Respiratory Flashcards
What are the signs of respiratory distress seen in a child?
Accessory muscles Tachypnoea Grunting Nasal flaring Recession Head bobbing Tripoding - optimise use of accessory muscles Cyanosis
What is grunting caused by?
Exhaling against a partially closed glottis to keep airway open
What is the difference between a wheeze and stridor?
Wheeze is an expiratory sound caused by lower airway obstruction. Intrathoracic airway collapse
Stridor is a high pitched inspiratory sound caused by upper airway obstruction. Extra thoracic airways collapse
Name some causes of wheeze
Asthma
Bronchiolitis
Viral wheeze
Foreign body
Name some causes of stridor
Croup Foreign body Epiglottitis Laryngomalacia Vocal cord dysfunction Abscess - peritonsillar or retropharyngeal Anaphylaxis
What causes of respiratory distress should you consider? (broadly speaking)
Cardiac problems?
Structural issues?
Infective cause?
Gas exchange problem?
What duration of cough corresponds to being acute, subacute and chronic respectively?
Acute <3 weeks
Subacute 3-8 weeks
Chronic >8 weeks
What about a cough could indicate it is due to asthma?
Night time
Wheeze
Has a trigger
What features of a cough could indicate it is due to a recurrent infection?
Start with additional respiratory signs
What feature of a cough would indicate a post nasal drip or GORD
Worse on lying down
What would suggest a cough is one of habit?
Won’t cough at night
Otherwise well
What would suggest a cough has an environmental cause?
History of smoking/parental smoking
Live in polluted area
How would a cough present in a child with Cystic Fibrosis?
Begin at young age
Systemically unwell
What are the red flag signs for a cough?
Sudden onset Haemoptysis Dysphagia Moist productive cough Night sweats Weight loss Worsening cough Failure to thrive
What investigations would you consider if a child had a chronic cough?
CXR
Lung function
Skin prick
Sputum sample for culture and microscopy
How is a diagnosis of obstructive sleep apnoea made?
Generally clinical
Can do overnight polysomnography
How is obstructive sleep apnoea managed?
Remove tonsils/adenoids
CPAP
Weight loss
Orthodontic/maxillary surgery
What should you not give to help treat obstructive sleep apnoea and why?
DONT GIVE CODEINE
Causes respiratory depression
What is cystic fibrosis?
Autosomal recessive disease leading to mutation in CFTR gene which leads to defective Cl- secretion and increased Na+ absorption
What systems can cystic fibrosis affect?
Respiratory system Pancreas Sweat Liver Intestines Bones Male fertility
How does Cystic Fibrosis present in a newborn?
Meconium ileus
Failure to thrive
Prolonged jaundice
How does meconium ileum happen in a newborn with Cystic Fibrosis?
Bowel blocked by sticky secretions leading to signs of intestinal blockage:
Bilious vomit
Abdo distention
Delay in passing meconium
Why do children with Cystic Fibrosis fail to thrive?
Malnutrition due to poor gut absorption
What is the pathophysiology behind Distal Intestinal Obstruction Syndrome in children with Cystic Fibrosis?
Insufficient pancreatic enzymes and thick mucus –> thick dehydrated contents –> Faecal obstruction in ileocaecum