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Paediatrics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Stridor: definition

A

High pitched noise heard in inspiration from partial obstruction at larynx or large airway

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2
Q

stridor: causes

A

Congenital- laryngomalacia
inflammation- laryngitis, epiglottitis, croup, anaphylaxis
Bacterial tracheitis
inhaled foreign body

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3
Q

Croup- overview

A

Acute laryngotracheobronchitis- subglottic oedema, inflammation and exudate
Signs: stridor, barking cough, hoarseness
<6y, autumn
Parainfluenza virus and respiratory syncytial virus

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4
Q

Croup classifications

A

Mild:
Moderate:
Severe

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5
Q

Croup: management

A

dexamethasone or prednisolone at home

Severe, hospital- nebulised adrenaline

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6
Q

Bacterial tracheitis

A 
Uncommon
6m-14y
viral prodrome for 2-5 days then rapid deterioration
Continuous stridor
stridor may be biphasic
swallows oral secretions
Very hoarse
Moderate-high fever, appear toxic
Barking cough
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7
Q

Epiglottitis

A 
Rare
2-7 y
Sudden onset
Continuous stridor, softer, like snoring
Drooling of secretions
Muffled voice
Toxic and feverish
non prominent cough
Haemophilus influenzae type B
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8
Q

Mild croup

A 
Common
6m-6y
Onset over a few days
Stridor only when upset
Harsh sounding
Swallows oral secretions
Hoarse voice
Likely to be apyrexial
Barking cough
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9
Q

Epiglottitis: management

A

DO NOT EXAMINE THROAT
Senior help from anaesthetist + ENT surgeon
Theatre- inhalation induction of anaesthesia
Tracheostomy if complete obstruction
Cefotaxime 25-50mg/kg/8h IV

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10
Q

Bronchiolitis: overview

A

Most common lung infection in infants. Those <6m/ with underlying condition most at risk
Coryzal symptoms preceding fever (sometimes), tachypnoea, wheeze, inspiratory crackles, apnoea,
intercostal recession +/- cyanosis +/- fever
RSV main cause.
Other causes: Mycoplasma, parainfluenza, adenoviruses

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11
Q

Bronchiolits: signs for admission

A

Inadequate feeding
Respiratory distress
Hypoxia

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12
Q

Bronchiolitis: Management

A

O2 (stop when SpO2 >92%)
NG feeds
Respiratory support

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13
Q

Pneumonia

A

Viral LRTI more common than bacterial in children <2
causes: pneumococcus, mycoplasma, Haemophilus, staphylococcus, TB viral
Signs: malaise, poor feeding, raised temp, respiratory distress
older children- lobar signs- pleural pain, crackles, bronchial breathing
Admit- SPO2 <92% + signs of respiratory distress
Amoxicillin 1st line.

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14
Q

Signs of respiratory distress

A 
Tachypnoea
Cyanosis
Grunting
intercostal recession
Use of accessory muscles
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15
Q

Whooping Cough (Pertussis)

A

peak age: infants, second peak at >14y
co-infection with RSV common
Signs: Apnoea, bouts of coughing ending with vomiting (+/- cyanosis), worse at night or after feeds
Diagnosis- PCR via nasal swab
Complications- prolonged illness, petechiae due to coughing bouts, conjunctival, retinal and CNS bleeds (rare)
Treatment: macrolide
Admit <6m
Vaccinating mother during pregnancy reduces risk

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16
Q

Viral induced wheeze

A

non atopic disorder
RSV most common cause
Haemophilus also a cause

17
Q

Cystic Fibrosis: definition

A

Mutuation in cystic fibrosis transmembrane conductance regulator gene (CFTR) on chrmosone 7
codes for cyclic AMP Na/Cl channel.
Dysfunction of endocrine glands- meconium ileus, lung disease, pancreatic exocrine insufficiency and raise Na sweat level

18
Q

CF: diagnosis

A

newborn screening (85% coverage)
10% present with meconium ileus as neonate
Later presentation: recurrent pneumonia +/- clubbing, failure to thrive, slow growth
Fatty, oily, pale stools
Sweat test

19
Q

Complications of CF

A 
Haemoptysis
Pneumonia
Pneumothorax
Pulmonary oseto-arthropathy
DM
Cirrhosis
Cholesterol gallstones
Fibrosing colonopathy
Male infertility
20
Q

CF: respiratory problems

A

infection by S.aureus, s, pneumoniae (younger kids), H.influenzae (rare). Eventually >90% are chronically infected with P. aeruginosa.
Treat acute infection- sputum culture + higher doses of ABx
Teach parents percussion +postural drainage.

21
Q

CF: GI problems

A

Energy needs rise by 130%- malabsorption and chronic lung inflammation
Steatorrhoea- pancreatic malabsorption
Enzymes to help, older children have Creon.
Omeprazole aids absorption by rising duodenal pH
high calorie, high protein diet
may need vitamin supplements- A and D
Impaired glucose tolerance with age, from 12 OGTT

22
Q

CF: prognosis

A

death may be from pneumonia or cor pulmonale

most survive to adulthood

23
Q

Asthma

A

reversible airway obstruction +/- wheeze, dyspnoea and cough
RF- low birthweight, FHx, atopy, bottle fed, male, pollution, past lung disease
Triggers- pollen, house dust mite, fur, exercise, viruses, smoke
DDx- foreign body, pertussis, croup, pneumonia, hyperventilation, CF, aspiration

24
Q

Treatment of exacerbation of asthma

A

2-5y: Pred 20mg/day for 5 days

5y: Pred 30-40mg/day for 5 days

25
Q

General management of asthma >5

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA +low dose ICS + LTRA
  4. SABA + low dose ICS + LABA
  5. SABA + low dose ICS/ moderate dose MART + LABA
  6. SABA + high dose ICS
26
Q

General management of asthma <5

A
  1. SABA
  2. SABA + 8 w moderate ICS
  3. SABA + low dose ICS + LRTA
27
Q

Moderate exacerbation of asthma: features

A

Increasing symptoms
PEFR 50-70% best or predicted
no feature of severe asthma

28
Q

Acute severe asthma: features

A 
Any 1 of:
PEFR 33-50% predicted
RR- > 40 (5-12), >30 (>12y)
Pulse- >140 (5-12), >110 (>12y)
inability to complete sentences
use of accessory muscles
29
Q

Near-fatal/life threathening asthma: features

A 
Respiratory acidosis and/or requiring mechanical ventilation
Any 1 of:
PEFR <33% predicted
Sats <92%
Silent chest, cyanosis
feeble respiratory effort
bradycardia
Dysrhythmia
Hypotension
Exhaustion
Confusion, coma
30
Q

Severe asthma: management

A
  1. Sit up, high flow O2 100%
  2. Salbutamol 5mg O2 nebulised in 4ml saline with ipratropium bromide 0.25mg
  3. Hydrocortisone 100mg IV or prednisolone
  4. consider one IV dose of magnesium sulfate 40mg/kg over 20min
  5. Aminophylline 5mg/kg IV over 20min
  6. Nebulisers continually until improving then ever 30 min intervals reducing frequency once improving. Give ipratropium 8hrly if needed
  7. consider CPAP. To ITU if exhausted, confused or coma
31
Q

Post asthma attack criteria for discharge

A 
Peak flow >75% predicted
good inhaler technique
stable on discharge regimen
Inhalted steroids + oral pred
Follow up at GP 1w and clinic 4w

Paediatrics (6 decks)

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