Respiratory Problems Flashcards

1
Q

What are the signs of respiratory distress in children?

A
Increased RR and HR
Nasal flaring
Agitation
Recession/retraction:
- subcostal (milder)
- intercostal (moderate)
- sternal (severe)
Accessory muscle use (scalene, SCM) and head bobbing (severe)
Grunting - expiratory noise due to attempt to maintain PEEP (severe)
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2
Q

What is the differential for a cough in children?

A
Infection
Asthma
2nd hand smoke
Inhaled foreign body, aspiration
CF
Habit cough
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3
Q

What is the differential for wheeze in children?

A
Infection: bronchiolitis, pneumonia
Allergic: asthma, milk allergy
Transient early wheeze, viral wheeze
Heart failure
CF
Inhaled foreign body +/- aspiration pneumonia
Tracheomalacia (+/- stridor)
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4
Q

What is the differential for stridor in children?

A
Infection: croup, bacterial tracheitis, epiglottitis
Anaphylaxis
Inhaled foreign body
Laryngomalacia
Tracheomalacia
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5
Q

What is croup also called?

A

Acute laryngotracheobronchitis

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6
Q

Who normal gets croup?

A

Age 6 months - 3 years

Peak incidence age 2

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7
Q

Which organism most commonly causes croup?

A

Parainfluenza virus

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8
Q

What are the clinical features of croup?

A

1-4 day history of cough, rhinorrhoea + fever
–> barking cough and hoarseness
Symptoms worse at night
Stridor
Chest sounds may be normal, but may be decreased if severe airflow limitation

May be signs of respiratory distress/failure if severe

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9
Q

When should you consider admission for a child with croup?

A
Previous history of severe airway obstruction
< 6 months old
Immunocompromised
Inadequate fluid intake
Poor response to initial treatment
Diagnosis uncertain
Significant parental anxiety
Moderate/severe croup or impending respiratory failure
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10
Q

What is the treatment for croup?

A

Single dose oral dexamethasone to all children with croup

Nebulised adrenaline if severe

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11
Q

What is bacterial tracheitis?

A

Bacterial infection of the trachea

Usually following viral URTI due to mucosal damage + local immune changes

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12
Q

What are the features of bacterial tracheitis?

A

Stridor
Purulent secretions
Mucosal necrosis + sloughing
High fever

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13
Q

How is bacterial tracheitis treated?

A

IV antibiotics

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14
Q

What causes epiglottitis?

A

Haemophilus influenzae type B

becoming less common due to vaccine

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15
Q

What are the features of epiglottitis?

A

Acute onset of high fever, sore throat + drooling
Stridor: soft + continuous (late sign suggesting airway obstruction)
Whispering
Tripoding

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16
Q

How is epiglottitis managed?

A

Anaesthetics, ENT + paediatrics
Do not disturb/upset child
Intubation + IV antibiotics

17
Q

Which investigations can diagnose epiglottitis?

A

Laryngoscopy during intubation
Lateral neck xray –> thumb print sign
Blood cultures + swab once airway secure

18
Q

What causes whooping cough?

A

Bordetella pertussis

–> highly contagious

19
Q

What are the clinical features of whooping cough?

A

First URTI:
- rhinitis, irritability, sore throat, low grade fever, dry cough

Then paroxysmal phase:

  • episodes of severe paroxysms of coughing followed by an inspiratory gasp producing the classic ‘whoop’ sound
  • may be accompanied by red face, bulging eyes, vomiting or syncope
  • often worse at night

Can last for up to 3 months

20
Q

Which investigations are done for whooping cough?

A

If cough for < 2 weeks:
- nasopharyngeal aspirate or swab for culture
If cough > 2 weeks:
- anti-pertussis toxin IgG serology

FBC –> lymphocytosis

21
Q

What is the treatment for whooping cough?

A
Macrolide antibiotic (clarithromycin or azithromycin) if duration of cough < 3 weeks
\+ supportive management

Prophylactic Abx to all members of household if any one of them is high risk:
- infants with < 3 vaccine doses, pregnant > 32 weeks, work with infants or pregnant women

22
Q

Who gets bronchiolitis and what is it caused by?

A

Children < 2 years

Most commonly caused by RSV

23
Q

What are the symptoms of bronchiolitis?

A
Low grade fever
Nasal congestion
Rhinorrhoea
Cough
Feeding difficulties/dehydration
24
Q

Which signs might be seen on examination of a child with bronchiolitis?

A
Tachypnoea
Grunting
Nasal flaring
Intercostal, subcostal or supraclavicular recessions
Bilateral fine end inspiratory crackles
Expiratory wheeze
Hyperinflated chest
Cyanosis/pallor
25
How is bronchiolitis diagnosed?
Clinically Nasopharyngeal aspirate or throat swab can confirm pathogen but not routinely recommended CXR only if diagnostic uncertainty
26
What would be seen on CXR in bronchiolitis?
``` Hyperinflation Focal atelectasis Air trapping Flattened diaphragm Peribronchial cuffing ```
27
How is bronchiolitis managed?
``` Conservatively Suction secretions if causing distress or feeding difficulties Oxygen if sats < 92% Fluids if inadequate oral intake CPAP if impending respiratory failure ```
28
When should a child be admitted for bronchiolitis?
``` Apnoea Looks seriously unwell Respiratory distress Central cyanosis Oxygen sats < 92% Inadequate fluid intake/clinical dehydration ```
29
What is viral induced wheeze?
Wheeze following a viral infection such as bronchiolitis
30
What is the investigation/management for an inhaled foreign body?
CXR (but only 25% of foreign bodies radiopaque) If location knows --> rigid bronchoscopy under GA to remove If location unknown --> flexible bronchoscopy under sedation to find it --> rigid bronchoscopy under GA to remove
31
What are the presenting features of CF?
``` Recurrent pneumonia most common Neonatal meconium ileus Steatorrhea, rectal prolapse, small bowel obstruction, GORD, PUD Failure to thrive Clubbing Nasal polyps/sinusitis Male infertility Salty sweat Pancreatic failure ```
32
How is CF diagnosed?
Fitting clinical history + positive chloride sweat test + supported by identification of 2 disease-causing mutations
33
Other than CF, what are the causes of bronchiectasis in children?
``` Post-infectious Immunodeficiency Primary ciliary dyskinesia Post obstructive e.g. foreign body aspiration Congenital syndromes: - Young's syndrome - Yellow nail syndrome ```
34
What are the principles of management of CF?
MDT + patient/family education Daily chest physiotherapy Exercise Creon (pancreatic enzymes) Vitamins A, D, E (+K) - fat soluble vitamins Regular sputum cultures + antibiotics (at least 2 weeks)
35
What are the respiratory complications of CF?
Allergic bronchopulmonary aspergillosis (ABPA) Bronchiectasis Pulmonary hypertension Pneumothorax Respiratory failure will eventually occur Nasal polyps
36
What are the GI complications of CF?
``` Rectal prolapse Distal intestinal obstruction syndrome Liver disease: - cholestasis - gallstones - liver cirrhosis ```
37
What are the endocrine + other complications of CF?
CF related diabetes Delayed puberty Other: - arthritis - reduced bone mineral density - sub/infertility