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Paediatrics for Finals > Respiratory > Flashcards

Respiratory Flashcards

(48 cards)

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1
Q

Name some differentials for a wheeze

A

bronchiolitis
toddler wheeze
asthma
foreign body

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2
Q

Name some differentials for stridor

A 
croup
epiglottitis 
laryngomalacia 
foreign body
anaphylaxis 
peritonsillar abscess
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3
Q

Name some differentials for a cough

A 
asthma 
infective 
post-nasal drip
GORD
habit 
CF
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4
Q

How does obstructive sleep apnoea present?

A
  • snoring
  • daytime sleepiness
  • headaches
  • dry, cracked lips

+/- repeated ENT infections if due to adenotonsilar hypertrophy

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5
Q

What are the causes of OSA and therefore the management?

A

Obesity = weight loss
Adenotonsilar hypertrophy = remove them
Craniofacial abnormalities = orthodontic/ maxillary surgery

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6
Q

How would CF present in a neonate?

A

Meconium ileus

  • delayed meconium
  • distension
  • bilious vomiting

Prolonged jaundice

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7
Q

What is distal intestinal obstruction syndrome?

A

Insufficient pancreatic enzymes + thick mucous leads to faecal obstruction in ileocecum

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8
Q

What are some signs and symptoms of CF?

A
  • nasal polyps
  • recurrent sinusitis
  • recurrent chest infections
  • DIOS
  • steatorhhoea
  • failure to thrive
  • osteoporosis
  • infertility in males
  • diabetes
  • liver disease and gallstones
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9
Q

Neonatal heel spot will be positive for what in CF?

A

immunoreactive trypsinogen

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10
Q

What can cause a false +ve sweat test?

A
  • malnutrition
  • G6PD
  • hypothyroid
  • adrenal insufficiency
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11
Q

What organisms commonly infect CF patients?

A
  • staph aureus
  • pseudomonas aeruginosa
  • burkholderia cepacia
  • aspergillus
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12
Q

What would the CXR of a CF patient show?

A
  • hyperinflated with flat diaphragm
  • nodules
  • bronchiectasis
  • pulmonary artery dilation
  • RV hypertrophy
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13
Q

How is CF managed?

A
  • chest physiotherapy
  • annual influenza vaccine
  • avoidance of other CF patients
  • mucolytics
  • fat soluble vitamins ADEK
  • creon (enzyme replacement)
  • high calorie intake
  • screening for diabetes and osteoporosis
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14
Q

How is asthma diagnosed under 5s?

A

clinical diagnosis

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15
Q

How is asthma diagnosed in 5-16 y/o?

What constitutes a positive result for these investigations?

A
  1. spirometry with bronchodilator reversibility giving >12% FEV1 improvement

If spirometry is normal or obstructive but <12% reversibility then….

  1. FeNO which is +ve if >35ppb
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16
Q

How is asthma managed in under 5s?

A
  1. SABA
  2. 8 week trial of moderate dose inhaled ICS
  • if no improvement then consider alternate diagnosis
  • if improves with trial but symptoms return on stopping then….
  1. SABA + low dose inhaled ICS
  2. SABA + low dose inhaled ICS + LTRA
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17
Q

How is asthma managed in 5-16 y/o?

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA (ditch LTRA)
  5. SABA + MART
  6. SABA + MART with moderate ICS
  7. Refer or theophylline or high dose ICS
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18
Q

Describe the features of a moderate asthma attack

A

Can talk
Sats >92%
Peak flow >50% predicted

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19
Q

Describe the features of a severe asthma attack

A 
Can't complete sentences 
Sats <92% 
Peak flow 33-50% predicted 
HR
>140 in 2-5 y/o
>125 in 5-16 y/o
RR
>40 in 2-5 y/o
>30 in 5-16 y/o
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20
Q

Describe the features of a life-threatening asthma attack

Study These Flashcards
A 
Sats <92%
Peak flow <33% predicted
Silent chest 
Cyanosis 
Poor respiratory effort 
Hypotensive
21
Q

Describe the management of an acute asthma attack

Study These Flashcards
A

SABA (can be via spacer if mild/moderate)
Prednisolone

+/- ipratropium bromide
+/- magnesium sulphate

22
Q

What investigations might you do to investigate pneumonia?

