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Paediatrics > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

What sx do you ask about in query URTI?

A

Sneezing
Itching (allergic salute)
Blocked nose
Runny nose

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2
Q

Complications of allergic rhinitis?

A

Recurrent sinusitis (in older child)
Recurrent middle ear effusions needing grommets
Recurrent sore throats and snoring
Dental malocclusion (caused by mouth breathing)

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3
Q

Sx to enquire about query LRTI

A

Coughing - dry/productive, clear/purulent
Fever (infection)
Attacks (exacerbated at certain times)
Noisy breathing (wheeze, strider, crackles, snoring)

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4
Q

What are features of allergic facaes?

A

Long pale face
Dark rings under eyes
Open mouth (mouth breathing)
Nasal crease

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5
Q

What does tracheal tug indicate?

A

Pathology in upper airway

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6
Q

What does intercostal recessions indicate?

A

Pneumonia

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7
Q

What does subcostal/Hoovers sign indicate?

A

Airway disease eg Asthma/bronchiolitis

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8
Q

What do you palpate for in resp exam?

A

Tracheal tug
Palpable P2
Left Parasternal heave
Apex beat

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9
Q

What do you percuss for on resp exam?

A

Front superior = upper lopes
Axilla = right middle lobe, lingual on left
Posterior = lower lobe
Heart and upper border of liver

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10
Q

What do you auscultation for on resp exam?

A

Snoring
Trachea - strider
Wheezing
Crackles
Loves of the lung breathe sounds (vesicular/bronchial)

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11
Q

What do you auscultation for on resp exam?

A

Snoring
Trachea - strider
Wheezing
Crackles
Loves of the lung breathe sounds (vesicular/bronchial)

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12
Q

Red flat SIGNS of chronic lung disease

A

Stunted/wasted growth
Hypoxia
Clubbing
Allergic face
Chest wall deformity
Persistent abnormalities on auscultation

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13
Q

Red flag SYMPTOMS of chronic lung disease

A

Chronic cough > 3weeks
Productive cough
Cough on feeding/choking
Recurrent/persistent noisy breathing
Recurrent/non-resolving LRTI
Dyspnoea
Exercise intolerance

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14
Q

Name chronic lung diseases

A

Bronchiectasis
Asthma
Cystic fibrosis
Primary immunodeficiency
Primary cilia dyskinesia
HIV associated chronic lung disease
Lymphoma/mediastinal mass
Congenital disorders (diaphragmatic hernia, lung malformations, GORD)

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15
Q

Physical findings of chronic lung disease

A

Clubbed
Growth chart
Chest deformities- Harrison sulcus, pectum excavatum/carinatum

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16
Q

What is bronchiectasis?

A

Permanent destruction of the bronchial walls and lung tissue due to chronic infection.

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17
Q

What systems are affected by cystic fibrosis?

A

All tubular systems

Reproductive system - semen secretion = infertility
ENT - sinus obstruction
GI - obstructive jaundice, pancreatic duct blockage (fat malabsorption), bowel obstruction
Lungs
Sweat glands

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18
Q

How do you diagnose CF?

A

Sweat test (high chloride in sweat) - 2 sweat chlorides >60mmol/l
Stool fecal elastase
Genetics

Diagnosis not always clear

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19
Q

How do you treat CF?

A

Lung - nebulise to liquify secretions, physio, aggressive infection treatment
Pancreatic enzyme replacement
Lung transplant

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20
Q

Prognosis of CF

A

Up to 40-50years

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21
Q

What are HIV related chronic lung diseases?

A

Bronchiectasis
Lymphocytic interstitial pneumonitis
Pulmonary TB
Lymphoma
Kaposi sarcoma

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22
Q

How will a patient with lymphocytic interstitial pneumonitis present?

A

Chronic cough
SOB
Recurrent pneumonia
Failure to thrive
Generalised lymphadenopathy
Hepatosplenomegaly

Digital clubbing
Chest deformity
Parotid enlargement

Recurrent infection leads to Bronchiectasis

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23
Q

Treatment of LIP

A

ARV’s
+- steroids

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24
Q

How does bronchiolitis obliterans present?

A

Hyperinflation
Diffuse wheeze and crackles
Other signs of chronic lung disease

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25
Q

How does primary ciliary dyskinesia present?

A

Usually from birth
Blocked nose in neonatal period
Term with resp distress
Middle ear infections, sinusitis, sinus invertus

Bronchiectasis

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26
Q

How do you classify Bronchiectasis?

A

CF related

Non-CF related
- focal
>FB
>endobronchial masses

  • generalised
    >HIV related
    >TB
    >primary immunodeficiency
    >primary ciliary dyskinesia
    >aspiration (cleft palate)
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27
Q

What is the pathophysiology of Bronchiectasis?

A

Trigger (infection) → inflammation of airway → ineffective pulmonary defense → sputum hypersecretion → impaired ciliary clearance → lung damage (dilation and distortion)→ infection…

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28
Q

What are the signs of Bronchiectasis?

A

Clubbing
Chest deformities
Air trapping
Failure to thrive
Stunting
Cor-pulmonary
Pulmonary hypertension

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29
Q

What are symptoms of Bronchiectasis?

