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Phase 3A > Paediatric - Respiratory > Flashcards

Paediatric - Respiratory Flashcards

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1
Q

AIR SOUNDS

What is a wheeze

A

Polyphonic expiratory noise originating from lower airways

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2
Q

AIR SOUNDS

What conditions present with a wheeze

A 
VIW 
Asthma 
CF 
Bronchiolitis 
Pneumonia 
Foreign body
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3
Q

AIR SOUNDS

What is stridor

A

high pitched monophonic inspiratory noise

originates from turbulent flow through partially obstructed airway

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4
Q

AIR SOUNDS

what conditions present with stridor

A 
foreign body 
croup 
acute epiglottitis 
laryngomalacia 
bacterial tracheitis 
anaphylaxis
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5
Q

BRONCHIOLITIS

What is bronchiolitis

A

Infection and inflammation of bronchioles

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6
Q

BRONCHIOLITIS

When does bronchiolitis commonly present

A

Winter

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7
Q

BRONCHIOLITIS

What age is bronchiolitis common in

A

< 1 year

Peak at 6m

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8
Q

BRONCHIOLITIS

Name 3 causes of bronchiolitis

A

RSV
Parainfluenza
adenovirus

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9
Q

BRONCHIOLITIS

Name 4 risk factors for bronchiolitis infection

A 
passive smoking 
prematurity 
low birth weight 
Immunocompromised - CF
Chronic lung or hear disease 
Downs syndrome
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10
Q

BRONCHIOLITIS

How does bronchiolitis present - sx

A 
Coryzal symptoms 
- rhinorrhoea 
- sneezing 
- dry cough 
- mild fever 
wheeze 
dyspnoea 
poor feeding
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11
Q

BRONCHIOLITIS

What are the signs of bronchiolitis

A 
signs of respiratory distress 
fine end inspiratory crackles
- Widespread  
Hyperinflation 
wheeze 
cough 
cyanosis 
pallor 
tachycardia
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12
Q

BRONCHIOLITIS

What are the Ix for bronchiolitis

A

1st line - Pulse oximetry
2nd line - PCR analysis of nasal secretions
3rd line - CXR

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13
Q

BRONCHIOLITIS

What is the management of bronchiolitis

A

Feeding support - NG tubes
Supportive
- Humidified O2
- Fluids

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14
Q

BRONCHIOLITIS

What presentations warrant admission for bronchiolitis

A 
< 3m 
Pre-existing conditions 
feeding < 50%
hx of apnoea 
signs of resp distress 
cyanosis 
Sats < 94%
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15
Q

BRONCHIOLITIS

What is the prevention for bronchiolitis and what group of people are eligible for it

A

Palivizumab - MAB that targets RSV

Monthly vaccinations for:

  • CF
  • Premature
  • Chronic lung disease
  • Immunocompromised
  • CHD
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16
Q

PNEUMONIA

Name 4 causes of pneumonia

A

Bacterial - older children

  • Strep pneumonia
  • Group B strep
  • S.aureus
  • Mycoplasma pneumonia
  • Pneumococcus

Viruses - < 2 years old

  • RSV
  • H.Influnzae
  • Influenzae
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17
Q

PNEUMONIA

Which pathogen commonly causes pneumonia in neonates

A

Group B strep

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18
Q

PNEUMONIA

What does S.aureus specifically present with

A

CXR - Pneumatoceles and consolidation in multiple lobes

Pneumatoceles - round air filled cavities

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19
Q

PNEUMONIA

What does Mycoplasma pneumonia specifically present with

A

Erythema multiforme - red circular rash

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20
Q

PNEUMONIA

Describe the presentation of pneumonia - symptoms

A 
cough 
High fever - > 38.5 
poor feeding 
chest recessions 
lethargy
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21
Q

PNEUMONIA

Describe the presentation of pneumonia - signs

A 
tachycardia 
tachypnoea 
Respiratory distress 
hypoxia 
Pleuritic chest pain 
auscultation 
- bronchial breath sounds 
- focal end inspiratory crackles 
Percussion 
- dullness to percussion
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22
Q

