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Respiratory Flashcards

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1
Q

What is the commonest cause of serious respiratory infection of infancy?

A

Bronchiolitis

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2
Q

What percentage of those with bronchiolitis are between 1-9months?

A

90%

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3
Q

What pathogen commonly causes bronchiolitis?

A

RSV (respiratory syncytial virus) - 80% cases.

Others:

  • Parainfluenza virus
  • Rhinovirus
  • Adenovirus
  • Influenza virus
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4
Q

What findings are typically found on examination in bronchiolitis?

A
  • Dry cough
  • Cyanosis and pallor
  • Subcostal and intercostal recession
  • Hyperinflation of the chest:
    • Sternum prominent
    • Liver displaced downwards
  • fine end-inspiratory crackles
  • prolonged expiration with wheeze
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5
Q

What Ix is typically done in bronchiolitis?

A
  • PCR for identifying virus.

- CXR in more serious cases = hyperinflation of lung

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6
Q

What is the management in bronchiolitis?

A

Supportive -
- Humidified oxygen

RSC is highly infective so good hand hygiene is essential.

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7
Q

What is the prognosis like of bronchiolitis?

A

recovery ~ 2 weeks.

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8
Q

In severe cases of bronchiolitis, what permanent damage can be done to the airways, what is this know as?

A

Bronchiolitis obliterans.

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9
Q

List the most common respiratory illnesses in - neonates, infants, under-5s and over 5s:

A

Neonates (0-28days):

  • Respiratory distress syndrome
  • Pneumonia

Infants (up to 1 yr):

  • Bronchiolitis
  • Pneumonia
  • Croup

Under-5s:

  • Viral induced wheeze
  • Croup
  • Pneumonia

Over-5s:

  • Asthma
  • Pneumonia

(basically only difference is in definition of those with asthma like symptoms)

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10
Q

List 7 signs which can be seen in respiratory distress:

A
  • Head bobbing
  • Nasal flaring
  • Tracheal tug
  • Tachypnoea
  • Recessions
  • Use of accessory muscles
  • Abdominal breathing
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11
Q

What is a ‘buzz phrase’ in terms of describing respiratory distress?

A

‘Increased work of breathing’

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12
Q

What is stridor and in what conditions can it be heard?

A

Sound hear on inspiration, low to medium pitched. Signifies airway obstruction.
Associated with croup and epiglottitis

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13
Q

What is stertor? When is it typically heard?

A

Noisy snoring-type breathing that results from airway obstruction in the nose, nasopharynx or oropharynx.

Viral URTI (snotty nose) or obstructive sleep apnoea.

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14
Q

What is grunting and when is it heard?

A

End-expiratory sounds due to closure of epiglottis. Self-induced positive end-expiratory pressure to keep airways open (self-PEEP). Similar to pursed lips expiration in adults with emphysema.

Heard due to severe respiratory distress.

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15
Q

What is wheeze? When is it typically heard?

A

A whistling sound on expiration: flow of high-velocity air through narrowed airways.

Heard in asthma, viral induced wheeze, anaphylaxis and foreign body aspiration.

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16
Q

What are the symptoms of bronchiolitis?

A 
Prodrome (3 days):
- Cold/harsh cough
Illness (3 days):
- Fever
- wheeze
- Breathlessness
(3 day recovery)
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17
Q

List 4 features prompting admission in those with bronchiolitis:

A
  • Poor feed (<50%/24hrs)
  • RR >50/min
  • Apnoea
  • Dehydration
  • SpO2 <94%
  • Respiratory distress
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18
Q

What children are at risk of severe bronchiolitis?

A
  • Preterms
  • Chronic lung disease
  • Heart condition
  • Immunodeficiency
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19
Q

Why does respiratory acidosis occur?

A

Due to decreased ventilation resulting in a higher pCO2 (hypercapnia). Respiratory alkalosis occurs due to hyperventilation (?)

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20
Q

What would you see in an FBC in whooping cough?

A

Lymphocytosis (more lympocytes)

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21
Q

What is given to those with increased risk of bronchiolitis?

A

Palivizumab - MAb to RSV surface protein (passive immunity). Make illness less severe.

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22
Q

What is asthma?

A

Chronic inflammatory disorder characterised by reversible obstruction of the airways.

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23
Q

Under what age is it difficult to diagnose asthma?

A

Under 3

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24
Q

What features of asthma suggest life threatening asthma?