Study These Flashcards
A

Sputum sample
Nasopharyngeal aspirate
Blood cultures
CXR

23
Q

How is pneumonia managed? How is this different if mycoplasma or chlamydia are the suspected causative organism?

Study These Flashcards
A

Amoxicillin

Erythromycin

24
Q

What causes bronchiolitis?

Study These Flashcards
A

RSV leading to increased mucous production and bronchiolar inflammation and obstruction

25
At what age and how does bronchiolitis present?
<2 but commonly 3-6 months - Few days of coryza - Dry cough - Wheeze and crackles - Tachypnoea - Recession
26
How is bronchiolitis managed?
Supportive management - oxygen - NG feeds +/- Ribavirin + prophylactic Palivizumab in at risk
27
How is pre-school wheeze managed?
SABA 10 puffs 30 seconds apart
28
What causes croup?
Parainfluenza leads to subglottal inflammation and oedema
29
How does croup present?
``` Few days of coryzal Symptoms worse at night: - Barking cough - Hoarse voice - Stridor ```
30
How is croup managed?
Single dose of oral dexamethasone O2 Nebulised adrenaline
31
What causes epiglottitis?
Haemophilus influenza B
32
How does epiglottitis present?
- Sore throat - Drooling - Hot potato voice - Systemically unwell - Neck hyperextended to open airway
33
Compare an effective vs an ineffective cough
Effective: loud, breath in between, responsive and alert Ineffective: quite/silent cough, no breaths in between, unable to vocalise, cyanosed
34
What could you see on a CXR of a child who inhaled a foreign body?
- Visualise the FB (often R main bronchus) - Hyperinflated lung on expiratory CXR (trapped air can't escape) - Lobar collapse
35
What is laryngomalacia and how does it present?
Cartilage problem leading to a soft, floppy larynx - Stridor worse when supine - Noisy breathing
36
What is subglottic stenosis and how does it present?
Narrowing of the subglottic airway due to malformed cricoid cartilage Presentation depends on severity - Biphasic stridor - Hoarse weak voice
37
What organism commonly causes tonsilitis?
EBV | Streptococcus pyogenes
38
When would you give abx in tonsillitis? What abx would you give?
``` >3 Centor criteria fulfilled: Tonsillar exudate No cough Fever >38 Tender anterior cervical lymphadenopathy ``` Phenoxymethylpenicillin
39
What are the indications for a tonsillectomy?
7 in 1 year 5 in 2 years 3 in 3 years Each episode should be disabling and prevent normal functioning
40
What organism causes whooping cough?
Bordetella pertussis
41
How does whooping cough present?
``` Few days of coryzal prodrome Characteristic cough lasting >14 days - Dry hacking coughing bout - Inhalational whoop - post cough vomit - can gasp, flail arms, go red, eyes water etc ```
42
How can whooping cough present in infants?
Apnoea
43
When would you give abx in whooping cough and what abx would you give?
If present within 21 days of cough | Give Azithromycin to whole family
44
What are the complications of whooping cough?
``` Conjunctival haemorrhage Pneumonia Hernias and prolapse (high intra-abdo pressure) Apnoea Seizures ```
45
What are the school exclusion criteria surrounding whooping cough?
48 hours after starting abx
46
What is transient tachypnoea of the newborn?
increased fluid in the lungs due to reduced mechanical squeeze and reduced lymphatic removal
47
How does TTN present?
Within hours of birth: - Tachypnoea - Distress - Increased O2 requirements
48
What does the CXR of TTN show?
Peri-hilar streaking indicating interstitial oedema Prominent pulmonary vasculature Fluid in horizontal fissure Hyperexpanded

Paediatrics for Finals (11 decks)

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