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Child Health > Respiratory Problems > Flashcards

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
Q

How is bronchiolitis diagnosed?

A

Clinically
Nasopharyngeal aspirate or throat swab can confirm pathogen but not routinely recommended
CXR only if diagnostic uncertainty

26
Q

What would be seen on CXR in bronchiolitis?

A 
Hyperinflation
Focal atelectasis
Air trapping
Flattened diaphragm
Peribronchial cuffing
27
Q

How is bronchiolitis managed?

A 
Conservatively
Suction secretions if causing distress or feeding difficulties
Oxygen if sats < 92%
Fluids if inadequate oral intake
CPAP if impending respiratory failure
28
Q

When should a child be admitted for bronchiolitis?

A 
Apnoea
Looks seriously unwell
Respiratory distress
Central cyanosis
Oxygen sats < 92%
Inadequate fluid intake/clinical dehydration
29
Q

What is viral induced wheeze?

A

Wheeze following a viral infection such as bronchiolitis

30
Q

What is the investigation/management for an inhaled foreign body?

A

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
Q

What are the presenting features of CF?

A 
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
Q

How is CF diagnosed?

A

Fitting clinical history
+ positive chloride sweat test
+ supported by identification of 2 disease-causing mutations

33
Q

Other than CF, what are the causes of bronchiectasis in children?

A 
Post-infectious
Immunodeficiency
Primary ciliary dyskinesia
Post obstructive e.g. foreign body aspiration
Congenital syndromes:
- Young's syndrome
- Yellow nail syndrome
34
Q

What are the principles of management of CF?

A

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
Q

What are the respiratory complications of CF?

A

Allergic bronchopulmonary aspergillosis (ABPA)
Bronchiectasis
Pulmonary hypertension
Pneumothorax
Respiratory failure will eventually occur
Nasal polyps

36
Q

What are the GI complications of CF?

A 
Rectal prolapse
Distal intestinal obstruction syndrome
Liver disease:
- cholestasis
- gallstones
- liver cirrhosis
37
Q

What are the endocrine + other complications of CF?

A

CF related diabetes
Delayed puberty

Other:

  • arthritis
  • reduced bone mineral density
  • sub/infertility

Child Health (16 decks)

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