Resp Flashcards
- I cause breathlessness, tight chest, Wheeze
- I cause Dinural symptoms
- I cause response to allergens, asprin and beta blockers
- I cause Atopy
- When I am chronic i cause severe Harrison’s sulcus - Funnel chest
What am I?.
- Asthma
How am I Investigated?
- Spirometry with a bronchodiolator reversibilty
- FeNo - Detects imflammation in the lungs
- Peak flow
How am I managed in Children >17?
- SABA (Salbutamol)
- Add ICS (Beclomethasone Dipropionate)
- Add LTRA (Montelukast)
- Add LABA (Salmeterol) + ICS (+/- LTRA)
- Swich to MART Therapy Combination which has low dose ICS
- Either continue MART with Moderate ICS or change to Fix ICS + LABA with SABA therapy
- Specialist supervison with High dose ICS
Management in children Under 5
- 8 Week trial of Paediatric moderate ICS (If uncontroleld with SABA & Causign symptoms)
- If symptoms resolved then restarted - 4 week trial ICS again
- Uncontrolled asthma is Low dose ICS and LTRA
- Specialist
I typically affect children under 3
They get signs of fever & Coryzal Symptoms.
-They eventually get Wheezy
What am I?
Viral Induced Wheeze
How am I Treated?
Treated like an acute asthma attack.
- Moderate: Nebulised Beta 2 agonist, Nebulised Ipratropium (LABA), Steroids: Oral Prednisolone or IV hydrocortisone
Severe: O2 If less than 94 to maintain 94-98, Aminophylline, IV salbutamol
Life threataning: IV Magnesium sulphate, Admission to ICU, Intubation
How do you grade Asthma Severity?
Moderate: PEFR: 50 - 75% Predicted
Severe: PEFR: 33-50%, >25 RR, HR >110, Unable to complete sentences
Life Threatening: PEFR: <33%, O2 <92%, Becoming tired, No Wheeze (Silent chest), Haemodynamically unstable
I cause Bronchiolar inflammation
Caused by RSV
I affect 1-9 months with 3-6 being my target months
I provide Coryzal Symptoms, Dry cough, Wheezing, Feeding difficulties and sometimes fine crackels.
WHAT AM I?
BRONCHOLITIS
How do you find out what I am?
Immunofluoresence of Nasopharyngeal RSV Positive
What is the requirement for sending me to emergency (Bronchiolitis)
- Resp rate over 60
- Apnoea
- Child looks unwell, Central cyanosis
- Chest recession
- O2 less than 92%
Bronchiolitis management
- If child is not in critical condition, It is self limiting condition, analgesia, Paracetamol (Calpol) fluids. Check nightly for fever/distress
- Humidified oxygen Head box for children with less than <92
- Nasogastric feed if child cannot take fluids
- Suction for excess secretions.
I cause the following:
- Stridor
- Barking cough worse at night
- Seal like cough
- Fever
- Coryzal symptoms
WHAT AM I?
CROUP
What Virus am I caused by?
- PARAINFLUENZA
How do you categorise Croup for medical emergencies?
- Mild - No Barking, Stridor, or signs of Intercostal recession, Child is happy to eat and drink.
- Moderate - Frequent Bark cough, Audible stridor, chest retraction at rest, not in agitation or stress, Child can be alert and interested in sounds
- Severe - Frequent bark cough, Prominent chest recession, significant distress, lethargic and restless (Hypoxemia), Tachycardic.
(Moderate and Severe require hospital admission, less than 6 months or with other conditions)
How do you identify Croup?
- Chest X ray - Subglottic narrowing - Steeple line, Narrow Larynx
How do you manage Croup?
- Oral dexamethasone 0.15mg/kg single dose. Prednisolone alternative.
- Emergency: High flow oxygen, nebulised Adrenaline
I cause the following:
- Fever
- Resp rate of 60 breaths per min
- Increased work of breathing.
- Crackles in chest
- Cyanosis
- Grunting and chest drawing
- Pneumonia
How do you manage me (pneumonia)?
- Emergency situation: Supplementary O2 if less than 92%
- Amoxicillin
- Macrolides if chlamydia or mycoplasma suspected (cold like pneumonia symptoms)
- Influenza pneumonia : Co amoxiclav
Which pathogen is most associated with Child Pneumonia?
S.pneumoniae - common bacterial agent
RSV (Respiratory Syncytial Virus)
I cause the following:
- Dull percussion
- Reduced tactile fremitus
- Asymmetrical chest expansion
- Diminished or delayed expansion
- Usually caused during or after a chest infection like pneumonia
WHAT AM I?
PLEURAL EFFUSION
How do you know what I am (Pleural Effusion)
- CRX
- Ultrasound - Identify where successful aspiration - Most common investigation
- Ct investigate underlying cause
How do you Investigate me? (Pleural effusion)
- 21G needle & 50ml Syringe (Sent for protein, PH, LDH)
- Light criteria:
Exudate have protein level more >30g/L.
