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Respiratory Flashcards

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1
Q

URTI- presentation

A

fever, painful throat, nasal discharge, earache

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2
Q

URTI- complications

A

difficulty in feeding, febrile convulsions, acute exacerbations of asthma

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3
Q

commonest pathogens in coryza

A

RSV, rhinovirus, coronavirus

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4
Q

tonsilitis pathogens

A

viruses or bacteria- group A b haemolytic strep, EBV

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5
Q

bacterial causes in tonsilitis shown by

A

constitutional symptoms- headache, apathy, abdominal pain, white tonsillar exudate, cervical lymphadenopathy

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6
Q

what do you treat tonsilitis with

A

penicillin or erythromycin. avoid amoxicillin as if EBV infection then will lead to maculopapular rash

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7
Q

indications for tonsillectomy

A

recurrent severe, Quinsy, obstructive sleep apnoea

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8
Q

why are infants prone to acute otitis media

A

short, horizontal Eustachian tubes which dont function well

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9
Q

what is seen on examination of tympanic membrane in acute otitis media

A

red bulging tympanic membrane, loss of normal light reflex

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10
Q

complications acute otitis media

A

mastoiditis and meningitis

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11
Q

what can be given to treat acute otitis media

A

amoxicillin

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12
Q

indications for adenoidectomy

A

recurrent otitis media with effusion with hearing loss, obstructive sleep apnoea

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13
Q

presentation of laryngeal/tracheal infection

A

stridor, hoarseness, barking cough, dyspnoea. chest recession, RR, HR, agitation. do not examine throat

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14
Q

most common pathogen in croup

A

parainfluenza. others- influenza, RSV

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15
Q

presentation croup

A

barking cough, hoarse. preceded by coryza. worse at night

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16
Q

treatment moderate croup

A

oral dexamethasone, prednisolone, nebulised steroids

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17
Q

treatment severe croup

A

neb adrenaline and warm humidified O2 via face mask

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18
Q

what happens in croup

A

laryngotracheobronchitis. mucosal inflammation and increased secretions. oedema of subglottic area is the dangerous part as leads to narrowing of trachea

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19
Q

what is bacterial tracheitis (pseudomembranous croup)

A

similar to croup but fever, appears toxic, copious secretions. caused by staph aureus, treat with IV antibios and intubate and ventilate

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20
Q

what is acute epiglottitis due to

A

H influenza type b

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21
Q

what happens to patient with epiglottitis

A

intubation with anaesthetic. then cefuroxime for 3-5 days

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22
Q

what prophylactic drug should be given to household contacts of pt with acute epiglottitis

A

rifampicin

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23
Q

difference between croup and acute epiglottitis

A

epiglottitis- more acute onset, no cough, soft insp stridor instead of harsh, no preceding coryza, high grade fever, not able to drink, drooling, toxic very ill appearance

