Cough/Dyspnoea/Wheeze Flashcards
How many RTIs can children have per year?
6-12 RTIs
DDx acute cough
- Respiratory infection: common cold, bronchiolitis, croup, pneumonia, pertussis
- Asthma
- Inhaled foreign body
DDx persistent/recurrent cough in ADULTS
- asthma
- gord
- post-nasal drip
DDx persistent/recurrent cough in PAEDS
- Protracted bacterial bronchitis
- Asthma
- Tracheomalacia: onset in infancy, barking
- Post-viral cough
- Pertussis
- Suppurative lung disease: wet (productive)
- CCF
- Psychogenic
- other e.g. smoking
Examples of suppurative lung disease
- Chronic suppurative lung disease
- Cystic fibrosis
- Immunodeficiency
- Primary ciliary dyskinesia
- Bronchiectasis
- Inhaled FB
- Protracted bacterial bronchitis: especially following a predisposing viral infection
DDx of cough in:
- infancy
- pre-school
- school age
- 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
DDx paroxysmal cough
○ Pertussis
○ Chlamydia
- Foreign body
Acute cough vs chronic cough
Acute < 4weeks
Compare cough and fever in:
- URTI
- Pneumonia
- Asthma
- Foreign body
- 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
Pulmonary causes of dyspnoea (upper airway, lower airway, pleural causes)
• Upper airway ○ Foreign body ○ Croup ○ Epiglottitis ○ Laryngeal oedema ○ Retropharyngeal abscess
• Lower airway ○ Asthma ○ Bronchiolitis ○ Pneumonia ○ Atelectasis ○ PE
• Pleura
○ Pleural effusion
○ Pneumothorax
○ Empyema
Cardiac causes of dyspnoea
- CHF
* Cardiac tamponade
List a few non-pulmonary/cardiac causes of dyspnoea
- Acidosis (e.g. DKA)
- Sepsis
- Raised ICP
- Ascites
DDx for wheeze
- 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
What might a persistent vs intermittent wheeze tell you about the cause of the wheeze?
- Persistent more likely structural
- Intermittent more likely functional
What is a common cause of persistent, acute onset wheeze?
Foreign body aspiration
Compare stridor and wheeze.
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)
Why do children grunt? What is it indicative of?
• Exhalation through closed glottis is an attempt to maintain FVC e.g. pneumonia
What is the most common cause of stridor in infants?
Laryngomalacia
What are some causes of stridor?
- 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)
List some signs of increased WOB, from most mild to most severe.
- 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
What is the tracheal tug?
Downward movement of thyroid cartilage towards the sternal notch on inspiration - sign of severe airflow limitation
What is the cause of crackles? What do they sound like?
- Discontinuous, bubbling sounds
- fluid/substance in lower aiwrways
What are rhonchi (previously rales)?
Low pitched wheeze continuous throughout insp and exp, clear after coughing
Most common cause of chronic cough in children?
Protracted bacterial bronchitis
