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Respiratory Flashcards

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1
Q

What is bronchiolitis ?

A

Inflammation and infection of the bronchioles. This is usually caused by the respiratory syncytial virus.
Very common in winter
Generally affects under 1 year olds

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2
Q

Why does bronchiolitis cause a wheeze in babies but not adults ?

A

As babies airways are so small the slightest inflammation and mucus in the airway has a significant effect on the infants ability to circulate air to the alveoli and back out.

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3
Q

How do babies with bronchiolitis present ?

A

Coryzal symptoms - runny nose
Signs of resp distress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Wheeze and crackles

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4
Q

What are the signs of respiratory distress ?

A

Raised RR
Use of accessory muscles - SCM, abdominal and intercostal muscles
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises

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5
Q

What are some abnormal airway noises ?

A

Wheezing - heard on expiration
Grunting - exhaling with the glottis
Stridor - high pitched inspiratory noise ( croup )

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6
Q

What is the typical RSV course ?

A

Bronchiolitis usually starts as an URTI with coryzal symptoms
Symptoms are generally worse on day 3 or 4.
Full recovery within 2 -3 weeks

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7
Q

What are some reasons for admission for babies with bronchiolitis ?

A

Ages under 3 months or any pre-existing condition ( prematurity, downs or CF )
50-75 or less of their normal intake of milk
Clinical dehydration
RR over 70
O2 below 92
Moderate to severe resp distress
Apnoea

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8
Q

What is the management of bronchiolitis ?

A

Ensuring adequate intake - NG tube or IV fluids if needed
Saline nasal drops
Nasal suctioning
Supplementary o2
Ventilatory support

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9
Q

What are some types of ventilatory support ?

A

High flow humidified o2
Continuous positive airway pressure
Intubation and ventilation

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10
Q

What is high flow humidified oxygen ?

A

Tight nasal cannula delivering air and oxygen continuously with some added pressure. It adds positive end expiratory pressure to maintain the airway.

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11
Q

What is CPAP ?

A

This involves using a sealed nasal cannula that performs in a similar way to high flow o2 but at higher and more controlled pressures.

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12
Q

How is ventilation assessed ?

A

Capillary blood gases

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13
Q

What are the signs for poor ventilation on a blood gas ?

A

Rising pCO2
Falling pH

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14
Q

What is given to babies who were ex-premature and hose with congenital heart disease when they have bronchiolitis ?

A

Palivizumab - monoclonal antibody that targets the RSV.

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15
Q

What is viral induced wheeze ?

A

An acute wheezy illness caused by a viral infection. When the small airways encounter a virus they become inflamed restricting small for airflow.

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16
Q

What features indicate viral induced wheeze over asthma ?

A

Presenting before 3 years old
No atopic history
Only occurs during an infection

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17
Q

How does viral induced wheeze present ?

A

SOB
Resp distress
Expiratory wheeze throughout the chest

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18
Q

What is the management of viral induced wheeze ?

A

Supplementary oxygen
Bronchodilators ( salbutamol or Ipratropium )
Steroids - prednisolone or hydrocortisone )
Abx

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19
Q

What is an acute exacerbation of asthma ?

A

Characterised by a rapid deterioration in the symptoms of asthma. This could be triggered by any of the typical asthma triggers such as infection, exercise or cold weather.

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20
Q

How does acute asthma present ?

A

Progressively worsening SOB
Signs of resp distress
Fast RR
Expiratory wheeze on auscultation heard throughout the chest

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21
Q

Why is silent chest an ominous sign ?

A

This is where the airways are so tight it is not possible for the child to move enough air through the airways to creat a wheeze. This is life-threatening

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22
Q

What are the BTS/SIGN guidelines for moderate asthma attack ?

A

Peak flow above 50%
Normal speech

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23
Q

What are the BTS/SIGN guidelines for life threatening asthma attack ?

A

Peak flow is between 33%
Saturations below 92%
Exhaustion and poor respiratory effort
Hypotension
Silent chest
Cyanosis
Altered consciousness

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24
Q

What are the BTS/SIGN guidelines for severe asthma attack ?

