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Year 4 Paeds Conditions > Respiratory system/ENT > Flashcards

Respiratory system/ENT Flashcards

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1
Q

Definition of asthma

A

recurrent, reversible obstruction of the airways due to inflamed bronchi

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2
Q

triggers for asthma

A

infection - eg rhinovirus especially in the winters

allergy - dust mites etc

emotions - severe emotional upset , excitement, anxiety etc

exercise - esp. running in cold air

atmosphere - dusty air, stuffy an smoke filled rooms etc

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3
Q

symptoms of asthma

A

triad of cough, SOB and wheeze
asthma should be syspected in any child with wheezing > one occasion

wheeze - exploratory high pitch wheeze, worse at night and early morning

Cough - dry, nocturnal cough usually after midnight

Chest tightness - esp with exercise and at night

SOB - establish when in exercise normally, but in severe attacks: SOB at rest, agitation, feeding difficulties and attenuated cry (infants), drowsy and confused

symptoms usually have a clear trigger and intervals in between exacerbation

strong FHX of atopy

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4
Q

what are some of the questions to be asked in suspected asthmatic patient

A

how frequent are the symptoms

what triggers the symptoms such as sport, general activities etc

how often is sleep disturbed by asthma

how severe are the interval symptoms between exacerbations?

how much school has been missed due to the illness #

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5
Q

examination findings of asthma?

A

long-standing asthmatic patients - hyperinflation of the chest/Harrison’s solci §

generalised polyphonic expiratory wheeze and prolonged expiratory phase

widespread wheeze on auscultation

harrison’s sulci possibly

evidence of eczema - atopy

growth may be affected

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6
Q

investigation of asthma

A

Usually clinical diagnosis over the age of 5 due to the present of viral wheeze

<5 yr - Diagnostic test
- treat then diagnosis after 5 yrs old

5-16 yrs
- spirometry —> BDR —> feNO

> 17 yrs follow adult diagnostic pathway

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7
Q

what are some of the differentials for asthma

A 
inhalation of foreign body 
allergic rhinities 
GORD 
aspiration syndrome 
bronchiectasis 
bronchiolitis 
bronchopulmonary dysplasia 
primary cillary dyskinesia
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8
Q

chronic management of asthma for children < 5 yrs old

A

PRN SABA

Step 0 - consider monitored initiation of treatment with very low to low dose ICS

Step 1 = LTRA < 5 years

Step 2 = v low dose ICS + LTRA

Step 3 = if not adequate response from LTRA, then stop LTRA, inc dose of ICS to low dose

if benefit from LTRA then continue LTRa and inc ICS to low dose

If benefit from LTRA still, can consider ICS and LABA

Step 4 - inc ICS to mediaum dose +/- theophylline + specialist input

Step 5 - daily steriod tablet in the lowest dose + medium dose ICS

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9
Q

what are the classification of asthma in children between 2-5yrs

A 
moderate asthma 
SpO2 > 92% 
able to talk 
HR <140
RR<40

severe asthma 
SpO2<92% 
too breathless to talk 
HR>140 
RR >40 
use of accessory neck muscle 
life-threatening 
SpO2 <92% 
any of the following 
1) silent chest 
2) poor respiratory effort 
3) agitation 
4) altered consciousness 
5) cyanosis
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10
Q

what are the classification of asthma in children >5 yrs

A 
moderate asthma 
SpO2 >92% 
PEFR>50% 
able to talk 
HR <125 
RR < 30 
severe asthma 
SpO2 <92% 
PEFR 33-50% 
too breathless to talk 
HR >125 
RR > 30 
use of accessory talk 
life-threatening 
SpO2 <92% 
any of the following
1) silent chest 
2) PEFʀ < 33% 
3) poor resp effort 
4) agitation 
5) altered consciousness 
6) cyanosis
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11
Q

acute management for moderate asthmatic attack

A

2-10 puffs of inhaled/nebulised salbutamol not exceeding 4 hourly

one puffs every 30/60 secs to make sure not excess

consider oral prednisolone if necessary

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12
Q

acute management for severe asthmatic attack

A

2-10 puffs of inhaled/nebulised salbutamol

oral prednisone or ɪV hydrocortisone if vomiting

assess response to treatment after 15 mins

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13
Q

acute management for life-threatening asthmatic attack

A

ɴebulised salbutamol and ipratropium bromide
ɪv hydrocortisone/ɪV salbutamol if necessary
consider ɪV aminophylline/ɪV Mg

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14
Q

who does inhaled foreign body most commonly occur to?

