Respiratory Flashcards

(81 cards)

1
Q

How many ribs are normal to visualise on a paediatric CXR?

A

6 anterior

9 posterior

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2
Q

Why is a caesarean a risk factor for respiratory distress syndrome?

A

Birth contractions during vaginal labour result in increased levels of glucocorticoids which aid lung maturation and surfactant distribution

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3
Q

Why is maternal diabetes mellitus a risk factor for respiratory distress syndrome?

A

Insulin inhibits surfactant production

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4
Q

What are the x-ray features of an infant with respiratory distress syndrome?

A

Reticulogranular ground-glass densities (fibrinous exudates from epithelial damage)

Air bronchograms (tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates)

Low lung volumes (airway collapse)

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5
Q

What is the main marker of foetal lung immaturity assessed by amniocentesis for respiratory distress syndrome?

A

Lecithin-sphingomyelin ratio <1.5

The amount of sphingomyelin in the amniotic fluid stays consistent during pregnancy

The lecithin concentration (the major component of surfactant) varies depending on the amount of surfactant present

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6
Q

What is the major long-term complication of prolonged mechanical ventilation and oxygen in neonates with respiratory distress syndrome?

A

Bronchopulmonary dysplasia

Chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy for neonatal RDS

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7
Q

How is neonatal respiratory distress syndrome prevented?

A

Antenatal corticosteroid therapy administered to the mother

Stimulates infant lung maturation

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8
Q

What is the most common cause of respiratory distress in term infants?

A

Transient tachypnoea of the newborn

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9
Q

What causes transient tachypnoea of the newborn?

A

Delay in the resorption of lung fluid

Mostly occurs in those born by caesarean section

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10
Q

What is the medical management for mild croup?

A

Prednisolone or oral dexamethasone

Reduces airway swelling, long-lasting

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11
Q

What is the medical management of severe croup?

A

Inhaled adrenaline (fast onset)

AND

Dexamethasone

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12
Q

Haemophilus influenzae type b typically caused which disease?

A

Epiglottitis

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13
Q

What is the management of bronchiolotis?

A

Supportive

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14
Q

What is the characteristic feature of laryngitis?

A

Hoarseness

Non-specific

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15
Q

Preterm infants suffer what due to insufficient surfactant production and/or distribution?

A

Neonatal respiratory distress syndrome

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16
Q

Why can infants with respiratory distress syndrome develop hyaline membrane disease

A

Hypoxemia and hypercapnia → vasoconstriction of the pulmonary vessels and acidotic metabolism → intrapulmonary right to left shunt → increased permeability due to alveolar epithelial damage → fibrinous exudation within the alveoli → development of hyaline membranes in the lungs (hyaline membrane disease)

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17
Q

Which type of asthma is typically triggered by allergens or environmental antigens?

A

Extrinsic (allergic)

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18
Q

Which type of asthma is typically triggered by drugs, respiratory tract infections, physical exertion and cold air?

A

Intrinsic (non-allergic)

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19
Q

What is the methacholine challenge test?

A

Used for diagnosing asthma when spirometry is unclear or diagnosis in doubt

Methacholine is administered and FEV1 is monitored for a drop

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20
Q

What is fluticasone?

A

An inhaled corticosteroid

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21
Q

What is montelukast?

A

Leukotriene-receptor antagonist

Decreases bronchoconstriction and inflammation

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22
Q

What is the MoA of omalizumab?

A

Anti-IgE antibody that binds to serum IgE

  • reduces IgE binding to basophils and mast cells
  • reduces surface expression of the IgE receptor on basophils and mast cells with long-term use
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23
Q

What is status asthmaticus?

A

An extreme asthma exacerbation that does not respond to initial treatment with bronchodilators

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24
Q

What is the definition of pulsus paradoxus?

