Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS IV - Junior Clerkship WCS > JC121 (Paediatrics) - Cough in children > Flashcards

JC121 (Paediatrics) - Cough in children Flashcards

1
Q

Physiology of cough reflex

A

Cough reflex protects the airway following inhalation of foreign material (food, secretions etc.):

Stimuli: Mechanical, chemical, thermal, inflammation
Cough receptors located within the epithelium of the pharynx, larynx, trachea, major bronchi become stimulated:

Local reaction:
 Local mediators: histamine, prostaglandins, leukotrienes
 Local bronchoconstriction

Afferent fibres from vagus nerve to cough centre in upper brainstem

Efferent fibres from vagus nerve and spinal cord to larynx, diaphragm, abdominal muscles  cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Respiratory and non-respiratory causes of cough

A 
Respiratory
 Upper respiratory tract infection
 Postnasal drip syndrome (upper airway cough syndrome)
 Asthma
 Aspiration
 Pneumonia/pneumonitis
 Bronchiectasis
Non-respiratory
 Heart failure
 Gastroesophageal reflux
 ACE inhibitor (S/E)
 Psychogenic/habit cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline history taking questions for cough

A

Patient background:

  • Age: type of organism, respiratory problem
  • Previous health: CAI or HAI
  • Immune status: Opportunistic infections
  • Neurological: aspiration pneumonia
  • Atopy: asthma, post-nasal drip
  • Living status: CAI from institutions

Cough characteristics: Dry vs productive, bloody or not, barking/ brassy/ wheezing/ paroxysmal

Duration of cough

Triggering factors

Associated constitutional symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of cough in infancy

A

Aspiration

Allergy: reactive airway (not dx asthma until 2 years old)

Infections: 
 Chlamydia
 Pertussis
 Tuberculosis
 Post- respiratory syncytial virus

Structural Congenital malformation:
 Laryngotracheomalacia/ bronchomalacia
 Vascular compression (ring/ sling innominate artery)

Passive smoking

Congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of cough in early childhood

A

Aspiration

Asthma (>2 years old)

Infections:
 Viral
 Tuberculosis
 Mycoplasma
 Fungal

Bronchiectasis:
 Immunodeficiency
 Cystic fibrosis
 Post-infectious

Sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of cough in late childhood/ adolescence

A

Aspiration

Asthma

Infections:
 Viral
 Tuberculosis
 Mycoplasma
 Fungal

Bronchiectasis:
 Immunodeficiency
 Cystic fibrosis
 Post-infectious

Sinusitis*

Mediastinal tumor*

Active or passive smoking*

Psychogenic cough*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Types of productive cough

A

Mucus: Normally produced by goblet cells and submucosal glands, increase in volume during illness

Exudates: Protein-rich fluid leaked from capillaries in alveoli due to inflammatory response (usually due to infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute cough

Define time limit
Causes

A

= recent onset of cough lasting <3 weeks

Causes of acute cough: 
URTI: mostly viral infection 
LRTI: Viral or bacterial infection 
Exacerbation of pre-existing disease: 
- Asthma (acute attack)
- Bronchiectasis (flare)
- Upper airway cough syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List viral and bacterial pathogens that cause acute cough

A

Viral:
Influenza, respiratory syncytial virus, parainfluenza, adenovirus, rhinovirus, human coronavirus, human metapneumovirus (hMPV), bocavirus

Bacterial: 
 Streptococcus pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis
 Pseudomonas (if immunocompromised)
 Chlamydia (if neonate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outline P/E for acute cough

A

A. Vital signs, temperature (fever)

B. Respiratory distress: RR, use of accessory muscles, dyspnea, cyanosis

C. Chest exam: deformity, percussion, auscultation (wheeze, crepitations, rhonchi)

D. Associated finding:
 Skin rash, eczema
 Lymph nodes, tonsils
 Rhinorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define respiratory rate for tachypnea in neonates < 2 months, 2-12 months and >1 year old

A

tachypnea in children:
>60 for <2m,
>50 for 2-12m,
>40 for >1 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Child presents with acute cough that worsens when laying down
The cough is triggered by pollen at certain seasons

Most likely dx

A

Post-nasal drip from allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Child presents with cough and nasal discharge, sore throat and fever

Most likely Dx

A

Acute upper respiratory tract infection

Most likely viral infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Child presents with hoarseness, acute cough, high fever, and stridor

Most likely ddx

A

 Viral croup
 Recurrent spasmodic croup
 Bacterial tracheitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Child presents with fever, tachypnea, increase work of breathing, productive cough and some wheezing

Most likely dx

A

Lower respiratory tract illness:

Acute bronchiolitis:
 Typically RSV, hMPV
 Present with wheezing due to inflammatory exudates in small airways
 +/- crepitations

