Week 2.2 - Respiratory Conditions

Question 1

Children are more likely to have lower airway inflammation be described as bronchiolitis and not bronchitis. Why is this?

Answer 1

It is more likely to affect their bronchioles –> Different terminology

Question 2

What are the most common viruses that effect children?

Answer 2

Respiratory Syncytial Virus

Also, nonpolioviruses, adenoviruses, parainfluenza, human metapneumoviruses, coronaviruses, influenza

Question 3

What are some modifiable risk factors for respiratory infection in children?

Answer 3

Not breastfed, daycare attendance, smoking in house, malnutrition, anemia

Question 4

What are not non-modifiable risk factors for respiratory infection in children?

Answer 4

Preterm, chronic lung disease, congenital heart disease, cystic fibrosis, chronic illness, immunocompromised, allergies, asthma.

Question 5

Why might warm humidity help with bronchiolitis/RSV?

Answer 5

Moisten secretions and promote their movement

Question 6

What are croup syndromes? What do they look like?

Answer 6

Affect upper Respiratory tract - pharynx, epiglottis, larynx, trachea, tonsils, middle ear (otitis media)

Characterizes by sudden onset of harsh, barking cough. Often inspiratory stridor with hoarseness and sore throat.
Causes mild to severe respiratory distress.

Question 7

What kind of croup is characterized by sudden onset? How does the onset present?

Answer 7

Acute Epiglottitis
–> Sore throat, inspiratory frog-like stridor

Question 8

What causes acute laryngo-tracheobronchitis?

Answer 8

Viral in origin

Question 9

What causes acute spasmodic croup?

Answer 9

Could be viral or anxiety related

Question 10

What causes acute epiglottitis?

Answer 10

H. Influenzae type B
–> Most serious of croup disorders due to high risk of airway obstruction

Question 11

What causes acute tracheitis?

Answer 11

Staphylococcus

Question 12

Acute laryngotrancheobronchitis is the most common croup syndrome. What usually causes it and what is it characterized by? What age group does it affect?

Answer 12

Usually viral in origin
–> Characterized by gradual onset of low-grade fever, barky brassy seal-like cough that is worse at night, inspiratory stridor, hoarseness

Usually affects children under five.

Question 13

What age group is most commonly affected by acute epiglottitis?

Answer 13

Age 2-8 years

Question 14

What are the 4Ds of acute epiglottitis?

Answer 14

Drooling, dysphonia, dysphagia, distress (agitation)

Question 15

Why should we try to minimize crying in a child with croup?

Answer 15

Causes increased edema in airway, not worth the risk of extra assessments

Question 16

What medications might be used for croup?

Answer 16

–> Dexamethasone
–> Antipyretics
–> Epinephrine
–> Inhalations (antibiotics for epiglottis)

Question 17

How can we treat foreign body aspiration? How is it diagnosed?

Answer 17

Back blows, abdominal thrusts initially - removal might be done by endoscopy

Diagnosed with Xray

Question 18

What is the most common cause bronchioilitis?

Answer 18

Respiratory Syncytial Virus

Question 19

Mucosal inflammation/edema, accompanied by bronchioles becoming constricted during expiration occurs during which illness process? What does this lead to?

Answer 19

Bronchiolitis
–> Air trapping + hyperinflation
–> Atelectasis with complete obstruction

Impaired gas exchange results in metabolic acidosis and mild respiratory alkalosis

Question 20

What is the most common cause of bronchiolitis?

Answer 20

RSV

Question 21

Chest overexpansion, rhinorrhea, and crackles are common in which airway issue in children?

Answer 21

Bronchiolitis
–> Alterations in behaviour and LOC is sign of cyanosis

Question 22

What does the course of RSV look like?

Answer 22

Peaks at day 3-5 and lingers for 2-4 weeks.

Question 23

What is most important treatment for bronchiolitis?