A
  • Any sign of altered consciousness
  • Signs of respiratory falling/failing
  • PEF <33% normal
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25
What are signs of moderate asthma?
- PEF >50% | - No clinical Features of severe asthma
26
Outline the management of moderate, severe and life threatening asthma:
Moderate: - Beta2 agonists 2-10 puffs via spacer - oral prednisolone Severe: - Beta2 agonist 1- puff via spacer or nebulised - Oral prednisolone or IV hydrocortisone - If poor response nebulise ipratropium bromide Life-threatening: - Nebulise Beta2 agonist and ipratropium bromide - Oral prednisolone or IV hydrocortisone - Discuss with senior clinician, PICU team or paediatrician
27
What acronym is used for the acute treatment of asthma?
``` (OSHIT!) O - O2 S - Salbutamol H - Hydrocortisone I - Ipratropium bromide T - Theophylline (relaxes airway) ! - MgSulphate (bronchodilating and anti-inflammatory effect) ```
28
What is nor present in viral induced wheeze?
- Interval symptoms | - PMH of atopy
29
What is viral induced wheeze and who does it typically affect?
Wheeze episode associated with viral URTI. Typically in children <5 years old.
30
What is the 'buzz phrase for viral wheeze?
'No interval symptoms'
31
What is the management for viral induced wheeze?
ABCD | steroids not currently indicated
32
What is acute viral laryngotracheobronchitis know as?
Croup
33
What is the commonest cause of stridor in children?
Croup
34
What characterises croup? What age group is typically affected?
- Hoarse voice - Barking cough - +/- respiratory distress Affects those 6 months - 6 years
35
What typically causes acute viral laryngotrachealbronchitis?
Parainfluenza virus
36
What is the management for croup?
Steroids | +/- adrenaline nebs
37
What is seen in acute epiglottitis but not in croup?
- Drooling | - Very unwell/toxic
38
Why is epiglottits rare?
Rare due to Hib vaccination
39
Outline the management in someone with epiglottitis?
- Leave patient alone - Summon Paeds anaesthetist and ENT surgeon - Abx once airway is secured
40
Give 6 indications for hospitalisation:
- Cyanosis - Pallor - Respiratory distress - Hypoxaemic - Stridor - Toxic looking child
41
What is the inheritance pattern in Cystic Fibrosis (CF)?
Autosomal recessive. | 1 in 25 people in the UK are CF carriers.
42
What is the commonest mutation in those with CF?
Chromosome 7 - Delta F508
43
Outline why the symptoms of CF develop:
1) Mutation of chromosome 7 2) Abnormal cystic fibrosis transmembrane conductance regulator protein (CFTR) 3) Responsible for cellular chloride secreations 4) Thick secretions 5a) This results in pancreatic insufficiency -> DM and malabsorption 5b) Recurrent chest infections + Bronchiectasis 6) These both results in faltering growth and chronic poor health (infertility is also a feature)
44
When should CF be diagnosed? What would be raised in a positive result?
During the Guthrie test at day 5. Raised immunoreactive trypsin (IRT).
45
List 5 features of CF:
- Short stature - Malabsorption - Failure to thrive - Chronic cough - Recurrent chest infections
46
What is the gold standard test in diagnosis of CF? What results suggest a CF?
Sweat test. >60mmol/l - 2 abnormal tests necessary for diagnosis.
47
What other investigations maybe performed in someone suspected of CF and what would be seen?
Genetics - 98% detected on genetic testing. CXR - Hyperinflation, peribronchial thickening, bronchiectasis Lung function testing - Obstructive picture Sputum - haemophilus influenzae, staph. aureus, pseudomonas aeruginosa, burkholderia cepacia, E. Coli, klebsiella
48
Outline what services may be involved in the care of someone with CF?
- Physiotherapy (to bring up muccus) - Medical - Paeds, endocrine, GP, transplant team - Nursing - Psychosocial - Education - Dietician (fat soluble vitamins, DM may develop)
49
What respiratory management may be needed for those with CF?
- Bronchodilators - Chest physio - Mucolytics (carbocystine) - Abx +/- prophylaxis
50
List one mucolytic:
Carbocystine
51
What may be found on examination in someone with CF?
- Cyanosis - Clubbing - Weight loss - Dry skin - Steatorrhoea
52
List the top 3 viral causes and the top 3 bacterial causes of pneumonia:
Viral: - RSV (Bronchiolitis) - parainfluenzae (croup) - Adenovirus Bacterial: - Strep. pneumoniae - Mycoplasma pneumoniae - Chlamydia pneumoniae
53
How is a 'mild chest infection managed'?
(mild pneumonia) Generally well child with fever and cough. SpO2 >93% Mangement: - At home - Oral abx (<5s = amoxicillin, >5s get erythromycin) - Safety netting
54
How should a child with 'moderate to severe' pneumonia be managed?
``` Unwell child, respiratory distress, poor fluid intake. Management: - Admit on ward - Oxygen to maintain sats >92% - IV Abx and fluids - Close observation ```
55
When are asthma symptoms typically worse?
- Night time - Exercise - cold to hot ect.
56
How many puffs of salbutamol are equivalent to a nebuliser?
10 puffs. Nebuliser only needed if patient is on O2
57
How many puffs 4 hourly should be allowed before help should be seeked? (shit grammer oh well)
10 puffs per 4 hours
58
When should a preventer inhaler be introduced?
If a reliever inhaler is needed more than once a day 5 times per week.
59
What therapy should be added on if a simple preventer/ beta2 agonist isn't working?
LABA and/or montelukast
60
What does montelukast do?
Leukotriene receptor antagonist. It is used as a preventer in chronic asthma. 2/3 of children respond
61
What may present as a maculopapullar rash?
``` Measles Rubella Scarlet fever Kawasakis Drugs ```
62
What may present as a petechial purpuric rash?
HSP ITP Meningococcal
63
What may present as a bullous rash/skin lesions?
Impetigo | Scalded skin syndrome
64
What may present as a vesicular rash?
- Chicken pox - Hand + foot + mouth - Herpes

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