PNEUMONIA

What investigations are used for a patient with suspected pneumonia

A

Sputum cultures / throat swabs for bacterial culture and PCR
- Establish organisms and guide treatment

Capillary blood gas analysis

  • metabolic acidosis
  • blood lactate

Blood cultures - Sepsis

CXR

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23
Q

PNEUMONIA

What is the management of pneumonia

A

Supportive

  • O2
  • Analgesia
  • IV fluids
Antibiotics 
Neonates - broad spectrum Abx 
Children 
1st line - Oral amoxicillin 
2nd line - Erythromycin
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24
Q

PNEUMONIA

What investigation should be performed for a child with pneumonia who gets unwell after a period of improvement

A

CXR - Check for empyema

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25
PNEUMONIA | What investigations should be performed for a child with recurrent LRTI and what are they looking for
``` FBC - WCC levels CXR - Structural abnormality Serum IgG - Antibody levels IgG - Test immunoglobulin G to previous vaccines Sweat test - CF ```
26
VIW | What is a VIW and what does it increase the risk of
Acute wheezy illness caused by viral infection Children have a higher risk of asthma development later in life
27
VIW | What are the risk factors
maternal smoking prematurity Family hx of wheezing
28
VIW | What is the presentation of VIW
``` Evidence of viral illness - fever - cough - coryzal sx for 1 - 2 days S.O.B Signs of respiratory distress Expiratory wheeze throughout chest ```
29
VIW | What is the pathophysiology of VIW
children have small airways virus - RSV or rhinovirus causes inflammation and oedema reducing airway size smooth muscle constriction occurs due to swelling air flow through restricted airways causes a wheeze restricted ventilation causes resp distress
30
VIW | Name 3 typical features of VIW that differentiates it from asthma
- presenting before 3 years of age - no atopic history - only occurs during viral infections - no interval sx - typically resolves by 5 years old
31
ASTHMA | Name 4 asthma triggers
``` cold weather strong emotions viruses bacterial infections exercise dust Drugs - NSAIDs / Beta blockers ```
32
ASTHMA | What is the definition of asthma
Chronic inflammation of airways that causes episodic exacerbations of bronchoconstriction due to hypersensitivity
33
ASTHMA | Name 3 risk factors for asthma development
``` Hx of atopy Allergens - dust / grass / pollen - hayfever family hx smoking exposure obesity pollution URTI ```
34
ASTHMA | What is the atopic triad
asthma allergic rhinitis eczema
35
ASTHMA | What is the pathophysiology of asthma
Bronchial inflammation - oedema - mucus hypersecretion Airway hyper-responsiveness - Mass histamine release - Hypersensitivity Reversible airflow limitation - Airway obstruction due to inflammation - Bronchospasm and chronic bronchoconstriction symptoms
36
ASTHMA | What are the distinguishing features of asthma
diurnal variation sx have non viral triggers interval sx between exacerbations
37
ASTHMA | What are the sx and signs of asthma
sx - wheeze - dry cough - S.O.B - Disturbed sleep signs - exercise tolerance - bilateral polyphonic wheeze - typical triggers
38
ASTHMA | What are the investigations for asthma
- hx and investigations - skin prick for common allergens - Serial PEFR if > 5 years old readings at morning and at night - FeNO > 35ppb - Spirometry
39
ASTHMA | What are the spirometry readings for an asthmatic patient
FEV1:FVC < 70% FEV1 improves by 15% after bronchodilator
40
ASTHMA - drugs What is used a preventer therapy - what is the MOA - What are the A/E
ICS Decreases airway inflammation to decrease sx A/E - Impaired growth - adrenal suppression - altered bone metabolism / osteoporosis - pepti ulcers