A

Peak flow 33-50%
Saturations below 92%
Unable to complete sentences in one breath
Signs of resp distress
HR ( above 140 in 1-5 years old, above 125 in over 5 years old )

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25
What is the stepwise management of acute asthma ?
Salbutamol inhalers ( spacer device ) Nebulised salbutamol / Ipratropium bromide Oral prednisolone IV hydrocortisone IV magnesium sulphate IV salbutamol IV aminophylline Call an anaesthetist
26
When is discharge appropriate in an asthma attack ?
Discharge is considered when the child is well on 6 puffs 4 hourly of salbutamol.
27
What is the presentation of asthma ?
Episodic symptoms with intermittent exacerbations Diurnal variability - worse at night and in the morning Dry cough with wheeze and SOB Typical triggers Atopy - hay fever, eczema and food allergies Family history Bilateral widespread wheeze
28
What is the presentation indicating a diagnosis other than asthma ?
Wheeze only related to coughs and colds Isolated or productive cough Normal investigations No response to treatment Unilateral wheeze - suggesting a focal lesion, inhaled foreign body or infection
29
What are the typical triggers of asthma ?
Dust (house dust mites) Animals Cold air Exercise Smoke Food allergens
30
What are some investigations for asthma ?
Spirometry FeNO Peak flow
31
What is the medical therapy for asthma patients under 5 years old ?
SABA Low dose ICS or Leukotriene antagonist
32
What is the medical therapy for asthma patients aged 5 - 12 years old ?
SABA Add Low dose ICS Add LABA Titrate the ICS up Consider adding oral montelukast or theophylline
33
What is the medical therapy for asthma patients aged 12 years and over ?
SABA Add low dose ICS Add LABA Titrate up the ICS Consider oral montelukast Add oral steroids
34
What is the MDI technique without a spacer ?
Remove the cap Shake the inhaler Sit or stand up straight Lift the chin slightly Fully exhale Make s tight seal with your lips Take a steady breath in whilst pressing the canister Continue breathing for 3-4 seconds Hold the breath for 10 seconds Wait 30 seconds before giving a second dose Rinse the mouth after using steroid inhalers
35
What is the MDI technique with a spacer ?
Assemble the spacer Shake the inhaler Attach the inhaler to the correct end Sit or stand up straight Make a seal around the spacermouthpiece Spray the dose into the spacer Take steady breaths in and out 5 times
36
How does someone present with pneumonia ?
Cough High fever Tachypnoea Tachycardia Increased work of breathing Lethargy Delirium
37
What are the characteristic chest signs in pneumonia ?
Bronchial breath sounds Focal coarse crackles Dullness to percussion
38
What are the bacterial causes of pneumonia ?
Streptococcus pneumonia Group A strep Group B strep Staph aureus Hamephilus influenza Mycoplasma pneumonia
39
What are the viral causes of pneumonia ?
RSV Parainfluenza Influenza
40
What investigations are performed for pneumonia ?
CXR Sputum cultures Throat swabs
41
What is the management of pneumonia ?
Amoxicillin first line Adding Macrolide will cover atypical or if penicillin allergy
42
What tests should be performed if a child is having recurrent LRTI’s ?
FBC CXR Serum immunoglobulins Test immunoglobulin G Sweat test for CF HIV test
43
What is croup ?
An acute infective resp disease affecting young children. It typically affects children aged 6 months to 2 years old. It is an URTI causing oedema in the larynx.
44
What is the classic cause of croup ?
Parainfluenza
45
How does croup present ?
Increased work of breathing Barking cough Hoarse voice Stridor Low grade fever
46
What is the management for pneumonia ?
Most can be managed at home Oral dexamethasone O2 if required If severe - nebulised Budesonide or adrenalin
47
What is epiglottitis ?
Inflammation and swelling of the epiglottis caused by infection - typically Haemophilus infleunza type B. The epiglottis can swell and obscure the airway within hours of symptoms developing. It is life threatening
48
What is the presentation suggesting possible epiglottis ?
Sore throat Stridor Drooling Tripod position - sat forward with hands on knees High fever Difficulty in swallowing Muffled voice
49
What investigations are performed for epiglottitis ?
Lateral x ray of the neck - characteristic thumb sign
50
What is the management of epiglottitis ?
Prepare intubation kit just in case IV abx Steroids
51
What is a common complication of epiglottitis ?
Epiglottis abscess
52
What is laryngomalacia ?
A condition affecting infants where the part of the larynx above the vocal cords is structured in a way that allows it to cause partial airway obstruction. This leads to a chronic stridor on inhalation when the larynx flops across the airway.
53
What are the structural changes in laryngomalacia ?
The aryepiglottic folds are shortened which pulls on the epiglottis and changes it shape to a characteristic omega shape. The tissue surrounding the supraglottic larynx is softer
54
How does laryngomalacia present ?
Peaks at 6 months Inspiratory stridor intermittent Difficulty feeding
55
What is the management of laryngomalacia ?
The problem resolves as the larynx matures and grows and is better able to support itself, preventing it from flopping over the airway. Usually no intervention is required. Rarely a tracheostomy may be necessary