Answer 23

Oxygen and hydration
–> We want to increase efficacy and decrease resp effort to prevent exhaustion

Question 24

Influenza is most severe in which age group?

Answer 24

Infants

Question 25

A child presents with dry throat, dry cough, is flushed and fevered with chills, has photophobia, myalgia and a lack of energy. What does this resemble?

Answer 25

Influenza

Question 26

How long does influenza last?

Answer 26

4-5 days.

Question 27

What bacteria causes pertussis or whooping cough?

Answer 27

Bordetella pertussis

Question 28

Pertussis is highly contagious and has a high risk to young infants. It has a high morbidity and risk of mortality. How is it prevented?

Answer 28

Vaccination --> Lifelong immunity after infection

Question 29

What is the usual etiology of pneumonia in children?

Answer 29

Viral - RSV/influenza most common May also be bacterial or aspiration

Question 30

What is the normal respiratory rate for a three year old?

Answer 30

20-30 rpm

Question 31

What is the normal respiratory rate for a school aged child?

Answer 31

3-6: 20-25 6-12: 14-22

Question 32

What is the normal respiratory rate for a youth (12+)

Answer 32

12-18 rpm

Question 33

What are the goals of care in a child with a respiratory tract infection?

Answer 33

To decrease respiratory effort, prevent exhaustion, and/or increase efficacy

Question 34

What is the most serious croup disorder? What causes it?

Answer 34

Acute epiglottitis due to high risk of airway obstruction --> caused by haemophilus influenzae

Question 35

What is Otitis media?

Answer 35

Fluid in middle ear alongside acute illness and symptoms of middle ear infection

Question 36

What causes mononucleosis? What symptoms are associated with it?

Answer 36

Caused by Epstein-Barr Virus --> Fever, exudative pharyngitis, lymphadenopathy, hepatosplenomegaly, and increased atypical lymphocytes.

Question 37

Which structures can be affected by croup syndromes?

Answer 37

Larynx, trachea, bronchi, epiglottis, pharynx (upper airway)

Question 38

What age group is usually effected by acute larygotracheobronchitis?

Answer 38

Children under 5

Question 39

What age is usually affected by acute spasmodic laryngitis?

Answer 39

1-3 years of age.

Question 40

What is the most common kind of croup?

Answer 40

Laryngotracheobronchitis

Question 41

Do children develop immunity to RSV?

Answer 41

No, re-infections are common

Question 42

What are the long-term effects of bronchiolitis?

Answer 42

Infection in the first year of life Increases the risk of childhood asthma

Question 43

What age group is typically effected by bronchiolitis?

Answer 43

Children ages 2-12 months, rare after 2 years

Question 44

What is tamiflu?

Answer 44

Antiviral that can be given in early infection of influenza to prevent severe infection.

Question 45

When is RSV season?

Answer 45

November-April

Question 46

What is choanal astresia?

Answer 46

A kind of congenital respiratory anomaly wherein a bony or membranous septum develops between the nose and pharynx, blocking airflow through nose.

Question 47

What is a congenital diaphragmatic hernia?

Answer 47

A defect in the diaphragm that allows abdominal organs to be displaced into the thoracic cavity. --> More common on the left side, where diaphragm closes last.

Question 48

What bacteria often causes respiratory infections in children?

Answer 48

Group A B-hemolytic strep Staph C. trachomatis, H. Influenza Mycoplasmas, pneumococci

Question 49

How does acute epiglottitis present?

Answer 49

With abrupt onset and inspiratory stridor --> Sore throat, retractions, fever, frightened look, tripoding 4Ds - drooling, dysphagia, dysphonia, distress

Question 50

What are the first two interventions for a child with a compromised airway?

Answer 50

Reposition Clear airway

Question 51

How do we manage a B. pertussis infection?

Answer 51

Supportive Care + Erythromycin

Question 52

Which populations are primarily affected by whooping cough?

Answer 52

Children under 4 who are not immunized