41
ASTHMA - drugs | What is adrenal suppression due to ICS usage caused by
decreased cortisol
42
ASTHMA - drugs | What is used as a reliver therapy
Bronchodilators Anticholinergics - Ipratropium bromide
43
ASTHMA - drugs | What techniques are used to minimise the adverse effects of ICS
Lowest possible dose spacer usage rinsing mouth after medication delivery
44
ASTHMA | What is the management of asthma in < 5 years old
SABA SABA + low dose ICS - If uncontrolled on low dose ICS SABA + ICS + LTRA
45
ASTHMA | What is the management of asthma in > 5 years old
SABA SABA + ICS - Recheck adherence - inhaler technique - elimination of triggers SABA + ICS + LABA - good response --> continue - poor response to LABA (1) - If no response to LABA (2) 1. SABA + Titrate ICS dose + LABA 2. Stop LABA and add LTRA - Refer to specialist - Oral LTRA OR Oral theophylline
46
ACUTE ASTHMA | What are the features of moderate acute asthma
peak flow > 50% normal speech
47
ACUTE ASTHMA | What are the features of severe asthma
peak flow < 33% sats < 92% unable to complete sentences in one breath signs of resp distress
48
ACUTE ASTHMA | What are the features of life-threatening asthma
33 / 92 / CHEST peak flow < 33% sats < 92% cyanosis hypotension exhaustion and poor effort silent chest tachycardia
49
ACUTE ASTHMA | What are the side effects of salbutamol
tachycardia hypokalaemia tremor
50
ACUTE ASTHMA | What is required when giving IV Salbutamol
cardiac monitoring
51
ACUTE ASTHMA | What is the management of acute asthma
OSHIT ME O - High flow O2 S - Nebulised salbutamol - every 15 mins - 1 puff every 30-60s up to 10 puffs H - IV Hydrocortisone / oral prednisolone I - Ipratropium bromide T - IV Theophylline M - IV magnesium sulphate E - Escalate
52
ACUTE ASTHMA | When can a patient be discharged following an acute asthma attack
PEFR > 75% constantly asthma action plan safety net information 1 week GP follow up
53
ACUTE ASTHMA | What are 4 common reasons response to asthma management is not occurring
``` adherence bad disease choice of drugs / devices diagnosis environment ```
54
ASTHMA | What is the presentation of chronic asthma
barrel chest hyperinflation - increased resonance on percussion Harrison's sulci
55
ASTHMA | What are the adverse effects of oral steroids
``` HTN Hyperglycaemia Adrenal suppression weight gain poor growth ```
56
ASTHMA | What are the adverse effects of Montelukast
nightmares coryzal sx diarrhoea fever
57
CYSTIC FIBROSIS | What is CF
AR disorder due to mutation in CFTR gene on chromosome 7
58
CYSTIC FIBROSIS | What is the pathophysiology of CF
Decreased Cl- secretion Increased Na+ absorption leads to increased H20 absorption into cells with thickened secretions Mucous stasis and dehydrated airway surface liquid predisposes to infection
59
CYSTIC FIBROSIS | What is the carrier rate for CF
1 in 25
60
``` CYSTIC FIBROSIS What is the presentation of CF for each of these systems: - Resp - GI - GU ```
``` Resp - chronic cough with thick sputum - sinusitis - nasal polyps - bronchiectasis Due to recurrent infection - breathlessness - haemoptysis - recurrent chest infections ``` GI - Cholesterol gallstones - meconium ileus - steatorrhea - Pancreatitis - failure to thrive GU - pubertal delay - Secondary amenorrhoea - Infertility
61
CYSTIC FIBROSIS | How does meconium ileus present
abdominal distension vomiting meconium is - thick - sticky
62
CYSTIC FIBROSIS | How does CF present in infancy
``` faltering growth malabsorption steatorrhea prolonged neonatal jaundice recurrent infections - pseudomonas ```
63
CYSTIC FIBROSIS | How does CF present in young child
bronchiectasis rectal prolapse nasal polyps sinusitis
