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Flashcards in Respiratory Conditions Deck (36)
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1

Which gene is defective in cystic fibrosis?

The cystic fibrosis transmembrane regulator gene on chromosome 7

2

How common is cystic fibrosis in Caucasians?

1 in 2500 live births, carrier rate 1 in 25

3

True / False - Testing for cystic fibrosis is routinely done as part of the newborn heel-prick test?

True

4

Which age group is most commonly affected by bronchiolitis?

0-12 months. It is rare after 3 year.

5

Which organism causes over 50% of cases of bronchiolitis?

Respiratory syncytial virus

6

What is the treatment for bronchiolitis?

Supportive - keep hydrated and maintain saturations with humidified oxygen. CPAP or ventilation only required in a very small number of severe cases.

7

What are the classical symptoms of croup?
and age group?

Barking cough
Stridor
URI (LOW - grade fever)
worse at night
3 months - 6 years

8

Which virus causes croup?

Parainfluenza virus

9

True / False: A throat examination should be performed on a child with epiglottis to check for exudates on the tonsils

FALSE - It's important not to distress a child with epiglottisitis as this can make it much worse so NEVER look in their throat

10

What is the management of croup?
all croup?
mild and moderate?

All croup - Corticosteriods (one dose IV or PO)
(dexamethasone)
Mild = no stridor at rest --> outpatient
Moderate = stridor at rest --> hospital
- Humidified oxygen
- Nebulised budesonide
- Nebulised adrenaline may be required
- Intubation in extremis (about 2% of children)

11

Which organism causes acute epiglottitis?

Haemophilus influenza B
streptococci, pneumonic

12

True / False: Whooping cough (pertussis) is highly infectious

True

13

What age group are affected by croup?

3 months to 6 years

14

Which organisms are responsible for causing pneumonia throughout childhood?

Neonate = Group B streptococcus
Infancy = Viral infection especially RSV
Childhood = Strep. pneumoniae, mycoplasma pnemonia, haemophilus influenza

15

When should a patient with chronic asthma be advised to check their peak flow?

At least morning and evening, and preferably again during the day as well

16

In asthmatics, are peak flow values generally lower in the morning or in the evening?

Morning

17

Give an example of a long-acting beta-2 agonist added in at Step 3 of asthma management in children

Salmeterol

18

What might be heard on auscultation of the chest in bronchiolitis?

Fine end-inspiratory crackles
Expiratory wheeze

19

Which infants are particularly at risk of severe bronchiolitis?

Premature
Chronic lung disease
Passive smokers

20

True / False: Steroids are not indicated in bronchiolitis, but bronchodilators are

FALSE - Neither of these have been shown to improve outcomes in bronchiolitis so NEITHER are indicated

21

What is the underlying pathology in bronchiolitis?

Inflammation of the small airways (bronchioles)

22

What is the underlying pathology in croup?

Inflammation of the upper airway and increased secretions causing upper airway obstruction

23

What causes the stridor in croup?

Subglottis edema causing tracheal narrowing

24

True / Flase: Epiglottitis is common in the UK

False - Children are vaccinated against HiB so it's uncommon

25

What are some clinical features of epiglottis?

Very acute onset
HIGH Fever, toxic looking child - they look unwell!
Child is open mouthed to help open the away
Drooling
Intensely painful throat - child cannot speak or swallow
Inspiratory stridor, respiratory distress
NO cough

26

What is the management of epiglottis?

- Sit child upright, do not examine throat, do not distress
- Alert senior paediatrician, ENT surgeon, anaesthetist
- ITU admission and intubation
- Antibiotics: Ceftriaxone or cefataxime...usually a 3-5 day course
- Extubation usually after 24 hours

27

Give some key clinical features of cystic fibrosis in neonates and children

Faltering growth
Meconium ileus
Recurrent infections
Bronchiectasis
Clubbing
Diabetes mellitus
Steatorrhoea

28

What is the goal standard test for diagnosis of cystic fibrosis?

Sweat test looking for raised chloride ion levels
pilocarpine iontophoresis sweat test

29

What is a key infective organism which affects patients with cystic fibrosis?

Pseudomonas

30

What is the causative organism in whooping cough?

Bordetella pertussis