Paeds Resp Flashcards
(180 cards)
1
Q
Common benign cause of inspiratory stridor (noisy breathing) in otherwise well infants?
A
laryngomalacia
2
Q
Who are the only girls who can develop X-linked conditions?
A
Those with Turner’s syndrome!
no Y chromosome!
45,X
3
Q
What is the posh name for croup?
A
viral laryngotracheobronchitis
4
Q
What is the commonest cause of stridor?
A
croup
5
Q
Which virus causes croup?
A
parainfluenza
6
Q
Which age group does croup affect?
A
6 months - 6 years
esp 2 yr olds
7
Q
What time of year do kids get croup?
A
autumn
8
Q
2 yr old with barking cough, stridor, hoarse cry, fever, preceding coryza. Suspect?
A
Croup
9
Q
“barking cough”. What FLASHES across your mind?
A
croup
ruff ruff ruff
10
Q
What kind of noisy breathing does croup cause?
A
stridor
11
Q
Is stridor when you breathe out or when you breathe in?
A
stridor is INSPIRATORY
12
Q
A child has croup. What will their cry be like?
A
hoarse
13
Q
What is the treatment for croup?
A
ORAL DEXAMETHASONE 0.15MG/KG
if severe - high flow O2 + nebulised adrenaline
14
Q
When do you give oral dexamethosone 0.15mg/kg?
A
CROUP
15
Q
What is the emergency treatment for SEVERE croup?
A
high flow O2, nebulised adrenaline
16
Q
What colour is the epiglottis in epiglottitis?
A
cherry red.
17
Q
What infective agent causes epiglottitis?
A
HiB
Haemophilus influenza B
18
Q
What don’t you do when a child has epiglottitis?
A
examine the throat
could cause complete obstruction
19
Q
The fever in croup tends to be <38.5. True or false.
A
True
croup = low-grade fever
20
Q
The fever in epiglottitis tends to be >38.5. True or false.
A
True
epiglottitis = high-grade fever
21
Q
A 5 yr old presents with soft stridor, fever of 39.5, minimal cough, sitting immobile with her mouth open drooling saliva. What do you do??
A
epiglottitis. Don’t examine the throat.
Call ENT and anaesthetists … INTUBATE under GA
22
Q
After you’ve intubated a child with epiglottitis to save their airway, what do you do next to treat it?
A
blood cultures … IV Abx
rifampicin to contacts
23
Q
My child has had epiglottitis. What should I be taking?
A
rifampicin
24
Q
What is a disease similar to acute epiglottitis, caused by Staph aureus?
A
Bacterial tracheitis (needs tracheal intubation under GA + IV Abx)
25
What infective agent causes bacterial tracheitis? (high fever and ill)
Staph aureus
26
Stridor is obstruction of which airways?
trachea / larynx
| extrathoracic airways
27
Wheeze is partial obstruction of which airways?
intrathoracic airways
28
Is wheeze breathing out or breathing in?
EXPIRATORY
| in exp, the intrathoracic airways are collapsed, so turbulent flow - wheeze
29
How many airways obstructed in monophonic wheeze?
one (e.g. foreign bod, carcinoma)
| mainly polyphonic
30
Kate. Give me 6 causes of ACUTE WHEEZE in kids.
```
bronchiolitis
viral episodic wheeze
asthma
anaphylaxis
foreign bod
atypical pneumonia
```
31
What season do kids usually get bronchiolitis?
winter
32
Give me 4 symptoms of croup.
barking cough
stridor
hoarse cry
low grade fever
33
Give me 4 symptoms of bronchiolitis.
dry wheezy cough
coryza
breathlessness
feeding difficulties
34
On examination of a child with bronchiolitis, what might you see? What might you hear?
tachycardia + tachpnoea
intercostal recession
hyperinflated chest
fine end inspiratory crackles
expiratory wheeze
35
You suspect a child has bronchiolitis. You listen to the chest. What are you expecting Doc?
fine end inspiratory crackles
| expiratory wheeze
36
What age group does bronchiolitis affect?
<1yr old
37
What infective agent causes bronchiolitis?
