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Osha 3a > Paediatric respiratory > Flashcards

Paediatric respiratory Flashcards

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1
Q

What is croup?

A
  • acute infective URTI
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2
Q

What is the epidemiology of croup?

A
  • 6 months to 6 years, most common under 3 years
  • more prevalent autumn - winter
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3
Q

What is the pathophysiology of croup?

A
  • inflammation and swelling resulting in partial obstruction of the upper airway
  • oedema in larynx
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4
Q

What are the most common causes of croup?

A
  • parainfluenza
  • influenza
  • adenovirus
  • respiratory syncytial virus (RSV)
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5
Q

How does croup present?

A
  • increased work of breathing
  • barking cough in clusters of coughing episodes
  • hoarse voice
  • stridor
  • low grade fever
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6
Q

How is croup managed?

A
  • supportive: fluids and rest
  • oral dexamethasone
  • infection control measures: handwashing, off school
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7
Q

What is the order of treatment for croup?

A
  • oral dexamethasone
  • oxygen
  • nebulised budesonide
  • nebulised adrenalin
  • intubation and ventilation
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8
Q

What is bronchiolitis?

A
  • chest infection causing inflammation and infection in the bronchioles
  • lower resp tract infection
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9
Q

What is the epidemiology of bronchiolitis?

A
  • observed in winter
  • mostly between 1-9 months
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10
Q

What causes bronchiolitis?

A
  • Majority attributed to respiratory syncytial virus
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11
Q

What is the presentation of bronchiolitis?

A
  • coryzal symptoms
  • resp distress
  • wheezing
  • tachypnoea
  • grunting
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12
Q

What are the signs of respiratory distress?

A
  • raised RR
  • accessory muscle breathing
  • inter and subcostal recessions
  • nasal flaring
  • head bobbing
  • tracheal tugging
  • cyanosis
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13
Q

What is wheezing and what is the cause?

A
  • whistling sound
  • narrowed airways
  • heard in expiration
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14
Q

What is grunting?

A
  • exhaling with glottis closed
  • increases positive end-expiratory pressure
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15
Q

What is stridor?

A
  • high pitched inspiratory noise
  • obstruction of upper airway
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16
Q

What resp reasons would cause a child to be admitted?

A
  • 50-75% less than normal milk intake
  • RR above 70
  • central cyanosis
  • O2 sats below 92%
  • apnoea
  • head bobbing/deep recessions
  • unwell to hcp
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17
Q

How can ventilation be assessed in children?

A
  • capillary blood gases
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18
Q

What capillary blood gas results show poor ventilation?

A
  • rising pCO2
  • falling pH
  • respiratory acidosis
  • if also hypoxic: type 2 resp failure
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19
Q

How can ventilatory support be provided?

A
  • high-flow humidified oxygen via a tight nasal cannula
  • oxygenates lungs and adds positive end-expiratory pressure to maintain airway
  • CPAP
  • intubation and ventilation
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20
Q

How is bronchiolitis managed?

A
  • adequate fluid intake
  • saline nasal drops
  • supplementary oxygen
  • ventilatory support
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21
Q

What is palivizumab?

A
  • monoclonal Ab targeting RSV
  • given to high risk babies
  • ex-premature
  • congenital heart disease
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22
Q

Why is aspirin usually avoided in children?

A
  • Reye’s syndrome
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23
Q

What is the pathophysiology of viral induced wheeze?

A
  • children <3 have small airways
  • when encountering virus they develop inflammation and oedema
  • swelling walls and restricting airflow
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24
Q

How can you tell the difference between viral induced wheeze and asthma?

