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Paeds FOP/TAS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Which organisms are most likely to cause an abscess or empyema?

A

Group A Strep or Staph aureus

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2
Q

List some sequelae / complications of pneumonia

A

Empyema
Pleural effusion
Lung abscess
SIADH

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3
Q

Which is the most common bacterial cause of pneumonia?

A

Strep pneumoniae

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4
Q

Risk factors for pneumonia

A

Prematurity
Congenital heart disease
Immunodeficiency

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5
Q

Which ages are more likely to have viral VS bacterial pneumonia

A

Viral infections are common in younger children and bacterial infections are more frequently identified with increasing age

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6
Q

Causes of viral pneumonia

A

RSV
Parainfluenza
Influenza
Adenovirus
Rhinovirus
Human Metapneumovirus
CMV
VZV
HSV
Coronavirus
Enterovirus

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7
Q

List the four stages of lobar pneumonia

A

1) Vascular congestion and alveolar oedema with high numbers of the infective organism
2) Red hepatisation: Significant infiltration of RBCs and neutrophils. Fibrin also infiltrates into the alveolar fluid.
3) Grey hepatisation: Fibrin and RBC breakdown to form a fibrinopurulent exudate
4) Resolution: macrophages clear the exudate

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8
Q

Define bronchopneumonia

A

Involves one or more lobes and is characterised by patchy consolidation. Exudate in the bronchi spreads to the adjacent alveoli

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9
Q

Define interstitial pneumonia

A

Patchy or diffuse inflammation. The interstitium is infiltrated by lymphocytes and macrophages.
The alveoli contain minimal exudate.

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10
Q

Define miliary pneumonia

A

Spread of a pathogen from the blood to the lungs producing multiple discrete lesions with foci of necrosis

Common pathogens: TB, CMV, VZV, histoplasmosis and coccidioidomycosis

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11
Q

Define lobar pneumonia

A

Involves a single lobe of the lung

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12
Q

General pathophysiology of pneumonia

A

Alveoli and terminal airspaces become inflamed secondary to the introduction of a pathogen. A resulting inflammatory cascade causes leakage of plasma and loss of surfactant, which results in air loss and consolidation.

In viral infections, mononuclear cells accumulate in the submucosa leading to narrowing of the airways producing wheeze and crackles. Pulmonary oedema then develops due to destruction of the alveolar type 2 cells and formation of hyaline membranes.

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13
Q

1st line antibiotic for bacterial pneumonia

A

Amoxicillin for a minimum of 7 days

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14
Q

1st line antibiotic for atypical pneumonia

A

A macrolide (e.g. Clari, Azithro or Erythromycin)

*note may be added to Amoxicillin

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15
Q

When to treat pneumonia with Abx?

A

All children >2 with a clinical diagnosis of pneumonia should be treated with Abx as difficult to differentiate between bacterial/viral

Children <2 do not require Abx if they have mild Sx of LRTI

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16
Q

Biggest risk factor for fungal pneumonia

A

Chronic granulomatous disease (genetic condition) as phagocytic cells are unable to kill engulfed organisms due to defects in enzyme function

Note other risk factors: chronic malnutrition/faltering growth, chronic lung diseases such as asthma + bronchiectasis, immunosuppression

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17
Q

Genetic cause of CF

A

Mutation in the CF-transmembrane conductance regulator (CFTR) gene on chromosome 7

There are >1800 mutations identified, however most labs will test for the 34 most common mutations (>90% cases)

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18
Q

What does the newborn screening blood spot test detect to diagnose CF

A

Raised immunoreactive trypsin (IRT)

19
Q

Life expectancy in CF

A

Mid-40s

20
Q

1) Inheritance pattern of CF
2) Prevalence

A

1) Autosomal recessive
2) In a white population there is a carrier frequency of 1:25

21
Q

List the five classes of mutation in the CFTR gene identified to cause CF

A

Class 1: nonsense, frame-shift or splicing mutation causes a premature termination of the messenger RNA sequence (2-5%)

Class 2: abnormal post-translational processing of CFTR protein so it is unable to move to the apical membrane. MOST COMMON EXAMPLE = Delta-F508 MUTATION.

