19/9/21 Flashcards
Demographic, Triggers and Timing of Recurrent Post-Infection Cough
Most common in pre-school age children
Triggered by Viral URTI
Episodes clustered around winter, less present in summer
Clinical Presentation of Recurrent Post-Infection Cough (Type of Cough & Pattern)
Type: Dry Paroxysmal Cough -> day and night, disturbs sleep. Worse with exercise, not associated with wheeze or SOB.
Paroxysms can be severe and can lead to post-tussive retching or vomiting but the child is asymptomatic between paroxysms
Pattern: cough lasts for 10-14 days until the next viral URTI
True or False:
Cough can be considered as part of the asthma symptom complex if there is no wheeze or SOB
False. Cough needs to be associated with wheeze or SOB to be part of the asthma symptom complex. If it is not, it is more likely a post-viral cough
What are the two types of habit cough and who are they most common in?
- Harsh “honking” cough → common in teenage girsl, very persistent during the days but settles once the child is asleep. No SOB or sputum production
- Annoying “throat-clearing” cough → occurs in boys 7-10yo, related to the common “transient tic disorder”
Management of Habit/Psychogenic Cough?
Usually reassurance is all that is required. If protracted habit/psychogenic cough -> refer for distraction therapies and/or psychological support
Pathogenesis of Protracted Bronchitis Cough
Cough as a result of a low grade infection -> isolated moist cough in a previously well child
Clinical Presentation of Protracted Bronchitis Cough
Isolated most cough in a previously well child
More prominent in the morning
Improves transiently after short course of ABx and then recurs
Treatment of Protracted Bronchitis Cough
Amoxicillin/Clavulanate for 3-4 weeks
If no improvement with this, refer to respiratory physician
Features of Chronic Cough that refer to specific underlying cause. (13 points - give me 5)
- Auscultation → crackles or differential breath sounds
- Barking Cough from Birth
- Chest Wall Deformity
- Dyspnoea - on exertion or at rest
- Failure to Thrive/Weight Loss
- Feeding Difficulties
- Finger Clubbing
- Haemopytisis
- Neuodevelopmental Abnormality
- Recurrent Pneumonia
- Habit/Psychogenic Cough >3 months
- Recurrent Episodes of Protracted Bronchitis
- Chronic Moist Cough → fails to response to prolonged antibiotic course
Management of Cough in a well child with normal examination (5 points)
- Investigations and treatment are rarely needed
- Reassure
- Avoid exposure to irritants such as cigarette smoke
- DO NOT give cough medicines, decongestants, antihistamines, antibiotics. Also no role for steam inhalation and humidified air.
- Arrange follow-up with GP in 2-3 weeks
Keratosis Pilaris: What is it? Who Gets it? Pathogenesis?
Very common - Dry skin, hair follicles plugged by scale
Affects up to half of normal children and up to 3/4 of children with icthyosis vulgaris
Clinical Features of Keratosis Pilaris.
- Affects the outer aspects of the upper arms. Can also occur on the thighs, buttocks and sides of the cheeks and less often on the forearms and upper back. Symmetrical distribution.
- Scaly spots - can appear skin coloured, red or brown. Not itchy or sore. More prominent in the winter months (low humidity)
Keratosis Pilaris - Distribution?
Symmetrical
Keratosis Pilaris - Where?
Outer aspects of upper arms. can also appear on buttocks, thigh or sides of cheeks. Uncommon on forearms and upper back
Who should get ovarian cancer screening?
No-one. There is no evidence for screening in low or high risk asymptomatic individuals.
