Resp/CVD Flashcards
Ddx cough acute vs chronic
- Acute- viral URTI, bronchiolitis, pneumonia, croup (barking), hay fever, foreign body inhalation, viral induced wheeze, asthma
- Chronic- asthma, CHD, GORD, TB, malignancy, laryngomalacia, pertussis, cystic fibrosis, immunodeficiency
Ddx wheeze acute vs chronic
- Acute- asthma, viral induced wheeze, pneumonia, bronchiolitis, foreign body inhalation, anaphylaxis
- Chronic- cystic fibrosis, GORD
Ddx stridor acute vs chronic
- Acute- foreign body inhalation, croup, epiglottitis, bacterial tracheitis
- Chronic- laryngomalacia
Signs of incread WOB
tracheal tug, accessory muscles, head bobbing grunting (caused by breathing against closed epiglottis), nasal flaring, tripod position, costal recessions
Viral induced wheeze
cause, sx, mx
Caused by:
- RSV
- Rhinovirus
- Coronavirus
- Parainfluenza
- Influenza
Asthma
sx, ix, mx
sx
- episodic Sx
- wheeze
- diurnal variabilty
- atopic Hx
- diagnosed after 5
- tachypnoea
- use of accessory mucles
ix
- FeNO > 35ppb
- spirometry with bronchodilator reversibility
- peak flow
- bloods for IgE
mx
- under 5 = ICS and SABA then checkn adherence LRTA
- over 5 = ICS and SABA then MART or add LRTA then refer to specialist
- salbutamol, 02 for life threatening, pred
Bronchiectasis
def, sx, mx
- Irreversible dilatation of bronchial tree which can be seen on CT
sx
- Diagnosed by wet cough, coarse crackles and finger clubbing
- Other sx include coughing up green or yellow mucus, wheeze, tiredness, breathlessness and reduced appetite
mx
- Management includes physiotherapist, active lifestyle, antibiotics, inhalers and nebulised saline
Cystic fibrosis
cause, sx, ix, mx
likely to be deficient in vitamins a, d, e and k
URTI
cause, sx
- sore throat, AOM,sinusitis
- Pharyngitis and tonsillitis
- Commonly viral <3 years old, can also be caused by Group A Strep
- EBV (infectious mononucleosis) important cause of exudative tonsillitis
- Clinical features
- Sore throat
- Fever
- Constitutional upset
- Bacterial vs viral cause:Centorcriteria
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy (lymphnodes) or lymphadenitis
- History oftemperature (>38)
- Absence ofcough
- Management: supportive care, if suspicion of Streptococcal infection, 10 day of Penicillin V
- Complications of bacterial URTI include retropharyngeal abscess, quinsy (I+D), scarlet fever, poststreptococcal glomerulonephritis or rheumatic fever
Bronchiolitis
cause, sx, ix, mx
Pneumonia
cause, sx, mx, ix
- amoxicillin first line treatment
Croup
cause, sx, mx
Epiglottitis
Cause, sx, mx
- Resus, keep them calm and avoid doing any procedures that might upset the child
- Senior paediatrician, ENT surgeon, anaesthetist
- Examination under anesthetic to confirm diagnosis (cherry-red, swollen, epiglottis on laryngoscopy) followed by intubation
- Once airway secured, blood culture, IV Abx
Laryngomalacia
Sx
- Common cause of stridor
- Congenital abnormality that usually presents about 4 weeks of age
- Symptoms worse when agitated, feeding to lying on back
- Resolve by 2 years of age
Pertussis
Cause, sx, ix, mx, comp
- AKA whooping cough
- Highly contagious and caused by Bordetella pertussis
- Spread by droplets and incubation period of 7-10 days
- Clinical features: after a week of coryza, develops characteristic paroxysmal or spasmodic cough followed by inspiratory whoop, worse at night and results in vomiting
- Investigations: culture/ PCR from pernasal swab, blood count
- Treatment: Macrolide antibiotics (oral azithromycin), young infants should be admitted due to risk of apnoea
- Complications: pneumonia, seizures and bronchiectasis are rare
- Significant mortality in <4 month old
Tetralogy of fallot
Path, sx, Ddx, ix, mx
Pathophysiology
Commonest cyanotic congenital heart disease. Cyanosis due to ↓blood flow to lungs and right→left shunt.
Symptoms present at birth or develop <1 yr.
Can be part of DiGeorge syndrome.
Components, ROVeR:
Right ventricular outflow tract obstruction (RVOT): pulmonary stenosis at valve or just below.
Overriding aorta: sits above VSD and connects to both ventricles.
VSD
RVH
Signs and symptoms
Poor growth.
SOB including acute hypoxic episodes (agitated, restless, cyanosis).
Cyanosis and clubbing.
Ejection systolic murmur.
Toddlers may squat to increase peripheral resistance and hence reduce right→left shunt.
DDx: Cyanotic congenital heart defects
Transposition of the great vessels.
Tricuspid atresia.
Total anomalous pulmonary venous return.
Persistent truncus arteriosus.
Hypoplastic left heart.
Eisenmenger’s syndrome.
Investigations
Echo is diagnostic.
ECG: right axis deviation and RVH, RBBB (especially after surgery).
CXR: normal or boot-shaped heart.
Management
Surgery usually performed by 1 yr (earlier if severe), and aims to close the VSD and relieves the RVOT.
Until then, medical therapy if symptomatic: O2, morphine, β-blockers, and prostaglandins to keep ductus open
phenylephrine as last line medical therapy
Acyanotic congenital heart disease
Rf, types, sx, ix, mx
Rf
- alcohol, diabetes and smoking in pregnancy
- genetic syndromes eg, downs, turners, noonans
- rubella infection in preganacy
Types
- VSD
- ASD (ejection murmur and a fixed split second heart sound)
- PDA (collapsing pulse, managed with indomethacin)
- coarctation
Sx
- murmur
- tachypnoea
- failure to thrive
- increased sweating
- more resp infections
- fatigue
- reduced appetite
Ix
- echo (first line)
- ECG
- CXR
Mx
Medications
- ACEs
- Diuretics
- Anti-arrhythmics
- Anticoagulants
- Digoxin
Surgery
- Balloon valvuloplsty
- Heart transplant
Innocent murmurs
Def, ix
They are caused by fast blood flow through various areas of the heart during systole.
Innocent murmurs have typical features, all beginning with S:
Soft
Short
Systolic
Symptomless
Situation dependent, particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish
Ix:
ECG
Chest Xray
Echocardiography
Transposition of the great arteries
Def, Ix, Mx
Transposition of the great arteries is a condition where the attachments of the aorta and the pulmonary trunk to the heart are swapped (“transposed”). This means the right ventricle pumps blood into the aorta and the left ventricle pumps blood into the pulmonary vessels. In this scenario are two separate circulations that don’t mix: one travelling through the systemic system and right side of the heart and the other traveling through the pulmonary system and left side of the heart.
The condition can also be associated with:
Ventricular septal defect
Coarctation of the aorta
Pulmonary stenosis
Ix:
Antenatal ultrasound
Clinical- cyanosis
Mx:
Prostaglandins to maintain ductus ateriosus
Balloon septostomy
Open heart surgery
Cardiac arrest
Causes, sx, mx
Causes:
Cardiac arrest in children usually follows a progression of respiratory failure or shock, and the most common causes include:
1. Respiratory causes:
• Airway obstruction: Foreign body aspiration (choking), asthma, or anaphylaxis.
• Respiratory infections: Such as severe pneumonia or bronchiolitis.
• Drowning or suffocation: Leading to lack of oxygen (hypoxia).
• Neuromuscular disorders: Affecting respiratory muscles.
2. Circulatory causes:
• Severe dehydration: Due to vomiting, diarrhea, or blood loss.
• Septic shock: From overwhelming infections.
• Congenital heart defects: Children born with structural heart problems may be at risk of cardiac arrest.
• Arrhythmias: Abnormal heart rhythms, which are less common in children but can lead to cardiac arrest.
• Trauma: Major injuries, such as head trauma, can lead to cardiac arrest.
3. Other causes:
• Electrolyte imbalances: Such as low potassium (hypokalemia) or high potassium (hyperkalemia).
• Poisoning or drug overdose.
• Sudden infant death syndrome (SIDS): In infants under one year of age, though the cause remains unclear.
• Genetic disorders: Such as long QT syndrome, which can predispose children to sudden cardiac arrest.
Sx:
• Unresponsiveness: The child is unconscious and does not respond to voice or touch.
• No normal breathing: Either no breathing or only gasping (agonal breathing).
• No pulse or signs of circulation: The absence of a detectable pulse or signs of life like movement or coughing.
Mx:
BLS
Respiratory arrest
Causes, sx, dx, mx
Causes:
1. Airway Obstruction:
• Foreign Body Aspiration: Common in young children who might swallow or inhale small objects.
• Anaphylaxis: Severe allergic reactions can cause airway swelling.
• Croup or Epiglottitis: Infections that lead to swelling of the throat and airway narrowing.
• Tumors or masses: These can obstruct the airway in rare cases.
2. Respiratory Diseases:
• Asthma: Severe exacerbations can lead to respiratory failure.
• Pneumonia: Infection of the lungs can cause difficulty breathing.
• Bronchiolitis: Common viral infection in infants leading to inflammation of the small airways.
• Chronic lung diseases: Such as cystic fibrosis or bronchopulmonary dysplasia.
3. Neuromuscular Conditions:
• Myasthenia Gravis: Weakening of the respiratory muscles.
• Spinal Cord Injuries: Can impair respiratory muscle function.
• Congenital Disorders: Conditions like congenital muscular dystrophy.
4. Central Causes:
• Head Injuries: Can affect the brain centers responsible for breathing.
• Neurological Disorders: Such as seizures or infections (e.g., meningitis).
• Toxicology: Overdose of sedatives, narcotics, or other medications can suppress the respiratory drive.
5. Environmental Factors:
• Drowning: Can lead to asphyxia.
• Exposure to smoke or toxic gases: Leading to respiratory distress.
Sx:
• Unresponsiveness: The child may be unconscious or difficult to arouse.
• Absence of breathing: No chest rise or audible breath sounds.
• Gasping or irregular breathing: May be the only sign of inadequate ventilation.
• Cyanosis: A bluish tint around the lips, face, or extremities due to low oxygen levels.
• Use of accessory muscles: Notable straining in the neck and chest muscles during breathing.
• Rapid heart rate: Initially increased heart rate (tachycardia) may occur, followed by bradycardia (slowed heart rate) if the situation worsens.
Dx:
• Physical Examination: Assessing responsiveness, airway patency, and breathing status.
• Pulse Oximetry: Measuring oxygen saturation levels to determine hypoxia.
• Capnography: Monitoring carbon dioxide levels if advanced monitoring is available.
• Blood Tests: Arterial blood gas (ABG) analysis to evaluate oxygen and carbon dioxide levels, especially in a hospital setting.
• Imaging: Chest X-rays may be performed if an underlying lung issue is suspected.
Mx:
BLS