Class 3: diminished protein activity (fully formed but non-functional protein channel)

Class 4: normal functioning protein in the correct part of the cell surface but the rate of Cl ions and stimulation of the channel are reduced

Class 5: reduced concentration of CFTR channels due to rapid degradation

22
Q

Which is the most common CFTR mutation

A

Delta-F508 mutation (class 2 mutation which leads to defective protein folding/processing so unable to reach the apical membrane)

23
Q

1) What is the primary function of the CFTR channel

2) What is the result of defective CFTR function

A

1) It is an ATP-responsive chloride ion channel (moves chloride from intracellular -> extracellular space). It also inhibits the epithelial sodium channel.

2) When defective the respiratory epithelium fails to secrete chloride ions and hyper-absorbs sodium ions + water (by osmosis) causing dehydration of the airway surface. This causes viscous secretions.

24
Q

Brief outline of the pathophysiology of CF

A

Defective secretion of chloride ions and increased absorption of sodium ions/water leads to viscous secretions and a dehydrated airway surface.
This impairs mucociliary clearance and host defence. This leads to inflammatory lung damage secondary to a neutrophilic response (IL-8 and elastase released).

25
Q

Which other organs are commonly effected in CF

A

Gut, pancreas, liver, reproductive tract

26
Q

How does CF usually present?

List other presentations as well

A

Most commonly detected on newborn screening result

Other presentations:
- Meconium ileus (10-20%)
- Recurrent URTI/chest infections
- Jaundice
- Pseudo-Bartter syndrome (hypochloraemic, hypokalaemic alkalosis)

27
Q

What percentage of CF patients are chronically infected with pseudomonas by the time they reach adolescence?

A

80%

28
Q

List the x3 most common organisms causing recurrent respiratory infections in CF

A

Staph aureus
Haemophilus influenzae
Pseudomonas aeruginosa

29
Q

What percentage of patients with CF will also have nasal polyps

A

30%

30
Q

What percentage of boys with CF will have infertility

A

99%

31
Q

What is the false negative rate for CF on the newborn screening test

A

3-6%

32
Q

What is the “gold standard” diagnostic test for CF

A

Sweat test

33
Q

What is a diagnostic result on sweat test for CF

A

> 60mmol/L chloride ions

34
Q

Which infection does a faulty CFTR gene protect against

A

Typhoid fever (Salmonella typhi uses proteins coded by CFTR to enter the epithelium from the gut)

This may explain why the CFTR gene remains so prevalent

35
Q

What bacteria causes Whooping Cough?

A

Bordetella pertussis

36
Q

Treatment for whooping cough

A

Macrolide (Clarithromycin or Erythromycin)

37
Q

What is tested for on the newborn blood spot test for CF?

A

Immunoactive trypsin levels

38
Q

What are the embryonic origins of the respiratory tract?

A

Development of the respiratory system begins with evagination of the respiratory diverticulum from the ventral wall of the foregut which is derived from endoderm.

39
Q

At what gestation do type 2 pneumocytes form?

A

Type 2 pneumocytes begin to form at the end of the six month (23 weeks)

40
Q

What is the embryonic origin of the parietal pleura?

A

Somatic mesoderm.

It also forms most of the chest wall.

41
Q

What is the embryonic origin of the visceral pleura?

A

Splanchnic mesoderm.

The cartilage, muscle and connective tissue of the respiratory system are also formed from splanchnic mesoderm.

42
Q

What is the anatomical abnormality seen in laryngomalacia?

A

Shortened aryepiglottic folds which causes the epiglottis to be pulled into an omega shape.

The arytenoid cartilage and mucosa prolapse anteriorly into the airway.

43
Q

Best antibiotic to treat Mycoplasma pneumoniae

A

Clarithromycin

Paeds FOP/TAS (12 decks)

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