Resp Flashcards
1
Q
Signs of respiratory distress
A
Tachypnoea Increased WOB Cyanosis Recessions Nasal flaring Tracheal tug Grunting See-saw abdomen
2
Q
Commonest cause of child death worldwide
A
Resp
3
Q
What is stridor
A
Narrowing/obstruction of upper airways
4
Q
4 causes of stridor
A
Croup
Epiglottitis
Foreign body
Larngomalacia
5
Q
Commonest causative organism of epiglottitis
A
Hib
6
Q
Epiglottitis age of presentation
A
1-6 years
7
Q
Epiglottitis clinical features
A
Sudden onset Quiter/whispering stridor High fever Sore throat Drooling - unable to swallow secretions (Absence of a preceding coryza - unlike croup)
8
Q
What must you not do in a child with epiglottitis?
A
Examine their throat or lie the child down
Allow them to position themselves
9
Q
Management of epiglottitis
A
Blood cultures Urgent admission (?PICU) IV ceftriaxone Steroids \+/- adrenaline nebs Prolonged intubation if severe
10
Q
Recovery of epiglottitis
A
Usually 2-3 days
11
Q
Clinical features of croup
A
Onset over days Barking stridor (seal) Preceding coryza Hoarseness Fever (Symptoms worse at night)
12
Q
Age of presentation croup
A
6mos - 6 yrs
13
Q
Percentage of croup with viral cause
A
95%
14
Q
What is croup
A
Laryngotracheal bronchitis with mucosal inflammation and increased secretions
15
Q
Management of mild croup
A
Single dose oral dex 0.15mg/kg
16
Q
Three severities of croup and defining features
A
Mild - symptoms disappear at rest
Moderate - symptoms persist at rest
Severe -
17
Q
Management moderate croup
A
ADMISSION
Oral/nebulised dex/budenoside
+/- nebulised adrenaline
18
Q
Management severe croup
A
ADMISSION
IV dex, nebulised adrenaline
100% O2
Intubation
19
Q
Prognosis croup
A
Usually resolves over 48 hours
20
Q
Where is a foreign body more commonly found
A
R main bronchus
21
Q
CXR features of foreign body
A
Hyperlucent on one days, mediastinal shift to the other side
22
Q
Management of foreign body in conscious child
A
Encourage coughing
5 back blows
5 heimlich’s (not on infants/very young children)
Flexible/rigid bronch (w/ conscious sedation/GA)
Surgery/thoracotomy
23
Q
Management of a foreign body in unconscius child
A
Secure airway (ET tube)
Remove FB from upper airway
Cricothyroidotomy
24
Q
Inspiratory stridor in otherwise well child
A
Laryngomalacia
25
What is laryngomalacia
Cartilage rings not yet strong enough to hole patent airway
26
Complications of foreign body
Bronchiectasis if diagnosis delayed
27
Ix for laryngomalacia
Flexible laryngoscopy showing omega shaped epiglottis
Monitor SATs
28
Mx of laryngomalacia (mild/mod/severe)
Mild: observation looking for resp distress/FTT. GORD therapy (thickened fluids, baby gaviscon, Nissen fundoplication. Patient fed upright)
Moderate: observation. Surgery - supraglottoplasty relieving obstruction. BiPAP. GORD therapy.
Severe: surgical therapy - supreaglottoplasty. BiPAP. GORD therapy.
29
Causes of cough in child
```
Asthma
URTI/LRTI (viral/bacterial)
Pertussis
CF
Smoking parents
GORD
Bronchiectasis
TB
```
30
Commonest cause of cough
URTI
31
Age of presentation pertussis
3 years
32
Causative agent pertussis
Bordatella pertussis
33
Pertussis presentation
1 week of coryza
Paroxysmal cough with expiratory "whoop" (+/- cyanosis)
Vomiting
Worse at night and after feeding
Epistaxis and conjunctival haemorrhage (from increased pressure)
34
How long does pertussis persist for?
3-6 weeks
35
Investigations and results for pertussis
Nasal swab
| Blood film shows marked lympocytosis
36
Three phases of pertussis
Catarrhal
Paroxysmal
Convalescent
37
Management of pertussis
NOTIFY HPU
Admission(isolation) if <6 months old, significant breathing difficulties, complications (e.g. seizure,pneumonia)
Azithromycin if still in catarrhal phase (within 21 days of cough starting)
School exclusion until 48 hours after starting abx
38
When can Azithromycin be given in pertussis?
Within 21 days of cough starting (catarrhal phase)
39
When can a child with pertussis return to school?