A

Inspiratory fall in SBP > 10 mmHg

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25
What normally occurs to BP during inspiration and why?
Decreases Inhalation → decrease in intrathoracic pressure → blood flows into the RV + blood pools in the lungs → compression on the LV → decreased stroke volume and peripheral pulses
26
Why does asthma cause pulsus paradoxus?
BP normally drops with inspiration due to increased RV volume and blood in the pulmonary vasculature that compresses the LV ## Footnote **During epsiodes of airway resistance, negative intrathoracic pressure seen on inspiration is greater than normal so this physiological response is exaggerated**
27
What is the most common cause of the common cold?
Rhinovirus
28
Vesicles on the posterior pharynx are characteristic of which disease?
Herpangina (coxsackie)
29
An amoxicillin-induced rash is characteristic of which disease?
EBV/infectious mononucleosis
30
What does a monophonic wheezes suggest?
Fixed obstruction e.g. foreign body, tumour
31
List 4 potential complications of sinusitis
1. Periorbital/orbital cellulitis 2. Meningitis 3. Encephalitis 4. Cavernous sinus thrombosis 5. Cerebral/subdural/epidural abscess 6. Osteomyelitis of the frontal bone
32
What anitbiotic is given for sinusitis when indicated?
Amoxycillin Only in severe or protracted illness
33
Which 3 agents are most commonly responsible for acute bacterial rhinosinusitis?
* Streptococcus pneumoniae* * Haemophilus influenzae* * Moraxella catarrhalis*
34
Why is a normal or high PaCO2 during an asthma attack concerning?
Normally: hyperventilation → low PaCO2 The PaCO2 will increase if the patient's respiratory muscles are fatiguing → respiratory failure
35
What is the clinical course of bronchiolitis?
Begins with upper respiratory tract symptoms Lower respiratory symptoms and signs develop on days 2-3 Symptoms peak on days 3-5 Resolve over the next 2-3 weeks
36
What are the three best ways of assessing disease severity in a child with bronchiolitis?
1. O2 saturations 2. Work of breathing 3. Feeding
37
What is the salbutamol dose for children having an acute asthma attack?
0-5 years/\<20kg: 6 puffs 6+ years/\>20kg: 12 puffs
38
What is the monoclonal antibody that binds IgE?
Omalizumab
39
What is the definition of good asthma control?
*All of* Daytime symptoms ≤2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator) No limitation of activities No symptoms during night or when wakes up Need for reliever ≤2 days per week
40
What is the definition of partial asthma control?
*Any of* Daytime symptoms \>2 days per week (lasting only a few minutes and rapidly relieved by rapid-acting bronchodilator) Any limitation of activities Any symptoms during night or when wakes up Need for reliever \>2 days per week
41
What is the definition of poor asthma control?
*Either of* Daytime symptoms \>2 days per week (lasting from minutes to hours or recurring, and partially or fully relieved by rapid-acting bronchodilator) ≥3 features of partial control within the same week
42
What is the stepwise escalation of asthma medications in children?
1. SABA as needed (all children) 2. ICS (low dose) 3. ICS/LABA (low dose) 4. ICS/LABA (high dose) 5. Referral
43
What is the most notable adverse effect of montelukast?
Aggressive behaviour
44
What is the MoA of cromoglycate?
Inhibits release of inflammatory mediators from mast cells
45
How does adrenaline work to relieve airway obstruction in patients with croup?
Constricts precapillary arterioles + decreases capillary hydrostatic pressure → fluid reabsorption → improvement of airway oedema
46
What O2 saturations correspond with mild, moderate and severe asthma?
Mild: \>94% Moderate: 90-94% Severe: \< 90%
47
A low-pitched, continuous wheeze which usually clears after coughing is characteristic of which adventitial sound?
Rhonchi Often resembles snoring https://www.youtube.com/watch?v=nokZ5sNt3fA
48
What is the second most common cause of bronchiolitis in children?
Rhinovirus
49
What is the mechanism of sodium cromoglycate?
Inhibits release of inflammatory mediators from mast cells
50
What is the difference between aminophylline and theophylline?
Aminophylline = managing asthma exacerbations Theophylline = preventor
51
When is aminophylline used during asthma exacerbation management?
