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Respiratory medicine > L3 - Respiratory Symptoms & Signs In Children ; The Important Diseases > Flashcards

L3 - Respiratory Symptoms & Signs In Children ; The Important Diseases Flashcards

1
Q

Difference between signs and symptoms ?

A

We can see signs e.g. swelling

People complain of symptoms e.g. back pain

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2
Q

Define cough

A

Vital defensive reflex that uses high pressure high volume air flow to clear the respiratory tract of obstruction and noxious substances.

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3
Q

Non- productive cough

A

Does not bring up mucus or other substances

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4
Q

Describe why you might cough in response to eating a spicy curry?

A

Capsaicin is a spicy compound.

Type 1 vanilloid receptor / transient potential cation channel subfamily V member 1 (TrpV1) receptor.

  • chemo receptor
  • sensitive to acid , heat and capsaicin
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5
Q

Examples of where you might find mechanical receptors?

A 
External auditory canal 
Ear drum 
Paranasal sinus 
Pharynx 
Diaphragm 
Pleura 
Pericardium 
Stomach
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6
Q

Afferent pathway of cough

A

Sensory fibres of:

  • pulmonary
  • auricular (Arnold’s nerve)
  • pharyngeal
  • superior laryngeal
  • gastric
  • cardiac
  • oesophageal branch’s of vagus nerve
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7
Q

Describe efferent pathway of cough?

A

Vagus , phrenic and spinal motor nerves to diaphragm and abdominal wall muscles

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8
Q

Which nerves give motor control to intercostal muscles?

A

Phrenic and spinal nerves

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9
Q

Which nerve innervates larynx ?

A

Laryngeal branch of vagus to larynx

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10
Q

Define Wheeze

A

Continuous high pitched whistling sound produced in respiratory airway during breathing.

Asthma ?
Inhaled object ?

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11
Q

Describe Rales aka fine crackles ?

A
  • Sounds like rubbing your hair together.
  • Indicates fluid in alveoli.
  • Bilateral or unilateral ?
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12
Q

Describe Ruttles aka rattily chest?

A

Coarse

Lower pitch than wheeze

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13
Q

Where might rattles be felt?

A

Transmitted vibration on posterior chest wall.

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14
Q

Ruttles may be indicative of?

A

Viral respiratory infection

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15
Q

Describe Rhonchi? (3)

aka large airway sounds

A
  • Coarse
  • non-continuous
  • popping noise
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16
Q

Large air way sounds may be indicative of what?

Rhonchi

A

Chunky mucous and pus in large conducting airways.

Often clears with an effective cough.

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17
Q

Describe sound of chronic stridor?

A

Very coarse, loud breathing

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18
Q

State three causes of chronic stridor?

A
  1. Inspiratory
    - obstruction in glottis above thoracic inlet
  2. Biphasic
    - inflammation of vocal cords
  3. Expiratory
    - tracheal obstruction
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19
Q

Laryngomalacia

A
  • Congenital softening of tissues
  • of the larynx above vocal cords.
  • Tissues to fall over the airway opening
  • and partially block it.
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20
Q

Croup

A

Acute onset stridor.

Exp. loud coarse intermittent barking cough like sound.

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21
Q

Croup caused by…

A

Viral infection with inflammation of trachea - parainfluenza virus.

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22
Q

Tracheomalacia

A
  • Flaccidity of supporting tracheal cartilage.
  • Widening of posterior membranous wall.
  • Cause tracheal collapse, especially in times of increased airflow.
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23
Q

What might be observed in a child with epiglottitis?

A
  • Inspiratory harsh sound on every breath.
  • Child sitting forward.
  • Neck extended.
24
Q

Epiglottitis typically caused by…

A

non Haemophilus influenzae type b vaccinated child.

25
Q

Describe the urgency of epiglottitis

A 
MEDICAL EMERGENCY. 
PARA-ARREST CRISIS 
- call for urgent help & ENT 
- do not lay flat
- do not cannulate
26
Q

Describe pleural friction rub?

A

Footsteps in snow, crump crump.

Very localised on chest wall.

