6. Respiratory / ENT minor Flashcards
What are the differentials for an acute cough?
-UPPER airway disease
–Common cold, whooping cough, croup, sinusitis
–Allergy
–Vocal cord dysfunction
-LOWER airway disease
–Asthma
–Bronchiolitis
-LUNG PARENCHYMAL disease
–Infection
–Atypical pneumonia
-FOREIGN BODY
What are the differentials for a chronic cough?
(>8 weeks)
-UPPER airway disease
–Infection - chronic tonsillitis, sinusitis, post-nasal drip, pertussis
–Inflammation eg GORD
-LOWER airway disease
–Congenital abnormalities eg CF
–Infection
–Asthma
–Foreign body
–Bronchiectasis
–TB
-LUNG PARENCHYMAL disease
-PSYCHOGENIC
-TOURETTE’S
What red flags are there for a cough?
-Haemoptysis
-Dyspnoea
-Pleuritic chest pain
-Stridor
-Respiratory distress
-Cyanosis / hypoxia
What are the different symptoms you’d expect from an inhaled foreign body in the larynx compared to the oesophagus?
Larynx:
-Hoarseness, cough, dysphonia
-Stridor, wheezing, dyspnoea
-Cyanosis, apnoea
Oesophagus:
-Drooling, dysphagia
-Vomiting
-Tracheal compression
How is an inhaled foreign body diagnosed?
-AUSCULTATION - monophasic wheeze / absent breath sounds on one side
-CXR - may show collapse consolidation or mediastinal shift
-ABG if in severe distress
How is an inhaled foreign body managed?
ABC
-If child is calm + good air exchange present, removal by back blow / chest thrusts
-If child is unconscious face 100% o2, bronchoscopy to remove FB
What commonly causes otitis media?
-Strep pneumoniae
-H. influenzae
-Some viruses eg RSV
What risk factors are there for developing OM?
Eustachian tube dysfunction eg
-URTIs
-Enlarged adenoids causing obstruction
-Cleft palate
-Down’s syndrome
What can be seen on examination of the ears?
NB examine eardrums of any ill / febrile toddler as may be asymptomatic
-Red, inflamed, bulging TM
-Purulent discharge may be present
-Loss of light reflex
How should OM be managed?
-Trial 72h paracetamol for symptomatic relief - most resolve spontaneously
-If symptoms >4 days / not improving / immunocompromised / bilateral <2yrs / perforation then five amoxicillin 5 days (erythromycin if allergic)
What complications can arise from OM?
-Conductive hearing loss
-Mastoiditis (otalgia, very unwell, external ear protrusion)
-Meningitis
-OM with effusion ie glue ear
How should glue ear be managed?
-TM looks thickened, retracted and speech / language delay often a feature
-Grommets inserted in cases of significant hearing loss + causing language delay
-Caused by thick exudate collecting in middle ear
What can cause shortness of breath in a child?
AIRWAY OBSTRUCTION
-Upper eg laryngitis, epiglottitis, foreign body
-Lower eg foreign body, bronchitis, bronchiolitis, bronchomalacia, asthma, pertussis
ABNORMAL LUNG MECHANICS
-Restrictive lung disease eg chest wall deformity
-Lung parenchymal disease eg pneumonia, pulmonary HTN
-Muscle weakness eg diaphragmatic paralysis
HYPOXIA
-VQ mismatch eg pneumonia, pneumothorax, PE
-Heart disease eg cyanotic CHD, pericarditis, myocarditis
What is stridor and what does it indicate?
-Noise heard during inspiration
-Pathology can be anywhere from nose to thoracic inlet
-Indicates:
–Upper airway obstruction
–Fixed extra-thoracic airway obstruction
What can cause stridor originating from the nose and pharynx?
-Congenital obstruction eg choanal atresia
-Inflammation eg rhinitis, sinusitis
What can cause stridor originating from the mouth, pharynx and larynx?
-Congenital eg laryngomalacia, laryngeal web, vocal cord paralysis
-Inflammation eg epiglottitis, croup, GORD
-Masses eg haemangiomas, abscess, lymphangioma
-Trauma eg FB inhalation
What can cause stridor originating from the trachea?
-Congenital obstruction eg tracheomalacia, trachea-oesophageal fistula
-Infection eg bacterial tracheitis
How do TB bacilli spread in the body once they are inhaled?
-Multiply in the lungs
-Multiply in regional lymph nodes
-Lesions in lungs + lymph nodes = Ghon complex
-Triggers a type 4 hypersensitivity reaction
-Spreads via blood and lymphatics
What are children <4yrs at risk of with TB infection?
-Miliary TB ie disseminated disease
-Lesions in liver, lungs, spleen, bone marrow due to haematogenous spread
What causes whooping cough?
-Bordetella pertussis
-URTI characterised by severe cough
-Occurs in young infants or unvaccinated children (pregnant women offered vaccine now)
How does whooping cough present?
-Paradoxical cough spasms during expiration followed by sharp intake of breath (whoop)
-Can cause apnoea in infants
-Starts with cold symptoms / dry cough
-Culture possible from nasal swab after 2 weeks of symptoms / antibodies after 3 weeks
How is whooping cough managed?
-Azithromycin for 5 days
-Clarithromycin for 7 days
-Avoid school / nursery for 48h if taking treatment / 3 weeks if no treatment
-Notifiable disease
-Cough can continue for months
