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Paeds Resp Flashcards

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1
Q

What produces surfactant?

A

Type 2 pneumocytes

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2
Q

What is pulmonary hypoplasia?

A

Rare congenital anomaly with incomplete lung tissue development -> impaired gas exchange + resp insufficiency

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3
Q

What is oxygenation?

A

Process of delivering oxygen from the air to the body’s tissues

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4
Q

What is ventilation?

A

Process of moving air in and out of the lungs

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5
Q

What is RDS of prematurity?

A

Respiratory Distress Syndrome of prematurity -difficulty breathing in prem babies due to a lack of surfactant in the lungs

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6
Q

What is bronchiolitis + when is it most common?

A

Infection and inflammation in the bronchioles, most common in winter

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7
Q

What pathogen is the most common cause of bronchiolitis?

A

RSV (Respiratory syncytial virus)

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8
Q

How does bronchiolitis affect children? (pathophysiology)

A

Inflammation, oedema, and increased mucus production in the bronchioles cause the airway to narrow
Airflow obstructed=increased work of breathing + reduced O2 sats

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9
Q

How does an RSV infection normally start?

A

Coryzal symptoms (runny nose, sneezing and a sore throat).

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10
Q

What are coryzal symptoms?

A

Coryza = inflammation of the nasal mucous membrane, (URTI). Symptoms include nasal congestion, runny nose, sneezing, and sore throat

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11
Q

In what ages would you diagnose bronchiolitis?

A

Generally in infants under 1yr
Most common in under 6mths
Can be Dxd up to 2yrs, particularly in ex-prem babies with chronic lung disease

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12
Q

Name the 4 steps of a typical RSV infection

A

Chest symptoms 1-2 days after the onset of coryzal symptoms
Peak of symptoms on days 3-5
Symptoms lasting 7-10 days total
Full recovery within 3 weeks

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13
Q

How do you manage bronchiolitis?

A

Adequate food intake (oral, NG, IV fluids)
Saline nasal drops/nasal suctioning
Supplementary O2
Ventilatory support if needed

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14
Q

Name 4 non-coryzal presentation of an RSV infection/bronchiolitis

A

Dyspnoea + tachypnoea - heavy + fast breathing
Reduced feeding
Mild fever
Wheezes/crackles

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15
Q

Name 5 signs of resp distress in children

A

Grunting
Accessory muscle use-recessions
Nasal flaring
Head bobbing

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16
Q

What is a wheeze?

A

Whistling sound heard on auscultation and caused by airway obstruction. It occurs during exhalation

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17
Q

What paediatric conditions might present with a widespread wheeze?

A

Bronchiolitis
Asthma
Viral-induced wheeze

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18
Q

What paediatric conditions might present with a focal wheeze?

A

Foreign body aspiration
Obstructing tumour

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19
Q

What is stridor?

A

High-pitched inspiratory noise caused by obstruction of the upper airway.

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20
Q

Name 3 key causes of stridor

A

Foreign body aspiration
Croup
Epiglottitis

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21
Q

What exam should you not do on a child with stridor?

A

ENT exam-don’t look in mouth as may distress child + close airway

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22
Q

When are RSV vaccines offered, to who + how long does protection last?

A

RSV offered to pregnant women from 28wks, antibodies protect baby for first 6mths

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23
Q

What is the role of Palivizumab in RSV Mx?

A

Monoclonal antibody that targets RSV.
Given to high-risk babies, e.g. ex-prems + those with congenital heart disease.
Passive protection so need repeated doses

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24
Q

What is croup?

A

URTI that causes oedema and inflammation of the larynx and airways.

