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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

What are common differentials for stridor in children?

A

Croup
Epiglottitis
Anaphylaxis
Bacterial Tracheitis
Foreign Body Aspiration

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2
Q

Why would rashes be important to consider in a stridor history?

A

Urticarial rashes or swellings might be important to ask about because this could indicate anaphylaxis.

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3
Q

Why would allergens be important to note in a stridor history?

A

This could help point to possible anaphylaxis

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4
Q

What does drooling indicate? (in stridor history)

A

Severe Upper Airway Obstruction (UAO), possibly cause by epiglottitis.

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5
Q

What does a high fever indicate in a stridor history?

A

Bacterial infection (sepsis until otherwise)

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6
Q

What does a barking, seal-like cough indicate?

A

Croup (laryngotracheobronchitis)

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7
Q

What is the most common cause of stridor in young children?

A

Croup

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8
Q

Why is Epiglottitis rare in young children nowadays?

A

Because they get immunised against Haemophillus Influenza type B (HiB) which is the bacterial that causes Epiglottitis

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9
Q

What is the age of onset for Croup?

A

6 months to 3 years

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10
Q

At what age is Foreign Body Aspiration most likely to occur?

A

Younger than 3 years

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11
Q

What is the most common causative organism in Croup?

A

Parainfluenza (virus)

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12
Q

What is the causative organism in Epiglottitis?

A

Haemophillus Influenza Type B (bacteria)

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13
Q

What is the causative organism in Bronchiolitis?

A

Respiratory Syncytial Virus (RSV) (Viral)

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14
Q

What three physical signs could be seen in anaphylaxis?

A

Hypotension, broncho-constriction and airway compromise

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15
Q

What is sensitisation?

A

When the body has develop IgE and mast cells for an allergen so that reinfection causes an allergic reaction.

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16
Q

What chemicals are released when a mast cell degranulates?

A

Histamine, Prostaglandins and Leukotrienes

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17
Q

What sign is seen on XR of the neck for someone with Croup?

A

Steeple sign

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18
Q

How would you investigate someone with Croup?

A

Viral PCR

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19
Q

How do you treat/manage Croup?

A

Steroids to manage the symptoms

(Prednisolone for mild cases)

(Dexamethasone for serious cases)

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20
Q

How would you treat very severe Croup?

A

Nebulised Adrenaline

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21
Q

What is the scientific name for Croup?

A

Laryngotracheobronchitis

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22
Q

What is bronchiolitis?

A

Inflammation of the small airways in children, which causes increased mucus production, bronchospasms and later airway obstruction.

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23
Q

What is the peak age of incidence for Bronchiolitis?

A

2-6 months old

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24
Q

How old are the children that are generally affected by Bronchiolitis?

