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Respiratory Flashcards

(118 cards)

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1
Q

What pathogen causes most resp infections in childhood?

A

Viruses

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2
Q

Which are the important viruses in resp infections? X6

A

RSV (respiratory syncytial virus), rhino viruses, parainfluenza, influenza, metapneumovirus and adenoviruses

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3
Q

Most important bacterial pathogens in resp infections x5

A

Streptococcus pneumoniae (pneumococcus), haemophilus influenzae, moraxella catarrhalis, bordetella pertussis (whooping cough), mycoplasma pneumoniae

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4
Q

Environmental risk factors for resp infection x3

A

Parental smoking - especially maternal, poor socio-economic status (overcrowding, large family, damp), poor nutrition

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5
Q

Host risk factors for resp infections x4

A

Underlying lung disease, male gender, haemodynamically significant congenital heart disease, immunodeficiency

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6
Q

Underlying lung disease which increase risk for resp infection x3

A

Bronchopulmonary dysplasia (preterm infants), cystic fibrosis or asthma

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7
Q

What is encompassed by URTI? X4

A

Common cold (coryza), sore throat (pharyngitis including tonsillitis), sinusitis

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8
Q

What can URTI cause in infants?

A

Poor feeding as blocked nose obstructs breathing
Febrile convulsions
Acute exacerbations of asthma

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9
Q

Classic features of common cold

A

Blocked nose and clear/mucopurulent nasal discharge

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10
Q

Commonest pathogenic causes of common cold

A

Viruses - rhinoviruses, corona viruses, RSV

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11
Q

Treatment of common cold

A

Self-limiting and no curative treatment

Fever and pain - treat with paracetamol and ibuprofen

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12
Q

What is pharyngitis?

A

Inflammation of pharynx and soft palate

Local lymph nodes enlarged and tender

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13
Q

What usually causes sore throat/pharyngitis? And in older children

A

Viruses - adenoviruses, enteroviruses and rhinoviruses

In older children group a b-haemolytic streptococcus

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14
Q

Common pathogens for tonsillitis?

A

Group a b-haemolytic strep and EBV

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15
Q

How do you tell between viral and bacterial tonsillitis

A

Clinically you can’t!
EBV exudate meant to be more membranous
Bacterial may have more constitutional disturbance (headache, apathy and abdominal pain, white exudate and cervical lymphadenopathy)

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16
Q

What is treatment for pharyngitis and tonsillitis - how long?

A

If severe often antibiotics even though only 1/3 are bacterial
To eradicate organism (b-haem strep) and prevent rheumatic fever need 10days of treatment

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17
Q

What antibiotic should be used in pharyngitis/tonsillitis and what should be avoided?

A

Penicillin and erythromycin (if penicillin allergy) usually used
Avoid amoxicillin because can cause maculopapular rash if due to EBV

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18
Q

When is acute otitis media most common?

A

6-12months

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19
Q

Symptoms and signs of acute otitis media?

A

Pain in ear and fever
Tympanic membrane bright red and bulging - loss of normal light reflection
May be visible pus if perforation of eardrum

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20
Q

Pathogens of acute otitis media

A

Viruses especially RSV and rhinovirus

Bacterial include pneumococcus, h.influenzae and moraxella catarrhalis

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21
Q

Serious complications of acute otitis media

A

Mastoiditis and meningitis

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22
Q

Treatment of acute otitis media

A

Paracetamol or ibuprofen for pain - constant rather than as required - more effective - may be needed for up to a week

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23
Q

Significance of antibiotics in acute otitis media

A

Shown to reduce the duration of pain but not affect risk of hearing loss - if no improvement after 4 days - give 5days of amoxicillin (erytho/clarithro if pen allergic)
Don’t wait for 4days if bilateral AOM or perforation in children

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24
Q

What can recurrent ear infections lead to?