Transudate have protein level of <30g/L
If protein is between 25 - 35g/L Use light criteria to determine EXUDATE:
- PFP/ SP >0.5
- PFP/Serum LDH >0.6
- Pleural fluid is 2 thirds upper limit normal serum LDH
Which other conditions cause me (Pleural Effusion)
- Rheumatoid arthritis, Tuberculosis(Low glucose)
- Pancreatitis (Raised amylase)
- Pulmonary embolism, Tuberculosis (Blood staining)
How do you manage me (Pleural Effusion)
- Aspiration
- Pleurodesis (Medical talc)
- Pleural catheter (to drain)
- Opioids - relieve dyspnoea
I cause the following:
- I cause very fast symptoms
- High temperature
- I make your patient very unwell
- Stridor
- Excessive drooling of saliva
- I cause a tripod position - leaning forward and extended neck
WHAT AM I?
ACUTE EPIGLOTTITIS
What pathogen am I caused by? (Acute epiglottitis)
- Haemophilius Influenzae type B (Bacterial)
What signs do I show in my investigations (Acute Epiglottitis)?
- Thumb sign of the epiglottis - CXR
How do you manage me (Acute Epiglottitis)?
- Senior management (anesthesiologist) for endotracheal intubation
- Do not examine, can cause worsening
- Oxygen and IV antibiotics
I cause the following:
- Sudden Onset stridor
- Fever
- Respiratory distress
- Follows after viral like infection where they are recovering then become worse.
WHAT AM I?
- BACTERIAL TRACHEITIS
What am I caused by? (Bacterial Tracheitis)
S.aureus
How am I Managed? (Bacterial tracheitis)
- Supportive measure
- O2 or intubation
- IV antibiotics - Flucloxacillin
I cause the following:
- 2 - 3 days of coryzal symptoms
- Coughing bouts worse at night and after feeding leading to vomiting
- Episodes of apnea (Breath holding)
- ## Persistent coughing (Whooping sound)
PERTUSSIS (WHOOPING COUGH)
What pathogen am I caused by? (Pertussis)
BORDETELLA PERTUSSIS
How am I diagnosed (Pertussis)
- Nasal swab
- PCR and Serology
How do you manage me?
- Notifiable disease
- Clarithromycin (Oral Macrolide)
- 21 days to eradicate organism and school exclusion 48 hours using antibiotic treatment
- Antibiotic prophylaxis for the family members
I cause the following:
- Auto Recessive genetic disorder
- I increase viscosity of lung and pancreas secretions
- CFTR defect is what causes this condition which regulates cAMP sodium channel
- Newborns experience meconium ileus (Thicker)
- Recurrent chest infections
- Malabsorption - Steatorrhoea
- Stunted growth
WHAT AM I?
CYSTIC FIBROSIS
How am I Investigated?
- Newborn pin prick heel test
- Sweat chloride test - Abnormally high chloride
- Normal value <40 mEql, CF: >60 mEql
Patient may experience false positive test due to skin oedema hypoalbuminaemia/ hypoproteinaemia
Some causes: Malnutrition, G6PD, Glycogen storage disease
How am I managed? (Cystic fibrosis)
- Lung physiotherapy twice daily, including breathing exercises. Postural drainage (Laying head down or legs up)
- High calorie and fat diet, slightly additional salt intake
- Minimise contact to reduce Burkholderia cepacia
- Vitamin supplication, Pancreatic enzyme supplements with meals
- Lung transplant if recurrent infection is present.
I cause the following:
- Usually due to a a chest disease or trauma
- I cause sudden symptoms
- Dyspnoea, Pleuritic chest pain, Sweating, Tachypnoea, Tachycardia.
PNEUMOTHORAX
How am I managed? (Pneumothorax)
- If rim air is more than >2 cm and patient is short of breath, insert chest drain
- Inserted 2nd intercostal space, midclavicular line
I cause the following:
- I usually develop soon after birth
- Usually noticed with first active viral infection
- Stridor on inspiration only with high pitched sound.
- Symptoms are more prominent in feeding or laying back
- I show severe symptoms in 8-12 months
WHAT AM I?
LARYNGOMALACIA (FLOPPY LARYNX SYNDROME)
How am I managed? (Laryngomalacia)
- Tracheostomy
- Excision of redundant mucosa
- Laser division of the aryepiglottic folds.
I cause the following:
- Symptoms starts or are triggered by allergens
- I cause severe life threatening hypersensitivity symptoms
- Swelling of the tongue, throat, Respiratory wheeze, Hypotension, tachycardia
ANAPHYLAXIS
How am I managed. (Anaphylaxis)
> 6 months : 100 - 150 mg
6 months - 6 years: 150mg
6-12 years: 300mg
adult and child >12: 500mg
Repeated every 5 mins IM injection anterolateral aspect of the thigh. Till reaction calms down
I cause the following:
- Sore throat
- Dysphagia
- Malaise (discomfort)
- Pharyngeal mucosa reddened
WHAT AM I?
ACUTE PHARYNGITIS
How am I managed? (Acute Pharyngitis)
- Analgesia Paracetamol & Nsaids
2. Usually resolves in 7 -14 days (Antibiotics not recommended)
I cause the following:
- Swelling with white exudate in the back of the throat
- I cause fever, sore throat, tender cervical chain lymphadenopathy.
