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Respiratory Disorders Flashcards

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1
Q

Are respiratory infections usually viral or bacterial

A

90% viral

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2
Q

Reasons why children are more susceptible to respiratory infections

A 
Chest wall more compliant than that of adult.
Fatiguability of respiratory muscles.
Increased mucous gland concentration.
Poor collateral ventilation.
Low chest wall elastic recoil
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3
Q

4 types of upper RTI

A

Common cold - acute nasopharyngitis
Sore throat - pharyngitis and tonsillitis
Acute Otis media (+/- effusion)
Sinusitis

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4
Q

Features of common cold (coryza)

A

Clear / mucopurulent discharge

Cough, fever, malaise

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5
Q

Treatment of common cold

A

Paracetamol / ibuprofen for symptomatic relief of pain / fever

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6
Q

Sore throat usually caused by a virus (especially in

A

Group A b- haemolytic strep

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7
Q

Features of sore throat

A

Sore throat , fever, constitutional upset

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8
Q

What features might indicate a bacterial sore throat

A

Severe pain, lymphadenopathy and purulent exudate

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9
Q

Treatment of sore throat

A 
Sx relief (paracetamol / ibuprofen) 
Bacterial - penicillin
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10
Q

What abx can be given in sore throat if allergic to penicillin

A

Erythromycin

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11
Q

How long corse of abx for sore throat

A

10/7 to eradicate organism and prevent rheumatic fever

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12
Q

What abx should not be given with sore throat and why

A

Amoxicillin - can cause widespread maculopapular rash in EBV infection

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13
Q

Complications of sore throat

A

Retro pharyngeal abscess
Peritoneal are abscess (quinsy )
Rheumatic fever
Post strep glomerulonephritis

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14
Q

Causes of acute Otis media

A

Viral - RSV, influenza

Bacterial - pneumococcal, h influenzae, group b strep, maraxella catarrhatis

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15
Q

Does sinusitis usually occur on own

A

Often with viral URTIs

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16
Q

Features of sinusitis

A

2^ bacterial infection causes pain, swelling and tenderness over the cheek from infection of maxillary sinuses

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17
Q

Treatment of sinusitis

A

Abx and analgesia

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18
Q

Indications for tonsillectomy

A

Recurrent tonsillitis
Peritoneal are abscess (quinsy)
Obstructive sleep apnea

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19
Q

Why do adenoids cause obstructive sleep apnea

A

Grow proportionally faster than airway -> narrowing effect greater at 2-8 years

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20
Q

Indications for adenoidectomy

A

Obstructive sleep apnea

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21
Q

What percent of children snore / have obstructive sleep apnea

A

10%, 1%

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22
Q

Usual cause of OSA

A

Airway obstruction due to adenohyperthrophy

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23
Q

Features of OSA

A

Hx of snoring followed by 30-45 seconds of apnea with disturbed sleep and struggling for breath

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24
Q

Treatment of OSA

A

Adeno-tonsillectomy

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25
Disorders which can cause sleep disordered breathing
Craniofacial - eg. Pierre-robin sequence Neuromuscular eg. Muscular dystrophy Hypotonia eg. Downs
26
Treatment of sleep disordered breathing
Overnight nasal mask ventilation
27
What should always be ruled out in laryngeal and tracheal infections
Inhaled foreign body
28
Egs of tracheal / laryngeal infections
Croup Diphtheria and bacterial tracheitis Acute epiglottitis
29
What is often caused by laryngeal / tracheal infections and why
Upper airway obstruction due to mucosal inflammation
30
Features of upper airway obstruction
Stridor Hoarseness - due to inflammation of vocal cords Barking cough - sea lion like Dyspnea
31
Basic management of laryngeal / tracheal infections ? What should you not do !
Don't examine throat. Monitor for signs of decreased O2 / deterioration. Add nebuliser adrenaline if in doubt and intubate if deterioration
32
What is croup
Viral laryngotracheaobronchitis
33
Most common cause of laryngotracheal infections and its cause
Croup - para influenza virus most common
34
Hx of croup
URTI for 1-2 days (coryza and fever) then barking cough and stridor
35
When are symptoms of croup worst
Night
36
What causes the barking cough and stridor in croup
Sub glottic inflammation and oedema
37
How long is management of croup symptomatic
3/7 as most improve spontaneously
38
When do children require hospital admission with croup
Young age (
39
Hospital management of croup ? | What else can be used
Small dose of oral dexamethasone (0.15mg/kg), oral prednisolone and nebulised steroids (budesonide) Nebulised adrenaline can be used
40
What causes diphtheria
Corynebacterium diptheriae
41
What is bacterial tracheitis also called
Pseudomembranous croup
42
What causes bacterial tracheitis
Staph aureus / h influenzae | Rare but serious
43
Features od bacterial tracheitis
Similar to viral croup but with high fever, toxic apperance and rapidly progressing airway obstruction
44
Why do you get rapidly progressing airway obstruction in bacterial tracheitis
Copious thick airway secretions
45
Treatment of bacterial tracheitis
Abx eg IV flucoxacilin | Intubation (if required)
46
How serious is acute bacterial epiglottitis and what causes
Life threatening | Haemophilus influenza type B (HiB) - rare due to immunisation
47
Onset of acute bacterial epiglottitis
Rapid onset (hrs) after intesely painful throat
48
Features of acute bacterial epiglottitis ?
Ill, toxic, febrile child who is unable to speak or swallow with soft inspiratory stridor Tend to sit upright with open mouth to maximise airway and might drool saliva
49
What does acute epiglottitis need to be distinguished from ? How?
Croup as different management Fast onset, no coryza, little or no cough, drooling saliva, >38.5 fever
50
How do you confirm diagnosis of acute epiglottitis and management
Examination under anaesthetic followed by intubation to secure airway 3rd gen ceflasporin eg. CEFUROXIME
51
Why should you not examine throat in acute epiglottitis
May cause complete airway obstruction
52
3 common types of LRTI
Pneumonia Bronchiolitis Pertussis (whooping cough)
53
What is characterised by pneumonia
Inflammation of the parenchyma and consolidation of the alveoli
54
Causative organisms by age of pneumonia
Neonates - group b strep, E. coli, chalmydia (from mother genital tract) Infants - respiratory viruses eg RSV, adenoviruses, strep pneumonae, h influenzae, bordetella pertussis Child - strep pneumoniae, h influenza, group A strep, mycoplasma pneumonia
55
Symptoms of pneumonia? When else should it be considered?
Fever and difficulty breathing usually preceded by URTI symptoms. Cough, lethargy, poor feeding. Chest / neck pain / acute abdomen
56
What does localised chest / neck pain imply in pneumonia
Pleural irritation and bacterial infection
57
Signs of pneumonia
Respiratory distress - flaring, tracheal tug, sub / intercostal recession Crepitations/ wheeze +/- bronchial breathing (darth Vader) Decreased SaO2
58
Investigations for pneumonia and results ?
CXR - lobar consolidation -> bacterial pneumonia FBC - neutropenia -> bacterial USS - distinguish between effusions and empyema
59
Management of pneumonia
Close SaO2 monitoring (
60
Abx in bacterial pneumonia ? If severe? If mycoplasma ?
1st line - penicillin Cefuroxime / flucloxacillin in severe Macrolide eg. Erythromycin if mycoplasma
61
What is the commonest sever respiratory infection in infants
Broncholitis (90% occurs in 1-9 months)
62
Commonest cause of bronchiolitis ? Others?
``` RSV - 80% Human metapneumovirus (MPV) and other respiratory viruses eg adenoviruses, parainfluenza ```
63
Features of bronchiolitis ? What may small infants develop?
Coryzal precede dry cough and progressive breathlessness Apnoeic episodes (
64
Physical signs of bronchiolitis
Tachypnea with respiratory distress Chest hyperinflation (prominent sternum / downward displaced liver) Fine end inspiratory crackles and high pitches wheeze
65
Is the wheeze in bronchiolitis louder inspiratory or expiratory
Expiratory
66
Risk factors for bronchiolitis
Preterm infants | Infants with CHD / chronic lung disease (eg. CF, bronchiopulmlnary displasia)
67
What is given to preterm infants to prevent bronchiolitis
RSV monoclonal antibody (PALIVIZUMAB)
68
How do you detect RSV
Nasopharyngeal swabs -> detect by immunofluorescence
69
What investigation for bronchiolitis
Swabs | CXR - hyperinflation with air trapping and focal atelectasis (collapse)
70
Management of bronchiolitis
Supportive | oxygen for hypoxia, maintain hydration
71
Cause of whooping cough
Bordetella pertussis
72
Features of whooping cough (pertussis)
Catarrhal stage - 1/52 of coryza Paroxysmal stage - cough with inspiratory whoop (worse at night & child may go blue). Convalescent stage -(recovery)
73
How long does whooping cough last
3-6/52
74
What can occur after vigourous coughing
Subconjunctival haemorrhage and epistaxes (nose bleed)
75
Diagnosis of pertussis
Lymohocytosis characteristic | Perinasal swab cultures
76
Treatment of whooping cough
Erythromycin
77
Define asthma
Chronic inflammatory disorder of the airways associated with widespread REVERSIBLE AIRWAY OBSTURCTION
78
3 types of wheezing
Transient early wheeze Non atopic wheeze IgE mediated wheeze (atopic asthma)
79
How to distinguish viral induced wheeze from asthma
No interval symptoms (main feature is symptoms only with infection) No excess of atopy Likely to improve with age (however lots of asthma does too) No benefit from regular inhaled steroids
80
What's affected in transient early wheezing
Small airways (often during viral infections)
81
Risk factor for transient early wheeze
Maternal smoking during pregnancy
82
Prognosis of transient early wheezing
Most resolve by 5 years of age (probably due to increased airway calibre)
83
What is non atopic wheezing and usual cause
Normal lung function in early life but a LRTI due to virus (usually RSV) leading to increased wheezing in first 10 years
84
Prognosis of non atopic wheeze
Usually improves as progresses to adolescence
85
Pathogenesis of IgE mediated (atopic) asthma
Genetic predisposition & environmental factors - > bronchial inflammation - > bronchial hyper reactivity - > triggers - > mucosal oedema, mucosal secretions, bronchoconstriction - > airway narrowing - > cough, wheeze, chest tightness, breathlessness
86
Trigger factors for asthma
Smoking, cold air, RTIs, allergens (house dust mite / pollens), exercise, emotional upset / excitement
87
5 stages of asthma management
Inhaled short acting b2 agonist (salbutamol / terbutaline) Regular inhaled steroid 200-400mg/day (beclamethasone, budesonide, fluticasone) Add long acting b2 agonist (salmeterol, formeterol) Increase steroid to 800mg/day Continuous / frequent use of oral steroids and refer to paediatric respiratory physician
88
Two outcomes of adding LABAs that don't fix asthma
Benefit but not adequate -> increase steroid to 400mg/day No response to LABA -> stop, increase steroid (400mg/day) and trial other therapies
89
What other therapies can be trailed if LABA is ineffective
Leukotriene receptor antagonists (MONTELUKAST), theophylline (slow release)
90
What is the usual continuous oral steroid used in asthma stage 5 treatment
Prednisolone
91
Complications with inhaled steroids