RSV
38
Name three groups of kids at increased risk of severe bronchiolitis.
ex prems with bronchopulm dysplasia
cystic fibrosis
congenital heart disease
39
What is the investigation for bronchiolitis?
nasopharyngeal aspirate (NPA)
check sats.
if severe - CXR, ABG .. exclude pneumonia
40
If bronchiolitis is severe, what do you need to exclude?
pneumonia
41
What is the treatment for bronchiolitis?
O2 aim >94%
IV fluids
if bad - CPAP
42
If bronchiolitis is severe, what treatment?
CPAP
43
How do you prevent bronchiolitis in prems?
IM monthly injections of PALIVIZUMAB
44
What is prevalence of CF?
1 in 2,500
45
What is prevalence of CF carriers?
1 in 25
46
CF is autosomal recessive. Which chromosome is affected?
chromosome 7
| delta F508
47
Which is the defective protein in CF?
CFTR
transmembrane conductance regulator
= abnormal Cl- ion transport across epi = THICK SECRETIONS
48
What effects can CF have on the resp system? (x3)
pneumonia (pseudomonas)
allergic bronchopulmonary aspergillosis
bronchiectasis
49
What effects can CF have on the intestines? (x3)
meconium ileus
rectal prolapse
malabsorption
50
What effects can CF have on the pancreas? (x2)
DIABETES MELLITUS
| steathorroea (malabsorption)
51
What effects can CF have on the reproductive system (esp men)?
INFERTILITY
52
What test is diagnostic for CF?
sweat test
| shows high chloride in sweat
53
Describe some aspects of the management of CF?
chest physio; postural drainage
pancreatic enzymes with meals - high fat, high kCal
may need heart + lung transplant
54
What age should viral episodic wheeze have improved by?
5yrs
55
What usually triggers viral episodic wheeze?
URTI
| small airways more likely to narrow when inflamed
56
Name a key risk factor for viral episodic wheeze.
Maternal smoking.
57
What is a multiple trigger wheeze?
wheeze in pre-school age triggered by not just viral but lots of different precipitants
including cold air, exercise, dust, animal dander
58
Kate. Give me 6 causes of RECURRENT WHEEZE in kids.
```
viral episodic wheeze
multiple trigger wheeze
asthma
cystic fibrosis
bronchopulm dysplasia
GORD
```
59
What proportion of UK children have asthma?
1 in 11
60
Give me three features of asthma pathophysiology.
bronchial infl. - mucus + swelling
bronchial hyper-responsiveness
reversible airway obstruction
61
THE BIG ASTHMA FOUR symptoms
wheeze
cough
breathlessness
chest tightness
62
When are asthma symptoms worse?
in morn / at night
63
Give me some pointers that point the finger towards asthma.
```
in morn / at night
non viral triggers
symptoms between attacks
FHx atopy
response to asthma therapy!
```
64
What are the investigations for asthma?
Peak flow diary (PEFR)
| spirometry
65
What would peak expiratory flow rate diary show to suggest asthma?
diurnal variation
66
What would expect from asthma spirometry?
low FEV 1
low FEV1/FVC
= OBSTRUCTIVE picture
WITH BRONCHODILATOR REVERSIBILITY!!!
67
Give me some examples of asthma triggers.
```
URTI
allergens
smoking
cold air
exercise
emotion
chemical irritants
```
68
Give me 2 examples of SABAs (short acting beta2 agonists)
salbutamol
| terbutaline
69
Give me an example of an anti-cholinergic bronchodilator
ipratropium bromide
70
Give me 3 examples of inhaled corticosteroids.
beclometasone
budenoside
fluticasone
71
Give me 3 examples of LABAs (long acting beta2 agonists)
salmeterol
| formeterol
72
What kind of drug is Montelukast (oral)?
leukotriene receptor antagonist
73
A child presents to A+E having an asthma attack. She can talk, her O2 sats are >92%. Some intercostal recession. Is this moderate, severe of life-threatening?
moderate
74
A child presents to A+E having an asthma attack. She is too short of breath to talk..her sats are <92%. HR >140/min. RR >40/min. She is using accesssory neck muscles to breathe. Is this moderate, severe, or life-threatening?
severe
75
A child presents to A+E having an asthma attack. She has a silent chest, cyanosis and altered consciousness. This is life-threatening. What might you find about her:
- heart
- breathing
- BP
arrythmias
poor resp effort
hypotension
76
What is the treatment of chronic asthma for <5yr old child?
