Resp Conditions/Exams Flashcards
Signs of increased work of breathing
→ Tachypnoea
→ Grunting
→ Alar flaring
→ Intercostal recession
→ Subcostal recession / Hoover’s sign, i.e. lower chest wall indrawing
→ Suprasternal recession / tracheal tug
→ Use of accessory muscles
→ Head bobbing
DISTINGUISH PLEURAL EFFUSION FROM DENSE CONSOLIDATION
Consolidation: decreased air entry, bronchial breathing, decreased chest movement, collapse, displaced
trachea, dull note on percussion, increased vocal resonance.
Pleural effusion: decreased chest movement, displaced trachea, stony dull note on percussion, decreased
vocal resonance, and decreased air entry.
Causes of large air trapping and small airway trapping
- Large airway:
Foreign body
TB
Congenital abnormalities - Large airway
Acute or viral bronchiolitis
Asthma
Pneumonia
Cardiac failure
CF bronchiectasis
Non CF bronchiectasis
Most common cause of viral pneumonia in SA (in paeds)
Respiratory synctytial virus
RSV
Which organisms commonly cause pneumonia in HIV/immunocompromised infants
P.Jirovecci
CMV
Drug tx for pneumonia in >2y/o
Amoxicillin 45mg/kg PO 12hourky 5days
Poor response: amoxicillin-clavulanate same dose (also add azythromycin 10mg/kg if atypical org suspected
Drug tx for severe pneumonia
Ampicillin IV 50mg/kg 6hourky ash Gentamycin Iv 6mg/kg 5-10days
Or
Amoxi-clav 30mg/kg IV 8hourly
Dry tx for p.jirovecci
Co-trimaxazole 5/25mg/kg IV 6hourky 21days
Tx for CMV caused pneumonia
Gamcivlovir 5mg/kg IV 12hourly
Reasons for failure of antibiotics
Non adherence
Incorrect dose
Incorrect diagnosis
Organism resistant
Organism not covered
A complication has developed
Grading system for stridor
Grade 1: Inspiratory stridor
observe, support
Grade 2: Insp and Exp stridor
Nebulised Adrenalin
Grade 3: Insp+Exp stridor +pulsus paradox
Continuous nebulised adrenalin, if poor imprv intubate
Grade 4: Impending apnoea
Intubate
Clinical signs seen in bronchiolitis (3)
Air trapping
Hyperinflation (barrel chest)
Widespread wheezing on auscultation
Tachypnoea
Common causative organism for bronchiolitis
Respiratory Syncitial virus
Tx for bronchiolitis
There’s no curative tx, tx is supportive
-O2 via NPO2, high flow nasal cannula or CPAP
-Oral feeding except is tachypnoea or distress
-Trial of nebulised beta2agonist (salbutamol). Nebulised Adrenalin
-Ab if secondary bacterial infection is suspected
-Ventilation if Resp failure
Complications of bronchiolitis
- Recurrent wheezing
- Bronchiolitis Obliterans (due to severe adenovirus bronchiolitis, tx with High dose steroids)
How would you diagnose TB lymph node compression of the large airways
-Doesn’t respond to bronchodilator
-On CXR: Trachea displaced from midline, and compression of left main bronchus intermedium’s on good Inspiratory CXR.
Triad of foreign body aspiration on clin exam
Unilateral wheezing
Decreased ventilation
Lung collapse
What is Loffers syndrome
Eosinophilia pneumonia.
Clin features: wheezing with alveolar consolidation
Dx: raised eosinophils with parasites in stool
Tx: steroids, doesn’t respond to Ab
Deworming with a germicide- Albendazole or Mebendazole
Children with intestinal parasites can develop an exaggerated eosinophilic response to it, characterised by alveolar consolidation and accompanying wheeze
Doesn’t respond to Ab
What can cause pneumonia to recur in the same area
TB involvement of the airway
Foreign body inhalation
Localised bronchiectasis
Anatomical abnormality of the lung
Mechanism of development of bronchiectasis
-Bronchial lumen obstruction ie by TB glandular obstruction or foreign body aspiration
-Lung parenchyma destruction due to necrotising pneumonia ie by staph aureus, S.pneumonia, S.pyogenes, H.influenza
-Repeated LRTI including pneumonia.
Signs of air trapping
Barrel chest
Displaced liver
Decreased cardiac dullness
Approach to a patient with bronchiectasis
-Determine the cause, commonly Cystic Fibrosis, complicated HIV or TB.
-Determine extent by CT, spirometer. As affects CVS if extensive, determine transcutaneous sats post exercise.
Complications of bronchiectasis
Bacterial superinfection
TB
Cor pulmonale
(Most common organism for LRTI is non typable H. influenza
Management of bronchiectasis
Medical
-Treat exacerbations of infections, broad spectrum amoxicillin-clavulanic acid, sputum before Ab
-Optimise nutrition
-Ensure immunisation (esp Influenza)
-Physio
-Bronchodilator response (see if relief with beta2agonists
-Immunomodulation of the airway inflammation. Usually with azithromycin.
Sugucal
-remove bronchiectasis lobe or lung, usually only if unilateral and medical has failed
Contra: pulmonary HPT and bilateral bronchiectasis
Cystic fibrosis presentation
Neonates: meconium ileus causing bowel obstruction, meconium peritonitis and prolonged neonatal cholestatic jaundice
During 1st year of life: recurrent Resp tract infections, prolonged and recurrent wheezing, failure to thrive.
Malabsorption if nutrients during to pancreas insufficient with peripheral odema often misdiagnosed as protein malnutrition
Clue to dx: Early onset malabsorption and large foul smelling bulky stool with fat globules
Can also present with:
Chronic liver failure, Hyponatremia dehydration (salt lost in sweat) and DM
How to dx cystic fibrosis
Genetic test
Sweat test (>60mmol/l of Cl concentration)
Pancreatic insufficiency(stool chemotrypsin and stool elastase
Tx of cystic fibrosis
Tx in tertiary care units
Physio
Manage exacerbations with Ab
Tx of pancreatic insufficiency with enzyme supplements and nutritional support
Manage GIT disease
Clinical presentation of croup
Barking cough
Stridor
Tx of croup (laryngo-tracheo-bronchitis)
-Nebulised Adrenalin in 1ml saline.
-Oral corticosteroids- oral prednisone or -Dexamethasone as alternative.
-Endotracheal Intubation
-Herpes Simplex LTB tx with acyclovir for 14 days
What is primary cilia dyskinesia
Dysfunctional cilia in resulting in mucociliary blanket not clearing secretions
Results in recurrent upper and lower airway infections esp Otitis media, sinusitis and recurrent pneumonia
Kartagener syndrome triad
Dextrocardia
Chronic sinusitis
Bronchiectasis