A
  • presenting before 3 years old
  • no atopic history
  • only occurring during viral infection
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25
How does viral induced wheeze present?
- evidence of viral illness - SOB - signs of resp distress - expiratory wheeze throughout chest
26
What is the cause of wheeze?
- narrowing of airways causes laminar flow to become turbulent
27
Which types of drugs are used to relax airway smooth muscle?
- β-2 agonists - anti-muscarinics - theophyllines
28
Which types of drugs are used to dampen inflammation?
- corticosteroids - leukotriene receptor antagonists - biologics - macrolides
29
What breaks a breath hold?
raised CO2 detected in CSF
30
Where does gas exchange begin?
- in the respiratory bronchioles - terminal bronchioles > resp bronchioles > alveolar ducts > sacs
31
What is asthma?
- chronic inflammatory condition causing variable (but reversible) airway obstruction - narrowed airways > obstruction of airflow to lungs - varies over time
32
What is the presentation of asthma?
- episodic - diurnal variability and worse at night - dry cough, wheeze, shortness of breath - atopic triad: hayfever, eczema, asthma - family history
33
What is the physiology behind asthma?
- smooth muscle contracts on irritation - chronic inflammation leads to scarring and airway remodelling
34
What are the causes of asthma?
- environmental: pollen, smoke, dust, mould - genetics - hygiene hypothesis
35
What is the investigation for asthma?
- spirometry: FEV1/FEV <0.7 - reversibility: give salbutamol and see if ratio normal (0.8) - fractional exhaled nitric oxide - peak flow variability by diary
36
What is the management of asthma in children aged 5-11?
- SABA PRN - +low dose ICS - +LABA and cont if good response - titrate up ICS to medium dose - consider adding LTRA/theophylline - Inc ICS to high dose
37
What is the management of asthma for children aged <5?
- SABA PRN - +low dose ICS/LTRA - try other - specialist
38
What is the management of asthma for children aged >12?
- SABA PRN - +low dose ICS - +LABA - medium dose ICS, consider LTRA/theophylline/LAMA - high dose ICS + consider oral salbutamol
39
What is an example of: 1. SABA 2. LABA 3. SAMA 4. LAMA?
1. salbutamol 2. salmeterol 3. ipratropium bromide 4. tiotropium bromide
40
How do leukotriene receptor antagonists work?
- Leukotrienes produced by immune system - cause inflammation, bronchoconstriction, mucus secretion - antagonists block effects
41
What is cystic fibrosis?
- autosomal recessive condition affecting mucus glands - caused by genetic mutation of CFTR gene on chromosome 7 coding for chloride channels
42
How is cystic fibrosis diagnosed?
- newborn blood spot testing - sweat test (GOLD) - genetic testing for CTFR by amniocentesis or chorionic villous sampling - faecal elastase
43
What is the sweat test for cystic fibrosis?
- pilocarpine applied to patch of skin - electrodes placed either side - current passed causing sweating and sample sent to lab for chloride conc testing - >60mmol/L is diagnostic
44
What are the symptoms of cystic fibrosis?
- chronic cough - thick sputum - recurrent RTIs - steatorrhoea - failure to thrive
45
What are signs of cystic fibrosis?
- low weight or height - nasal polyps - clubbing - crackles and wheeze on auscultation - abdo distention
46
Which bacteria commonly affect children with cystic fibrosis and how is it prevented?
- S. aureus - Pseudomonas aeruginosa - prophylactic flucloxacillin taken
47
What is the first sign of cystic fibrosis?
- meconium ileus - thick and sticky black stool - obstructs bowel - not passing within 24 hrs of birth > abdo distention and vomiting
48
What is the pathophysiology of the symptoms behind cystic fibrosis?
- thick pancreatic and biliary secretions: block ducts > lack of digestive enzymes - low volume, thick airway secretions > reduce clearance leading to bacterial colonisation and infection - congenital bilateral absence of vas deferens
49
What is the pathology of cystic fibrosis?
- issues with Cl- channel on apical membrane of epithelial cells - dec Cl- secretion and inc Na+ absorption leads to reduced water secretion and thickened mucus
50
What is the management of cystic fibrosis?
- chest physio: clear mucus - exercise: improve resp function - high calorie + fat diet: malabsorption - bronchodilators: salbutamol
51
What is pneumonia?
- infection of lung tissue and inflammation - causes inflammation and sputum in airways and alveoli - community, hospital acquired or aspiration
52
What are the symptoms of pneumonia?
- wet, productive cough - high fever - inc work of breathing - lethargy and delirium
53
What chest signs present with pneumonia (of consolidation)?
- harsh bronchial breath sounds - focal coarse crackles + wheeze - dullness to percussion
54
What are signs of pneumonia?
- tachycardia - tachypnoea - hypoxia - hypotension - confusion
55
What investigations are done for pneumonia?
- CXR - sputum cultures and throat swabs - viral PCR - blood culture if septic - capillary BG if unwell
56
What are the bacterial causes of pneumonia?
- S. pneumoniae - Group A strep - S. aureus - Mycoplasma pneumoniae
57
Which bacteria cause pneumonia in prevaccinated children?
- Group B strep - H. influenza
58
What are viral causes of pneumonia?
- RSV - parainfluenza virus - influenza virus
59
How is pneumonia managed?
- amoxicillin - add a macrolide e.g. erythromycin - IV Abx if sepsis - O2 above 92%
60
What is the management of children with recurrent admission for LRTI?
- FBC - CXR - serum immunoglobulins - IgG - sweat test - HIV test
61
Which bacteria is epiglottitis typically caused by?
- haemophilus influenza type B
62
What is epiglottitis?
- inflammation and swelling of the epiglottis
63
How does epiglottitis present?
- sore throat - stridor - drooling - tripod position - high fever - painful swallow - muffled voice
64
How is epiglottitis investigated?
- lateral X-ray of neck - thumb(print) sign - soft tissue shadow looks like thumb pressed into trachea - caused by oedematous and swollen epiglottis
65
How is epiglottitis managed?
- don't examine and don't upset - distress could prompt airway closure - secure airway - prepare to intubate at any time
66
What medical management is there for epiglottitis?
- IV Abx (ceftriaxone) - steroids (dexamethasone)
67
What is the prognosis of epiglottitis?
- most recover without intubation - epiglottic abscess
68
What is whooping cough?
- URTI - caused by Bordetella pertussis
69
What type of bacteria is Bordetella pertussis?
- gram negative coccobacillus
70
What are the initial symptoms of whooping cough?
- mild coryza symptoms - low grade fever - paroxysmal cough
71
What is paroxysmal cough?
- sudden and recurring fits with cough free periods
72
How does whooping cough present after a week?
- paroxysmal cough - severe fits > loud inspiratory whoop
73
What are the complications of severe coughing fits in whooping cough?
- fainting - vomiting - pneumothorax
74
How do infants present in whooping cough?
- sometimes without whoop - with apnoea
75
How is whooping cough diagnosed?
- nasopharyngeal or nasal swab - PCR testing or bacterial culture - if >2 weeks then test for anti-pertussis toxin IgG
76
How is whooping cough managed?
- supportive care - notify PHE - macrolide Abx e.g. clarithromycin if presenting within 21 days
77
What is a key complication of whooping cough?
- bronchiectasis
78
What is bronchopulmonary dysplasia?
- infants who still require oxygen at an age of 36 weeks
79
What is the cause of bronchopulmonary dysplasia?
- lung damage - from pressure and volume trauma of artificial ventilation, oxygen toxicity and infection
80
What is seen on CXR in bronchopulmonary dysplasia?
- widespread opacification - cystic changes - fibrosis
81
How is bronchopulmonary dysplasia treated?
- weaning onto CPAP - additional oxygen where needed - prophylactic palivizumab for bronchiolitis

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