Pneumonia (viral, bacterial)

Asthma (should not present with crepitations, just wheeze)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Child with acute cough presents with finger clubbing, failure to thrive and some chest deformity

Most likely Dx

A

Acute exacerbation of a chronic respiratory disorder e.g. bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical features of allergic rhinitis/ reactive airway/ asthma in a child

A

 Seasonal and diurnal variation
 Posture (more cough when lay down worsen postnasal drip)
 Triggers (dust, pollutant, pollen etc.)
 Association with rhinitis
 ‘Clearing of throat’ (postnasal drip)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical features of acute URTI in children

A

 Coryzal symptoms (common cold: cough, nasal discharge)
 Sore throat
 Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical presentation of acute airway obstruction in children e.g. croup, epiglottitis

A

 Stridor (upper airway obstruction)
 ‘Barking’/ brassy/ ‘croupy cough’
 Hoarseness
 +/- fever

20
Q

Clinical features of LRTI in children

A

 Fever
 Tachypnea
 Respiratory distress with increased work of breathing
 (Productive cough)
 Chest signs (crepitations/ wheeze/ rhonchi)

21
Q

Clinical features of chronic respiratory disorder in children

A

 Failure to thrive
 Finger clubbing
 Chest deformity
 Features of atopy

22
Q

First-line investigations for acute cough in children

A

Not needed in most children with simple URTI

CXR - indications:

  • LRTI
  • Relentless progressive cough past 2 weeks
  • Hemoptysis

Microbiological workup:

  • CBC and differentials (bacterial pneumonia)
  • Nasopharyngeal aspirates for common viruses, Mycoplasma
  • Sputum for Gram stain and culture
  • Blood culture e.g. pneumococcus
23
Q

Definition of pediatric (<15yrs) chronic cough

A

American College of Chest Physician Guideline:
daily cough lasting for > 4 weeks

British Thoracic Society
Cough lasting >8 weeks
Recognizes a ‘grey’ area of ‘subacute cough’ between 2-8 weeks

24
Q

Outline history taking for chronic cough in children

A

HPI:

  • Onset of cough: e.g. from neonatal period or later
  • Start of cough: after choking? with URTI?
  • Quality of cough
  • Trigger of cough: Exercise/ cold air, nocturnal, feeding

Ddx underlying cause:

  • Feeding difficulties
  • Chest pain-related
  • Neurodevelopmental abnormality (cerebral palsy)
  • Recurrent pneumonia
25
Q

Ddx causes of chronic cough depending on onset and start/ first episode

A 
Neonatal onset
 Aspiration (tracheoesophageal fistula)
 Congenital malformation
 Cystic fibrosis (inherited)
 Primary ciliary dyskinesia (inherited)

With choking: inhaled foreign body

With URTI: Post-viral cough

26
Q

Ddx causes of chronic cough by quality of cough ***

A

Dry cough: Mycoplasma, asthma, viral infection

Dry/ repetitive/ disappears with sleep/ Honking cough: Psychogenic/ habit cough

Productive (Moist/ wet) - Chronic suppurative lung disease/ pneumonia

Hemoptysis/ blood-stained: TB, Bronchiectasis, AV malformation, Pneumonia, Excoriated airway

Paroxysmal spasmodic cough: Pertussis, Parapertussis, Mycoplasma, Viral

Barking/ brassy cough: Croup, Tracheomalacia, Habit cough

Staccato cough: Chlamydia

27
Q

Ddx dry vs productive chronic cough in children

A

Dry:
 Mycoplasma (1st week)
 Asthma
 Viral (e.g. coronavirus)

Productive:
 Chronic suppurative lung disease (e.g. bronchiectasis)
 Pneumonia

28
Q

Ddx hemoptysis/ blood stained chronic cough in children

A 
 TB (in adolescents)
 Bronchiectasis
 AV malformation (in younger children)
 Pneumonia
 Excoriated airway
29
Q

Ddx Paroxysmal spasmodic chronic cough in children

A

 Pertussis, parapertussis
 Mycoplasma
 Virus

30
Q

Ddx causes of chronic cough due to trigger by exercise, cold air, nocturnal, feeding

A

Exercise, cold air = Asthma/ reactive airway

Nocturnal (2-3am, early morning)
 Upper/ lower respiratory allergy
 Sinusitis

Feeding = Recurrent aspiration

31
Q

Ddx chronic cough with feeding difficulties in children

A

 Serious systemic illness (including pulmonary)

 Aspiration

Neurodevelopmental abnormality (cerebral palsy)

32
Q

Ddx chronic cough with chest pain in children

A

 Arrhythmia

 Asthma, increased respiratory distress (parenchymal disease)

