Resp Exam Flashcards
How long should a cough not lost for?
- it should not be more than 14 days
-if it is >21 days it is a chronic cough caused by:
Undiagnosed TB
Whooping cough
Bronchiectasis
Poorly controlled asthma
Describe wheezing
It is a high pitched polyophonic (continuous) musical sound caused by narrowing of the small airways
-usually in the expiratory phase
Describe stridor
- High pitched inspiratory sound from the narrowing extrathoracic airways after a viral subglottic infection
- usually auscultated in the apices of the lungs
Describe crackles
- There are fine crackles And course crackles (both known as rales)
- they are caused by sudden opening of the airways
- usually heard at the base of the lungs
What are fine crackles indicative of?
- Pneumonia
- Bronchiolitis
- Left sidded heart failure
What are coarse crackles indicative of?
- Bronchiectasis
2. Bronchitis
What does air trapping present with?
- flattening of the diaphragm and indrawing of the subcostal ribs along the sheet margins causing Hoover’s sign
- if prolonged it leads to Harrison’s sulcus which is also seen in rickets
What are the causes of clubbing?
- Cyanotic lung disease
- Bronchiectasis
- HIV
- Infective endocarditis
How do we diagnose respiratory failure in babies?
We diagnose on blood gas and not clinically
‘-we notice hypoxia or hypercapnea
What organisms can we expect in pneumonia in children with HIV?
- Pneumocystis jirovecii penumonia
2. Cytomegalovirus
What is the presentation of pneumonia in children less than 2 months?
- Lethargy
- Failure to feed
- Hypothermia
- Apnea
- Convulsions
On physical exam in infants what can we expect?
- Tachypnoea
- Fever
- Widespread crackles
What type of pneumonia do infants usually get?
-bronchopneumonia
What kind of pneumonia do older children usually get?
-lobar pneumonia
What organisms contribute to causing peumonia?
- Viral organism
- RSV, Adenovirus, parainfluenza, influenza - Bacterial organism
- streptococcus pneumoniae,staphylococcus aureus, previously haemophillus before vaccines were available
What organisms do immune compromised children get-due to HIV, malnutrition or after malnutrition
- CMV
- Pneumocystis jirovecci
- Klebsiella pneumonia
- Mycobacterium TB
What are the danger signs of admitting a child into hospital as a result of pneumonia?
- Stridor
- Altered level of consciousness
- Severe malnutrition
- HIV positive not on treatment
What organisms can we expect in neonatal penumonia?
1, streptococcus B
2. Chlamydia trachomatis
What organisms can we expect babies under 3 months in CAP?
- Gram negative organisms
- Group B streptococcus
- Staphylococcus aureus
- Haemophillus influenzae
When should we admit a neonate or infant?
- Cyanosis
- Chest indrawing
- SATS<92%
- Neonates and infants<2 months
- Congenital heart disease
- Chronic lung disease
How does viral penumonia show up on X-Ray?
- Hyperinflation
- Perihilar streaking
- Interstitial changes
What is a pneumatocoele?
- thin walled air filled cystic lesions followed after pneumonia infection and they resolve spontaneously
What special investigations can we do fo patients with pneumonia?
- Bacterial cultures by taking a blood culture or aspirating if pleural effusion is present
- Nasopharyngeal aspirate if it is viral
- Sputum or pharyngeal aspirate
- FBC with white cell count(not very specific in determining difference between viral and bacterial)
What are the key features of bronchopneumonia?
- Patchy consolidation either bilaterally or involving multiple lobes
- Diffuse crackles heard in affected areas
- Percussion: dull to percussion
- Mostly young children
- Centered in the bronchioles and bronchi
What is the differential diagnosis of pneumonia in a child?
- Bronchiolitis
- Asthma
- TB
- Cystic fibrosis
- Underlying cardiac lesion
What is community acquired pneumonia?
It is an acute infection of les than 14 days acquired in the community and causing dyspnea, tachypnea, coughing and chest wall indrawing due to lower respiratory tract infection
What is the most common VIRUS causing community acquired pneumonia in children?
RSV
What is simple pneumonia?
It is bronchopneumonia involving only the airways and possibly the surrounding interstitium or if lobar pneumonia affecting only a single lobe
What is complicated pneumonia?
It is pneumonia affecting more than one lobe, causing parapneumonic effusions, abscesses or cavity, empyema, pneumothorax or bronchopleural fistula
What are the VIRUSES that cause community acquired pneumonia?
- Respiratory syncytial pneumoniae
- adenovirus
- Influenza A or B
- Parainfluenza type 1 and 2
What are the common BACTERIAL causes of community acquired pneumonia?
- Streptococcus pneumoniae
- Staphylococcus aureus
- Mycobacterium TB
- Haemophillus influenzae
What bacteria can we expect between 3 months and 5 years in CAP?
- Staphylococcus aureus
- Haemophillus influenza
- Streptococcus pneumoniae
What bacteria can we expect in children older 5 years?
- Streptococcus pneumoniae
- Mycoplasma pneumoniae
- Staphylococcus aureus
How does mycoplasma pneumoniae present?
- usually children >5 years
- presents with malaise, sore throat, fever, cough over 3-5 days
What organisms can we expect to develop in HIV positive patients?
- PJP
- CMV
- Candida species
What are the signs of severe pneumonia according to WHO?
- Cough or difficulty breathing in addition to signs of respiratory distress
- nasal flaring
- chest indrawing
- expiratory grunting
What is VERY severe pneumonia characterised by?
- cough and difficulty breathing with
- cyanosis
- severe respiratory distress
- decreased level of conscious, lethargy, convulsions
How do we diagnose pneumonia?
- Blood culture
2. Chest X-ray
When should we admit a child in hospital for pneumonia?
- If the child has respiratory distress-nasal flaring, grunting, chest indrawing
- Stridor
- Decreased level of conscious
- Severe acute malnutrition
- Cyanosis
At what age can we expect PJP infection in HIV positive patients?
Between 6 months and 6 years
Which extremely virulent pathogen can cause hospitalization in children?
-CA-MRSA
Community associated methicillin resistant staphylococcus aureus
What is the antibiotics we can give to children?
-we usually give oral amoxicillin 90mg/kg/day because it provides appropriate coverage for streptococcus pneumoniae
What do we give in immune compromised children?
- IV ampicillin
- An aminoglycoside (gentamycin)
- 3rd generation cephalosporin (ceftriaxone)
What supportive treatment can we give children with pneumonia?
- Supplemental oxygen via nasal prongs with Fi02 of 28-35%
2. Oxygen mask at a flow rate of 6-10l/min
What supportive treatment can we give children with pneumonia?
- Supplemental oxygen via nasal prongs with Fi02 of 28-35%
- Oxygen mask at a flow rate of 6-10l/min
- Supplemental zinc (20mg per day) is found to decrease the duration of hypoxia
Which organism usually causes empyema?
- Streptococcus penumonia
What is empyema?
-it is a complication of penumonia where pus collects in the thoracic cage
What is the criteria of RW light in empyema?
-parapneumotic effusions are exudates and so at least one of the following criteria must be fulfilled:
- Pleural fluid LDH/Plasma LDH>0,6 of pleural >200 IU/L
- Pleural fluid protein/plasma protein >0,5
- Glucose levels <60 mg/d
What is necrotising pneumonia?
- it is pneumonia with cavitations or cavitatory necrosis
- on chest X-ray you see dense lobar consolidation and pleural effusion
How do we definitively diagnose necrotising pneumonia?
On chest CT
What is the pathophysiology of of necrotising penumonia?
-massive pulmonary gangrene, tissue liquefaction and necrosis
What organisms are known to cause necrotising pneumonia?
- Streptococcus pneumonia
- Staphylococcus aureus
- Mycoplasma pneumoniae
When should we consider that a child is not responding to treatment?
1.after 48-72 hours
What could be reasons for a child not responding to treatment effectively?
- The bug
- the organism could be resistant to the AB
- there could be an unusual organism like TB
- there could be other additional organism - The drug
- Wong AB
- Wrong dose of AB - The host
- immunodeficiency
- complicated pneumonia
- foreign body aspiration
When should we consider transfer of the child to ICU?
- Failure to obtain SATS of >90% on Fi02 >70%
- If the child is apneac
- Exhaustion
- Hypercarbic patient leading the acidaemia (Ph<7,25)
What can we do to prevent to pneumonia in chilsdren?
- Influenza vaccine
2. Pneumococcal vaccine
What is the treatment for a child less than 3 months?
- Ampicillin
- Gentamycin
- Cloxacillin
How long do we usually treat complicated PJP and CMV pneumonia?
21 days
How long do we treat children with who are HIV positive or neonates?
7-10 days
What antibiotics do we use to treat children with atypical bacteria?
- Azithromyin or erythromycin
When does hospital acquired/nosocomial pneumonia usually occur?
72 hours after admission into hospital