SABA
+ ICS
+ leukotriene
+ refer to resp paediatrician
77
What is the treatment of chronic asthma for >5yr old child?
```
SABA
+ ICS
+ leukotriene
+ increase ICS dose / add theophylline
+ oral pred
+ refer to resp paediatrician
```
78
What is the treatment of a MODERATE asthma attack?
1,
2,
salbutamol via spacer (max 10 puffs)
| oral pred
79
```
What is the treatment of a SEVERE asthma attack?
1,
2,
3,
4,
```
+/- .... / ...... /......
1. high flow O2
2. salbutamol via spacer/ neb
3. oral pred / IV hydrocortisone
4. inhaled ipratropium bromide
+/- IV salbutamol / aminophylline / Mg
80
In severe asthma, what would you expect from the HR and RR?
HR >140
| RR >40
81
In a moderate asthma attack, what is their peak flow like?
>50% of their best
82
In a severe asthma attack, what is their peak flow like?
<50% of their best
83
In a life-threatening asthma attack, what is their peak flow like?
<33% of their best
84
```
What is the treatment for a LIFE-THREATENING asthma attack?
1,
2,
3,
4,
```
+/- ..... / ..... / .....
1. high flow O2
2. salbutamol nebs
3. oral pred / IV hydrocortisone
4. nebulised ipratropium bromide
+/- IV salbutamol / aminophylline / Mg
85
If the treatment for life-threatening asthma attack is not working.........
PICU
senior review
CXR, ABG
.... mech vent :/
86
The child has responded to treatment for her asthma attack and is doing much better :) What now?
continue bronchodilators PRN
discharge when stable on 4hrs treatment
continue oral pred for 3-7ds
87
You've discharged a child after her asthma attack, with PRN bronchodilators and a supply of oral pred for 3-7ds. What else does she need?
follow up arranged for...
personalised asthma action plan
review meds and inhaler technique
88
What dose of oral pred should you discharge a child on after an asthma attack?
1-2mg/kg OD
89
In severe asthma attack, you've given high flow O2, salbutamol neb, IV hydrocortisone. What else?
inhaled ipratropium bromide
+/- IV salbutamol / aminophylline / Mg
90
What are the 3 Ts of asthma counselling
adherence to Treatment
inhaler Technique
avoid Triggers
91
what IV Abx for acute epiglottitis?
iv cefuroxime
92
Give me 4 types of upper respiratory tract infection (URTI)
- common cold
- pharyngitis, inc tonsillitis
- sinusitis
- acute otitis media
93
Sore throat, coryza and asthma exacerbation can by symptoms of URTI. What else?
```
febrile seizures
feeding difficulties (blocked nose, can't breathe)
```
94
Common virus culprit of the common cold (coryza)?
rhinovirus
| self limiting, paracetamol + ibuprofen
95
infectious mononucleosis a.k.a.
glandular fever
96
Give me two common bugs causing pharyngitis (sore throat)
Group A strep throat
| adenovirus
97
Give me two common bugs causing tonsillitis (sore throat, type of pharyngitis)
Group A strep throat
| EBV (glandular fever)
98
What criteria are used to estimate the probability that pharyngitis / tonsillitis is bacterial (strep).
Centor criteria
99
Centor criteria are used to estimate probability that pharyngitis/tonsillitis is bacterial (strep) rather than viral. What are the 5 criteria which score points?
1. age (3-14)
2. exudate
3. cervical lymphadenopathy
4. fever >38
5. absent cough
100
What is treatment for tonsillitis?
Pen V 10 days
| or erythromycin
(if unable to swallow may need IV fluids + analgesia)
101
inflammation of paranasal sinuses may occur with URTI. occasionally there is secondary bac infection (pain + sweeling of cheek, maxillary sinus). if so, what Rx
Abx + analgesia
102
when is acute otitis media most common and why?