A

Mobile toddlers who would put objects into their mouth - objects that are small enough to pass the pharynx.

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15
Q

clinical features of inhaled foreign body

A

unilateral wheeze
resp distress
asymmetrical dull on percussion if collapse occur post obstruction
hyper-resonance on percussion around the collapse area due to compensatory emphysema

most commonly occur in the R main bronchi since it is straighter than the L one

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16
Q

Ix for inhaled foreign body

A

CXR- - segmental collapse or hyperinflation seen

bronchoscopy

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17
Q

management for inhaled foregin body

A

Bronchoscopy and removal of foreign body at the same time

if complete blockage - medical emergency - Heimlich manoeuvre

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18
Q

what are the prognosis of inhaled foreign body

A

bronchiectasis occur distal to obstruction –> dilated air sac and inefficient exchange of air –> recurrent/chronic infection –> require surgical removal

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19
Q

what is ottitis media

A

inflammation and possibly infection of the media ear

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20
Q

epidem of ottitis media

A

most frequent up to 7yrs
2.5-5yrs most common
most children will have an episode of OM but some 20% will have at least 3 episodes

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21
Q

Aetiology of Ottitis Media in children

A

children have a much shorter, more horizontal and poorly functioned Eustachian tube and so the drainage of the middle ear is not as good as in adult

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22
Q

causes of Ottitis media

A

virus - RSV, rhinoviruses

bacterial - strep pneumonae, haem. influenzae

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23
Q

what condition predisopse children with dysfunction Eustachian tube?

