Paeds Resp Flashcards

Question

What is is Acute Epiglottitis

Answer 1

Inflammation & Swelling of epiglottis due to infection. Life threatening. | Typically caused by Haemophilus influenza type B - Hib Vaccine Protectiv ## Footnote Caution when unvaccinated child when they present with croup as it can be Epiglottitis

Answer 2

* Rapid Onset * High Temperature * **Stridor** * Drooling * Sore throat * **Tripod Position**: Pt finds it easier to sit fwd with elbows on knees

Answer 3

* Made by direct visualisation only by senior/airway trained staff * X rays: Thumb sign & Steeple Sign * X rays can also rule out foreign bodies | Must not start investigating too invasively risk of aspiration.

Answer 4

Do not distress patient and inform seniors * Endotracheal intubation to secure airway (not in all cases) * IV antibiotics * Oxygen

Answer 5

Common complication is the development of **epiglottic abscess** which is a collection of pus around the epiglottis. Death can be caused if airway not secured

Answer 6

Infection of the lung tissue causing inflammation and sputum filling airways and alveoli. * Bacterial oft caused by: **Strep Pneumoniae** (others Group A and B Strep, Staph Aureus etc) * Viral: RSV, Parainfluenza, Influenza ## Footnote Seen as consolidation on X ray

Answer 7

* Wet cough * Fever * Tachypnea, Tachycardia * Hypoxia * Confusion * Bronchial breath sounds: harsh breath sounds that are equally loud on inspiration and expiration | - Focal coarse crackles ## Footnote - Dullness to percussion due to tissue collapse or consolidation

Answer 8

CXR Throat swabs for causative organism

Answer 9

Can be associated with a **pleural effusion ** this can become infected where it is then termed an empyema. Can lead to **sepsis**

Answer 10

* Amoxicillin is first-line for all children with pneumonia * Macrolides may be added if there is no response to first line therapy *erythromycin, clarithromycin or azithromycin* | Macrolides should be used if mycoplasma or chlamydia is suspected ## Footnote In pneumonia associated with influenza, co-amoxiclav is recommended

Answer 11

Autosomal recessive disorder, causing increased viscosity of mucuos secretions, due to defective CFTR gene which codes Cl channel | 1 in 2500 affected ## Footnote Carrier rate is 1:25 so 25% chance

Answer 12

* Thick billiary and pancreatic secretions: blocked ducts = low digestive enzymes * Thick airway secretions: reduce airway clearance and easy for bacteria to colonise * Absence of Vas Deferens: Infertility | Common bacteria: Staph Aureus, P. Aeruginosa, Aspergillius

Answer 13

* Chronic Cough with thick sputum * Steatorrohea with abdo pain * Recurrent infections * Failure to thrive - Short stature * Nasal Polyps * Finger Clubbing * Rectal Prolapse - due to bulky stools ## Footnote Delayed Puberty Diabetes Mellitus Infertility in Males Subfertility in Females (takes longer to get pregnant)

Answer 14

* Newborn screening Day 5: blood spot test & Meconium ileus * **Sweat Test**: Test sweat for Chloride levels (high) **GOLD STANDARD** * Genetic Testing: CFTR mutation check during pregnancy ## Footnote Meconium ileus is when meconium is sticky and thick which gets stuck in the gut and obstructs the bowel. Cause of False +ve Sweat test: Malnutrition, Adrenal Insufficiency, Glycogen storage disease, diabetes insipidus. Cause of Flase -ve Sweat test: Skin Oedema due to Hypoalbuanemia 2ndry to pancreatic exocrine insuffiency

Answer 15

Need Specialist MDT * Regular physiotherapy and postural drainage * High calorie/high fat diet * Minimise contact with other CF patients * Vit & pancreatic ennzyme supplementation * Chronic infection with **Burkholderia cepacia** contraindication to lung transplantation *(can't have it)* | **Lumacaftor** for Pts with delta F508 mutation, increases CFTR proteins ## Footnote **Pseudomonas Aeruginosa** bacteria may become resistant to Abx, PA can lead to morbidity and mortality

Answer 16

* Life expectancy: 47y * Pancreatic insufficiency * CF related diabetes requiring insulin * Development of Liver disease | Absent Vas Deferes in most males rendering them infertile

Answer 17

**Moderate**: Able to talk, SpO2 above 92% **Severe**: Inability to complete sentences SpO2 below 92% PEF: 33-50% use of accessory muscles Raised HR and RRR **Life threatening**: SpO2 below 92%, PEF below 33% Silent Chest, Very unresponsive, Cyanosis, Poor respiratory effort

Answer 18

* Atopy: Eczema, hayfever & Allergies * FH * Triggers include Cold air, excercise, emotions, smoking and certain drugs, dust mites.

Answer 19

- Bronchial inflammation leading to Oedema, excess mucus production, cellular infiltration (WBC) - Bronchial hyperresponsiveness - exaggerrated muscle contractions to inhaled and physical stimuli leading to narrowing of airways. | Smooth muscle is always hypersensitive

Answer 20

* Diagnosis usually made with response to treatment * Spirometry with reversibility testing (in children aged over 5 years) * Direct bronchial challenge test with histamine or methacholine * Fractional exhaled nitric oxide (FeNO) * Peak flow variability measured by keeping a diary of peak flow measurements several times a day for 2 to 4 weeks | FEV1 is reduced FVC remains normal resulting in an FEV1:FVC ratio <80% ## Footnote U5 based on history and examination, response to treatment, skin prick test can help identify sensitisation to certain allergens.

Answer 21

Mild To Moderate **Bronchodilator therapy**: Beta 2 agonist via spacer (can use close fitting mask), One puff every 30-60s 10 times Steroid Therapy: 3-5 days, 2-5Y 20mg OD >5Y 40mg OD

Answer 22

Children 5-16: SABA -> ICS -> LTRA -> LABA Children 5: SABA -> Moderate ICS -> LTRA If neither work consult specialist Daily Steroids may be required

Answer 23

* Wheeze, cough and breathlessness typically worse at night (diurnal variation) * Wheeze and breathlessness with non-viral triggers * FH of atopic disease * Interval symptoms (nocturnal cough, morning SOB) ## Footnote Asthma should be suspected in any child with wheezing on more than one ocassion.

Paeds Resp Flashcards

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