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Med Finals - Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

(55 cards)

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1
Q

Define bronchiolitis

A

Inflammation and infection of the bronchioles. Generally considered to occur in children under 1

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2
Q

What is the most common causative organism in bronchiolitis

A

Respiratory syncytial virus (RSV)

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3
Q

Presentation of bronchiolitis

A

Coryzal symptoms
Respiratory disetress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Apnoea
Wheeze
Crackles

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4
Q

Clinical signs of respiratory distress

A

Raised resp rate
Use of accessory muscles - sternocleidomastoid, abdominal, intercostal
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal noises - wheezing, grunting, stridor

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5
Q

Reasons for admission in bronchiolitis

A

<3 months
Pre-existing condition - prematurity, Downs or cystic fibrosis
50-75% reduction in milk intake
Clinical dehydration
Resp rate >70
O2 <92
Signs of moderate to severe respiratory distress
Apnoeas
Parents not confident to manage at home

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6
Q

Management of bronchiolitis

A

Supportive
Adequate intake - NG, IV, frequent feed
Saline nasal drops, suctioning,
Supplementary O1
Ventilatory support

Prevention in those at high risk (prem or congenital heart disease) - palivizumab

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7
Q

Define viral induced wheeze

A

Acute wheezy illness caused by viral infection. Caused by inflammation of the small airways leading to swelling and constriction,

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8
Q

Presentation of viral induced wheeze

A

Viral illness - fever, cough, coryza
Shortness of breath
Signs of respiratory distress
Expiratory wheeze through out chest

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9
Q

Management of viral induced wheeze

A

Same as acute asthma
O2
Bronchodilators - salbutamol, ipratropium, magnesium,
Steroids
Antibiotic if bacterial

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10
Q

Define acute asthma

A

Rapid deterioration of asthma symptoms - triggered by infection, exercise or cold weather.

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11
Q

Presentation of acute asthma

A

Progressively worsening shortness of breath
Signs of respiratory distress
Fast resp rate
Expiratory wheeze throughout chest
Chest sounds “tight” with reduced air entry

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12
Q

Parameters for moderate asthma exacerbation

A

Peak flow >50% predicted
Normal speech
No features of severe or life threatening asthma exacerbation

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13
Q

Parameters for severe asthma exacerbation

A

Peak flow <50 % predicted
Saturations <92
Unable to complete sentences
Signs of respiratory distress
Resp rate > 40 (1-5 years) >30 (>5)
Heary rate >140 (1-5) >125 (>5)

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14
Q

Parameters for life threatening asthma exacerbation

A

Peak flow <33%
Saturations <92%
Exhaustion and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered conciousness/confusion

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15
Q

Management of acute asthma

A

O2
Bronchodilators
Steroids
Antibiotics

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16
Q

Parameters for discharge in acute asthma

A

6 puff 4 hourly
Once steroids complete
Safety net

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17
Q

Define chronic asthma

A

Chronic inflammatory airway disease leading to variable airway obstruction -

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18
Q

Presentation of asthma

A

Episodic symptoms - exacerbations
Diurnal variability - worse at night or early morning
Dry cough
Triggers
History of atopy - eczema, hayfever and food allergies
FH of asthma
Bilateral wheeze
Improvement with bronchodilators

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19
Q

Typical triggers of asthma

A

Dust
Animals
Cold air
Exercise
Smoke
Food allergens

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20
Q

Investigations of asthma

A

Clinical trial of bronchodilator
Spirometry with bronchodilator reversibility
Fractional exhaled nitric oxide
Peak flow diary

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21
Q

Management of asthma

A
  1. SABA
  2. ICS
  3. leukotriene receptor antagonist
    Refer
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22
Q