A

Otitis media with effusion

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25
Symptoms and signs of otitis media with effusion
Children asymptomatic apart from possible decreased hearing | Eardrum is retracted and dull and can often see a fluid level
26
Diagnosis of otitis media with effusion
Flat trace on tympanometry Conductive hearing loss on pure tone audiometry (if >4) or reduced hearing on distraction hearing test in younger children
27
When is otitis media with effusion common
Age 2-7 | Peak incidence 2.5-5
28
Treatment of otitis media with effusion
No evidence for benefit of long term antibiotics, steroids or decongestants Condition usually resolves spontaneously If affecting hearing - grommet insertion
29
What surgery can be useful for otitis media with effusion
Adenoidectomy because believed adenoids can harbour organisms contributing to infection spreading up Eustachian tubes Also hypertrophied adenoids can obstruct and affect function of Eustachian tubes - poor ventilation of Middle ear
30
Another name for otitis media with effusion
Glue ear
31
When does sinusitis occur
Infection of para nasal sinuses with viral URTIs
32
What can occur with sinusitis and symptoms?
Secondary bacterial infection | Pain, swelling and tenderness over cheek from infection of maxillary sinus
33
What sinuses not usually affected in childhood sinusitis
Frontal sinuses because they do not develop until late childhood
34
Treatment for sinusitis
Reassure that >95% are viruses and can take 2.5 weeks to get better Analgesia, intranasal steroids and decongestants, saline irrigation, warm face packs but if bacterial suspected then antibiotics
35
Treatment for bacterial sinusitis
But if bacterial suspected (purulent discharge, severe pain, temp >38, worsening after initial being okay) then give antibiotics Amox 7 days, or phenoxymethylpenicillin 7 days (pen allergic doxy (not children) erythro or clarithro)
36
Growth of tonsils and adenoids in childhood
Large in childhood and then gradually regress | If too large can cause trouble such as obstruction of airways (adenoids) and therefore be indication for removal
37
Number of resp infections in preschool children per year
6-8
38
Most common laryngeal/tracheal infection (acute upper airway obstruction)
Croup - viral laryngotracheobronchitis
39
What are symptoms and signs of acute upper airway obstruction x6
Stridor (rasping sound heard on inspiration) Hoarseness (inflammation of vocal cords) Barking cough Dyspnoea Tachypnoea (severe) Tachycardia (severe)
40
How can you assess severity of upper airway obstruction
Degree of chest retraction (none, only on crying, at rest) | Degree of stridor (none, only on crying, at rest or biphasic)
41
What is pathology of croup x3
Mucosal inflammation and increased secretions | Oedema of subglottic area - most dangerous factor as causes critical tracheal narrowing
42
Pathogenic cause of croup
Viruses 95% including metapneumovirus, RSV, influenza | Most common is parainfluenza virus
43
Peak incidence of croup
Occurs from 6months-6 years but peak is in 2nd year of life
44
What season is croup most common
Autumn
45
Typical features of croup x6
Barking cough, harsh stridor and hoarseness Usually preceded by fever and coryza Symptoms often start and are worse at night
46
Treatment of croup
Oral Dexamethasone, prednisolone or neb budesonide | one dose - repeat next day if not better
47
Treatment of severe upper airway obstruction
Neb adrenaline - needs careful monitoring because risk of rebound symptoms 2hours after adrenaline when effects wear off
48
What is bacterial tracheitis?
Pseudomembranous croup Rare but dangerous Similar to viral croup but high fever, toxic and rapidly progressive obstruction with thick airway secretions
49
What causes bacterial tracheitis?
Staph aureus - treated with IV antibiotics
50
What is epiglottis and incidence?
Life threatening emergency caused by h.influenza type b - now massively reduced due to immunisation in infancy Swelling of epiglottis and surrounding tissues
51
What complicates epiglottis?
Septicaemia
52
What age group is epiglottis common in?
Children 1-6 | But can occur in all ages
53
Differences of presentation between croup and epiglottis