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25
What age group is typically affected by croup?
6mths-3yrs
26
What causes croup + what is the main cause of croup?
*Parainfluenza virus Influenza Respiratory syncytial virus (RSV) Rhinovirus
27
What is the key presenting feature of croup?
Rapid-onset “seal-like” barking cough.
28
Name 4 other signs/symptoms of croup
Increased work of breathing Hoarse voice Stridor (high-pitched inspiratory noise) Low-grade fever
29
How do you manage croup?
Dexamethasone (0.15mg/kg) for even mild croup, often see sig improvement after single dose but can give more if required
30
How would you manage severe croup/if dexamethasone isn't working?
Can escalate to: Oxygen Nebulised budesonide Nebulised adrenalin Intubation and ventilation
31
What is viral-induced wheeze?
When a viral infection causes airway narrowing, leading to shortness of breath and wheeze (asthma in under 3's)
32
Name 2 common viral illnesses that can cause viral-induced wheeze
RSV Rhinovirus
33
What age of children does viral-induced wheeze affect + why is this more concerning?
Affects under 3s typically-have small diameter airways=minimal narrowing can cause large airflow restriction
34
How does viral-induced wheeze present?
Viral illness coryzal symptoms for 1-2 days then: Shortness of breath Signs of respiratory distress (e.g., raised respiratory rate, accessory muscle use and recessions) Widespread expiratory wheeze on auscultation
35
How do you manage viral-induced wheeze?
Similar to acute asthma exacerbation: Bronchodilators (e.g., inhaled salbutamol-via spacer, higher doses then stepped down) Steroids (e.g., oral prednisolone for 3 days) Supplementary oxygen
36
What is epiglottitis?
Inflammation and swelling of the epiglottis, usually due to infection, it is a life-threatening emergency
37
Name the 2 kay causes of epiglottitis
Haemophilus influenzae type B (the leading cause but now rare due to vaccination) Streptococcus pneumoniae
38
What population does epiglottitis commonly affect?
Can affect any age (incl adults) but most common in 2-7yrs
39
How does epiglottitis present?
Similar to croup but more rapid +: Sore throat Difficulty swallowing (dysphagia) Painful swallowing (odynophagia) High fever Stridor Drooling Muffled “hot potato” voice
40
What is a classic exam patient with epiglottitis like?
Unvaccinated child with a high fever, sore throat, dysphagia, and drooling.
41
How do you investigate epiglottitis?
Emergency-don't investigate as may scare child + worsen airway obstruction
42
If you did an x-ray of the neck with epiglottitis what would you see?
“thumb sign” or “thumbprint sign”. This is a soft tissue shadow that looks like a thumb pressed into the trachea, caused by the oedematous and swollen epiglottis.
43
How do you manage epiglottits?
Secure airway-potential intubation/tracheostomy O2 IV Abx e.g. ceftriaxone
44
How is HAP defined?
Hospital-acquired pneumonia-developed after spending more than 48hrs in hospital
45
What are the 2 types of pneumonia?
Community-acquired pneumonia (CAP) Hospital-acquired pneumonia (HAP)
46
What is pneumonia?
Infection of the lung tissue, causing inflammation in the alveoli-a LRTI
47
What is acute bronchitis?
Infection and inflammation in the bronchial tubes-a LRTI
48
What is bronchiolitis?
Infection and inflammation in the bronchioles, occurs in children under 2 years, usually under 6 months
49
What are the symptoms of URTI?
Blocked nose, sore throat, dry cough-usually viral
50
What is a general rule for differentiating between viral and bacterial respiratory conditions?
As a general rule, the lower down the respiratory tract, the higher the probability of bacterial infection (as opposed to viral).
51
Name the 2 top causes of bacterial pneumonia
Streptococcus pneumoniae (most common) Haemophilus influenzae
52
Name the 3 main viral causes of pneumonia
*Respiratory syncytial virus (RSV) Parainfluenza virus Influenza virus
53
What are the main pneumonia-causing organisms in neonates + why?
Originate from birth canal: Group B streptococcus (GBS) Escherichia coli (E. coli) Listeria Klebsiella
54
Name the 2 most common pathogens that cause pneumonia in children with CF
Staphylococcus aureus Pseudomonas aeruginosa
55
Name some symptoms of pneumonia in young infants
Poor feeding, Drowsiness, Restlessness Abdominal pain.
56
Name 4 presenting symptoms of pneumonia in children
Productive cough High fever Shortness of breath Lethargy/confusion
57
Name 5 signs + obs of a child with pneumonia
Fever >38.5C Tachypnoea + tachycardia Signs of resp distress e.g. recessions, nasal flaring Low O2 sats Cyanosis
58
What chest findings would you have with pneumonia?
Harsh + loud bronchial breath sounds Focal coarse crackles Dullness to percussion over affected area
59
How would you investigate uncomplicated pneumonia?
Not routinely performed-Dx made clinically
60
How would you investigate complicated pneumonia/diagnostic doubt?
CXR-consolidation WCC + CRP raised Sputum culture + viral PCR Blood culture if suspected sepsis
61
How do you manage paediatric pneumonia?
Check local guidelines, normally: Amoxicillin (usually first-line) Co-amoxiclav (particularly with concurrent influenza or in cystic fibrosis, to cover Staph aureus) Clarithromycin (penicillin allergy)
62
What is cystic fibrosis?
Autosomal recessive genetic condition affecting the mucus glands
63
What are the 3 main affects of CF?
Thick bile duct and pancreatic secretions Thick airway secretions Congenital bilateral absence of the vas deferens (males)
64
What effect do the thick and sticky secretions that block the pancreatic and bile ducts have in patients with CF?
