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Flashcards in Respiratory Deck (80):
1

URTI- presentation

fever, painful throat, nasal discharge, earache

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URTI- complications

difficulty in feeding, febrile convulsions, acute exacerbations of asthma

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commonest pathogens in coryza

RSV, rhinovirus, coronavirus

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tonsilitis pathogens

viruses or bacteria- group A b haemolytic strep, EBV

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bacterial causes in tonsilitis shown by

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

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what do you treat tonsilitis with

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

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indications for tonsillectomy

recurrent severe, Quinsy, obstructive sleep apnoea

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why are infants prone to acute otitis media

short, horizontal Eustachian tubes which dont function well

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

red bulging tympanic membrane, loss of normal light reflex

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complications acute otitis media

mastoiditis and meningitis

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what can be given to treat acute otitis media

amoxicillin

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indications for adenoidectomy

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

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presentation of laryngeal/tracheal infection

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

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most common pathogen in croup

parainfluenza. others- influenza, RSV

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presentation croup

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

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treatment moderate croup

oral dexamethasone, prednisolone, nebulised steroids

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treatment severe croup

neb adrenaline and warm humidified O2 via face mask

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what happens in croup

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

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what is bacterial tracheitis (pseudomembranous croup)

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

20

what is acute epiglottitis due to

H influenza type b

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what happens to patient with epiglottitis

intubation with anaesthetic. then cefuroxime for 3-5 days

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

rifampicin

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difference between croup and acute epiglottitis

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

24

what is whooping cough caused by

bordatella pertussis

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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)

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what happens in infants when whooping is absent

apnoea

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treatment of whooping cough

erythromycin but given in catarrhal phase. prophylactic erythromycin to household contacts

28

what is the commonest serious respiratory infection

bronchiolitis

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what age is common in bronchiolitis and what pathogen

1-9 months, rare after 1 year. RSV in 80%

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features bronchiolitis

coryzal symptoms, dry cough, SOB, difficulty feeding, recurrent apnoea

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those at risk of severe bronchiolitis

premature (bronchopulmonary dysplasia), underlying lung disease, congenital heart disease

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signs in bronchiolitis

recession, tachypnoea, fine end inspiratory crackles, wheeze, tachycardia, cyanosis/pallor

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investigations in bronchiolitis

PCR analysis of nasopharyngeal secretions, CXR- hyperinflated chest, atelactesis

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management in bronchiolitis- when to admit patient

supportive, humidified Ox. fluids assisted ventilation. admit if sats

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what is a rare complication of bronchiolitis

bronchiolitis obliterans- permanent damage to airways

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what 2 pathogens are the cause in severe bronchiolitis

RSV, metapneumovirus

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pathogens implicated in pneumonia in newborn

organisms from mothers genital tract- group B strep

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pathogens in pneum- infants and young children

RSV, strep pneum, H influenza, bordatella pertussis, chlamydia trachomatis

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pathogens in pneum- children >5 years

mycoplasma pneum, strep pneum, chlamydia pneum

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what does the conjugate vaccine in pneum work against

13 of most common serotypes of strep pneum

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features pneumonia

fever, difficulty breathing, preceded by URTI, cough, lethargy, poor feeding, unwell child

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signs of examination in child with pneumonia

nasal flaring, tachypnoea, chest indrawing, increased resp rate

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classic signs pneum

dullness to percuss, decreased breath sounds and bronchial breathing- over consolidation. may be missed in children

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what does CXR show in pneumonia

in strep pneum- lobar consolidation

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investigations pneumonia

nasopharygeal aspirate for viral

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complications of pneumonia

effusion, empyema,

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management pneumonia- indications for admission

sats

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management pneumonia

oxygen, analgesia, IV fluids

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choice of antibiotic in pneumonia

newborn- broad spec IV antibiotics, older infant- oral amoxicillin, child >5 years- amoxicillin or erythromycin

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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

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what is the pathophysiology of asthma

bronchial inflammation (oedema, mucus, infiltration with cells), hyperresponsiveness, airway narrowing, symptoms

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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

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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

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investigations in asthma

skin prick testing, CXR, PEFR- should be 10-15% improvement after bronchodilator

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what happens to PEFR if uncontrolled asthma

increased variability in peak flow diurnal and day to day variability

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what are SABAs

salbutamol, terbutaline

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what is ipratropium bromide

anticholinergic bronchodilator

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examples of inhaled corticosteroids

budesonide, beclametasone, fluticasone, mometasone

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examples of LABA and when should they be used

salmeterol, formoterol- should be used with inhaled corticosteroid

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what is montelukast

leukotriene inhibitor

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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

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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

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signs life threatening asthma attack

silent chest, poor resp effort, altered conciousness, cyanosis, sats

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signs TB

anorexia, low fever, failure to thrive, malaise. cough common but may be absent.

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diagnosis TB

tuberculin tests. culture + ziehl neelsen stain of sputa and gastric aspirate. CXR- consolidation, cavities

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treatment TB

isoniazid, rifampicin, pyrazinamide, ethambutol

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inheritance CF and carrier rates

autosomal recessive, 1 in 25. mutation CFTR gene on chromosome 7

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how many CF infants present with meconium ileus. presentation of meconium ileus

10%. vomiting, abdominal distension, failure to pass meconium

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what can CF patients be chronically infected with

staph aureus, H influenza, pseudomonas

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features CF

recurrent chest infections, poor growth, malabsorption, persistent loose cough, purulent sputum, clubbing, steatorrhoea

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how does pancreatic insufficiency present in CF

maldigestion and malabsorption- leads to failure to thrive. freq offensive and greasy stools. low elastase in faeces

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diagnosis CF

sweat test- incr Cl

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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.

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what are some complications CF

diabetes mellitus. infertility in males as absent vas deferens

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what should be considered in any patient with recurrent infections, loose stools, failure to thrive

CF

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features CF infant

meconium ileus, neonatal jaundice, FTT, recurrent chest infections, malabsorption

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features CF young child

bronchiectasis, rectal prolapse, sinusitis, nasal polyp

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features CF older child

diabetes, cirrhosis, portal hypertension, pneumothorax, sterility, aspergillosis