2. Respiratory Flashcards
24hrs fever in a 2 year old- what should you ask?
- immunisations
- eating/drinking/behaviours
- wheezing/cough/runny nose
- ears - pulling at them/hx of ear infection
- sick contacts
- rash - esp petechial (small non blanching - bigger is purpurae)
- uti features (stomach pain, dysuria, nocturia)
If you lose the right heart border on CXR, which lung lobe is affected? What about right lower lobe?
R middle lobe
R lower lobe = lose R diaphragm border
antibiotics for CAP and targets
amoxycilin > strep pneumoniae
amoxy/clav (augmentin)> staph aureus
Management if no progress continues after antibiotics- eg ongoing fevers, reducing O2 requirement, tolerating oral fluids
Consider viral pathogen (eg RSV), resistant bacteria, consider empyema (percuss- stony dullness, reduced air entry).
Repeat CXR if empyema/concern
Most common cause of chronic cough in children?? What is it? Why does it become chronic?
Protracted bacterial bronchitis - persistent infection of conducting airways- biofilm formation> difficult to eradicate
What are the common organisms causing protracted bacterial bronchitis (3) ?
- H influenzae
- Strept pneumoniae
- Moraxella catarrhalis
treatment of peristent BB
antibiotics 4-6wks, B adr dilators, ICS if prolonged
patient’s cough resolved during antibiotic tx for PBB, then returned 1 wk after stopping abx- management now?
Could be Chronic Suppurative Lung Disease (symptoms indicating chronic endobronchial infection) - there could be overlap between CSLD, PBB and bronchiectasis
6 causes of chronic suppurative lung disease
- cystic fibrosis
- primary ciliary dyskinesia
- immunodef
- previous severe pneumonia
- foreign body
- tuberculosis
Inheritence of cystic fibrosis?
AR, gene located on chr 7, incidene 1/2500 live births
Systems involved in CF?
- chronic pulm disease- exacerbations of cough, sputum, SOB
- pancreas
- liver
- gut
- electrolyte disturbance
- genito-urinary
Mechanism of CFTR in CF of lungs (CF transmembrane conductance regulator)
- eNAc not inhibited > increased absorption of sodium and therefore water
- Cl- ions not secreted> increased NaCl and water absorption
> decreased airway surface liquid= adherent mucus plaque (no lubrication)
> depleted periciliary liquid layer= failure of ciliary beating
Primary ciliary dyskinesia inheritance
AR- several genes
> functional and structural defects of cilia
> impaired mucociliary clearance
Dx of primary ciliary dyskinesia
- ciliary beat frequency and pattern
- cilial ultrastructure: electron microscopy
PCD treatment
- antibx
- airway clearance
- routine vaccinations
- hearing aids
- grommets