6-12 months
| short Eustachian tubes
103
Where in particular would you examine if you suspected acute otitis media, and what would you expect to see?
tympanic membrane
| red, bulging, loss of light reflection
104
Give me three potential complications of acute otitis media
mastoiditits
meningitis
glue ear if recurrent
105
Give me 5? bacterial causes of acute otitis media.
rhinovirus, RSV
| penumococcus, Hib, moraxella
106
What is the treatment for acute otitis media
ANALGESIA
| NOT ANTIBIOTICS
only if >3days
107
When would you give antibiotics for an ear infection?
if lasts longer than 3 days
amoxicillin
(Abx marginally shorten pain but dont decrease the risk of hearing loss)
108
otitis media with effusion =
glue ear
109
What kind of hearing loss does glue ear cause?
conductive hearing loss
110
What is the treatment for glue earm if persistent?
grommets
| ventilation tubes. only last 12 months
111
If your child has got bad glue ear, and grommets have not worked, what might be considered?
adenoidectomy
112
Give me two indications for adenoidectomy.
1. bad glue ear
| 2. obstructive sleep apnoea
113
Give me two indications for tonsillectomy.
1. recurrent severe tonsillitis
| 2. peritonsillar abscess (quinsy)
114
Quinsy a.k.a
peritonsillar abscess
115
Do children usually get hypoxic / tachypnoeic with URTI?
no - infeciton of conducting airways, as opposed to respiratory, so doesnt usually affect gas exchange.
116
URTI is an infection of which airways.
conducting airways
| so doesnt usually affect gas exchange
117
What three infections in kids does pneumococcus tend to cause?
otitis
bronchitis / pneum
meningitis
118
What four infections in kids does Hib tend to cause?
otitis
epiglottitis
pneumonia
meningitis
119
what counts as a persistent cough?
not improved after 4 wks
120
what does a 'habit cough' sound like?
dry barking
121
give me some causes of PERSISTENT cough in a child
```
smoking
asthma
recurrent URTIs
TB
bac bronchitis
persistent lobar collapse after pneum
aspiration + GORD
habit cough
whooping cough!
```
122
What bug causes whooping cough?
bordetella pertussis
123
how contagious is whooping cough?
highly, mainly in catarrhal phase
NOTIFIABLE
124
tell me the three phases of whooping cough.
catarrhal
paroxysmal
convalescent
125
What happens in the catarrhal phase of whooping cough?
week of coryza
126
What happens in the paroxysmal phase of whooping cough?
spasmodic cough + inspiratory whoop
| red / blue in face, mucussy
127
In paroxysmal phase of whooping cough, get spasmodic cough + inspiratory whoop. Go red / blue in face and mucus flows from nose / mouth. How long does this phase tend to last?
~3 months
| sometimes called 100 day cough
128
Paroxysmal phase of whooping cough can be really bad. As well as spasmodic cough, if it's severe what else might happpen?
epistaxis!
subconjunctival haemorrhage!
break ribs, hernia!
vom
129
does pertussis vacccination guarantee protection?
no but decreases risk and severity
130
In paroxysmal phase of whooping cough can have epistaxis, subconjunctival haemorrhage, break ribs, hernia and vom. Give me three longer term complications of whooping cough.
pneumonia
seizures
bronchiectasis
131
A child presents with spasmodic cough and inspiratory whoop. What investigations?
per nasal swab (for culture / PCR if severe)
| FBC
132
What would FBC show in whooping cough?
lymphocytosis
133
You have done per nasal swab and culture which confirmed whooping cough. What is the treatment?
Macrolide Abx within 3 wks of onset
CLARITHROMYCIN
(erythromycin if preg)
(fluids, para + ibuprofen)
close contacts - clarithromycin prophylaxis
134
What age group does whooping cough particularly affect?
infants <3 months
135
Is whooping cough a notifiable disease?
yes
136
The child chokes, gasps and flails the extremities, with eyes bulging and watering and face reddened. There is frequently post-cough vomiting. What is the likely diagnosis?
whooping cough
137
When do you admit a child with whooping cough
<6months acutely unwell
| or any age if resp difficulties
138
When should clarithromycin be started in whooping cough?
within 3 wks
139
Does clarithromycin do anything to alter the clinical course of whooping cough?
NO it just decreases the length of INFECTIVITY
140
Why has the whooping cough vaccination been extended to pregnant women ?
to give neonates protection for the time before they get vaccine
141
What is the incubation period for whooping cough?
