Resp Flashcards
Questions for asthma history
- Cough - when, what triggers, what time of day?
- How many acute exacerbations/admissions?
- How does it affect daily life? Any limitations?
- How often using salbutamol?
- Atopic symptoms?
- Peak flow?
- Smoking in house
- Pets
- Asthma action plan
- Inhaler technique
Whooping cough
Pertussis. It’s a notifiable disease. Pregnant women offered vaccine at 16-32 weeks as newborns are vulnerable
Presentation:
- 2/3 days of coryza
- Bouts of coughing with inspiratory whoop - often worse at night, might vomit
- Young babies might get apnea and turn blue as can’t take large breaths in between coughing
- Cough can last up to 10-14 weeks (‘the 100 day cough’)
Investigation:
- Nasal swab - PCR
- Serology
Management:
- Mostly supportive
- Admit babies under 6 months
- Antibiotics - clarythromycin helps reduce spread
- Give antibiotics to household contacts
- Stay home from school for 48hrs after antibiotics or for 21 days after symptoms (if no antibiotics)
Croup
Caused by parainfluenza virus
Presentation:
- Age 6 months - 3 yrs
- Starts with coryza
- Stridor
- Barking cough
- Fever
Investigation:
- Clinical diagnosis
Management:
- Admit if audible stridor at rest
- Single dose of oral dexamethesasone regardless of severity
- High flow oxygen if needed
Acute epiglottitis
Caused by haemophilia influenza B. Rare as vaccinated against.
Presentation:
- Age 2 - 4 years
- Tripod position
- Drooling
- Can’t talk
- Fever
Investigation:
- X-rays may be done if worried about foreign object
- Direct visualisation - laryngoscope but only by someone who can intubate
- Blood cultures
Management:
- Don’t examine airway!!!
- Intubation by anaesthetist
- Oxygen
- IV antibiotics - cefotaxime
Laryngomalacia
Relatively common congenital abnormality of the larynx - cartilage is soft and collapses during inspiration
Presentation:
- Neonates - around 4 weeks
- Variable stridor from birth
- Otherwise well
Investigations:
- If otherwise well, no investigations needed - clinical diagnosis
Management:
- Usually self-resolving by 2 years
Cystic fibrosis
Recessive genetic disorder - CFTR gene leading to production of viscous secretions
Presentation:
- Newborns - prolonged jaundice (caused by obstructive jaundice); meconium ileum; failure to thrive
- Young - recurrent chest infections, steattorhea and malabsorption; diabetes due to pancreatic exocrine failure
- Older - infertility esp males
Investigation:
- Newborn bloodspot screening
- Gene testing
- Sweat test - abnormal sweat gland function leads to excessive Na+ and Cl- in sweat
Management:
- Chest infections - regular bronchodilators, antibiotics, preventive physio, immunisations
- Malabsorption - high calorie diets, take pancreatic enzymes
Bronchiolitis
Caused by respiratory syncytial virus (although can be caused by other resp infections). Most common cause of LRTI in under 1s
Presentation:
- Coryzal symptoms
- Low grade fever
- Cough
- Breathlessness
- Wheeze
- Feeding difficulties associated with dyspnoea
Investigations:
- Chest XR - patch collapse/consolidation
Management:
- Indications for admission - feeding difficulties leading to dehydration; respiratory distress
- Supportive care - fluid maintenance, oxygen, can try saline nebs
- Palivizumab monoclonal antibody can be given prophylactically to high risk babies
Signs of respiratory distress in babies (early to late)
Difficulty feeding
Nasal flaring
Subchostral recession
Tachypnoea
Tracheal tug
Intercostal recessions
Grunting
Head bobbing
Slow breathing - tiring
When is surfactant made?
Week 26-35
Neonatal respiratory distress syndrome (NRDS)
Caused by lack of surfactant - alveoli collapse
Presentation:
- Signs of respiratory distress within 4hrs of birth
Investigations:
- Chest XR - ground glass diffuse opacities
Management:
- If a preterm delivery is expected - give steroids to the mother to increase surfactant production
- For neonate - intubate for intratacheal instillation of surfactant into lungs
Transient tachypnoea of the newborn
Most common cause of resp distress in neonate, caused by delayed fluid resorption. More common post-C-section as fluid hasn’t been ‘squeezed out’ during journey through birth canal.
Presentation:
- Resp distress within first hours
Investigation:
- Chest XR - hyperinflation of lungs, fluid in horizontal fissure
Management:
- Supportive - may need O2
