Rhinorrhea / nasal blockage Sore throat Red watery eyes

Chest Flashcards by Ahmed Sagheir

mention the classification of cough

Acute → < 3 weeks
Subacute → 3 ~ 8 weeks
Chronic → > 8 weeks

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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.

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M/C location of foreign body inhalation

Rt. main bronchus (wider / more vertical)

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dry irritative husky cough indicates

pharyngeal irritation

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coryza triad

Rhinorrhea / nasal blockage
Sore throat
Red watery eyes

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incidence of common cold

6 / 7 per year (up to 12)
m/c → rhinovirus

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choice of antibiotics in frontal sinusitis

parenteral

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incidence of croup

2 ~ 5 years
M > F
(inflammation in subglottic region and vocal cords)

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DD of acute stridor in infancy

Croup
Foreign body inhalation
Epiglottitis
Laryngitis

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DD of chronic stridor

Laryngomalacia
Vocal cord paralysis
subglottic stenosis
subglottic Hemangioma

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most common cause of stridor in infancy

Laryngomalacia

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M/C cause of acute bronchiolitis

RSV
most severe at 1 ~ 2 months in winter age
** < 2 years **

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inv of croup

only clinical is sufficient
Optional :
* Pulse oximetry
* X-Ray → steeple sign

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M/C cause of lobar pneumonia
(and bacterial pneumonia)

Strept. pneumoniae

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M/C cause on pneumonia

Viral → RSV
influenza, parainfluenza

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Commonest causative organisms of pneumonia in infants

GBS
Listeria monocytoses
E. coli

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Commonest causative organisms of pneumonia in 1 ~ 3 months

Viral
Chlamydia (febrile pneumonia)
Bordetella Pertussis

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Commonest causative organisms of pneumonia in ** 4m ~ 4 y**

Viral
Bacterial ( Strept. pneumoniae , Moraxella catarrhalis)

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Commonest causative organisms of pneumonia in ** > 5y**

atypicals:
1. Mycoplasma (walking pneumonia )
2. Chlamydia trachomatis

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child with pneumonia + staccato cough

Chlamydial pneumonia
Pertussis

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asthma demography

more common in urban than rural areas

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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. ## Footnote culture is only positive in 30 %

M/C extrapulmonary TB

TB lymphadenopathy ## Footnote * 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

1. hydrocephalus 2. affection of CN 3,5,8 3. SIADH ## Footnote 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 ## Footnote * 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

1. very young age 2. malnutrition 3. immunodeficiency 4. heavy TB load (miliary) 5. vaccination with live virus 6. 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

1. TB meningitis 2. Miliary TB 3. Pleural effusion + mediastinal shift 4. Pericardial effusion 5. 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