A

Down’s
post- common cold
adenoidal hypertrophy
cleft palate

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24
Q

clinical features of Ottitis Media

A

fever
painful ears
hearing loss
Preceded by URTI

younger children - anorexia, vomiting + diarrhoea

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25
what examination must you carry out if a child has a fever
exam of the tympanic membrane for ottitis media
26
what are the exam finding of ottitis media
inflamed tympanic membrane bulging tympanic membrane loss of light reflex perfusion of eardrum along with pus present
27
management of ottitis media
many causes are viral - supportive and should resolve in time delayed Amoxicillin prescription - give the prescription to the parents but ask them only to get the medication after 2-3 days if not better - ABx only indicative if children >6mnths old and symptoms persist > 48 hrs
28
prognosis of ottitis media
most cases resolve fine | some might have recurrent infection and have ottitis media with effusion, more severe - mastoiditis, meningitis
29
what is ottitis media with effusion
glue ear - recurrent ottitis media leading to exudate production and and building up pushing against the eardrum and so conductive hearing loss
30
exam finding of OME
tympanic membrane thicken, retarted, absent light reflex
31
IX for OME
flat trace of tympanometry and conductive hearing loss
32
management of OME
if significant hearing loss - insert ventilation tube ( grammets) if fluid still persist - insert another grammet (might be blocked) + consideration of adenoidectomy (long term benefit)
33
what are some of the causes of resp failure in children
``` lower airway obstruction Upper airway obstruction cardiac neurological toxic allergy ```
34
signs and symptoms of resp failure
``` dyspnoea tachypnoea cyanosis nasal flaring subcostal, intercostal recession tracheal tug grunting in baby head bobing in baby wheeze - maybe quiet if wheeze caused by asthma restless, agitation impaired consciousness and confusion ```
35
causes of lower airway obstruction RF
``` asthma bronchiolitis pneumonia cystic fibrosis neonatal lung disease ```
36
causes of upper airway obstruction RF
inhaled foreign body croup epiglottitis
37
causes of cardiac RF
severe HF
38
management of RF
If cyanosed/hypoxic, but PaCo2 normal then give O2 support aiming for 92% - be mindful of re-perfusion injury If hypoxic and raised PaCO2, then this is a sign of lack of ability to self ventilate which means it is now time for some external ventilation support treat underlying causes - ABx, steroids, bronchiodilator for asthma, bronchoscopy for foreign body
39
what is stridor
it is a symptom - loud, harsh, high pitched sound usually heard on expiatory breathing, but in severe cases of upper airway obstruction eg trachea and bronchial obstruction, it can occur in inspiratory
40
what are the emergency causes of stridor
inhaled foreign body croup epiglottitis
41
what are some of the common cuases of stridor
``` laryngomalacia subglottitis stenosis epiglottis croup inhaled of foreign body ```
42
what does biphasic stridor usually suggest in children
subglottitis/glottitic obstruction
43
What is the different between asthma and viral wheeler induced wheeze
Viral induced wheeze usually Preston in 1-5 yrs caused by virus - no symptoms when well Asthma - wheeze and SOB and continue when symptoms continue even when well
44
what is the chronic management of asthma for a child who is > 5 yrs old
step 0 = PRN SABA Step 1 = v.low dose of ICS Step 2 = V.low dose of ICS + inhaled LAMA Step 3 = if LAMA not beneficial then stop and inc dose of ICS to low dose if LAMA beneficial then continue and inc dose of ICS to low dose If LAMA beneficial then continue + inc dose of ICS to low dose + consider adding in LTRA Step 4 = inc ICS dose to medium dose + inhaled LAMA + LTRA + theophylline + specialist input Step 5 = daily oral steroid tablet + inhaled medium dose of ICS + specailist inout
45
What is bronchiolitis
It is a viral infection of the small bronchioles which in adults do not commonly cause any problems but in children with small bronchioles, they cause restriction too small that it will stop the breathing of the child
46
What is the common affected age group of bronchiolitis?
< 18 months
47
What are the common pathogens that cause bronchiolitis?
Respiratory syncytial virus (75%) - epidemics in winter Parainfluenza virus, adenovirus, influenza, rhinovirus Mycoplasma pneumoniae
48
Clinical features of bronchiolitis?
``` Wheeze, cough Rhinitis Signs of resp distress if severe - eg recession, nasal flaring, tachypnoea Overexpression of lung, fine crackles Fever ```
49
What are the investigation for bronchiolitis
Usually clinical diagnosis Oximeter CXR - if severe and chronic CHD and respiratory problem suspected - shows over-inflated, collapse, consolidation if severe
50
Management of bronchiolitis
Usually supportive If feeding okay at home If resp distress, hospital admission
51