33
Q

Ddx recurrent pneumonia in children

A

 Immunodeficiency
 Congenital lung abnormalities
 H-type tracheoesophageal fistula

34
Q

Outline P/E for chronic cough in children ***

A

Growth: Failure to thrive
Respiratory distress: Hypoxia/ cyanosis
Finger clubbing: chronic suppurative lung diseases

Upper respiratory tract: Sinusitis, allergic rhinitis

  • Sinusitis: facial tenderness, persistent purulent nasal discharge
  • Allergic sinusitis: nasal obstruction/ discharge

Lower respiratory tract: Chronic lung disease

  • Chest wall deformities: Harrison sulcus, Pectus carinatum, Barrel chest
  • Hyperresonance
  • Creptitation and breath sounds

Cardiac: Murmur, heart failure
Skin: Eczema

35
Q

Causes of non-specific chronic cough in children
(dry cough in absence of an identifiable respiratory disease of known etiology)

Management of non-specific cough

A

Causes:
 Post-viral
 Another episode of acute infection
 Others: foreign body, asthma, GERD (reflux) etc.

Evaluation: conservative, non-interventional
 Avoid Tobacco smoke, other pollutants
 Child’s activity and thriving

36
Q

First-line investigations for chronic cough in child

A
  • Workup bronchiectasis, TB, Primary immunodeficiency, Chronic pneumonia, structural lesions in bronchi

List:
- CXR
- Spirometry tests: obstructive or restrictive pattern
- CBC with differentials (immunodeficiencies, infections)

Microbiological workup:

  • Test for TB (Mantoux test or purified protein derivative test or interferon-based test
  • Sputum/ gastric aspirate for AFB stain and culture, TB PCR, routine culture and CST

Radiological:
- HRCT/ MRI

DDx:

  • Cilia study for primary ciliary dyskinesia
  • 24h esophageal pH study - Reflux
  • VFSS - aspiration
  • Bronchoscopy - intraluminal lesions
37
Q

Treatment for viral URTI

A

most viral infection, including: bronchitis, viral pneumonia

  • No specific antivirals
  • Supportive

Influenza:
- Antivirals available: oseltamivir, zanamivir

38
Q

Treatment of CAP in children

A

Community acquired pneumonia
 Streptococcus pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis

Augmentin

39
Q

Treatment of atypical pneumonia in children

A

Commonly Mycoplasma pneumoniae, others: Legionella and Chlamydia

 Quinolone
 Doxycycline (avoid in <8yo because permanent teeth discoloration)
 Clarithromycin (macrolide resistance 30%)

40
Q

Treatment of pseudomonas and S. aureus respiratory infection in children

A

Pseudomonas
 Extended-spectrum penicillins (e.g. piperacillin-
tazobactam)
 3rd/ 4th generation cephalosporins (e.g. ceftazidime)
 Carbapenems (e.g. meropenem)
 Aminoglycosides (e.g. amikacin)
 Fluoroquinolones (e.g. levofloxacin) = only oral
available

Staphylococcus aureus:
Vancomycin

41
Q

Symptomatic treatment options for cough in children

A

Antihistamine: diphenhydramine, Chlorpheniramine

Antipyretic, analgesic: paracetamol, ibuprofen

Antitussives/Cough suppressants: Codeine, Dextromethorphan, Hydrocodone

Expectorant: Guaifenesin

Nasal decongestants: Ephedrine, Phenylephrine, Pseudoephedrine, Phenylpropanolamine

Cough relief:

  • Oral hydration with warm liquid
  • Honey in water
42
Q

Which symptomatic relief agents are not recommended for treating cough in children

A

Antihistamines: no effect, not recommended

Expectorants, mucolytics: No recommendation for expectorants, limited recommendation for mucolytics

Cough suppressants: Definitely NOT recommend codeine or hydrocodone-containing cough suppressants

43
Q

Codeine

  • Reasons for contraindicated use in children
  • S/E
A 
Codeine: 
- Narcotic with addictive potential
- Dose-related toxicity: 
 Respiratory depression
 Narcosis, somnolence
 Ataxia
 Miosis
 Vomiting, rash
 Swelling
 Itching
44
Q

Dextromethorphan

  • Reasons for contraindicated use in children
  • S/E
A

Nonaddictive but abused by teenagers

Dose-related S/E:
 Ingesting huge doses = bizarre behaviour
 CNS depression

45
Q

Honey as cough relief for children

  • Recommendation on use
  • Contraindications
A

Recommendation: Modest beneficial effect on nocturnal cough (more effective than placebo or diphenhydramine)

Contraindication: risk of botulism (food poisoning)

MBBS IV - Junior Clerkship WCS (131 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions