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Respiratory disorders Flashcards

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1
Q

What cells make up the lining of the respiratory tract?

A

Pseudostratified columnar epithelium

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2
Q

What should you ask on respiratory history?

A 
URTI:
Blocked nose
Itching
Sneezing
Rhinorrhoea

LRTI:
Coughing (acute vs chronic, dry vs productive, colour, hyperresponsiveness)
Fever
Noisy breathing (stridor, snoring, wheezing, crackles)
Attacks (infection/asthma)

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3
Q

What is the clinical manifestation of nasal itching?

A

Allergic salute

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4
Q

Name complications of allergic rhinitis

A 
Recurrent sinusitis
Recurrent OM 
Grommets 
Snoring (adenoid hypertrophy)
Recurrent snore throat
Dental malocclusion (braces)
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5
Q

What do you suspect in a child with a hoarse voice and stridor?

A

Croup

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6
Q

What do you look for generally in a direct respiratory examination?

A

Clubbing
Lymph nodes
Anthropometry
Upper resp tract (facies, nose, ear, throat)

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7
Q

What is tachypnoea

A 
0-2m = >60
2-12m = >50
1-3 y = >40
4-10y = >35
>10y = >30
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8
Q

Name patterns of respiratory distress and what they entail

A 
Subcostal recession = bronchiolitis/asthma
Intercostal recession = pneumonia
Tracheal tug (UA obstruction)
Alar flaring (severe)
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9
Q

In which direction can a child’s trachea naturally deviate slightly?

A

Right

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10
Q

What could be a respiratory cause of a palpable P2 and LPH?

A

Pulmonary hypertension -> RVH

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11
Q

What do you look for on inspection in a direct respiratory examination?

A

Scars (thoracotomy, stenotomy)
Chest expansion
Shape
Pattern of resp distress

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12
Q

What do you look for on palpation in a direct respiratory examination?

A

Trachea position
Apex beat
LPH
Palpable P2

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13
Q

What do you look for on percussion in a direct respiratory examination?

A

Front (upper lobes)
Right axilla (right middle lobe) and left axilla (lingular segment)
Back (lower lobes)
Heart and upper border of liver

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14
Q

What are you percussing in the left axilla?

A

Lingular segment of upper left lobe

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15
Q

What is dullness in the right middle lobe a sign of?

A

Atelectasis eg asthmatic

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16
Q

What is dullness in the lower lobes a sign of? And if this dullness is stony dull?

A

Free fluid

Stony dull = pleural effusion

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17
Q

What do you look for on auscultation in a direct respiratory examination?

A

Mouth (snoring)
Trachea (stridor)
Breath sounds
Crackles

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18
Q

What are signs of acute illness?

A

Respiratory distress
Dehydration
Seizures
Wasting

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19
Q

What are signs of chronic illness?

A

Deformities
Stunting
Wasting
Contractures

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20
Q

How does the mechanism of central cyanosis differ to peripheral cyanosis

A 
Central = saturation issue
Peripheral = circulation issue
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21
Q

Name causes of clubbing

A 
Suppurative lung disease
Cystic fibrosis
IE
Liver cirrhosis
Ulcerative colitis
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22
Q

Name signs of respiratory distress

A

Recessions
Accessory muscle use
Nostril flaring
Head bobbing

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23
Q

What is Hoover sign indicative of?

A

Hyperinflation -> peripheral airway disease

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24
Q

What is a chronic Hoover sign known as?

A

Harrison sulcus

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25
What is stertor and what is it a sign of?
Stertor = snoring, low pitched sound | Indicates obstruction in nasal, nasopharyngeal or oropharyngeal areas
26
What is stridor and what is it a sign of?
Stridor = musical sound on inspiration | Indicates obstruction of upper airway
27
What is wheezing and what is it a sign of?
Wheezing = musical sound on expiration | Indicates obstruction of distal airways
28
What is grunting and what is it a sign of?
Grunting = expiratory sound due to exhalation against partially closed glottis Indicates severe resp distress 2nd to lower airway disease
29
Name causes of a pectus carinatum
Idiopathic lung disease Chronic lung disease Rickets Connective tissue disease
30
Name causes of a pectus excavatum
Idiopathic tissue disease Connective tissue disease Neuromuscular Repaired diaphragmatic hernia
31
Name reasons for a hyperresonant lung
Hyperinflation Pneumothorax Amphysema
32
Name reasons for a dull lung
Consolidation Collapse Pleural thickening Fibrosis
33
How can you check if the lung sounds are simply transmitted sounds?
Listen over cheek/mouth
34
Practice video on respiratory distress in paediatrics fifth year at 42minutes
x
35
What are the 2 criteria for acute otitis media?
Hyperaemia | Bulging tympanic membrane
36
Which frontal view is more common in older child and adult?
Posteroanterior | AP used in non-cooperative children
37
How do you decide the inspiration on a CXR?
Normal = 8/9 posterior rib OR 5-6 anterior rib Hyperinflation = >9 post OR >6 anterior Poor inspiration = <8 posterior ribs
38
Discuss the systematic review of a CXR
1. Trachea and bronchi 2. Hilar structures 3. Mediastinum 4. Heart 5. Lungs/pleural cavities 6. Diaphragms/costophrenic angle 7. Below diaphragm 8. Bones 9. Soft tissue 10. Hidden areas
39
Which hilum is slightly higher?
Left hilum is slightly higher than the right hilum
40
Define an acute asthma attack
Progressive increase in typical asthma symptoms not responding to its usual bronchodilator therapy
41
Define near fatal asthma
Acute asthma attack assoc w/ respiratory arrest/hypercapnia
42
Name clinical signs of moderate asthma exacerbation
Able to talk in sentences Pulse rate normal RR normal PEFR>50%
43
Name clinical signs of severe asthma exacerbation
``` Tachypnoea Tachycardia Accessory mm use Agitation Unable to complete sentences in 1 breath Too breathless to feed PEFR 33-50% ```
44
Name clinical signs of life-threatening asthma
``` Silent chest Cyanosis Poor resp effort Hypotension Exhaustion Confusion Drowsiness Bradycardia (preterminal event!) PEFR <33% ```
45
Discuss management of an acute asthma attack
1. High flow oxygen 2. SABA - 2 puffs every 2min up to 10puffs and repeat every 20-30min - salbutamol 2.5-5mg dilute w/ saline to volume of 4ml and repeat every 20-30min 3. Corticosteroid - oral prednisone 1mg/kg/day x 3-5 days OR 1. SAMA - IB 250mcg to normal SABA dose 2. IV magnesium sulphate - 50mg/kg/hr if poor tx response
46
How long does steroid treatment take to work in acute asthma attack?
After 4 hours
47
What can you give to help the child/parents remember how to control their asthma?
Asthma plan
48
What sign will you look for on CXR for croup?
Steeple sign
49
What is croup also known as?
Laryngotracheobronchitis
50
What is the most common cause of LTB?
Parainfluenza virus
51
Name the clinical signs of LTB
Barking cough Hoarseness Stridor
52
What setting does croup usually present?
Age 6-24m Autumn/early winter At night
53
Classify the severity of croup
Grade 1: inspiratory stridor Grade 2: + passive expiratory stridor Grade 3: + active expiration w/ access mm + pulsus paradoxus Grade 4: cyanosis, marked retractions, impending apnoea
54
How do you treat croup?
Grade 1: steroids Grade 2: steroids and adrenaline nebs Grade 3-4: steroids and adrenaline nebs + intubate
55
Name clinical signs of epiglottitis
High fever Tripod position Drooling
56
What is the junior and adult dose for adrenaline epipen?
``` Jnr = 0.15mg Adult = 0.3mg ```
57
What is the dose of adrenaline for anaphylaxis?
10mcg/kg (max 500mcg)
58
Name common URTIs
``` Viral rhinitis Rhinosinusitis Otitis media Mastoiditis Tonsillitis ```
59
What is the most common cause of viral rhinitis?
Rhinovirus
60
Name clinical features of viral rhinitis
``` Nasal stuffiness Nasal discharge Throat irritation Fever Cough w/o tachypnoea ```
61
Why is acute bacterial rhinosinusitis uncommon in children younger than 5 years old?
Sinuses are not fully developed
62
Name clinical features of acute bacterial rhinosinusitis
``` Common cold gets worse Headache Purulent nasal discharge Pain/tenderness over sinuses Fever ```
63
What is the treatment for acute bacterial rhinosinusitis?
45mg/kg/dose 12hrly for 5 days
64
Which sinuses are present at birth?
Maxillary | Ethmoid
65
When does the sphenoid sinus develop?
4 years old
66
When does the frontal sinus develop?
6 years old
67
Name complications of bacterial rhinosinusitis
Orbital - preseptal periorbital cellulitis - postseptal periorbital cellulitis Intracranial - meningitis - abscess - cavernous sinus thrombosis
68
How do you treat the complications of bacterial rhinosinusitis?
REFER! | Admit -> IV ceftriaxone 50-80mg/kg daily
69
Differentiate preseptal vs postseptal cellulitis
``` Preseptal = normal eye examination Postseptal = abnormal eye examination ```
70
What will be anormal on the eye examination in a patient with postseptal orbital cellulitis?
``` Erythema Chemosis Proptosis Vision loss Ophthalmoplegia ```
71
Name pathogens that cause acute otitis media
Strep pneumo | Haemophilus influenza
72
Name clinical features of acute otitis media
``` Fever Earache Irritability lying down Pulling of ear Acute purulent otorrhoea ```
73
What is the treatment of acute otitis media?
Children >6mo wait 72hours 45mg/kg amoxicillin 12hrly (strep pneumo) x 5d Augmentin (haemophilus influenza) x 5d
74
When do you refer otitis media with effusion to ENT for grommets?
Persistent OM (>3m)
75
What are clinical features of mastoiditis?
Swelling/redness in postauricular area | Pinna down and forwards
76
How do you treat mastoiditis?
REFER! | Admit -> IV ceftriaxone 50-80mg/kg daily
77
How do you treat tonsillitis?
Phenoxymethylpenicillin oral for 10 days Benzathine benzylpenicillin, IM , single Amoxicillin, oral, 50 mg/kg daily for 10 days
78
Name complications of tonsillitis
Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess
79
How do you treat complications of tonsillitis?
REFER! | Admit -> IV augmentin
80
Name causes of stertor
``` Allergic rhinitis Choanal atresia Adenoid hypertrophy Hypotonia Tonsillitis ```
81
What are consequences of nose obstruction in the infant?
Difficulty feeding Poor growth Apnoea
82
What are consequences of nose obstruction in older children?
``` Neurological - lethargy - irritability - ADHD - poor school performance Cardiac - hypoxia -> PH -> cor pulmonale -> cardiac failure Enuresis nocturia ```
83
How can you diagnose OSA in children?
Polysomnograph Standardized questionnaire Nocturnal saturation monitoring Video recorded by parents
84
How do you treat OSA in children?
Nasal steroid spray | Continues? REFER
85
What conditions are assoc with OSA in children?
``` Obesity Craniofacial abnormalities Midface hypoplasia Muscle weakness Tone weakness ```
86
Which children can have midface hypoplasia?
Down syndrome
87
How do you test for choanal atresia?
Try to pass suction catheter through the nose
88
Name causes of acute onset stridor
``` Supraglottic: Anaphylaxis Epiglottitis Retropharyngeal abscess Paratracheal gland enlargement FB LTB Trauma Bacterial tracheitis ```
89
Name organisms other than parainfluenza virus that are known for causing LTB
HSV Measles Candidiasis (HIV+)
90
What is the management of epiglottitis?
Secure airway | IV ceftriaxone
91
Where do FBs often get lodged?
Between vocal cords and cricoid cartilage
92
Name causes of chronic stridor
``` Laryngomalacia Laryngeal web Laryngeal cyst Subglottic stenosis Vascular compression Laryngeal papillomatosis ```
93
Name clinical features of laryngomalacia
>14 days old | Inspiratory stridor that improves when prone
94
Name clinical features of pertussis
Paroxysmal cough w/ inspiratory whoop Vomiting Subconjunctival haemorrhage
95
How do you diagnose pertussis?
Leucocytosis PCR Serology
96
How do you treat pertussis?
Azithromycin
97
What is the likely organism in an otitis media that doesn't respond to augmentin?
Pseudomonas -> give fluoroquinolone
98
Name common LRTIs
``` Pneumonia Brochiolitis Bronchitis Bronchiectasis Tracheitis Non-infectiou ```
99
Name pathogens that cause LRTIs
``` Bacterial Viral Atypical Fungal PJP ```
100
Name complications of LTRIs
``` Pleural effusion -> empyema Necrotising pneumonia -> pneumotocele Pneumothorax Hypoxia Resp failure ```
101
What are the 3 signs of LRTI?
Fever Cough Tachypnoea
102
Name clinical signs of pneumonia
Crackles Bronchial breathing Dull percussion Indrawings
103
Differentiate coarse vs fine crackles
``` Coarse = fluid in large airway Fine = fluid in alveoli ```
104
Name kinds of indrawings and explain why they occur
``` Subcostal Tracheal tug Supraclavicular Intercostal Paradoxical breathing ``` Alveoli close on expiration due to fluid -> need more negative pressure to open up collapsed alveoli -> body compensates
105
Why does grunting occur?
Alveoli close on expiration due to fluid -> body tries to increase PEEP
106
Why does bronchial breathing occur?
Alveoli not opening up -> loss of vesicular breathing -> bronchial breathing
107
What investigations can you do when you suspect pneumonia?
CRP Procalcitonin (more specific and sensitive but expensive) WCC
108
Name the common causative organisms of pneumonia in newborns
GBS | Enteric gram -
109
Name the common causative organisms of pneumonia in children 1-3m
Chlamydia trachomatis Ureaplasm Viruses Bordatella pertussis
110
Name the common causative organisms of pneumonia in children 3-12m
``` Viruses Strep pneumo Haemo influenza Staph aureus Moraxella catarrhalis ```
111
Name the common causative organisms of pneumonia in children 1-5y
Viruses Strep pneumo Mycoplasmia pneumo Chlamydia pneumo
112
Name the common causative organisms of pneumonia in children >5y
Strep pneumo Mycoplasma pneumo Chlamydia pneumo
113
Name the common causative organisms of pneumonia in HIV positive children
``` Strep pneumo Staph aureus Haemo influenza E coli Salmonella Klebsiella Pseudomonas Mycobacterium tuberculosis ```
114
What is the treatment for pneumonia?
``` Amoxicillin 80mg/kg/day twice daily x 5 days Aminoglycoside for gram - - neonates - severe acute malnutrition - HIV + ``` Severe pneumonia - ampicillin + gentamycin Atypicals - macrolides Necrotising - cloxacillin (staph aureus)
115
Why should you consider augmentin for pneumonia in Pretoria?
High incidence of beta lactamase producing haemophilus influenza
116
What is normal oxygen saturation?
94% sea level | 92% Gauteng
117
When should you give oxygen in pneumonia?
Oxygen
118
What are complications of oxygen use?
Ciliary clearance reduced (dry, cold O2) Mucus plugs Dry secretions -> obstruction Radicals
119
Give a differential diagnosis for pneumonia
``` URTI PCP Asthma Pulmonary TB Chronic suppurative lung disease ```
120
Name causative pathogens of bronchiolitis
``` RSV Rhinovirus Adenovirus Influenza Parainfluenza Metapneumovirus Coronavirus Enterovirus ```
121
Discuss the pathogenesis of bronchiolitis
Virus uses TLR-4 to enter epithelial cells -> inflammation -> epithelial cell necrosis -> ciliary destruction -> mucus plug -> bronchiolar narrowing -> air trapping
122
How do we treat bronchiolitis?
Oxygen therapy Nasal decongestion Feeding No ABs!
123
Name clinical signs of PCP
``` Cough SOB Hypoxia High LDH High beta D glucan PJP on sputum ```
124
Name causative organisms of PCP
Pneumocystis jeruvicii | CMV
125
Discuss management of PCP
Supportive - Oxygen - CPAP - Invasive ventilation Pharmacological - bactrim - gancyclovir - systemic steroids
126
Name clinical signs of asthma
Recurrent - cough - wheeze - SOB
127
Name clinical signs of pulmonary TB
Chronic - cough - weight loss - night sweats - lymphadenopathy
128
Name clinical signs of chronic suppurative lung diseases
Wet cough Clubbing Harrison's sulcus
129
What should you suspect in a patient with recurrent pneumonias (>2/year)
Primary immune deficiency
130
Name red flags of chronic lung disease
