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Respiratory Flashcards

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1
Q

What age group is most affected by bronchiolitis

A

infants, 1-9 months

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2
Q

When is bronchiolitis most common?

A

during annual winter epidemics

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3
Q

What is the most common pathogen causing bronchiolitis?

A

Respiratory syncytial virus

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4
Q

what other viruses cause bronchiolitis

A

parainfluenza
rhinovirus
adenovirus
influenza

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5
Q

What are the symptoms and signs of bronchiolitis

A 
symptoms
coryzal symptoms
dry wheezy cough
high pitched wheeze
temporarily stop breathing
breathlessness

signs
tachypnoea and tachychardia
subcostal and intercostal recession
hyperinflation of chest
fine inspiratory crackles
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6
Q

What investigations would you do for bronchiolitis?

A

Pulse oximetry

if respiratory failure - ABG, CXR

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7
Q

when do you admit infants with bronchiolitis?

A

if apnoea
sats less than 90
inadequate oral intake (50-70% of usual)
severe resp distress

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8
Q

what is the management for bronchiolitis?

A
  • humidified oxygen
  • fluids NG or IV
  • non invasive resp support - CPAP
  • good infection control measures as RSV is highly contagious
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9
Q

how soon do children with bronchiolitis recover and what are the possible complications?

A
  • most recover within 2 weeks

complications
- rarely - adenovirus infection, can go on to cause Bronchiolitis Obliterans

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10
Q

Which group of children are considered high risk for bronchiolitis?

A

premature babies with

  • bronchopulmonary dysplasia
  • congenital heart disease
  • CF
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11
Q

What can be given to prevent Bronchiolitis? Who is it for?

A

monoclonal antibody to RSV
palvizumab - monthly via IM injection
for high risk preterm babies, reduces hospital admissions

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12
Q

Which bacterium causes whooping cough?

A

Bordatella pertussis

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13
Q

what are the three phases of whooping cough?

A

Coryzal (catarrhal phase)

Paroxysmal phase (paroxysmal cough followed by inspiratory whoop)

Concalescent phase (symptoms decrease)

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14
Q

When are symptoms of whooping cough worse and what can they cause?

A

Symptoms are worse at night,

can cause vomiting

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15
Q

What are the symptoms of whooping cough?

A
  • during paroxysm- child goes red or blue
  • in infants, whoops can be absent, apnoea may occur
  • epistaxis and subconjuntival haemorrhage after significant coughing
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16
Q

What are some uncommon complications of whooping cough

A

Pneumonia

Seizures

Bronchiectasis

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17
Q

What investigations should you do for whooping cough?

A

Prenasal swab culture
PCR is more sensitive

Blood count - marked lymphocytosis

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18
Q

What is the management for whooping cough?

A

Macrolide antibiotic - eradicate organism and decrease symptoms (clarithromycin

Close contacts - macrolide prophylaxis

unimmunised infant contacts - immunise!

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19
Q

List some of the causes of recurrent/persistent cough in children?

A
  1. recurrent respiratory infections (or following RSV, Mycoplasma or Pertussis)
  2. Asthma
  3. Persistent lobar collapse following pneumonia
  4. recurrent aspiration
  5. suppurative conditions e.g CF, cilliary dyskinesia, immune deficiency
  6. persistant bacterial bronchitis
  7. inhaled foreign body
  8. cigarette smoke - active or passive
  9. TB
  10. airway anomalies e.g trachea-bronchomalacia, trachea-oesophageal fistula
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20
Q

Define Pneumoniae

A

Disease characterised by inflammation of lung parachyma with congestion caused by viruses or bacteria or irritants

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21
Q

What are the causes of Pneumonia ?

A

Newborns: organisms from mothers genital tract - esp. GBS but also gram negative enteroccoci and bacilli

most common viral: RSV

most common bacterial cause:pneumococcus

Also
Hib, 
S.aureius
K.pneumoniae 
mycobacterium Tuberculosis
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22
Q

Which age range is viral causes of pneumoniae more common?

A

viral causes more common in younger children

bacterial in older children

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23
Q

Symptoms of pneumoniae?

A

fever, cough and rapid breathing usually precede URTI

lethargy, poor feeding, unwell child

  • localised chest, abdominal and neck pain suggests ????
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24
Q

what does localised chest, abdominal and neck pain suggest in pneumoniae?

A

bacterial infection!