48h after starting abx
40
Causes of bronchiectasis
```
CF
Kartagener's (ciliary dyskinesia)
Delayed foreign body
Chronic aspiration
Immunodeficiency
```
41
Presentation of bronchiectasis
```
Recurrent URTI/LRTI infections
Purulent cough (green sputum)
```
Chronically dilated bronchi
42
Investigations and results bronchiectasis
CT - permanent dilatation of bronchi
43
Management of bronchiectasis
Improved nutrition
Exercise
Airway clearance therapy (physiotherapists)
Inhaled SABA/hypertonic saline
Tobramycin if common P.aeuroginosa infections
Long term macrolide PO (e.g. azithro)
Surgical lung resection/transplantation
44
Which abx is appropriate in a patient with recurrent P.aeuruginosa infections?
Tobramycin
45
Which patients often get P.aeuruginosa infections?
CF
Bronchiectasis
Kartagener's
46
Pathophysiology of GORD
Inappropriate relaxation of LES
47
Management of GORD
Physical - position during feeding, winding
Feed - smaller, more frequent feeds. Consider thickener.
Baby gaviscon
PPI
48
Complications of GORD
Oesophagitis
| FTT
49
What must be considered (feeding) in patients with resp illness?
Ensuring they have enough feed.
| Also cutting down feed to 2/3 because thorax working hard, more likely to precipitate GORD/vomit
50
Causes of wheeze in child
```
Asthma (acute/chronic)
Viral episodic wheeze
Bronchiolitis
Pneumonia
Allergy
CF
```
51
Age of presentation viral episodic wheeze
<3 years
52
Presentation of viral wheeze
Resp distress
Wheeze
Coryzal symptoms (+preceding)
Reduced feeding
53
Risk factors for viral wheeze
```
Smokers in household
Mother smoking during pregnancy
Pets
Damp/mould
Other ill contacts
```
54
Management viral wheeze
```
Burst therapy (3x salbutamol nebs, ? 1x ipratroprium).
If inhaled -- SPACER
```
Inhaled glucocorticoids
"Stretching" - once they can last 4 hours without symptoms, can be discharged.
(At home can be given 10 puffs every 4 hours (via space))
55
Viral episodic wheeze (parent explanation)
Narrowing of airways due to viral chest infection causes whistling sound
56
Paent information on discharge: viral wheeze
Salbutamol - 10 puffs every 4 hours via spacer.
If requiring more than every 4 hours, or requiring more than 10 puffs, come back.
Any other resp distress, come back - recessions, nasal flaring, tracheal tug, etc.
57
Two types of asthma
Atopic/non-atopic
58
Features of asthma
```
Child > 3 years
Wheeze on more than one occasion
Worse at night/morning
Worse in cold/on exercise
Interval symptoms
(Response to SABA)
DRY COUGH
```
59
Asthma signs
Prolonged expiratory phase
Polyphonic widespread wheeze
Hyperinflated chest
Harrison Sulci - COPD of childhood
60
Investigations in suspected asthma
Examination
CXR - hyperinflated chest, Harrison sulci
PEFR
Skin prick to gauge atopy
61
Features of moderate asthma attack
PEFR >50%
| SPO2 >92
62
Features of severe asthma attack
```
PEFR 33-50%
SPO2 <92
Difficulty talking
Tachycardia/pnoea
Use of accessory muscles
```
63
Features of life threatening asthma attach
```
PEFR <33%
SPO2 <92
Silent chest
Reduced consciosness
"Normal" CO2
Reduced BP
```
64
Acute asthma attack treatment (escalation ladder)
ABCDE
O2 if hypoxic
Burst therapy (3x back to back SABA nebs)
Ipratroprium nebs
Oral pred
IV bronchodilators - aminophylline, theophylline, MgSO4
IM adrenaline
TRANSFER TO ICU
65
Appropriate salbutamol dose in <5 yr child
2.5mg
66
Appropriate salbutamol dose in >5 yr child
5mg
67
What factors does chronic asthma management depend on? And what is it trying to achieve?
```
Frequency of attacks
Severity of attacks
Interference with school
Sleep disturbance
Exercise tolerance
Growth/nutrition
```
68
Chronic asthma management in child <5 years
```
Inhaled SABA (10 puffs 4x/day)
+ low dose ICS/LTRA
+ med dose ICS
+ high dose ICS and specialisr r/f
+ PO steroids
```
69
Chronic asthma management in child >5 years
```
Inhaled SABA (10 puffs 4x/day)
+ low dose ICS/LTRA
+ med dose ICS + LABA
+ high dose ICS and specialisr r/f and omalizumab
+ PO steroids
```
70
What is omalizumab?
Monoclonal antibody used in asthma therapy (>5 years). Used in allergy therapy
71
What is asthma?
