Cough/Dyspnoea/Wheeze

Question 1

How many RTIs can children have per year?

Answer 1

6-12 RTIs

Question 2

DDx acute cough

Answer 2

• Respiratory infection: common cold, bronchiolitis, croup, pneumonia, pertussis
• Asthma
• Inhaled foreign body

Question 3

DDx persistent/recurrent cough in ADULTS

Answer 3

1. asthma
2. gord
3. post-nasal drip

Question 4

DDx persistent/recurrent cough in PAEDS

Answer 4

• Protracted bacterial bronchitis
• Asthma
• Tracheomalacia: onset in infancy, barking
• Post-viral cough
• Pertussis
• Suppurative lung disease: wet (productive)
• CCF
• Psychogenic
• other e.g. smoking

Question 5

Examples of suppurative lung disease

Answer 5

• Chronic suppurative lung disease
• Cystic fibrosis
• Immunodeficiency
• Primary ciliary dyskinesia
• Bronchiectasis
• Inhaled FB
• Protracted bacterial bronchitis: especially following a predisposing viral infection

Question 6

DDx of cough in:

• infancy
• pre-school
• school age

Answer 6

• Infancy: infections (URTI, bronchiolitis, pneumonia), congenital malformations of airway, GORD, CF
• Pre-school: infections (URTI, croup, acute bronchitis, pneumonia), FB aspiration, asthma, CF
• School-age: asthma, URTI, cigarette smoking, post-nasal drip, psychogenic, CF

Question 7

DDx paroxysmal cough

Answer 7

○ Pertussis
○ Chlamydia
- Foreign body

Question 8

Acute cough vs chronic cough

Answer 8

Acute < 4weeks

Question 9

Compare cough and fever in:

• URTI
• Pneumonia
• Asthma
• Foreign body

Answer 9

• URTI: +/- fever, non-productive cough
• Pneumonia: fever, productive cough
• Asthma: +/- if URTI present, wheeze often nocturnal cough or on exercise
• Foreign body: fever if infection, cough often preceded by choking episodes

Question 10

Pulmonary causes of dyspnoea (upper airway, lower airway, pleural causes)

Answer 10

• Upper airway
	○ Foreign body
	○ Croup
	○ Epiglottitis
	○ Laryngeal oedema
	○ Retropharyngeal abscess

• Lower airway
	○ Asthma
	○ Bronchiolitis
	○ Pneumonia
	○ Atelectasis
	○ PE

• Pleura
○ Pleural effusion
○ Pneumothorax
○ Empyema

Question 11

Cardiac causes of dyspnoea

Answer 11

• CHF

* Cardiac tamponade

Question 12

List a few non-pulmonary/cardiac causes of dyspnoea

Answer 12

• Acidosis (e.g. DKA)
• Sepsis
• Raised ICP
• Ascites

Question 13

DDx for wheeze

Answer 13

• Asthma: recurrent wheezing episodes, identifiable triggers
• Viral-induced wheeze
• Bronchiolitis: first episode of wheezing
• Recurrent aspiration: often neurological impairment
• Pneumonia: fever, cough, malaise
• Croup: stridor
• Foreign body
• CF
• Congestive heart failure
• Laryngomalacia

Question 14

What might a persistent vs intermittent wheeze tell you about the cause of the wheeze?

Answer 14

• Persistent more likely structural

- Intermittent more likely functional

Question 15

What is a common cause of persistent, acute onset wheeze?

Answer 15

Foreign body aspiration

Question 16

Compare stridor and wheeze.

Answer 16

Stridor
• A high pitched inspiratory noise due to partial obstruction of upper airways (trachea or larynx)

Wheeze:
- expiratory sound through narrowed airways (e.g. asthma, bronchiolitis, CHF, foreign body, GORD)

Question 17

Why do children grunt? What is it indicative of?

Answer 17

• Exhalation through closed glottis is an attempt to maintain FVC e.g. pneumonia

Question 18

What is the most common cause of stridor in infants?

Answer 18

Laryngomalacia

Question 19

What are some causes of stridor?

Answer 19

• Within the lumen (e.g. foreign body, mass)
• Within the wall (e.g. epiglottitis, croup, oedema from anaphylaxis, laryngospasm)
• Extrinsic (e.g. goitre, lymphadenopathy, oesophagus)

Question 20

List some signs of increased WOB, from most mild to most severe.

Answer 20

• Mild: tachypnoea
• Mod: retractions - subcostal (i.e. abdominal breathing), substernal, intercostal, nasal flaring
• Severe: head bobbing, tracheal tug, retractions - supraclav, suprasternal, sternal
• Very severe: grunting
• Other: body posture, behaviour, conscious state, ability to talk
• NB: accessory muscle use = posture, SCM contraction, head bobbing

Question 21

What is the tracheal tug?

Answer 21

Downward movement of thyroid cartilage towards the sternal notch on inspiration - sign of severe airflow limitation

Question 22

What is the cause of crackles? What do they sound like?

Answer 22

• Discontinuous, bubbling sounds

- fluid/substance in lower aiwrways

Question 23

What are rhonchi (previously rales)?

Answer 23

Low pitched wheeze continuous throughout insp and exp, clear after coughing

Question 24

Most common cause of chronic cough in children?

Answer 24

Protracted bacterial bronchitis