A

Halitosis
Cough (productive and chronic)
Haemoptysis

30
Q

How do you manage Bronchiectasis?

A

Physio daily
Antibiotics for acute exacerbations (2/52 amoxicillin-clav)
Immunisations
Immuno-modulation of airway inflammation with azithromycin (only in some patients)
Lobectomy
Treat underlying cause

31
Q

What is cystic fibrosis?

A

A disease caused by a defect in the Cl- channel (mutation in CFTR gene on chromosome 7) leading to movement of Cl- intracellularly followed by Na and water leading to viscous, concentrated luminal contents. Leads to mucus plugging and recurrent infections.

32
Q

What is lymphocytic interstitial pneumonitis?

A

Chronic infiltration of lymphocytes due to a dysregulated immune response with HIV/EBV interaction

33
Q

Define anaphylaxis

A

Anaphylaxis is a medical emergency which requires prompt recognition and treatment. It occurs due to a massive release of inflammatory mediators from mast cells and basophils commonly triggered by some foods, drugs, insect venom and latex.

Or

A severe life threatening generalised or systemic hypersensitivity reaction

34
Q

Commonest foods that cause anaphylaxis

A

Hens eggs
Peanuts
Milk
Tree nuts
Fish
Shellfish
Seeds

35
Q

Signs and symptoms of anaphylaxis?

A

Swelling of tongue, lips +- throat
Runny nose
CVS - fast/slow HR, low BP
Skin - hives, itching, flushing
CNS - LOC, dizziness, confusion, headache, anxiety
GI - abdominal pain, diarrhoea, vomiting
Genitourinary - loss of bladder control
Resp - SOB, wheeze/stridor, hoarseness, cough, pain on swallowing

36
Q

Diagnostic criteria of anaphylaxis

A

One of 3

① acute onset illness with involvement of skin/mucosa AND airway compromise /hypotension

② two + after allergen exposure:
> skin/mucosa
> resp compromise
> hypotension /associated signs
> GI sx

③ hypotension after exposure to a known allergen
= low bp for age or >30% in systolic bp

37
Q

How do you treat anaphylaxis and what is the MOAof the treatment?

A

Adrenalin

Alpha 1 = smooth muscle contraction → peripheral vasoconstriction, improves coronary artery perfusion
Alpha 2 = smooth muscle contraction, inhibits release inflam mediators
Beta = increases myocardial contraction, smooth muscle relaxation, bronchodilator

38
Q

What are the steps of management of ACUTE anaphylaxis?

A

Eliminate exposure
Give 0,01ml/kg Adrenalin IM stat (repeat every 5min as needed)
Call for help
Place in recumbent position with lower limbs elevated
Give supplemental O2
Administer IV fluids for resus

39
Q

What other management modalities can you consider after management of ACUTE anaphylaxis?

A

Hydrocortisone every 4-8hrs for 24hrs
Asthmatic = bronchodilators (acute max still adrenaline)
Antihistamine - flushing, purities, urticaria
Glucagon - positive ionotropic affect on heart

40
Q

What is the dose of an epipen?

A

Fixed doses
Junior = 0,15mg
Adult = 0,3mg

Single dose

41
Q

What are the absolute indications for epipen prescription?

A

Previous severe anaphylaxis to food/latex/aeroallergens
Coexistence unstable/severe asthma with food allergy
Exercise induced anaphylaxis
Idiopathic anaphylaxis
Untreated venom allergy with systemic reactions
Underlying mast cell disorder with previous systemic reactions

42
Q

Disadvantages of epipen

A

Fixed doses
Expensive
Single dose
Limited shelf life
Limited availability

43
Q

Define food hypersensitivity

A

Any reproducible, abnormal, non-physiologically mediated reaction to food. (Immune = food allergy/non-immune related = food intolerance)

44
Q

Food allergy definition

A

Adverse health reaction arising from a specific immune response that occurs reproducibly on exposure to given food

45
Q

Define food intolerance

A

Non-immune mediated reaction to food that include toxic, metabolic, pharmacological and undefined mechanisms

46
Q

Define sensitisation

A

The presence of IgE antibodies, induced in a susceptible individual after exposure to allergens. (Doesn’t necessarily or relate with clinical symptoms)

47
Q

What are risk factors for food allergy development?

A

Atopic eczema (severe and early onset)
Prolonged allergen avoidance
Dietary factors
- vitamin D deficiency
- reduced intake omega 3 poly-unsaturated fatty acids
- reduced consumptions of antioxidants
- obesity
Increased hygiene and reduced exposure to microbes

48
Q

How do you classify food allergy?

A

IgE mediated
Non IgE mediated
Mixed

49
Q

What details of the history do you ask about query food allergy?

A

Which food suspected
How long after ingestion is reaction (IgE normally 20min-2hrs) - non-IgE mediated usually >48hrs
Description of reaction
Route of exposure (aero/ingestion/skin)
Any reaction of other foods
Any associated allergic disease/drugs/history

50
Q

How do IgE mediated allergic reactions present?