Bronchial hyperresponsiveness and airway narrowing
72
Commonest serious resp condition in <2 years
Bronchiolitis
73
Commonest causative organism in bronchiolitis
RSV
74
What % of patients with bronchiolitis are admitted?
2-3
75
Presentation of bronchiolitis
Preceding coryzal features, then dry distinctive cough, increased SOB/WOB
- Feeding difficulty
- Recurrent apnoea
- Fever
- Pallor
- Tachy
76
Bronchiolitis signs
- Fine end inspiratory crackles
- Prolonged expiration
- Hyperinflation
77
Ix bronchiolitis
NPA (viral PCR)
Monitor O2 SATs
CXR
Blood gas
78
Mx bronchiolitis
Humidified O2 if SATs <92% (optiflow/airvo)
CPAP
Suction
IVI (maintenance/recovery fluids - consider 2/3 if breathing affecting feeding)
Pavulizumab - monoclonal antibody against RSV
79
What is pavulizumab?
Monoclonal antibody against RSV
Reduced incidence of bronchiolitis when given to preterm infants
80
What causative organism is commonly associated with lobar consolidation?
S.pneumoniae
81
Features of pneumonia
```
Preceding URTI
Fever
DIB
Poor feeding
Generally unwell
```
82
Mx penumonia
```
Admission if:
SATs <92 on air
Resps >60/min
T > 38 (if <3 mos)
Cyanosis
Clinically dehydrated
```
Amoxicillin 7-14/7
Controlled O2
83
Commonest life long AR conditions in caucasians
CF
84
Common presentation of CF
```
Persistent purulent cough after acute infection
Meconium ileus
Pale, greasy stools
(Clubbing)
POOR GROWTH
```
85
Pathophysiology of CF
Mutation in Cl- ion transporters. Blocks flow of H2O - thick, viscous secretions
86
Three commonly affected organs in CF
Lungs
Bowel
Pancreas
87
Resp effects of CF
Thick, viscous secretions
| Recurrent endobronchial chest infections (P.aeruginosa)
88
Bowel effects of CF
Thick, viscid meconium
| Meconium ileus in 10-20% patients
89
When is CF detected?
Guthrie
90
Pancreatic effects of CF
Thick, viscid pancreatic secretions = reduced enzymes into bowel.
Reduced elastae
Enzyme deficiency
Malabsorption
91
Resp treatment for CF
Chest physio (with SABA first to help open up airways)
Mucolytics (rhDnase and inhaled hypertonic saline)
Inhaled tobramycin
Ibuprofen/steroids (anti-inflammatories)
CFTR modulators (e.g. ivacaftor)
92
How often should CF patients be reviewed?
Annual review of their condition AND at least one other review per year by specialist CF MDT
93
What is ivacaftor?
CFTR modulator used in CF management - helps thin the thickened mucous
94
Which conditions are classes as "URTI"?
Common cold
Sinusitis
Pharyngitis/tonsilitis
Acute otitis media
95
Why does frontal sinusitis rarely present in children under 10 years?
Frontal sinuses only develop in late childhood
96
Sinusitis presentation
Coryza/cough
Bad breath
General feeling unwell
Painful cheeks/eyes
Yellow-green nasal/post-nasal drip
97
Commonest cause of sinusitis <10 days
Viral
98
When should pt with sinusitis be admitted?
If severe systemic infection
Intracranial symptoms - meningitis
Intra-periorbital symptoms
99
Treatment for sinusitis lasting <10 days
NO abx
Consider nasal decongestant/nasal steroid spray
Paracetamol/ibuprofen for fever
Return if lasts longer than 3/52
100
Commonest cause of sinusitis >10 days <4 weeks
Bacterial
101
Treatment for sinusitis lasting >10 days
Abx (delayed - if persists beyond 10 days) AMOXICILLIN
Paracetamol/ibuprofen for fever
High dose nasal steroids if >12 years (mometasone)
Seek advice if symptoms worse
102
Persistent cough after acute infection
CF
| Unresolved lobar collapse
103
Persistent cough
```
CF
TB
Unresolved lobar collapse
(Asthma)
GORD
```
104
Kartagener's syndrome
Primary ciliary dyskinesia
Situs inversus
Dextrocardia
105
Predisposing factors for sleep disordered breathing
```
Hypotonia
Obesity
Muscle weakness
Anatomical problems
Enlarged tonsils/adenoids
```
106
Ix sleep disordered breathing
Overnight O2 saturations: frequency/severity of periods of desaturation
107
Mx sleep disordered breathing
Adenotonsillectomy (if hypertrophy)
CPAP/BiPAP to maintain upper airway
Montelukast +/- intranasal budesonide if surgical intervention does not help