Inadequate response to salbutamol ## Footnote *Evidence is limited for children and non-existent for adults*
52
What is the major adverse effect of aminophylline?
Vomiting *Also giddiness and cardiac arrythmias*
53
When is tiotropium used for asthma?
Alongside ICS + LABA when asthma remains moderate/severe In consultation with a specialist
54
What is the role of azithromycin for asthma?
Can be used as a preventer when asthma remains moderate/severe despite treatment with ICS + LABA Anti-inflammatory and anti-microbial
55
What is the role of magnesium sulfate in asthma management?
Can be used acutely when response to a SABA is inadequate
56
What is the role of adrenaline in acute asthma management?
Not routinely used Only when salbutamol cannot be given to a patient with respiratory arrest or when anaphylaxis is suspected
57
What is the difference between CPAP and BiPAP?
CPAP = PEEP only (keeps airways open to reduce respiratory effort) BiPAP = PEEP + PIP (breathing for infant)
58
What is a Harrison's sulcus?
Horisontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm ## Footnote *Associated with chronic lung disease e.g., severe asthma*
59
What is bronchomalacia?
Collapsable airways Causes: congenital absense of cartilage, extrinsic airway compression, acquired narrowing after infection or lung/heart transplant
60
What are the clinical features of bronchomalacia?
Fixed expiratory wheeze Chronic cough Recurrent infections Exercise intolerance Respiratory distress Apnoeas
61
When should oxygen therapy be given to children with bronchiolitis?
SpO2 persistently \< 90%
62
At what rate do you give oxygen for bronchiolitis?
1L/kg/minute
63
What effect can ventolin have on BGLs?
Hyperglycaemia
64
What electrolyte abnormality may occur with salbutamol?
Hypokalaemia
65
A patient is given ventolin and their RR increases. Why?
Side effect of the medication
66
A patient is given ventolin and their SpO2 decreases. Why?
Shunts open → areas of poor perfusion are opened
67
What is chronic suppurative lung disease?
Children clinically appear to have bronchiectasis but without consistent radiographic features ## Footnote *Chronic wet cough, recurrent chest infections, clubbing, growth failure, chest wall deformity, chronic hypoxemia, pulmonary hypertension*
68
What is the most common cause of pneumonia in children \< 5 years?
RSV (commonly an extension of bronchiolitis) More commonly viruses than bacteria * Influenza A + B* * Human metapneumovirus* * Parainfluenza virus*
69
Which organisms cause aspiration pneumonia?
Anaerobic oral flora * Peptostreptococcus* + other anaerobic streptococci * Fusobacterium* spp * Bacteroides* spp * Prevotella melaninogenica*
70
What dose of prednisone is given in acute asthma?
1mg/kg (max 50mg) for 3-5 days Begin within 1st hour *Use hydrocortisone or methylprednisolone is oral is unable to be tolerated*
71
What is Cheyne-Stokes respiration?
A breathing pattern that cycles between apnoea and hyperpnoea A type of central sleep apnoea
72
What are the types of apnoea?
Central Obstructive Mixed
73
What are some of the extra-pulmonary manifestations of myoplasma pneumonia?
Erythema multiforme Fatigue Headache Sore throat Myalgia
74
How is mycoplasma pneumonia treated?
Tetracycline (doxycycline) Or a macrolide (azithromycin, clarithromycin)
75
How is pertussis treated?
Azithromycin/clarithromycin ## Footnote *Within 3 weeks of cough onset*
76
What CXR findings are suggestive of mycoplasma/chlamydia pneumonia?
Unilateral lower lobe interstitial pneumonia Looks worse than presentation
77
What is infrequent intermittent asthma?
Symptom-free for at least 6 weeks at a time Flare-ups up to once every 6 weeks on average but no symptoms between flare-ups
78
What is frequent intermittent asthma?
Flare-ups more than once every 6 weeks on average but no symptoms between flare-ups
79
What is persistent asthma?
Asthma that has symptoms between flare ups Can be mild, moderate or severe
80
During an asthma exacerbation, when should a child see a doctor/come to hospital?
3-4 hourly Ventolin: see a GP \< 3 hourly Ventolin: come to hospital
81
On spirometry, what result demonstrates reversibility with bronchodilators?
FEV1 increases \> 12% 10-15 minutes after a bronchodilator