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Paediatrics > Paediatric Respiratory > Flashcards

Paediatric Respiratory Flashcards

1
Q

What is asthma?

A

A chronic condition characterised by reversible and paroxysmal constriction of the airways and airway occlusion from inflammatory exudate.

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2
Q

What is the most common chronic condition in children?

A

Asthma

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3
Q

Although poorly understood what is the general pathophysiology of atopic asthma?

A

Allergens are presented to TH2 cells from dendritic cells, these release cytokines.
This increases humoral immune system response causing a proliferation of mast cells and eosinophils
Cytokines contribute to underlying airway inflammation, bronchoconstriction and exudate production

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4
Q

What are some risk factors for developing asthma?

A

FHx of asthma/atopy
Low birth weight, prematurity, parental smoking
Viral bronchiolitis in early life

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5
Q

What are precipitating factors in regards to asthma?

A

Stimuli which initate an exacerbation of asthma

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6
Q

What are some example of precipitating factors of asthma?

A

Cold air, exercise, pollution, NSAIDs, beta blockers, exposure to allergens

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7
Q

What s laryngomalacia?

A

A condition affecting infants, where the supraglottic larynx is structured in a way that causes partial airway obstruction leading to stridor on inhalation

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8
Q

What is stridor?

A

A harsh whistling sound caused by air being forced through an obstruction of the upper airway

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9
Q

What is the usual structural change seen in laryngomalacia?

A

The arytenoid folds are shortened, which pulls on the epiglottis and changes its shape to a characteristic omega shape

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10
Q

How would a child with laryngomalacia present?

A

Peak at 6 months, inspiratory stridor which is usually intermittent and more prominent with feeding, distress, lying on their back or with URTIs. Do not usually have respiratory distress or complete airway obstruction

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11
Q

What us the management for laryngomalacia?

A

Usually improves as the larynx matures with age
Surgery can be performed to alter tissue in the larynx, rarely tracheostomy is needed

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12
Q

What is whooping cough?

A

URTI caused by bordetella pertussis. Child will have severe coughing fits where they cant inhale and subsequently make a loud whooping sound as they forcefully inhale after

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13
Q

Who are vaccinated against pertussis?

A

Children and pregnant women

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14
Q

How does whooping cough usually present?

A

Starts with mild coryzal symptoms, low grade fever and mild dry cough. After around 1 week the more severe coughing fits start.
Infants with pertussis may present with apnoeas rather than a cough

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15
Q

What can you use to confirm the diagnosis of whooping cough?

A

Nasal swab with PCR testing or culture

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16
Q

Is whooping cough a notifiable disease?

A

Yes pertussis is a notifiable disease

17
Q

What features may make you admit someone with pertussis?

A

Acutely unwell, under 6 months, apnoeas, cyanosis, severe coughing fits

18
Q

What is the management of pertussis?

A

Supportive care, infection control measures to reduce spread
Macrolide antibiotics

19
Q

What is a complication of whooping cough?

A

Bronchiectasis

20
Q

How long does a cough from pertussis usually last?

A

Typically resolves in 8 weeks however can last several months

21
Q

What is bronchopulmonary dysplasia also known as?

A

Chronic lung disease of prematurity (CLDP)

22
Q

How is CLDP dignosed?

A

Through CXR and if infant requires oxygen after 36 weeks gestational age

23
Q

How can we prevent bronchopulmonary dysplasia?

A

Giving mothers showing signs of premature labour corticosteroids (betamethasone)
Once neonate born:
- use CPAP rather than intubation+ventilation
- caffeine to simulate respiratory effort
- not over oxygenating

24
Q

What is the management of CLDP?

A

Infant may require low dose home oxygen and weaned off over 1st year of life
Protection against RSV with monoclonal antibody injection monthly

25
Q

What are common LRTIs in children?

A

Pneumonia, bronchiolitis, whooping cough

26
Q

What are common URTIs in children?

A

Croup, common cold, pharyngitis/tonsillitis
(Not common but epiglottitis important differential)

27
Q

What are symptoms of obstructive sleep apnoea in children?

A

Excessive daytime sleepiness or hyperactivity, learning and behaviour problems, faltering growth, in sever cases pulmonary hypertension

28
Q

What is the most common cause of obstructive sleep apnoea in children?

A

Adenotonsillar hypertrophy leading to upper airway obstruction

29
Q

How can obstructive sleep apnoea be diagnosed?

A

Overnight pulse oximetry and polysomnography in more complex cases

30
Q

How do we treat OBA secondary to adenotonsillar hypertrophy?

A

Adenotonsillectomy
Topical steroid nasal sprays and antihistamines in milder cases

31
Q

For children with OBA and persistent obstruction following medical and surgical treatment, what management would we start?

A

CPAP or BiPAP may be required at night

32
Q

What makes up kartagners triad?

A

Paranasal sinusitis, bronchiectasis, situs invertus

33
Q

What is bronchiectasis?

A

Abnormal dilation of the airways with associated destruction of bronchial tissue

34
Q

What are some different aetiologies for bronchiectasis?

A

Post infectious, cystic fibrosis, immunodeficiency, primary ciliary dyskinesia, post-obstructive (foreign body aspiration), youngs syndrome, yellow-nail syndrome

35
Q

What features may suggest the cause for pneumonia is more likely bacterial rather than viral?

A

Fever >38.5
age >2
Absence of rhinorrhoea or wheeze
Localised pain

36
Q

What are features of severe CAP in infants?

A

RR >70, CRT >2secs, Nasal flaring, intermittent apnoea, grunting, unable to feed

37
Q

What are some features of severe CAP in older children?

A

RR >50, CRT >2secs, unable to complete sentence, severe recessions, nasal flaring, signs of dehydration

38
Q

What features in a history would suggest that the patient is at risk of severe asthma?

A

Previous near fatal asthma, previous admissions for asthma in last year, requiring three or more classes of asthma meds, heavy SABA use, brittle asthma

Paediatrics (15 decks)

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