Case 13: 6 yo with chronic cough Flashcards
What are the general causes for a chronic cough in a child?
infection inflammation irritation anatomic psychogenic
True or false: most children with TB will display symptoms.
false - more than 50% of infnats and children with radiographically evident disease have no physical findings
What is the primary hallmark of TB in the lung?
primary gohn complex (relatively larger size of the hilar lymphadenopathy compared with the relatively small size of the initial lung focus)
then focal hyperinflation and then atelectasis
What is the most practical diagnostic test to diagnose TB infection in an asymptomatic child?
Mantoux
Describe how the mantoux is interpretted.
positive if
> 5 mm in high-risk kids (exposed)
> 10 mm in moderate risk children
>15 mm in low risk children
What are some physical exam findings you might see in a patient with bad allergies?
allergic shiners
allergic salute (transverse nasal crease in the bridge of the nose from pushing the nose upward and backward with the hand to relieve nasal itching and obstruction)
Dennie-morgan lines (infraorbital creases that appear due to intermittent edema caused by allergies)
can also see clubbing if severe
cobblestoneing of posterior pharynx
boggy turbinates
What is the most important distinguishing characteristics of sinusitis compared to viral URI?
persistence of symptoms without improvement for over a week at least
also persistence of bilateral nasal discharge or daytime cough lasting for more than 10 days or worsening after initial improvement or high fever and purulent nasal discharge for more than 3 days
What are the most common indoor aeroallergens that are responsible for sensitizing susceptible people to asthma?
house dust mites
animal dander
cockroaches
What is the most specific means of determining whether or not a child has asthma?
spirometry before and after bronchodilator therapy
What tests can be done in cases where asthma is strongly suspected, but spirometry is normal or near normal?
bronchoprovocation with methacholine, histamine or exercise
Who should be started on a daily controller medication (usually inhaled corticosteroids)?
anyone with persistent asthma (regardless of severity)
How long does it take before inhaled steroids provide some benefit?
several weeks
What side effects should you monitor children for if they are on long-term high dose inhaled steroids?
HTN
hyperglycemia
growth delay
cataracts
What should be on your differential for cough?
asthma allergies sinusitis bronchitis GERD Atypical pneumonia
What will you see on spirometry for a diagnosis of asthma?
reduced FEV1 and FVC, but FEV1 is more reduced, so you get a low FEV1/FVC ratio