Associated with chest wall pain ‘pluerisy’

27
Q

Dyspnoea

A

Diseased, difficult breathing

28
Q

Signs of dyspnoea

A 
Rapid breathing 
Chest wall indrawing in  young children. 
Tracheal tug 
Head bobbing 
Child can't finish sentences.
29
Q

Describe other causes of increased respiratory rate

A
  • Fever / Pain
  • Infection due to hypoxic drive or hypercapnia
  • Metabolic acidosis
30
Q

Haemoptysis

A

Coughing up blood.

31
Q

Costochondritis

typically seen in:

A
  • Pain, tenderness sites of sternum at parasternal joints.
  • Presumed inflammation of rib cage cartilage.
  • Typically age 12-14 y/o , girls more likely to have it than boys.
32
Q

Cause costochondritis

A

cause unknown.

May be due to viral infection.

33
Q

Tietze syndrome

A

Pain, swelling and tenderness at parasternal joints

Occurs in adolescents and adults < 40 y/o

34
Q

Summarise some common URTIs

A

Ottitis media - middle ear infection PAIN FEVER

Tonsilitis - PAIN FEVER FOETOR

Pharyngitis - PAIN FEVER

Coryza - Nasal mucous congestion and discharge with sneezing

35
Q

Summarise some common LRTIs

A

Bronchitis
Bronchiolitis
Pneumonia
Pneumonitis

36
Q

Common signs bronchitis (2)

A

Cough
- May be productive

Rhonci

37
Q

Common signs of bronchiolitis

A

Cough, crackles and wheeze

38
Q

Pneumonia clinical signs (3)

A
  • Crackles
  • Wheeze
  • dullness
39
Q

Pneumonitis signs

A

Crackles

40
Q

Be aware of common organisms causing RTI deaths in children

A

Streptococcus pneumoniae

Haemophilus influenzae

Respiratory syncytial virus

Human Metapneumovirus

Adenovirus

Influenza

41
Q

Pneumonia signs

A

COUGH + RAPID / DIFFICULT BREATHING

42
Q

Severe pneumonia

A

Not able to drink, persistent vomiting, convulsions, lethargic, stridor in calm child. Severe malnutrition

43
Q

Treating severe pneumonia

A

Oxygen!
IV penecillin
IV gentamicin
(5 days approx)

44
Q

Treating pneumonia

A

Oral amoxicillin

3 days

45
Q

Pneumonia investigations

A
  • Pulse oximetry

- Early warning scores

46
Q

Why might you assess urea and electrolytes in severely ill patients with pneumonia?

A

to assess SIADH

- syndrome of inappropriate antidiuretic hormone secretion.

47
Q

State some microbiological investigations which may be done as part of a pneumonia investigation?

A

Nasopharyngeal aspirate - RSV rapid test, multiple viral detection assays.
Cough swap, sputum culture.
Lung aspiration.
Antigen detection.
Antibody detection - virus , chlamydia and mycoplasma

48
Q

Antibody detection in pneumonia investigation for: (3)

A
  • Virus
  • chlamydia
  • mycoplasma
49
Q

General management of pneumonia in UK?

A

Maintain oxygen.
Antipyretics and analgesics
Maintain fluid intake
IV fluids in severe patients.

50
Q

Examples of macrolide antibiotics

A

Erythromycin, Azithromycin and clarithromycin.

51
Q

When may macrolide antibiotics be used?

A

If mycoplasma or chlamydia pneumonia is suspected.

52
Q

Empyema

A

Medical term for pockets of pus that have collected inside body cavity.

53
Q

Causes of empyema

lil culprits

A

S pneumoniae
S aureus
Group A streptococci
H influenza (Rare)

Fungal/ mycobacterial infections in immunosupressed patients.

54
Q

Treatment of empyema

A 
IV antibiotics 
Chest drain: large or pigtail 
Urokinase: break down fibrin bands 
Mini thoracotomy 
Decoritcation
55
Q

Decortication

A
  • Surgical removal of the surface layer, membrane or fibrous cover of lung.
  • Performed when lung is covered by thick, inelastic pleural peel
  • restricting lung expansion.

Respiratory medicine (16 decks)

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