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25
what are some of the signs of penumoniae?
- Tachypnoea - nasal flaring - chest indrawing - high RR - most sensitive sign end-inspiratory coarse crackles over the affected areas (consolidation - dull to percussion) - decreased breath sounds - bronchial breathing
26
How do you diagnose pneumoniae in a child?
1. history of cough +/- difficulty breathing (<14 days) with increased RR - age dependant > 2 months: > 60 / min 2 - 11 months: > 50 / min > 11 months: > 40 / min 2. CXR dense or fluffy opacity over a portion or entire lobe. can contain air bronchogram
27
what investigations would you do for pneumoniae?
CXR - can show pleural effusion or empyema Nasopharyngeal aspirate
28
when should you admit a child with pneumonia and what is the management?
admit if: <92% sats, recurrent apnoea, grunting, inability to maintain adequate fluid/feed intake. (supportive care - oxygen and analgesia. + iv fluids) IV benzylpenicillin or oral co-amoxiclav - 7-14 days
29
what does persistent fever despite 48h abx in children with pneumoniae suggest and what should you do?
suggests pleural collection requires drainage
30
what are complications of pneumoniae? what should you do?
Lobar collapse, atelectasis repeat CXR after 4-6 weeks
31
what are the four stages of pneumoniae?
1. consolidation 2. red hepatization 3. grey hepatization 4. resolution
32
Which is the most common causative organism of lobar pneumonia?
streptococcus pneumoniae
33
What does Streptococcus pneumoniae look like under the microscope?
Gram +ve cocci, in pairs
34
Which organisms might cause pneumonia in a HIV-positive child?
- Mycobacterium tuberculosis Others - Pneumocystis jiroveci - Mycoplasma pneumoniae
35
what is the genetics of CF
- autosomal recessive - defective CFTR on chromosome 7 - commonest in caucasions
36
What is the pathphysiology of CF?
- abnormal ion transport across epithelial cells (reduced cl- out of cells, increased Na+ reabsorption) - thicker mucus secretions - chronic pseudomonias auerugonosia infecion
37
Clinical features of CF? | typical, newborn, infancy, young child and older children/adults
- persistent wet cough, purulent sputum - newborn - meconium ileus - infancy - prolonged neonatal jaundice, growth faltering, recurrent chest infections, malapsorption, steatorrhoea young child - bronchiectasis, rectal prolapse, sinusitis and nasal polyps - older children and adults • Allergic bronchopulmonary aspergillosis, DM, Cirrhosis and portal HTN, Pneumothorax, recurrent haemoptysis, Distal intestinal obstruction, sterility in males
38
What are the signs of CF?
- hyperinflation of chest due to air trapping - coarse inspiratory crepitations and/or expiratory wheeze - Finger clubbing
39
Diagnosis of CF?
abnormally raised immunoreactive trypsinogen on heel prick test CFTR mutations on genetic tests confirmed with sweat test - >60mmol/L Cl ions supports the diagnosis CXR: hyperinflation, cysts, bronchial dilation (+)
40
what can cause false positives and negatives in the sweat test?
False Positive - Atopic eczma - Adrenal insufficiency - hypothyroidism - dehydration - malnutrition False negative oedema
41
How is CF managed? - Resp
- regular lung function measurement using spirometry - physio 3x daily to clear airway secretions - percussion and postural drainage - continuous abx prophylaxis (flucloxacillin) - rescue abx -Ticarcillin (>1 month) + gentamicin - bilateral lung transplant in end stage CF disease
42
How is CF managed - gastro and nutrition?
- enteric coated pancreatic replacement enzymes - high calorie diet - may need overnight gastrostomy feeding - fat soluble vitamin supplements
43
What are the phases of TB?
Primary phase: - Latent phase - asymptomatic, uninfectious - treat with chemoprophylaxis to prevent disease - Active phase - symptomatic/ clinical evidence e.g x-ray, lymph nodes Dormancy and dissemination Reactivation Post-primary TB
44
What is the stain for Mycobacterium tuberculosis?
Ziehl-Neelsen stain
45
Why may a mantoux test be positive other than in TB?
Due to BCG vaccine Interferon gamma release assay does not have false positives (looks for antigens only on mycoplasma tubeculosis) but does not rule out false negatives
46
What are the symptoms of TB
fever sweats weight loss cough
47
What are the tests you can do for TB?
``` Sputum CXR Tissue Mantoux interferon gamma release assay ```
48
What do you have to do for TB ?
Contact tracing | test with IGRA and mantoux
49
Treatment for TB? | + side effects
Active phase - Rifampicin - 6 months (hepatitis - raised bilirubin) - Isoniazid - 6 months (neuropathy) - Pyrazinamide - 2 months Latent phase - Rifampicin - 3 months - Isoniazid - 3 months
50
What should you do with children <2 years who have been in contact with someone with a +ve sputum sample
- start on prophylactic isoniazid | - if mantoux and IGRA negative 6 weeks later give BCG vaccine
51
who provides additional support in TB
community TB nursing team
52
What is primary ciliary dyskinesia?
impaired mucociliary clearance
53
What does primary ciliary dyskinesia lead to?
- recurrent URTI and LRTI - can lead to bronchiectasis | - recurrent productive cough, purulent nasal discharge, chronic ear infection
54
What is primary ciliary dyskenia associated with?
dextrocardia and situs invernus | kartagener syndrome - when they have both PCD + ^
55
How is Primary Ciliary Dyskinesia diagnosed?
examination of nasal epithelial cells brushed from nose
56
How do you manage primary ciliary dyskinesia?
- daily physiotherapy - treatment of infections with abx - ENT follow up
57
what is otitis media?
infection of the middle ear inflammation and build up of fluid behind ear drum
58
Which age range is acute otitis media most common in and why?
6-12 months | - risk due to short eustachian tubes that are horizontal and function poorly
59
What are the signs and symptoms of AOM
- bright red and bulging tympanic mebrane - with loss of normal light reflection - may be acute perforation of eardrum + pus
60
which pathogens cause AOM?
- Viruses - RSV, Norovirus | - Bacterial - pneumococcus, H.influenza, moraxella etc
61
What are the complications of AOM?
mastoiditis | meningitis
62
Treatment of otitis media?
- Analgesia for pain | - Amoxicillin if unwell after 2-3 days
63
What can recurrent ear infections lead to? what are the risks?
- otitis media with effusion - can cause conductive hearing loss - manage by: ventilation tubes + adenoidectomy
64
Define Pharyngitis and what is it usually due to?
When pharynx and soft tissue are inflamed, local lymph noeds enlarged and tender Usually due to viral infection (adenovirus, enterovirus, rhinovirus) older children also get group A beta haemolytic strep
65
Define Tonsilitis and what is the most common cause?
form of pharyngitis where there is intense inflammation of tonsils often with purulent exudate common pathogens = - Group A beta haemolytic strep - Ebstein Barr Virus
66
Although it is difficult to tell the difference clinically between bacterial and viral tonsilitis, what is more commonly seen in bacterial?
- headache - apathy - abdo pain - white tonsiller exudate - cervical lymphadenopathy
67
How do you treat tonsilitis?
- Pencillin V or Eryhtomycin (if allergic) | - 10 days
68
Why do you treat tonsillitis for 10 days?
eradicate and prevent rheumatic fever
69
What else can Group A Beta haemolytic strep also cause besides tonsillitis that is a possible complication?
Scarlet fever | Rheumatic fever
70
What are the signs of Scarlet fever as a complication of tonsillitis and what is a further complication? What is the Tx?
- fever 2-3 days before tonsillitis and headache - sandpaper like maculopapular rash - flushed cheeks, perioral sparing - tongue often white and coated, may be swollen Tx - Abx further complications = acute glomerulonephritis + rheumatic fever
71
What is epiglottitis
Swelling of epiglottis and surrounding tissue, associated with septicaemia
72
Why is acute epiglottitis considered a life threatening condition?
Due to the risk of respiratory obstruction
73
What is the most common cause of acute epiglottitis?
Haemophilus influenza b
74
When do you vaccinate for Hib?
2, 3 and 4 months
75
What do you expect to see in a child with acute epiglottitis?
o High fever o Child appears toxic o Painful throat making it difficult to swallow or talk o Child sits still and upright with open mouth (drooling) to optimize airway o Soft inspiratory stridor, increasing resp distress o Cough minimal or absent
76
How do you manage acute epiglottitis?
o Senior anaesthetist, paeds and ENT – all o Intubate under GA o Urgent tracheostomy may be needed o After airway secured – blood culture, IV abx o Prophylaxis with rifampicin for close household contacts

Paediatrics (9 decks)

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