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Flashcards in Respiratory Deck (41):
1

What are the most common pathogens responsible for croup?

Parainfluenza 1-4, adenovirus, influenza, RSV

2

What is the typical presentation of croup?

Prodromal coryzal symptoms followed by seal-like barking cough and hoarseness ± inspiratory stridor ± respiratory distress (recession etc.) Worst at night.

3

What age does croup typically occur?

6m to 6y (peak in 2nd year)

4

How is croup severity graded?

The Wesley clinical scoring system, using points for stridor, recession, air entry, cyanosis, LoC.

5

How is croup managed?

Mild: single dose PO dexamethasone, parental advice, conservative measures.

Moderate / severe: hospital assessment ± nebulised steroids ± nebulised adrenaline ± O2.

Impending respiratory failure: intubate.

6

What is the most common pathogen responsible for epiglottitis?

Haemophilis influenzae B (since intro of Hib vaccine, now very rare)

7

What is the usual presentation of epiglottitis?

Sore throat, odynophagia (thus off food, drooling), 'hot-potato' voice, fever, toxic looking, stridor, respiratory distress (± tripod position).

Rarely have cough, thus useful to distinguish from croup. Also, quicker onset (hours).

8

What age does epiglottitis typically occur?

1-6 years.

9

What must you NOT do to patients with epiglottitis?

Examine their throat or neck. It risks distressing them and closing the airway even more.

10

What investigations are required for epiglottitis?

Laryngoscopy followed by throat swabs and bloods (cultures).

A lateral neck X-ray may show thumbprint sign.

11

What is management for epiglottitis?

Ensure airway is managed, availability of intubation. IV / oral ABx ± steroids ± adrenaline.

12

What is the most common pathogen responsible for bronchiolitis?

RSV (+ adenovirus, influenza)

13

What is the usual presentation of bronchiolitis?

Prodromal coryzal symptoms, cough, off food + fluids, irritability, expiratory wheeze / late inspiratory crackles, respiratory distress, apnoeas (in young), tachycardia.

14

What age does bronchiolitis typically occur?

1-12 months.

15

What investigations are required for bronchiolitis?

Pulse oximetry is the most important. Do not routinely do CXR or bloods.

Consider cultures and ABG for very unwell patients.

16

What is the management of bronchiolitis? How can it be prevented?

Respiratory support (O2, CPAP) and NG fluids.

Scant evidence for steroids or nebulised bronchodilators / saline.

Palivizumab is a monoclonal antibody given to high-risk preterm infants.

17

What is the usual pathogen responsible for bacterial tracheitis?

Staph. aureus

18

What is the presentation of bacterial tracheitis?

Prodromal coryzal + croup-like symptoms, but after 2-7 days a sudden deterioration.

Fever, toxic appearance, progressive airway obstruction, poor response to nebulised adrenaline.

19

What investigation is required?

Bronchoscopy

20

What is the management of bacterial tracheitis?

Intubation and IV antibiotics.

21

What age does bacterial tracheitits typically occur?

6-14 months.

22

What are other causes of stridor? (Not croup, epiglottitis or bacterial tracheitis)

Foreign body inhalation, anaphylaxis, laryngomalacia, compression by vascular ring / lymph nodes / tumour.

23

What is viral induced wheeze?

Wheeze symptoms in conjunction with a viral illness. The child is well in between episodes.

24

What is the peak age of viral induced wheeze?

1-3 years.

25

What are common triggers for atopic asthma symptoms?

Viruses, cold air, dust, animal dander and exercise.

26

What are key features of asthma?

Interval symptoms (not just viral induced), worst at night, history of atopy, positive response to bronchodilators.

27

How can asthma be diagnosed?

Ages 3-5 years can be diagnosed on clinical history alone. Above 5 years, children can use PEFR or spirometry.

28

What is step-wise management of asthma?

1) SABA
2) + low-dose ICS (or consider LTRA if <5y)
3) <5y add LTRA if not already. >5y trial LABA.
4) High dose ICS, theophylline etc.

29

What is criteria for moderate acute asthma?

Able to talk
O2 >92%
PEFR >50%
RR <40(2-5y), <30(5-12y), <25(12-18y)
HR <140 (2-5y), <125(5-12y), <110 (12-18y)

30

What is the criteria for severe acute asthma?

Too breathless to talk
O2 <92%
PEFR 33-55%
RR >40(2-5y), >30(5-12y),>25(12-18y)
HR >140(2-5y), >125(5-12y), >110(12-18y)

31

What is criteria for life threatening acute asthma?

Silent chest
Poor resp effort
Arrhythmia / low BP
Reduced LoC
PEFR <33%

32

What is management of asthma attack?

1) SABA via spacer (2-10 puffs every 10-20 minutes)
2) O2
3) SABA via neb (2.5mg <5y, 2.5-5.0mg 5-11y, 5mg >11y every 20-30 minutes)
4) Oral (or IV) steroid for 3 days
5) Ipratropium +/- magnesium +/- aminophylline
6) ICU

33

What is pathogen responsible for pertussis?

Bordetella pertussis

34

What is typical presentation of pertussis?

Unvaccinated child, prodromal coryzal symptoms followed by paroxysmal / spasmodic cough (child turning red or blue) with inspiratory whoop. Often followed by epistaxis, subconjunctival haemorrhage and vomiting.

35

What investigations are required for pertussis?

Nasal swab and culture, bloods (very high lymphocyte count)

36

What is management of pertussis?

Macrolide (clarithromycin, azithromycin, erythromycin)

37

What are the different pathogens responsible for pneumonia at different ages?

Neonate: bacteria from maternal genital tract (Group B Strep, Gram-negative enterococci and bacilli)

Infants / young children: RSV, Strep pneumoniae, Haem influenzae, Bordetella pertussis, Chlamydia trachomatis

>5y: Mycoplasma pneumoniae, Strep pneumoniae, Chlamydia pneumoniae

38

What is the management of pneumonia?

Newborn: broad spectrum IV ABx

Infants: Amoxicillin, with co-amoxiclav for severe or resistant

Children: Amoxicillin or eythromycin

39

What are common causes of bronchiectasis?

CF, PCD, immunodeficiency, chronic aspiration, focal pneumonia, foreign body inhalation.

40

What is the carrier rate of CF gene?

1 in 25 people carry CF gene. (1 in 2500 live births)

41

What are the features of CF?

Neonate: +ve heel prick (immunoreactive trypsinogen), meconium ileus

Infant: prolonged neonatal jaundice, faltering growth, recurrent chest infections, malabsorption and steatorrhoea

Child: bronchiectasis, nasal polyps, sinusitis

Older: DM, cirrhosis, intestinal obstruction, pneumothorax, sterility