Preventing digestive enzymes (e.g., pancreatic lipase) from entering the digestive tract. Chronic obstruction can lead to liver disease, pancreatitis and diabetes.
65
What effect do the thick and sticky airway secretions have in patients with CF?
Reduce airway clearance, resulting in a chronic cough, bacterial colonisation and recurrent infections.
66
What gene mutation causes CF + where is the gene?
Mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7.
67
What is the inheritance pattern for CF?
Autosomal recessive
68
What is the incidence of children with CF + carriers for CF?
1 in 2500 children have CF 1 in 25 are carriers
69
What is often the first sign of CF?
Meconium ileus-meconium is thick and sticky, causing it to get stuck and obstruct the bowel. Presents as no stool passed within 24hrs, abdo distension + vomiting
70
How can CF present later in childhood?
Recurrent lower respiratory tract infections Failure to thrive Pancreatitis
71
Name 5 ongoing symptoms children with CF might have
Chronic cough + sputum production Recurrent RTIs Loose, greasy stools Abdo pain + bloating Poor weight + height gain
72
Name 4 signs you might notice on exam for a child with CF
Nasal polyps Finger clubbing Crackles + wheezes Abdo distension
73
What are the 3 causes of clubbing in children?
Cyanotic heart disease IBD CF
74
How is CF screened for?
At birth with newborn bloodspot test
75
How is CF diagnosed + how does the test work?
Sweat test-pilocarpine + electrodes added + current passed, causing skin to sweat. Sweat is absorbed by gauze/paper + chloride concentration is tested
76
What happens to chloride lvls in sweat in CF + what lvl would indicate CF?
Impaired reabsorption due to gene malfunction = higher chloride conc (over 60mmol/L = CF)
77
What % of CF patients are colonised with Pseudomonas + can we treat it?
25% have pseudomonas, difficult to treat, have to avoid contact with other children with CF
78
What is the main therapy Tx for CF?
CFTR modulator therapies (e.g., Kaftrio, Symkevi and Orkambi) are combination drugs that include ivacaftor.
79
Name 3 key lifestyle adaptations for patients with CF
Chest physiotherapy to clear mucus Exercise to improve resp function High-calorie diet to compensate for coughing, infections + malabsorption
80
Name 3 regular meds/Tx's that CF patients should take
CREON tablets(Pancreatic enzyme replacement) Prophylactic flucloxacillin Vaccinations for flu + covid
81
What is asthma?
Chronic inflammatory airway disease leading to variable airway obstruction.
82
Name 2 characteristics of asthma symptoms
Episodic-worsen + improve Diurnal variability
83
Name 4 key asthma symptoms
Shortness of breath Chest tightness Dry cough Wheeze
84
Name 5 asthma triggers
Viral infections Exercise Animals Cold, damp or dusty air Strong emotions
85
What drugs can exacerbate asthma?
BB e.g. propranolol NSAIDs e.g. naproxen
86
Name 5 investigations for asthma diagnoses
FeNO testing Spirometry Reversibility testing Peak flow variability Direct bronchial challenge testing
87
What is FeNO testing?
Fractional exhaled nitric oxide - measures the concentration of nitric oxide exhaled by the patient. It is a marker of airway inflammation.
88
What is spirometry + how is it used in asthma diagnosis?
It involves different breathing exercises into a machine that measures volumes of air and flow rates.
88
What FEV1:FVC ratio suggests asthma?
A FEV1:FVC ratio of less than 70% suggests obstructive pathology (e.g., asthma or COPD).
89
What is reversibility testing?
Involves giving a bronchodilator (e.g., salbutamol) before repeating the spirometry to see if this impacts the results
90
What reversibility testing results would suggest asthma?
> 12% increase in FEV1 on reversibility testing supports a diagnosis of asthma.
91
What does peak flow variability involve?
Keeping a peak flow diary with readings at least twice daily over 2 to 4 weeks.
92
What peak flow variability results would suggest asthma?
Variability >20%
93
What is direct bronchial challenge testing?
Opposite of reversibility testing. Inhaled histamine or methacholine is used to stimulate bronchoconstriction, reducing the FEV1 in patients with asthma.
94
What is the first line testing for asthma in adults + children over 16?
FeNO or eosinophil count
95
What is the first line testing for asthma in children 5-16?
FeNO then reversibility w/ spirometry
96
How does adrenaline affect the resp system?
Acts on smooth muscle-causes relaxation + dilation of bronchioles
97
What kind of drug are bronchodilators?
Beta-2 adrenergic receptor agonists
98
Name an ICS
Beclometasone
99
How do ICS work?
Reduce the inflammation and reactivity of the airways
100
What is a key side effect of an ICS?
Oral candidiasis
101
What is a LAMA? Name one
Long-acting muscarinic antagonists work by blocking acetylcholine receptors + reversing bronchoconstriction e.g. tiotropium
102
How do LKTRAs work?
By blocking the effects of leukotrienes which are produced by the immune system and cause inflammation, bronchoconstriction and mucus secretion in the airways
103
What is a side effect of LKTRAs?
Neuropsychiatric reactions, particularly nightmares.
104
What is AIR asthma therapy?
Anti-inflammatory reliever (AIR) therapy = dry powder inhaler containing ICS + fast-acting LABA, used when required by patients who don't have regular inhalers/asthma Tx
105
What is MART asthma therapy?
Maintenance and reliever therapy = dry powder inhaler with ICS + LABA used regularly as preventer + reliver when symptomatic
106

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