64
CYSTIC FIBROSIS | How does CF present in adolescents
``` diabetes cirrhosis portal HTN Infertility distal intestinal obstruction ```
65
CYSTIC FIBROSIS | What ix are required for CF
1st line - Guthrie card 2nd line - Sweat test DIAGNOSTIC 3rd line - Genetic testing other: - CXR - Faecal elastase - Lung function
66
CYSTIC FIBROSIS | What is the Guthrie screening test looking for
Immunoreactive trypsinogen test conducted between days 5 - 9
67
CYSTIC FIBROSIS | What does the sweat test measure
measures chloride ions | > 60 mmol/L - diagnostic
68
CYSTIC FIBROSIS | What is the general management of CF
Stop smoking | vaccinations
69
CYSTIC FIBROSIS | What is the management of pulmonary disease in CF
Airway clearance techniques to reduce incidence of infections chest physiotherapy mucoactive agents - dornase alpha - hypertonic NaCl amiloride lung transplant - FCV < 30%
70
CYSTIC FIBROSIS | What is the MOA of amiloride
Inhibits Na transport
71
CYSTIC FIBROSIS | How are infections managed in CF
Prophylactic flucloxacillin - reduced risk of bacterial infection (s.aureus) vaccinations - pneumococcal - flu - varicella
72
``` CYSTIC FIBROSIS What is the extrapulmonary management of CF - Nutrition - fertility - hepatobiliary ```
``` Nutritional assesment - increase portion size - high calorie diet - supplements - PERT CREON tablets help patients with pancreatic insufficiency to digest fats (replace lipase) ``` testicular sperm extraction liver transplant
73
CYSTIC FIBROSIS | What microbial colonisers are common for CF in childhood
staph aureus Haemophilus influenza Pseudomonas aeruginosa
74
CYSTIC FIBROSIS | How is pseudomonas aeruginosa managed
avoid contact with other CF patients - hard to clear once colonised - resistant to multiple Abx Nebulised Abx - Tobramycin Oral ciprofloxacin
75
CYSTIC FIBROSIS What is the main differential for CF? How does it present
Primary ciliary dyskinesia ``` Presentations - URTI and LRTI bronchiectasis productive cough nasal discharge chronic ear infections dextrocardia ```
76
HYPERSENSITIVITY | What is type 1 hypersensitivity reaction and give an example
Allergic - IgE mediated bee sting medications
77
HYPERSENSITIVITY | What is type 2 hypersensitivity reaction and give an example
Cytotoxic - Antibody mediated haemolytic reactions good pastures syndrome
78
HYPERSENSITIVITY | What is type 3 hypersensitivity reaction and give an example
Immune complex hypersensitivity pneumonitis SLE serum sickness
79
HYPERSENSITIVITY | What is type 4 hypersensitivity reaction and give an example
Delayed - T cell mediated SJS
80
HYPERSENSITIVITY | How does anaphylaxis present
``` urticaria itching angio-oedema S.O.B wheeze stridor tachycardia collapse ```
81
HYPERSENSITIVITY | What is the management of anaphylaxis
ABCDE IM Adrenaline repeat after 5 mins other: Fluid challenge and O2 Antihistamines - Chlorphenamine - Cetirizine steroids - IV Hydrocortisone
82
HYPERSENSITIVITY | What is the follow on management of anaphylaxis
observation for 6 - 12 hours - Biphasic reactions education for family
83
HYPERSENSITIVITY | What investigation can be used to determine if a true anaphylactic attack occurred
Serum mast cell tryptase | - elevated for 12hrs following event
84
CROUP | What is the other name for croup
Laryngotracheobronchitis
85
CROUP | When does croup commonly present
autumn and spring
86
CROUP | What are the causes of croup
Parainfluenza 1 and 3 adenovirus RSV
87
CROUP | What is the presentation of croup
Preceeding - low grade fever - coryzal sx At time: - barking cough - worse at night - Coughing in clusters - hoarse voice - stridor - breathlessness - poor feeding
88
CROUP | What are the investigations for croup