What is bronchiolitis called after 18 months
Viral wheeze
52
What can be give to infant who have chronic resp problem and CHD?
Palivizumab - monoclonal antibodies against RSV
53
What is another name for croup?
Acute laryngotracheobronchitis
54
What is the most common pathogen that causes croup
Parainfluenza virus Other also incl RSVm, adenovirus, influenza A/B
55
What is the most common age for croup
6 months - 2/3 years
56
Symptoms of croup?
``` Croyza Fever Stridor Seal-like barking cough Hoarseness (esp on crying) Wheeze Tachypnoea ``` Symptoms worse at night IWOB Cyanosis if severe Restlessness
57
What causes the seal-like symptoms?
Caused by the inflammation of the subglottic region which causes airflow turbulence so high pitch
58
Investigation for croup?
Clinical diagnosis CXR not needed (but if done, will show the steeple sign)
59
What is a steeple sign
Wine bottle signs which is specialised in croup (where the subglottis region is swollen)
60
Management of croup
Most cases will only need supportive management However, if swelling persist then oral dexamethasone (0.15mg/kg) Oral prednisolone is alternative For severe cases, neb adrenaline can be used to acutely reduce inflammation
61
What is epiglottis
It is cellulitis of the supra-glottis region which can potentially cause airway obstruction Can be life-threatening, considered to be emergency
62
What is the most common causative pathogen for epiglottis
It is haemophilia influenza B (although it should be rare nowadays due to vaccination against HIB) Other common curative agent —> parainfluenza, Staph aureus, strep pneumoniae, MRSA, Candida (rare)
63
What is the most common age group that presents with epiglottitis
Age 2-4 (age group just after croup which can present just like epiglottitis)
64
What is the symptoms of epiglottitis
3Ds Drooling, dysphasia, distress Sore-throat, hot potato voice Inability to swallow Irritable/restless
65
What should you not do in epiglottitis
Do not examine the mouth/throat, you might just cause obstruction which means airway loss
66
What are the examination findings of epiglottitis
Stridor (inspiratory noises) Tripod position/recession Tachycardia Tachypnoea
67
Investigation for epiglottitis?
If done at all Gold standard - nasal laryngoscopes Lateral neck X-ray - thrums signs (epiglottis thickening) Throat swab (after airway secure with intubation) Blood culture (if systemically unwell)
68
Management of epiglottitis
Protect airway - intubation, may need a cricothyroidectomhy IV cefotaxime or ceftriaxone Humidified O2 Can use dexamethasone to further reduce inflammation of the epiglottis Can use neb adrenaline to manage acute closure
69
What is the prognosis of epiglottitis
If able to intubation and treat with IV cefotaxime or ceftriaxone = excellent outcome If not, then death or severe brain injury from hypoxia
70
What are the most common pathogens that causes pneumonia in neonates?
Group B strep, E.coli, klebisella, staph. Aureus
71
What are the most common pathogens that causes pneumonia in infant?
Strep pneumonia, chlamydia
72
What are the most common pathogens that causes pneumonia in school age?
Strep pneumoniae, staph aureus, group A step, bordetella pertussis, mycoplasma pneumoniae
73
What are some of the viral causes to pneumonia?
``` RSV Parainfluenza Influenza Adenovirus Coxsackie virus (coxsackie A —> Hand, for, mouth disease ```
74
What predispose children to pneumonia
``` Chronic lung disease CF CHD Immunodeficiency Tracheotomy in situ Inhaled foreign body ```
75
Symptoms & signs of pneumonia in neonates?
``` Grunting Recession Cyanosis Cough poor feeding Irritable Fever ```
76
Symptoms & signs of pneumonia in infant
``` Cough, grunting, recession Fever Wheezy Preceded by URTI Irritable Feeding difficulties Tachypnoea ```
77
Symptoms & signs of pneumonia in pre-school/older children?
Cough Tripod position Fever Preceded by URTI Pain (chest/abdo - lower lobe infection irritates the abdo area) Post-tussive vomiting - post cough vomiting)
78
Investigation of pneumonia in children
``` FBC - WCC raised CRP - raised Sputum culture - in older children only Blood culture - if severe CXR - focal - bacterial / diffuse - viral ``` Skin tuberculin test - test for TB Cold agglutinis - mycoplasma pneumoniae (atypical pneumonia)
79
Management of pneumonia
Supportive Anti-pyrexia - avoid aspirin due toe danger of Reye’s syndrome Admission to hospital - usually okay to management in community, but if resp distress, poor feeding, tachycardia, raised CRT, chronic lung disease etc then admit ABx - can’t differentiate between viral and bacterial if high fever then usually bacterial then consider ABx Acute - IV penicillin Sub-acute - PO amoxicillin If allergic - clarithromycin, erythromycin
80
Prognosis/complications of pneumonia
Prognosis usually good Complications ``` Lung abscess Emphysema Pneumothorax Septicaemia Bronchiectasis Pleural effusion ```

Year 4 Paeds Conditions (10 decks)

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