A

Younger than 2 years old

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25
What are the 3.5 ways to identify someone with bronchiolitis?
1. Increased work of breathing (recessions, tracheal tug and nasal flaring) 2. Reduced oxygen saturation (less than 90%) 3. Reduced fluid intake and output (less than 50% of norm - 150ml/kg/day) 3. 5. Parental concern
26
What are 4 signs of Bronchiolitis?
Wheeze, nasal flaring, subcostal/intercostal recessions and hyperinflation
27
Can oxygen be given in Bronchiolitis?
Yes - it helps with breathing
28
How is bronchiolitis managed?
Conservatively
29
What symptoms should be asked about in a respiratory history?
PC - SOCRATES Cough, breathlessness, recessions and other signs of difficulty breathing, Cyanosis, cold peripheries, flu symptoms Poor feeding, reduced wet nappies/stool output, lethargy/irrtation Depending on age, do a full systems review also (don't forget immunisations and antenatal history)
30
What are common differentials for difficulty breathing?
Asthma, CHDs, foreign body aspiration, URTI/LRTI, DKA, Cystic Fibrosis, Anxiety (panic attack)
31
What is Harrison's Sulci?
An indentation on the chest roughly along the 6th rib which corresponds with the costal insertion of the diaphragm.
32
What does morning cough/dyspnoea indicate?
Asthma
33
What is the triad of asthma
Airway obstruction Smooth muscle hyperplasia with hyperresponsiveness Inflammation
34
Is Asthma reversible or irreversible?
Reversible
35
What are the two types of asthma?
Extrinsic and Intrinsic
36
What is atopic asthma general caused by?
Allergens in the environment (outside sources)
37
What is intrinsic asthma caused by?
This is when the body reacts abnormally to normal stimuli like stress, exercise or medicines.
38
Is asthma IgE mediated or T cell mediated?
Trick question - it uses both (it is phasic) Immediate IgE response and later T cell response
39
Which T cell do the antigen presenting dendritic cells bind to?
T helper 2 (Th2)
40
What interleukins do the T cells release in asthma?
Interleukins 4 and 5
41
Which type of immune cell causes the most damage in asthma?
Eosinophils
42
Where can mast cells be found in the airway histology?
Within the epithelium and the lamina propria?
43
What are the clinical features of Asthma?
Cough Difficulty breathing (SOB) Wheeze Exercise intolerance Chest tightness
44
What kind of lung disease is asthma?
Obstructive lung disease (FVC/FEV1 ratio is markedly)
45
How does spirometry help with diagnosing asthma?
The FVC/FEV1 ratio is reduced and when bronchodilator therapy causes this to be reversed.
46
What are the signs of a **moderate** asthma exacerbation?
Normal speech Respiratory rate \<25 breaths/minute Pulse rate \<110 beats per minute PEF 50% to 75% of best or predicted.
47
What are the signs of **severe** acute exacerbation of asthma?
Patient can’t complete a sentence without taking a breath Respiratory rate \>25/minute Pulse rate \> 110 beats per minute PEF 33% to 50% of best (or predicted if unknown)
48
What are the signs of a life-threatening asthma exacerbation?
Silent chest and Poor respiratory effort Cyanosis Arrhythmia Hypotension Exhaustion and Altered consciousness PEF \<33% of best or predicted Oxygen saturation (SpO2) \<92% Partial pressure of oxygen (PaO2) \<8 kPa (\<60 mmHg) ‘**Normal**’ partial pressure of carbon dioxide (PaCO2) 4.6 to 6.0 kPa (35-45 mmHg) *Raised PaCO2 is a marker of near-fatal asthma.*
49
What is the first line treatment in asthma treatment? (Not acute exacerbation)
Short acting beta agonist (SABA - salbutamol) as needed
50
What is the second line treatment in asthma treatment?
Low-dose Inhaled Corticosteroid (ICS) (Budesonide or Fluticasone) and SABA PRN
51
What is the third line treatment for asthma?
Medium-dose ICS (Budesonide or Fluticasone, but higher dosage) OR *option for 5-11 years old:* Low-dose ICS and Long acting beta agonist/montelukast/theophylline and SABA PRN
52
What kind of genetic condition is cystic fibrosis?
Autosomal recessive
53
On which chromosome is the faulty gene for the Cystic Fibrosis?
Chromosome 7
54
What is the faulty gene called in the disease of Cystic Fibrosis
CFTR (cystic fibrosis transmembrane conductance regulator)
55
Which channel is affected in cystic fibrosis?
Chloride ions on the apical membrane of the epithelial cells
56
There are 5 main mutations for the CFTR gene which result in Cystic Fibrosis. What are they?
Protein production mutations (Class 1) Protein processing mutations (Class 2) [**f508del**] Gating mutations (Class 3) Conduction mutations (Class 4) Insufficient protein mutations (Class 5)
57
What is the most common mutation for CF?
58
Which clinical test can be used to diagnose Cystic Fibrosis?
Sweat Chloride Test
59
What are the clinical features in Cystic Fibrosis?
Haemopytsis - due to chronic chest problems Nasal polyposis Recurrent pancreatitis Constipation Hepatomegaly Failure to thrive - not getting enough nutrients from diet Steatorrhoea
60
Which newborn test is carried out to help identify CF (and other diseases)?
Guthrie Heel Prick Test
61
How is Cystic Fibrosis treated?
By managing each damaged system individually

Paediatrics (10 decks)

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