Signs - stunting/wasting - hypoxia - clubbing - allergic face - chest wall deformity - persistent abnormalities on auscultation Symptoms - cough >3w - productive cough - cough/choking on feeding - noisy breathing - dyspnoea - exercise intolerance - recurrent LRTIs
131
Name chronic lung diseases
``` Asthma Bronchiectasis Cystic fibrosis Primary immunodeficiency Primary ciliary dyskinesia HIV assoc Lymphoma Mediastinal mass Congenital d/o Diaphragmatic hernia Cystic lung CLD of prem GERD ```
132
What is bronchiectasis
Infection -> permanent destruction of bronchial walls and lung tissue -> impaired secretion clearing -> repeated LRTIs -> vicious cycle
133
Name the clinical signs of bronchiectasis
``` Chronic cough Productive cough Halitosis Haemoptysis Clubbing Chest deformities Hyperinflation FTT Stunting Pulmonary hypertension Cor pulmonale ```
134
Name causes of focal bronchietasis
FB | Endobronchial mass
135
Name causes of diffuse bronchiectasis
``` HIV TB Primary ciliary dyskinesia Aspiration Mediastinal mass ```
136
Name causes of aspiration
Neuromuscular disease Cleft lip/palate Tracheosophageal fistula GERD
137
Name causes of bronchiectasis
Cystic fibrosis vs non-cystic fibrosis
138
Discuss the management of bronchiectasis
``` PT Immunisation Azithromycin Lobectomy Treat acute episodes w/ ABs (augmentin) Treat underlying cause ```
139
What is cystic fibrosis?
Autosomal recessive defect in CF transmembrane conductance regulator gene on chromosome 7 which is responsible for chloride channel ion transport -> water follows chloride out the cell -> abnormal viscous mucus -> plugs -> recurrent infections
140
What is the most common cystic fibrosis mutation?
DeltaF508 (caucasian) | 31201GA (african)
141
Which systems does cystic fibrosis impact?
``` Sinuses Sweat glands Pancreas Lungs Reproductive system GIT ```
142
What is the common, non-pulmonary presentation of cystic fibrosis?
Cholestatic jaundice -> fat malabsorption (steatorrhoea) -> ADEK deficiency
143
How is cystic fibrosis diagnosed?
Sweat chloride test Stool faecal elastase Genetics
144
Discuss treatment of cystic fibrosis
``` Lungs - nebulise - PT - ABs - transplant Pancreatic enzyme replacement ```
145
Why is azithromycin given in CF and bronchiectasis?
Role in immunomodulation
146
Name HIV related chronic lung diseases
``` Bronchiectasis Lymphocytic interstitial pneumonitis T and B cell lymphoma Pulmonary TB Kaposi's sarcoma ```
147
What is lymphocytic interstitial pneumonitis?
Chronic lymphocytic infiltrative disease due to dysregulated immune response to HIV/EBV interaction
148
Name clinical signs of lymphocytic interstitial pneumonitis
``` Chronic cough SOB Recurrent pneumonia FTT Clubbing Lympadenopathy Parotid enlargement HSM Barrel chest Diffuse crackles ```
149
How do we treat lymphocytic interstitial pneumonitis?
ARVs | Prednisone 2mg/kg for 30 days (symptomatic)
150
What are typical features of lymphocitis interstitial pneumonitis and what is this confused with?
Peribronchiolar lymphoid follicles Lymphocytic infiltration of alveolar spaces Miliary TB
151
What are clinical features of pulmonary TB
``` Chronic cough Weight loss Night sweats Poor appette Haemoptysis ```
152
How do you diagnose pulmonary TB?
CXR AFB+ gene Xpert (sputum) Mantoux test
153
How do you treat pulmonary TB
RIPES 2nd line = kanamycin, amikacin, ofloxacin, levofloxacin (KOAL)
154
What are clinical features of bronchiolitis obliterans
Hyperinflation Wheeze Crackles
155
How do you treat bronchiolitis obliterans?
ARVs
156
What is primary ciliary dyskinesia
Autosomal recessive disorder -> defects of cilia -> impaired mucous clearance
157
What do you suspect in a patient with primary ciliary dyskinesia and situs inversus?
Kartagener syndrome
158
Name clinical features of primary immunodeficiency diseases
``` Recurrent ENT infections Resp infections Bronchiectasis FTT Severe eczema Intractable diarrhoea Pyogenic infection ```
159
How do you treat primary immunodeficiency diseases
Treat underlying condition Vaccination Prophylaxis Immunoglobulin therapy

Coovadias Paediatrics (10 decks)

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