WHAT AM I?
ACUTE TONSILLITIS
How do you assess me if I need to be treated with Antibiotics?
FeverPAIN SCORE - Score of 4/5 likely antibiotic treatment
How do you manage me? (Acute Tonsillitis)
First line >18: Phenoxymethylpenicillin 500mg 4 times a day or 1000mg 2 times a day - 5 - 10 times a day
Alternative if allergic: Clarithromycin 250mg to 500mg twice a day for 5 days
Pellicin allergy in pregnancy: Erythromycin 250mg to 500mg 4 times a day
Acute tonsillitis management in children
1.Phenoxymethylpenicillin:
1 month to 11 months- 62.5 mg four times a day or 125 mg twice a day for 5 to 10 days
1 year to 5 years - 125 mg four times a day or 250 mg twice a day for 5 to 10 days
6 years to 11 years - 250 mg four times a day or 500 mg twice a day for 5 to 10 days
12 years to 17 years - 500 mg four times a day or 1,000 mg twice a day for 5 to 10 days
Clarithromycin
- 8kg: 7.5mg/kg twice daily
- 9-11kg: 6.25mg/kg twice daily
- 12-19kg: 125mg twice daily
- 20 -29kg: 187.5mg twice daily
- 30 - 40kg: 250mg twice daily
- 12 - 17 years: 250mg twice daily, increase to 500mg severe infection
i cause the following:
- Middle ear inflammation
- Sudden pain and fever
- Inflamed bulging eardrum, purulent discharge
- I present sometimes after a URTI
WHAT AM I?
OTITIS MEDIA
How do you manage me (Otitis Media)
- Self limiting within 3 days but can last a week
- Amoxicillin for 5 days if TM perforated
If discharge is in the ear >4 days or less than 2 years of age
I cause the following:
- Inflammation on the external ear
- I can be Acute <3 weeks or Chronic > 3 months
- Itchy and painful external ear
- Localised OE: Folliculitis, swelling with yellow centre
Diffused OE: widespread scaly
Malignant OE: discharge, hearing loss, tissue destruction due to severe P.aeruginosa
WHAT AM I ?
OTITIS EXTERNA
How do you manage me? (Otitis Externa)
Localised OE: Self limiting may need antibiotic for cellulitis fever or drainage acetic acid 2% ear drops or spray
DIffused OE: Oral antibiotics like Oral Flucloxacillin, Topical antibiotics Gentamicin and or corticosteroid Prednisolone (Otomize)
Malignant OE: Ciprofloxacin IV
I cause the following:
- Facial pain
- Frontal forward pressure when leaning forward
- Thick and purulent discharge
- Nasal obstruction
WHAT AM I?
SINUSITIS
What pathogen causes me? (Sinusitis)
- S.pneumoniae
- Haemophilus influenzae and rhinoviruses
How do you manage me? (Sinusitis)
- Usually caused by virus takes 2-3 weeks to resolve. Analgesia can be used paracetamol & Ibuprofen
- Symptoms >10 prescribe nasal corticosteroid 12 years and >: Mometasone x2 daily
- Antibiotics:
1st line: >18 years phenoxymethylpenicillin 500mg x4 daily for 5 days.
2nd line: Co-amoxiclav 500/125 mg three times a day for 5 days
3rd line: Doxycycline 200 mg on the first day, then 100 mg once daily for 4 days or Clarithromycin 500mg x4 daily for 5 days
4th line: Erythromycin 250 mg to 500 mg four times a day
How do you manage me in children? (Sinusitis)
Prescribe
Phenoxymethylpenicillin first-line:
1 to 11 months: 62.5 mg four times a day for 5 days.
1 to 5 years: 125 mg four times a day for 5 days.
6 to 11 years: 250 mg four times a day for 5 days.
12 to 17 years: 500 mg four times a day for 5 days.
Second line:
Prescribe co-amoxiclav
1 to 5 years: 5 mL of 125/31 suspension three times a day 5 days
6 to 11 years: 5 mL of 250/62 suspension three times a day for 5 days.
12 to 17 years: 250/125 mg three times a day for 5 days.
I cause the following:
- IGE mediated reaction
- Sneezing, Nasal itching, discharge, Congestion
- I cause symptoms when in contact with allergens
WHAT AM I?
Allergic rhinitis
How do you manage me? (Allergic Rhinitis)
First line: Mild to moderate: Azelastine hydrochloride intranasal spray
Oral antihistamine Loratadine
Moderate to severe: Regular intranasal corticosteroid (2 weeks usually results start).
I cause the following:
Heavy nostril bleeding
Dizziness
Fullness in nostrils
WHAT AM I?
EPISTAXIS
How do you manage me? (Epistaxis)
- Asking the patient to sit with their torso forward and their mouth open.
- Pinch the cartilaginous (soft) area of the nose firmly for at least 20 minutes.
- Topical antiseptic such as Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis (Stinging)
- Continuous bleeding 10-15 mins, find source of bleeding. Topical local anaesthetic spray Co-phenylcaine (Silver nitrate stick) or packing.