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24
Q

what is whooping cough caused by

A

bordatella pertussis

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25
phases of whooping cough
catarrhal phase (runny nose, coryza for a week), paroxysmal phase (coughing followed by whoop, can lead to vomiting- lasts 3-6 weeks), convalescent phase (symptoms decline, lasts months)
26
what happens in infants when whooping is absent
apnoea
27
treatment of whooping cough
erythromycin but given in catarrhal phase. prophylactic erythromycin to household contacts
28
what is the commonest serious respiratory infection
bronchiolitis
29
what age is common in bronchiolitis and what pathogen
1-9 months, rare after 1 year. RSV in 80%
30
features bronchiolitis
coryzal symptoms, dry cough, SOB, difficulty feeding, recurrent apnoea
31
those at risk of severe bronchiolitis
premature (bronchopulmonary dysplasia), underlying lung disease, congenital heart disease
32
signs in bronchiolitis
recession, tachypnoea, fine end inspiratory crackles, wheeze, tachycardia, cyanosis/pallor
33
investigations in bronchiolitis
PCR analysis of nasopharyngeal secretions, CXR- hyperinflated chest, atelactesis
34
management in bronchiolitis- when to admit patient
supportive, humidified Ox. fluids assisted ventilation. admit if sats
35
what is a rare complication of bronchiolitis
bronchiolitis obliterans- permanent damage to airways
36
what 2 pathogens are the cause in severe bronchiolitis
RSV, metapneumovirus
37
pathogens implicated in pneumonia in newborn
organisms from mothers genital tract- group B strep
38
pathogens in pneum- infants and young children
RSV, strep pneum, H influenza, bordatella pertussis, chlamydia trachomatis
39
pathogens in pneum- children >5 years
mycoplasma pneum, strep pneum, chlamydia pneum
40
what does the conjugate vaccine in pneum work against
13 of most common serotypes of strep pneum
41
features pneumonia
fever, difficulty breathing, preceded by URTI, cough, lethargy, poor feeding, unwell child
42
signs of examination in child with pneumonia
nasal flaring, tachypnoea, chest indrawing, increased resp rate
43
classic signs pneum
dullness to percuss, decreased breath sounds and bronchial breathing- over consolidation. may be missed in children
44
what does CXR show in pneumonia
in strep pneum- lobar consolidation
45
investigations pneumonia
nasopharygeal aspirate for viral
46
complications of pneumonia
effusion, empyema,
47
management pneumonia- indications for admission
sats
48
management pneumonia
oxygen, analgesia, IV fluids
49
choice of antibiotic in pneumonia
newborn- broad spec IV antibiotics, older infant- oral amoxicillin, child >5 years- amoxicillin or erythromycin
50
how are parapneumonic effusions managed in pneumonia
antibiotics but small proportion that develop empyema need drainage- chest drain with fibrinolytic agent (urokinase) or surgical decortication
51
causes of childhood wheeze
transient early wheezing, atopic asthma (IgE mediated), non atopic asthma, recurrent aspiration of feeds, foreign body, CF
52
what is the pathophysiology of asthma
bronchial inflammation (oedema, mucus, infiltration with cells), hyperresponsiveness, airway narrowing, symptoms
53
symptoms of asthma
polyphonic wheeze, cough, SOB, chest tightness, symptoms worse at night and early in morning, symptoms that have triggers, interval symptoms, personal or family history, positive response to asthma therapy
54
assessment of child with asthma
how freq are symptoms, what triggers the symptoms, how often is sleep affected, how severe are interval symptoms, how much school has been missed
55
investigations in asthma
skin prick testing, CXR, PEFR- should be 10-15% improvement after bronchodilator
56
what happens to PEFR if uncontrolled asthma
increased variability in peak flow diurnal and day to day variability
57
what are SABAs
salbutamol, terbutaline
58
what is ipratropium bromide
anticholinergic bronchodilator
59
examples of inhaled corticosteroids
budesonide, beclametasone, fluticasone, mometasone
60
examples of LABA and when should they be used
salmeterol, formoterol- should be used with inhaled corticosteroid
61
what is montelukast
leukotriene inhibitor
62
what are the 5 steps in asthma management
1- SABA; 2- add inhaled steroid; 3- >5 add LABA, 5 increase inhaled steroid dose; 4- add extra eg montelukast; 5- add oral steroids
63
what age should you refer to paediatrician if asthma
64
signs severe asthma attack
sats 50 >5 >30; pulse >130 2-5 or >120 >5; peak flow
65
signs life threatening asthma attack
silent chest, poor resp effort, altered conciousness, cyanosis, sats
66
signs TB
anorexia, low fever, failure to thrive, malaise. cough common but may be absent.
67
diagnosis TB
tuberculin tests. culture + ziehl neelsen stain of sputa and gastric aspirate. CXR- consolidation, cavities
68
treatment TB
isoniazid, rifampicin, pyrazinamide, ethambutol
69
inheritance CF and carrier rates
autosomal recessive, 1 in 25. mutation CFTR gene on chromosome 7
70
how many CF infants present with meconium ileus. presentation of meconium ileus
10%. vomiting, abdominal distension, failure to pass meconium
71
what can CF patients be chronically infected with
staph aureus, H influenza, pseudomonas
72
features CF
recurrent chest infections, poor growth, malabsorption, persistent loose cough, purulent sputum, clubbing, steatorrhoea
73
how does pancreatic insufficiency present in CF
maldigestion and malabsorption- leads to failure to thrive. freq offensive and greasy stools. low elastase in faeces
74
diagnosis CF
sweat test- incr Cl
75
management CF
physio 2x a day- chest percussion and draining; continuous antibiotic prophylaxis- flucloxacillin. take pancreatic enzymes (creon) with every meal- oral enteric coated pancreatic replacement therapy. high caloric diet. fat soluble vitamins.
76
what are some complications CF
diabetes mellitus. infertility in males as absent vas deferens
77
what should be considered in any patient with recurrent infections, loose stools, failure to thrive
CF
78
features CF infant
meconium ileus, neonatal jaundice, FTT, recurrent chest infections, malabsorption
79
features CF young child
bronchiectasis, rectal prolapse, sinusitis, nasal polyp
80
features CF older child
diabetes, cirrhosis, portal hypertension, pneumothorax, sterility, aspergillosis

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