubella, CMV, syphilis Preterm: Birth asphyxia, hyperbilirubinaemia Post natal/ childhood: Drugs eg aminoglycosides, Meningitis, head injury
68
What are some causes of Conductive deafness?
Secretory otitis media (glue ear) | Eustachian tube dysfunction (Down syndrome, cleft palate, micrognathia, mid facial hypoplasia)
69
What decibel loss affects development?
over 40dB will affect speech and language development

3a (25 decks)

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