Define pneumonia

A

Infection of the lung tissue - seen as consolidation on chest xray

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23
Q

Presentation of pneumonia

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A

Cough
High fever
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium

24
Q

Clinical signs of pneumonia

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A

Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

25
Common causes of pneumonia
Streptococcus pneumonia Group A strep RSV Parainfluenza Influenza
26
Investigations in pneumonia
CXR Sputum and throat cultures Blood gas Lactate!
27
Management of pneumonai
Antibiotics - amoxicillin O2
28
Define croup
An acute infection of the upper respiratory tract causing oedema in the larynx typically affecting young children
29
Causative organism in croup
Parainfluenza virus (influenza, adenovirus, RSV)
30
Presentation of croup
Increased work of breathing Barking seal like cough Hoarse voice Stridor Low grade fever
31
Management of croup
Dexamethasone!!! O2 Nebulised budesonide Nebulised adrenaline Intubation and ventilation
32
Define epiglottis
Inflammation and swelling of the epiglottis caused by infection
33
Causative organism in epiglottitis
Haemophili's influenza type B
34
Presentation of epiglottitis
Sore throat and stridor Drooling Tripod position High fever Difficulty Muffled voice Scared and quiet child Septic and unwell appearance
35
Investigations in epiglottitis
Do not examine! Refer to ENT Lateral xray of neck - thumb sign.
36
Management of epiglotitis
Refer to ENT! Secure airway - ?intubate IV abx Teroids
37
Define Laryngomalacia
A condition that affects infants where the part of the larynx above the vocal cords is structured in a way that allows partial obstruction of the airway - leading to chronic stridor on inhalation.
38
Define whooping cough
Upper respiratory tract infection where child has classic coughing fits followed by loud whooping noise sucking air in.
39
Causative organism in whooping cough
Bordetella pertussis
40
Presentation of whooping cough
Mild coryzal Low grade fever Mild dry cough Severe coughing fits - paroxysmal Inspiratory whoop at ends of coughing fit. May develop pneumothorax Apnoeas
41
Investigations in whooping cough
Nasopharyngeal or nasal swab and PCR testing or bacterial culture
42
Management of whooping cough
Notifiable disease Supportive care Avoid contacts - prophylactic abx Macrolides - clarithromycin
43
Define chronic lung disease of prematurity
Also known as bronchopulmonary dysplasia Premature babies suffer respiratory distress.
44
Features of bronchopulmonary dysplasia
Low O2 Increased work of breathing Poor feeding and weight gain Crackles and wheezes Increased infections
45
Prevention of chronic lung disease of prematurity
Steroids in premature labour CPAP Caffeine Not over oxygenating
46
Management of chronic lung disease of prematurity
Low dose home oxygen Monthly RSV monoclonal antibodies
47
Define cstic fibrosis
Autosomal recessive conditiong affecting mucus glands. Affects chloride channels
48
Key consequences of cystic fibrosis mutation
Thick pancreatic and biliary secretions - lack of digestive enzymes Low volume thick airway secretions - reduce airway vlearance Congenital bilateral absence of the vas deferens
49
Presentation of cystic fibrosis
Newborn bloodspot test - heel prick Meconium ileus Recurrent lower resp tract infection Chronic cough Thick sputum Loose greast stools Abdo pain Parents report child tastes salts Poor weight gain
50
Clinical signs of cystic fibrosis
Low weight or height Nasal polyps Finger clubbing Crackles and wheezes Abdo distension
51
Causes of clubbing in children
Hereditary Cyanotic heart disease Infective endocarditis Cystic fibrosis Tuberculossis Inflammatory bowel disease Liver cirrhosis
52
Investigations in cystic fibrosis
Newborn bvlood spot test Sweat test - gold standard Genetic testing -
53
Common infectious organisms in cystic fibrosis
Staphylococcus aureus Pseudomonas aeruginosa Haemophilus influenza Klebsiella penumoniae E. Coli Burkhodeheria cepacia
54
Management of cystic fibrosis
Chest physio Exercise Hight calorie diet Creon tablets Prophylactic flucloxacillin Treat infection Bronchodilatiors Nebulised DNase Nebulised hypertonic saline Pneumococcal influenza and varicella vaccines Lung transplant Liver transplant Fertility treatment - soerm extraction Genetic counsellingd
55
Define primary ciliary dyskinesia
Also knowns as kartagner's syndrome Autosomal recessive condition affecting the cilia of various cells in the body. Common in inbred populations

Med Finals - Paediatrics (17 decks)

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