A

Immediate onset (minutes -2hrs)
Skin - acute urticaria and angioedema, pruritis, flushing
GI - vomiting, diarrhoea, abdo cramps, itching of lips and mouth
Resp - wheeze, stridor, rhinitis
Multisystemic - anaphylaxis
Behavioural - “feeling of impending doom” in adults, child irritable

51
Q

How do non-IgE mediated allergic reactions present?

A

Delayed response

Food protein-induced enterocolitis syndrome
-vomiting, diarrhoea, hypotonia, pallor severe
-associated rice, soya, oats, fish,

Allergic proctocolitis
-fresh bloody/mucous stool in thriving baby
-cows milk

Coeliac disease
-autoimmune of small intestine
-malabsorption, bloating, anaemia
-gluten protein = gliden

Food protein-induced pulmonary haemosiderosis
-bleeds into GI tract and lungs
-iron def anaemia
-failure to thrive
-Pulmonary haemosiderosis
-cows milk

52
Q

What are examples of mixed IgE and non-IgE mediated reactions?

A

Eosinophilia oesophagitis

Oesinophilic gastroenteritis

Asthma

Atopic dermatitis

53
Q

How do you diagnose IgE mediated food allergies?

A

Oral food challenge = gold standard
** done b6 specialist/ experienced doctor

Skin testing

IgE specific IgE testing by specialist

54
Q

Types of food challenge tests

A

Blind (anxious patients/caregivers)
Open

55
Q

How do you diagnose non-IgE / mixed allergic reactions?

A

No specific tests

Elimination-reintroduction diet
History
Endoscopy
Biopsy

56
Q

How do you manage a food allergy?

A

Milder reaction = prompt dose of quick acting antihistamine

Sx of anaphylaxis = IM injection Adrenalin

ABC

57
Q

What is the non-medical management of allergies?

A

Education - not curable, read food labels, early recognition, how to treat themselves
Emergency plan
Dietary - cornerstone. avoid food

58
Q

What are the 10 commandments of URTI?

A

1) call a cold a cold
2) cough + no tachypnoea = URTI
3) use AB only if really needed
4) high dose
5) short course
6) treat acute otitis media if severe otalgia/red drum
7) acute bacterial sinusitis diagnose only if sx >10days
8) healthy children get frequent URTI’s
9) avoid OTC medications
10) practice hand sneeze hygiene

59
Q

Define acute asthma attack

A

Progressive increase in typical asthma symptoms not relieved by normal bronchodilator therapy

60
Q

What is near fatal asthma?

A

Asthma attack with associated resp arrest/hypercapnia

61
Q

What are indications for admission of an asthmatic?

A

1) Any sign of severe/life threatening asthma
2) moderately severe asthma not responding to B-agonist therapy
3) home circumstances which do not allow for safe/reliable treatment

62
Q

What is the initial/1st line treatment of acute asthma attack?

A

1) high flow oxygen
2) short acting beta agonist (2 puffs up to 2 minutes up to 10puffs - assess/repeat every 20-30 mins) or salbutamol via nebs 2.5-5mg
3) corticosteroids - oral 1mg/kg/day for 3-5days or IV if life threatening

4) Short acting masculinisation agonist
5) magnesium sulphate if poor response to treatment

63
Q

What is croup and what are the symptoms?

A

Inflammation of trachea, larynx and +- bronchi

Barking cough, hoarseness, stridor

64
Q

How do you grade croup?

A

1: inspiratory stridor
2: inspirator stridor + passive expiratory stridor
3: inspirator stridor + passive expiratory stridor + pulses paradoxis
4: cyanosis, impending apnoea, apathy, marked retractions

65
Q

How do you treat croup?

A

Grade 1: steroids
Grade 2: steroids + adrenal nebs
Grade 3: steroids + adrenal nebs - no improvement in 1hr = intubate
Grade 4: steroids + adrenal nebs + intubate

66
Q

What dose of adrenaline do you give in anaphylaxis?

A

10micrograms/kg undiluted IMI (max 500micrograms)

67
Q

Clinical presentation of allergic rhinitis?

A

Runny nose, postnatal drip, itching nose, palate, ears, eyes, headache, fatigue, drowsiness, malaise, earache

68
Q

Physical features of allergic rhinitis

A

Nasal crease, allergic salute, hypertrophied turbinates, thin watery nasal secretions

Dennie Morgan lines, lacrimation, allergic shines, swelling of palpebral conjunctivae.

Tonsillar hypertrophic, high arched palate, overbite

69
Q

What investigations for suspected allergic rhinitis?

A

Skin prick test
Immunicap (specific IgE)
CT/MRI (acute or chronic)

70
Q

Describe the hyperoxia test and what it is used for?

A

It is conducted to determine whether the patient is cyanosis due to respiratory disease or due to poor vascular circulation

1) measure arterial saturation while patient breathes on room air
2) measure arterial saturation after 10mins of 100% oxygen

If arterial partial pressure oxygen increases, then it is lung pathology.
If there is no improvement = circulation pathology (usually right to left shunt, avoiding lungs)

Paediatrics (13 decks)

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