Chest Flashcards
mention the classification of cough
- Acute → < 3 weeks
- Subacute → 3 ~ 8 weeks
- Chronic → > 8 weeks
define the criteria of recurrent cough
cough repeated more than two attacks per year, apart from those
associated with common colds, that each last more than 7–14 days.
M/C location of foreign body inhalation
Rt. main bronchus (wider / more vertical)
dry irritative husky cough indicates
pharyngeal irritation
coryza triad
- Rhinorrhea / nasal blockage
- Sore throat
- Red watery eyes
incidence of common cold
6 / 7 per year (up to 12)
m/c → rhinovirus
choice of antibiotics in frontal sinusitis
parenteral
incidence of croup
2 ~ 5 years
M > F
(inflammation in subglottic region and vocal cords)
DD of acute stridor in infancy
- Croup
- Foreign body inhalation
- Epiglottitis
- Laryngitis
DD of chronic stridor
- Laryngomalacia
- Vocal cord paralysis
- subglottic stenosis
- subglottic Hemangioma
most common cause of stridor in infancy
Laryngomalacia
M/C cause of acute bronchiolitis
RSV
most severe at 1 ~ 2 months in winter age
** < 2 years **
inv of croup
only clinical is sufficient
Optional :
* Pulse oximetry
* X-Ray → steeple sign
M/C cause of lobar pneumonia
(and bacterial pneumonia)
Strept. pneumoniae
M/C cause on pneumonia
Viral → RSV
influenza, parainfluenza
Commonest causative organisms of pneumonia in infants
- GBS
- Listeria monocytoses
- E. coli
Commonest causative organisms of pneumonia in 1 ~ 3 months
- Viral
- Chlamydia (febrile pneumonia)
- Bordetella Pertussis
Commonest causative organisms of pneumonia in ** 4m ~ 4 y**
- Viral
- Bacterial ( Strept. pneumoniae , Moraxella catarrhalis)
Commonest causative organisms of pneumonia in ** > 5y**
atypicals:
1. Mycoplasma (walking pneumonia )
2. Chlamydia trachomatis
child with pneumonia + staccato cough
- Chlamydial pneumonia
- Pertussis
asthma demography
more common in urban than rural areas
asthma predictive index
based on presence of a wheeze before
the age of 3.
one major risk factor
*parental history of asthma/eczema
or
2/3 minor risk factors
* eosinophilia
* wheezing without cold
* allergic rhinitis
M/C cause of non-specific chronic cough
secondary to protracted URTI
treatment of Non-specific cough without impact:
observe before diagnostic tests or treatment are initiated,
with a follow-up examination of the child after 6–8 weeks.
treatment of Non-specific dry cough disturbing daily activity/ sleep :
A trial treatment with inhaled CS at half doses is recommended (budesonide 400μg/day or equivalent)
for 2–12 weeks
then
The patient should be reassessed after 2–3 weeks and if there has been no response to treatment, it should be
discontinued
diagnosis of cough variant asthma
if symptoms recur after treatment withdrawal
and respond again after re-introduction
TTT of Non-specific productive cough
course of antibiotics (amoxicillin–clavulanate) for 2–3
weeks
regarding TB transmission
children < 10y generally cannot transmit TB
The probability that TB will be transmitted depends on what four factors?
- Infectiousness of person with TB disease
- Environment in which exposure occurred
- Length of exposure
- Virulence (strength) of tubercle bacilli
detection of latent TB infection
interferon-gamma release assay
mention types of pulmonary TB
a) Primary pulmonary TB with focal lymphadenopathy
b) Progressive pulmonary disease.
c) Reactivated pulmonary disease.
d) Pleural involvement
pleural effusion in TB is dt
rupture of subpleural pulmonary focus or caseated lymph node in the pleural cavity.
culture is only positive in 30 %
M/C extrapulmonary TB
TB lymphadenopathy
- occurs within 6 ~ 9 months of initial infection
- group affected depends on the primary site
- surgical removal is not an adequate ttt
Co-morbidities of CNS TB
- hydrocephalus
- affection of CN 3,5,8
- SIADH
tuberculin test is negative
Tuberculoma is diagnosed by
CT brain
TB pericardial effusion results from
lymphatic drainage from subcarinal lymph nodes
or
direct invasion
onset of miliary TB
within 2 ~ 6 months of initial infection
early diagnosis of miliary TB
Liver / BM biopsy
age of onset in congenital TB
2nd / 3rd week of life
- history clue → Maternal TB + no response to ordinary Ab
- Tuberculin test is -ve, becomes +ve in 1 ~ 3 months
Children for whom immediate TST is indicated:
- Contacts of people with confirmed or suspected tuberculosis.
- Children with radiographic or clinical findings suggesting tuberculosis
- Children immigrating from countries with endemic infection
- Children with travel histories to countries with endemic infection and substantial contact with people from such countries
false -ve tuberculin test
- very young age
- malnutrition
- immunodeficiency
- heavy TB load (miliary)
- vaccination with live virus
- improper technique
M/C cause of false -ve TB
poor technique and misreading of the results
False +ve tuberculin test
❑ Cross sensitization to antigens of non-tuberculous mycobacteria
❑ Previous vaccination with (BCG)
indications of CS in TB
- TB meningitis
- Miliary TB
- Pleural effusion + mediastinal shift
- Pericardial effusion
- endobronchial TB
type of TB in BCG vaccine
M. Bovis
Risk Factors For Progression Of Latent Tuberculosis Infection To
Tuberculosis Disease
❑ children ≤4 yr of age and adolescents
❑ Persons co-infected with HIV
❑ Persons who are immune-compromised
biomarkers for asthma activity include
FeNO
preferred delivery system for asthma delivery
pMDI with a valve holding device
face mask is recommended for children < 4 years of age
Primary therapies for exacerbations:
- Repetitive administration of rapid-acting inhaled β2
agonist. - Early introduction of systemic glucocorticosteroids.
- Oxygen supplementation.
- Closely monitor response to treatment with serial
measures of lung function.
patient with normal appearance ,
normal circulation to skin
abnormal work of breathing
respiratory distress → O2
If normal circulation
abnormal Appearance, breathing
respiratory failure
narrowest part of the child airway
cricoid cartilage
X ray findings in stridor
- Croup → steeple sign
- Acute epiglottitis → thumb sign