Epiglottis onset over hours without preceding coryza - no cough, can't drink or swallow so drooling saliva. They appear very toxic and ill with high fever. Have soft whispering stridor not harsh and muffled voice rather than hoarse
54
Appearance of child with epiglottis
Sitting upright with open mouth to optimise airway
55
Treatment of epiglottis
Intubated with general anaesthetic (24hours) Blood for culture IV antibiotics such as cefuroxime (3-5days)
56
What should be done for contacts of epiglottis patients
As with all serious h.influenzae infections - prophylaxis with rifampicin
57
Presentation of bronchitis in childhood
Cough and fever are main symptoms (not usually wheeze presentation) Cough may persist for 2 weeks
58
What is whooping cough
Highly contagious infection caused by bordetella pertussis
59
Incidence of whooping cough
Epidemic - occurring every 3-4 years
60
Presentation of whooping cough
1) catarrhal phase - week of coryza | 2) paroxysmal phase - spasmodic cough followed by inspiratory whoop (3-6weeks)
61
What can occur as a result of the cough in whooping cough
Often worse at night - may lead to vomiting May also get epistaxis and subconjunctival haemorrhages if vigorous coughing Red/blue in face during coughing and mucus flows from nose and mouth
62
Uncommon complications of whooping cough x3
Pneumonia Convulsions Bronchiectasis
63
Blood count in whooping cough
Typically lymphocytosis >15 x 10(9)
64
Treatment of whooping cough and its effect
Started within 21days of cough onset under 1m clarithro >1m azithro or clarithro
65
Contact treatment with whooping cough
Prophylaxis in close contact and vaccination of any unvaccinated infant contacts same unless pregnant in which case erythro
66
Most common age for bronchiolitis
90% are 1-9months | Rare after age 1
67
Pathogen in bronchiolitis
RSV in 80% | Also other viruses and mycoplasma pneumoniae
68
Symptoms of bronchiolitis
Coryzal symptoms precede: Dry cough, increasing dyspnoea and difficulty feeding Cyanosis, pallor, hyperinflation, SDL
69
Auscultation in bronchiolitis x2
Fine end-inspiratory crackles | High pitched wheeze (exp>insp)
70
Chest X-ray in bronchiolitis
Hyperinflation due to air trapping following small airway obstruction
71
Management of bronchiolitis
Humidified oxygen | Antibiotics, steroids and bronchodilators not shown to reduce severity or duration of illness
72
Prognosis of bronchiolitis
Most recover within 2 weeks | Adenovirus can have permanent damage to airways - bronchiolitis obliterans
73
What is palivizumab?
Monoclonal antibody to RSV given to high risk preterm infants
74
Pathogenic cause of pneumonia
50% cause not found | Can be viral or bacteria (viral more common in younger children and bacterial in older)
75
Most common pathogen in newborn pneumonia
Group b strep
76
Clinical features of pneumonia - most common presentation
Fever and difficulty breathing | Usually preceded by URTI
77
Other symptoms of pneumonia - including indication of bacterial infection
Cough, lethargy, poor feeding | Localised pain may suggest pleural irritation and therefore bacterial infection
78
Signs of pneumonia
SDL - tachypnoea, nasal flaring, chest indrawing
79
Auscultation in pneumonia
End inspiratory resp coarse crackles over affected area | Classical signs of consolidation (dullness on percussion, reduced air entry and bronchial breathing) not usually present
80
Management of pneumonia x4
Oxygen for hypoxia Analgesia if pain IV fluids if dehydrated Antibiotics depending on age
81
Antibiotics in newborn with pneumonia
Broad spectrum - amox
82
Antibiotics in older infants with pneumonia
Oral amoxicillin Broad spectrum eg co-amoxiclav for complicated or unresponsive Can add in macrolides (azithro etc) if not responding
83
%of children affected by asthma
15-20
84
Two patterns of wheezing in children- indications of asthma
Transient early wheezing | Persistent and recurrent wheezing
85
What is transient early wheezing?
Virus associated wheeze or episodic viral wheeze Due to small airways being more likely to narrow and obstruction due to inflammation from viral infection Hence episodically triggered by viral infections
86