7-21 days
142
A 2 yr old is being treated for whooping cough with clarithromycin. What should you give his dad who is his main carer?
clarithromycin
143
Persistent WET cough. Give me two key differentials.
bac bronchitis
| bronchiectasis
144
Infection --- inflammation --- airway damage --- bad mucociliary escalator --- infection etc. What's this?
bronchiectasis
145
What happens in bronchiectasis (persistent wet cough)?
infection --- inflammation --- airway damage --- bad mucociliary esclator -- infection etc.
146
Do you get tachypnoea / hypoxia in bac bronchitis (persistent wet cough)?
no its conducting airways not resp airways so gas exchange not usually affected
147
Give me two bac that cause bac bronchitis (persistent wet cough).
moraxella catrrhalis
| Hib
148
What investigations for bac bronchitis (tends to be Hib and moraxella).
sputum culture
| bronchial lavage
149
Child has persistent wet cough. You've confirmed bac bronchitis with sputum culture which shows moraxella. How do you treat?
co-amoxiclav
| CHEST PHYSIO
150
co-amoxiclav to treat..
bac bronchitis
151
clarithrommycin to treat..
whooping cough
152
Pen V to treat..
tonsillitis
153
amoxicillin to treat..
otitis media if >3ds
154
CF is a cause of generalised bronchiectasis. Give me one another thing.
primary ciliary dyskinesia.
155
Post- severe pneumonia is a cause of focal bronchiectasis. Give me one other thing.
inhaled foreign body.
as per
156
inflammation of lung parenchyma
(exlcuding bronchi)
What's this ?
pneumonia
157
Define pneumonia.
inflammation of lung parenchyma
| excluding bronchi
158
What bugs tend to cause pneumonia in neonates?
Group B strep
| Hib
159
What bugs tend to cause pneumonia in <5yrs?
RSV + VIRUSES mainly
160
What kind of pneumonia should you make sure to consider in all ages?
TB!
161
What bugs tend to cause pneumonia in >5yrs?
strep pneum
mycoplasma pneum
chlamydia pneum
the pneumoniae bacteria!
162
Strep pneum, mycoplasma pneum, chlamydia pneum
| tend to cause pneumonia in what age group?
>5yrs
163
What 2 bugs causes pneumonia in imm supp?
pneumocystis jiroveccii
| toxoplasma gondii
164
What bug causes pneumonia in CF?
pseudomonas
165
What bug causes aspiration pneumonia?
E.coli
166
What pneumonia can chickenpox cause?
varicella pneumonitis
167
Give me 6 symptoms of pneumonia from the history.
fever cough
lethargy poor feeding
chest/abdo/neck pain
preceding URTI
168
On examination, give me 6 signs you might get in pneumonia.
```
TACHYPNOEA
Tachycardia
low sats
nasal flaring
chest indrawing
coarse end-inspiratory crackles
```
169
What might you hear on the chest of a child with pneumonia?
coarse end-inspiratory crackles
170
coarse end-inspiratory crackles. What FLASHES across your mind?
pneumonia
171
7 yr old child presents with fever, cough, chest pain and lethargy. On examination, she has tachypnoea, tachycardia, and nasal flaring. What bugs might be the likely culprit?
strep pneum
chlamydia pneum
mycoplasma pneum
172
3 yr old child presents with fever, cough, and poor feeding. On examination she has chest in-drawing, low stats and coarse end-inspiratory crackles. What bugs might be the likely culprit?
RSV + VIRUSES! (<5yrs)
173
What might you expect to see on CXR for lobar pneumonia?
CONSOLIDATION
174
What are the four stages of lobar pneumonia?
congestion --- red hepatization --- grey hepatization -- resolution
175
Investigations for suspected pneumonia?
?nasopharyngeal aspirate (can distinguish bac/viral)
| ?CXR (not routine)
176
What is the treatment of pneumonia for a neonate?
broad spec IV Abx (BenPen)
supportive - O2 + analgesia + IV fluids
177
The majority of bacterial pneumonia are..
strep pneumoniae
178
What is the treatment of pneumonia for a <5yr old?
oral amoxicllin
supportive - O2 + analgesia + IV fluids
179
What is the treatment of pneumonia for a > 5 yr old?
oral amoxicillin OR erythromycin
supportive - O2 + analgesia + IV fluids
180
i want four complications of pneumonia.
parapneumonic effusion
empyema
bronchiectasis
persistent lobar collapse
