respiratory Flashcards

1
Q

examples of viral infective agents

A
adenovirus
influenza A, B
RSV - respiratory syncytial virus 
para'flu I, III
rhinovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

examples of bacterial infective agents

A

H influenzae, M catarrhalis, streptococci, B haemolytic S pyogenes, Non hameolyic S pneumoniae, S aureus, mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

give examples of URTI

A

rhinitis, ottitis media, tonsilitis/pharyngitis, croup, epiglottitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is rhinitis and its management

A

presents with a runny nose, usually self limiting, v common 5-10/ year, winter mainly, no antibiotic. can be a prodrome to illness - meningitis, pneumonia, bronchiolitis, septicaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is otitis media and its management ?

A

common, erythematous ear canal with bulging drum seen. can be primary viral infection or secondary bacterial infection ( pneumococcus. H’flu). drum will rupture spontaneously - antibiotics usually dont help - give analgesia and review if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

tonsilitis/ pharyngitis management ?

A

viral or bacterial ?
swabs would take 48 hours to come back. can do swab and then get patient to call in 48 hours. either nothing or 10 day penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

croup, cause, presentation and treatment ?

A

para’flu 1, common, barking cough ,stridor , coryza, but systemically well child, treat with oral dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

epiglottitis, cause , presentation and treatment ?

A

H influenzae B, rare but severe, will have stridor, drooling - needs intubation and antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

examples of LRTIs

A

tracheitis, broncitis, bronciolitis, pneumonia, pertussis, empyaema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is tracheitis and its treatment

A

croup that doesnt resolve, sick child and fever, inflammed tracheal wall and luminal debris -> narrow tracheal lumen. caused by staph or strep. treat with augmentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

bronchitis and its treatment ?

A

very common endobronial infection. loose rattly cough with URTI. post-tussive vomit. chest free of wheeze or creps. caused by haemophilus/pneumococcus. mostly self limting - no antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what causes bacterial bronchitis and its treatment?

A

disturbed muco-ciliary clearance - minor airway malacia and RSV/ adenovirus. infection secondary. History - follows URTI, lasts 4 weeks- gets better by 3rd winter - pneumococcus/ H flu. Persistent: wet cough, more than a month, remission with antibiotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are red flag signs in bronchitis?

A
age <6 months or >4 years 
static weight
disrupts childs life 
associated SOB when not coughing 
acute admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is bronchiolitis and its treatment

A

common in infants. caused by RSV, paraflu III, HMPV. presents with nasal stuffiness, tachypnoea, poor feeding. will have crackles +/- wheeze. < 12 months old. ONE off NOT recurrent. management - minimal intervention, maximal observation - have a nasopharyngeal airway and monitor oxygen sats.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how does CA pneumonia present and how is it managed?

A

bronchial breath sounds, fever, SOB, cough, grunting. pneumonia is focal sings + creps + fever. cause can be mixed, viral or bacteria pneumococcus, mycoplasma.
Mx: if mild do nothing , oral amoxycillin if moderate, only IV if vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is pertussis and how is it managed ?

A

pertussis presents as coughing fits, vaccination reduced the risk and severity of it.

17
Q

how do you manage empyaema ?

A

it is a complication of pneumonia where the infection has extended into the pleural space, should use IV antibiotics and drain if needed

18
Q

what is asthma ?

A

chronic, wheeze, SOB at rest and cough ( dry, nocturnal , exertional), ideally 1 trigger

19
Q

what can be triggers for asthma ?

A

exercise, cold air, smoking, allergens, rhinovirus, menstruation, emotion

20
Q

what are the similarities for asthma in children and adults

A

same symptoms, same triggers, same pathology, same treatment , common in both

21
Q

what are differences in asthma in adults and children

A

boys more common in children and women in adults, occupational asthma uncommon , severity differs

22
Q

what causes asthma?

A
multiple hit:
genetic 
inherently abnormal lungs
early onset atopy 
later exposure - rhinovirus, smoking, excercise, allergen
23
Q

what causes a wheeze in asthma ?

A

bronchoconstriction , aieway wall thickening, increased luminal secretions

24
Q

how to tell if asthma or not ?

A

should have wheeze, sob and cough , try ICS for 8 weeks then break and see if returns ?

25
Q

what are DDx for asthma ?

A

ciliary dyskinesia, cystic fibrosis, foreign body, immune deficiency, viral induced wheeze

26
Q

how do you treat infrequent episodic wheeze plus a cold

A

salbutamol

27
Q

when is it not asthma ?

A

if no wheeze, if under 18 months more likely infection, if it is an isolated cough only then - bronchitis, pertussis etc

28
Q

what are the goals of asthma management?

A
minimal day time and night time symptoms
minimal nocturnal symptoms
no attacks or exacerbations
no limitations to physical activity 
normal lung function
29
Q

how do you measure asthma control ?

A
SANE 
s - saba use per week
a - absence form school or nursery 
n- nocturnal symptoms per week 
e- excertional symptoms per week
30
Q

what do you need to consider if treatment not working for asthma ?

A

is it really asthma ? are they taking the treatment ? are they taking it correctly? dose increase?

31
Q

contrast between children and adult asthma care ?

A

max dose ICS 800 microg
LTRA is first dose for < 5 year old
no oral B2 tablet

32
Q

what is the asthma management steps in children ?

A

step 1 - start low dose ICS or LTRA < 5 yo
step 2 - children > 5 add LABA and children > 5 add ICS?
step 3 - if LABA not working then remove, increase ICS dose, consider adding LTRA
step 4 - can increase dose of ICS up to medium dose and consider adding theophylline
step 5 - daily steroid tablet
step 6 - experimental medicine - half psychological and half compliance issues

33
Q

what should you sue for exacerbations of asthma ?

A

salbutamol - SABA - if using more than 3 times a week needs stepped up on treatment

34
Q

what are side effects from ICS?

A

height suppression, oral candiasis?

35
Q

benefits of MDI spacer over nebuliser

A

quieter, cheaper, quicker, portable, valve mechanism, dont breakdown

36
Q

how to manage acute asthma ?

A
  • SABA via spacer
  • SABA via nebuliser
  • IV salbutamol + intubate and ventilate
    acute = oral steroids and chronic = inhaled