Risk factors for transient early wheezing x5
Decreased lung function from birth due to small airway diameter Maternal smoking during and or after pregnancy Preterm Family hx of atopy not a risk factor More common in males
87
When does transient early wheezing resolve
Age 5
88
What is persistent and recurrent wheezing
Wheezing due to IgE hypersensitivity - aka asthma
89
3 main pathological features of asthma
Bronchial inflammation, bronchial hyperresponsiveness and airway narrowing
90
What triggers most asthma exacerbations
Rhinovirus infection
91
Signs of long standing asthma x3
Hyperinflation Generalised polyphonic wheeze Prolonged expiratory phase
92
Indications of another cause of wheeze (not asthma) x3 and what do they indicate?
Wet cough or sputum production Finger clubbing Poor growth Indicate chronic infection such as cystic fibrosis or bronchiectasis
93
Ladder of treatment of asthma in infant >5
``` Short acting inhaled bronchodilator Inhaled steroids ( 3 or more b2 needed per week) Long acting b2 Increase steroid dose Oral steroids ```
94
Other than b2 and steroids for asthma what can be added and when?
Leukotriene receptor antagonist or theophyllines - if no response to LABA
95
Asthma ladder in less than 5 years old
Ipratropium bromide + SABA Inhaled steroids or oral leukotriene r-antagonist (montelukast, zafirlukast) if inhalers not tolerated LABA refer to resp paediatrician
96
What is good for exercise induced asthma
LABA + inhaled steroid
97
Signs of severity in acute asthma attack
If less than 5 - RR > 50 (not as good as HR) or HR >130 If older than 5 RR >30 or HR >120 Accessory muscle use and chest recession Pulsus paradoxus Can't talk
98
Signs of life threatening asthma
Cyanosis fatigue, drowsiness and silent chest
99
What is good in treating acute asthma
Ipratropium bromide | Steroids - IV if severe
100
Most common cause of recurrent cough in children
1) URTI - common cold 2) Asthma 3) Wet - cystic fibrosis 4) GORD 5) Parents smoking
101
Chronic wet cough is indicative of...
Chronic lung infection eg. Bronchiectasis due to cystic fibrosis, primary ciliary dyskinesia, immunodeficiency or chronic aspiration
102
What is Kartagener syndrome?
Situs inversus Dextrocardia Primary ciliary dyskinesia (recurrent productive cough, purulent nasal discharge, chronic ear infections)
103
Who has chronic aspiration
Children with neurodisability
104
Incidence of cystic fibrosis
1 in 2500 live births | Carrier rate 1 in 25
105
Correlation between genotype and phenotype in CF
Weak for lung disease but stronger for GI disease | Indicates that environmental factors influence lung disease (passive smoking, social deprivation, microbial pathogens)
106
Pathogen usually causing infection in CF
Pseudomonas aeruginosa
107
Incidence of meconium ileus in infants with CF
10-20%
108
Other organ affected in CF
Pancreas - pancreatic enzyme deficiency leads to malabsorption Also sweat glands - increased sodium and chloride in sweat
109
Presentation of CF if not picked up at heel-prick screening x3
Recurrent chest infections, poor growth and malabsorption
110
Examination (resp) in CF
Hyperinflation (air trapping), coarse inspiratory creps and/or expiratory wheeze Established disease - clubbing
111
Disease in older CF children
DM due to pancreatic dysfunction
112
Diagnosis of CF
Sweat test Cl 60-120 (10-40normal) Stimulated by pilocarpine iontophoresis
113
Drugs in CF
Prophylactic antibiotics - usually flucloxacillin Nebulised DNAse or hypertonic saline to decrease sputum viscosity Macrolide antibiotic azithromycin - immunomodulatory not antibiotic action
114
Eventual treatment for CF lung disease
Lung transplant Fortunately not needed in childhood Usually 50% 10 year survival rate
115
Diet in CF
High calorie 150% of normal | Fat soluble vitamin supplements
116
Organ problems in older patients with CF
1/3 have evidence of liver disease - hepatomegaly or LFT abnormalities
117
Fertility in CF
Females normal | Males always infertile due to absent vas deferens (have sperm therefore can have kids with ICSI)
118
What is Guthrie test
Heel prick test for CF for all children

Paediatrics (16 decks)

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