56
What is whooping cough ?
An upper respiratory tract infection caused by Bordetella pertussis ( a gram negative bacteria ). The coughing fits can become so severe that the child is unable to take in air between coughs.
57
How does whooping cough present ?
Starts with mild coryzal symptoms - low grade fever and mild dry cough After a week - severe coughing starts - inspiratory whoop
58
How is a diagnosis of whooping cough made ?
Nasopharyngeal or nasal swab with PCR testing or bacterial culture
59
What is the management of whooping cough ?
Pertussis is a notifiable disease Supportive care Macrolide Prophylactic abx
60
What is a complication of whooping cough ?
Bronchiectasis
61
What is chronic lung disease of prematurity ?
It occurs in premature babies typically those born before 28 weeks gestation. These babies suffer with resp distress requiring o2 therapy and intubation
62
What are some features of chronic lung disease of prematurity ?
Low o2 sats Increased work of breathing Poor feeding and weight gain Crackles and wheezes on chest auscultation Increased susceptibility to infection
63
How is chronic lung disease of prematurity prevented ?
Giving corticosteroids to mothers that show signs of premature labour Using CPAP rather than intubation and ventilation Using caffeine to stimulate the resp effort
64
What is the management of chronic lung disease of prematurity ?
A formal sleep study to assess their oxygen saturations during sleep supports the diagnosis. Palivizumab - given for protection against RSV
65
What is cystic fibrosis ?
An autosomal recessive genetic condition affecting the mucus gland. It is caused by a mutation in the CFTR gene on chromosome 7.
66
What are the physiological consequences of CF ?
Thick pancreatic and biliary secretions - blockage of the ducts resulting in a lack of digestive enzymes. Low volume thick airway secretions Congenital bilateral absence of the vas deferens in males
67
How does the meconium in a CF baby present ?
Thick and sticky causing it to get stuck in the bowel Meconium ileus
68
When is CF diagnosed ?
Newborn blood spot test Recurrent LRTI, failure to thrive or pancreatitis
69
What are some symptoms of CF ?
Chronic cough Thick sputum production Steatorrhoea Abdominal pain and bloating Poor weight and height gain
70
What are some signs of CF ?
Low weight or height on growth charts Nasal polyps Finger clubbing Crackles and wheezes Abdominal distention
71
What are some causes of clubbing in children ?
Hereditary clubbing Cyanotic heart disease Infective endocarditis CF TB IBD Liver cirrhosis
72
What investigations should be performed when suspected CF ?
Sweat test Genetic testing
73
What is a sweat test ?
Key investigation for cystic fibrosis Gold standard A patch of skin is chosen and pilocarpine is applied. Electrodes are placed on either side and a small current is passed between them. This causes the skin to sweat. The sweat is then absorbed and tested for chloride concentration. Diagnostic chloride concentration for CF is more than 60mmol/L
74
Why do patients with CF colonise microbes ?
Patients with cystic fibrosis struggle to clear the secretions in their airways. This creates a perfect environment with plenty of moisture and oxygen for colonies for bacteria to live and replicate.
75
What are some common colonisers in cystic fibrosis ?
Staph aureus Haemophilus influenza Klebsiella pneumoniae E. coli
76
How is pseudomonas colonisation treated in patients with cystic fibrosis ?
It can be treated with long term nebulised antibiotics such as Tobramycin. Oral ciprofloxacin is also used
77
How is cystic fibrosis managed ?
Specialist MDT Chest physiotherapy - to clear mucus and reduce the risk of infection and colonisation Exercise - improves resp function High calorie diet CREON tablets - digest fats in patients with pancreatic insufficiency Prophylactic flucloxacillin Bronchodilators
78
What should patients with CF be monitored and screened for ?
Diabetes Osteoporosis Vitamin D deficiency Liver failure
79
What is primary ciliary dyskinesia ?
Also known as Kartagner’s syndrome Autosomal recessive affecting the cilia of various cells in the body. It causes dysfunction of the motile cilia around the body. This leads to a build up of mucus in the lungs. It can cause chronic chest infections, poor growth and bronchiectasis. Also affects the fallopian tubes of women and the flagella of the sperm.
80
What is Kartagner’s triad of primary ciliary dyskinesia ?
Paranasal sinusitis Bronchiectasis Situs inversus
81
What is situs inversus ?
A condition where all the internal organs are mirrored inside the body. Therefore the heart is on the right and the liver is on the left. Dextrocardia is when only the heart is reversed.
82
How is primary ciliary dyskinesia diagnosed ?
Recurrent respiratory tract infections Family history CXR - situs inversus Semen analysis - investigate male infertility Nasal brushing or bronchoscopy ( sample of ciliated epithelium )
83
What is the management of primary ciliary dyskinesia ?
Daily physiotherapy High calorie diet Antibiotics

Y4 Paeds (14 decks)

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