Adrenal suppression | Brief slowing of growth (no evidence saying affects final adult height)
92
How do b2 agonists work
Relax smooth muscle
93
Side effects of b2 agonists
Tachycardia Hypokalaemia Restlessness
94
How does theophylline work
Phosphodiesterase inhibitor
95
Side effects of theophylline
Restlessness, arrythmias, diuresis
96
Eg of anticholinergic for asthma
Ipratropium bromide ("atrovent")
97
How do anticholinergics work in asthma
Inhibit choline rigid brinchoconstriction
98
Side effects of anticholinergics
Dry mouth, urinary retention
99
How do steroids work in asthma
Inhibit synthesis of inflammatory mediators (cytokines, leukotrines, prostaglandins) -> decreased airway hyperresponsiveness
100
Local side effects of steroids? How to reduce
Oral candidiasis | Wash mouth with dry powder inhaler / use spacer with metered dose inhalers
101
Features of acute asthma attack
Respiratory rate >50bpm in under 5 (>30 in over 5) Pulse >140bpm in under 5 (>120 in over 5) Use of accessory muscles Too breathless to talk
102
Feature of life threatening asthma
Central cyanosis Silent chest (insufficient air flow to generate wheeze) Exhaustion / poor respiratory effort Agitation & diminished conciousness (severe hypoxia )
103
What is CFTR
Camp dependent chloride channel | ATP-binding cassette transporter
104
What is carrier rate of CF
1 in 25
105
How many affected by CF
1:2500
106
Cause of cf
Deletion of d-F508 of CFTR gene on chromosome 7
107
What do mutations in CFTR gene cause ? Especially where?
Defective chloride ion transport across epithelial cells & Increased viscosity of secretions Respiratory tract and exocrine pancreas
108
What is the diagnostic test for cf and why
Sweat test | Abnormal transport in sweat glands -> increased NaCl in sweat
109
Features of cf
*Recurrent RTI and failure to thrive* Cough with purulent sputum, hyperinflation, Crepitations, wheeze, finger clubbing Deficient pancreatic enzymes -> Steatorrhoea, failure to thrive and malnutrition
110
Pancreatic enzymes deficient in cf
Protease, amylase, lipase
111
What can be first sign of cf
10% get meconium ileus
112
Systems affected by cf
``` Airway and GI Pancreas / endocrine Reproductive Joints Vascular Hepatic Psychological ```
113
Cf in Airway and Gi
Nasal polyps, distal ileal obstruction syndrome
114
Cf in pancreas / endocrine
Diabetes, poor growth, osteoporosis
115
Cf in reproductive
Infertility in males - absent vas deferens
116
Cf in joints
Athropathy
117
Cf in vessels
Vasculitis
118
Cf in hepatic
Portal hypertension -> ascities, varicies, hepatic encephalopathy
119
Sweat test result needed for cf diagnosis ? | What's used to test?
Two tests showing chloride of >60mmol/L | Pilocarpine iontoploresis
120
Management of cf 2 aims
Prevent progression of lung disease | Promote adequate nutrition and growth
121
Members of cf MDT
Parents, specialist paediatrician, specialist nurse, physiotherapist, dietician
122
Most important part of resp management in cf ? What's involved ?
Physiotherapist - 2x/day | Chest percussion with postural drainage, breathing exercises, positive expiratory pressure masks
123
What is monitored in cf ? What are used to hell with symptoms ?
Fev1 - declines with disease progression | Mucolytics eg nebulised DNase & hypertonic saline (aid mucocilary clearance )
124
What is given to many cf patients ? Why?
Prophylactic Abx eg flucoxacilin. | Need additional cover against common resp pathogens (s aureus, h influenzae, pseudomonas aeurgnosa)
125
What's given for nutritional management of cf
High calorie Vitamin supplements Pancreatic enzymes supplements
126
Which vitamins are essential to be given as supplements in cf
Fat soluble (ADEK )
127
Eg of pancreatic enzymes supplement and effect
Crean | Improve Steatorrhoea and allow catch up growth
128
What is the genetic screen for cf ? What else does it screen for ?
Guthrie test | Cf, phemylketanuria, congential hypothyroidism, MOAD deficiency, sickle cell, thalassaemia
129
Specifically looked for in genetic test of cf
Immunoreactive trypsin
130
Specifically looked for in genetic test of phenylketonuria
Phenylalanine
131
Specifically looked for in genetic test of congential hypothyroidism
TSH

Peadiatrics (14 decks)

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