Bedside - O2 stats / HR / RR CXR - Steeple sign Minimal examination required
89
CROUP | What is contraindicated in a child presenting with croup
Throat examination - leads to laryngospasms
90
CROUP | what is the management of croup
Acronym - ODA Self-limiting Supportive - fluids - rest - oxygen Oral dexamethasone / prednisolone - 1 dose --> 150mcg/kg - Can be repeated 12hrs later Nebulised adrenaline - If severe: signs of resp distress
91
ACUTE EPIGLOTTITIS | What is acute epiglottitis
Life threatening emergency inflammation and swelling of epiglottis due to infection common in aged 2 - 7
92
ACUTE EPIGLOTTITIS | Why is acute epiglottitis rare
Due to child immunisation suspect in an unvaccinated infant
93
ACUTE EPIGLOTTITIS | What is the cause of acute epiglottitis
Haemophilius influenza B
94
ACUTE EPIGLOTTITIS | What is the presentation of acute epiglottitis
``` 4 D'S Dysphagia Drooling - difficulty swallowing Distress Dysphonia ``` HIGH FEVER Septic looking child
95
ACUTE EPIGLOTTITIS | What signs are present in a child with acute epiglottitis
``` stridor - soft inspiratory tripod position - sitting upright and leaning forward muffled voice septic looking absent cough ```
96
ACUTE EPIGLOTTITIS | What investigations are required for a child with acute epiglottitis
Direct visualisation - Laryngoscopy - Beefy red oedematous epiglottis X-Ray - thumb sign
97
ACUTE EPIGLOTTITIS | What is the management of acute epiglottitis
Keep child calm do not examine throat 1st line - Secure airway 2nd line - cultures
98
ACUTE EPIGLOTTITIS | what is the pharmacological management of acute epiglottitis
IV Abx - Ceftriaxine steroids - Dexamethasona
99
ACUTE EPIGLOTTITIS | what should be given to unvaccinated close contacts
Rifampicin
100
ACUTE EPIGLOTTITIS | How do you differentiate croup from acute epiglottitis
AE - faster onset - no coryzal sx - no cough - can't drink - drooling - toxic appearance - HIGH FEVER - Whispering stridor - fullfed voice croup - slow onset - coryzal sx - barking cough - low grade fever - hoarse voice - harsh stridor only when upset
101
BACTERIAL TRACHEITIS | What is bacterial tracheitis and what causes it
uncommon condition similar to severe epiglottitis occurs 6m to 14 years old causes - S.aureus - strep A
102
WHOOPING COUGH | what is whooping cough
Pertussis - NOTIFIABLE DISEASE URTI occurring before babies first vaccinations (<4m) 100 day cough
103
WHOOPING COUGH | What infection commonly co-exists with whooping cough
Bronchiolitis
104
WHOOPING COUGH | What causes whooping cough
Pertussius bordatella Gram -ve cocobacilli
105
WHOOPING COUGH | How does whooping cough present
1st - mild coryzal sx - low grade fever - dry cough - conjunctivitis - nasal discharge - sore throat 2nd - coughing fits - Proxysmal cough (3-6wks) - dry hacking cough - child can turn blue - worse at night or feeds - loud inspiratory woop Apnoea in infants
106
WHOOPING COUGH | What can occur due to coughing fits in whooping cough
``` sunconjunctival haemorrhage syncope of seizures fainting vomiting pneumothorax nose bleed ```
107
WHOOPING COUGH | What investigations are required in a child presenting with whooping cough
within 2-3 weeks Nasopharyngeal swabs - PCR testing - bacterial culture cough > 2 weeks - Anti-pertussis toxin IgG - Looked for in oral fluid or blood
108
WHOOPING COUGH | What is the management of whooping cough
supportive care Abx - reduce infectivity period and useful if given within first 3 weeks Infants < 1m --> Azithromycin / Clarithromycin infants > 1m --> Macrolides / Trimethoprim Pregnant (20-32wks) --> Erythromycin
109
WHOOPING COUGH | What prophylaxis is given to close contacts
Erythromycin

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