Respiratory Flashcards
Congenital laryngeal stridor; presentation and management.
Progressive stridor during crying/supine. Doesn’t interfere with feeding.
Mx with reassurance or ENT referral if necessary.
Examples of URTI.
-common cold
-sore throat (include pharyngitis, tonsillitis)
- acute otitis media
-sinusitis (rare)
Complications of URTI.
Difficulty feeding, acute exacerbations of asthma and febrile convulsions.
Pharyngitis; aetio.
Viral usually = adenovirus, enterovirus, rhinovirus, EBV, corona
Older kids = Streptococcus pyogenes
Tonsillitis; definition, aetio, management
-Inflammation of the tonsils with purulent exudate.
- Group A beta-hemo Streptococci and EBV
-Penicillin 6hr for 10d (macrolides is allergic), salt water gargling, paracetamol etc
*avoid amoxicillin; maculopapular rash if due to EBV
Infectious mononucleosis; presentation, Ix.
- fever, malaise, generalised lymphadenopathy, sore throat, palatal petechia. Splenomegaly 50%, hepatomegaly 10%
-Monospot test (Abs for EBV), FBC (atypical lymphos)
Indications for tonsillectomy.
-recurrent tonsillitis (>3/yr)
-peritonsillar abscess (quinsy)
-obstructive sleep apnoea
Indications for adenoidectomy.
-recurrent otitis media (>4/yr)with effusions and hearing loss.
-obstructive sleep apnoea
Acute otitis media.
-6 to 12m commonly due to short and horizontal Eustachian tubes (m/o from throat)
-bulging and loss of light reflex on otoscopy
-Causes are RSV, rhinovirus, pneumococcus, H.influenza, Moraxella catarrhalis
-Mx is analgesia, Abx
-Complications = glue ear, chronic otitis media, meningitis and mastoiditis
Viral croup; aetio, epi, CF.
-Parainfluenza and other viruses (RSV, metapneumovirus…)
-6m to 6yrs but peak at 2yrs
-Barking cough and harsh stridor preceded by cough and fever. Worse at night.
Viral croup; management.
Admission of moderate/severe croup (+other cases)
- One time PO dexamethasone 0.15mg/kg. Prednisolone if unavailable.
- Other Mx= nebulised adrenaline, oxygen supplementation, Abx if underlying bacterial infection present.
Pseudomembranous croup (Bacteral tracheitis)
-Similar to croup + high fever, progressive airway obstruction, toxic
- Aetio = S. aureus, S. pneumoniae, S. pyogenes, M. catarrhalis etc (follows viral infection)
-Males>females 5-7yrs.
-Mx = IV ABx and ventilation
Acute epiglottis; aetio, epi and CF.
- Life threatening infection by H.influenza (immunisation available w/ Hib)
-1-6yrs but can affect all ages
-Very acute onset of high fever, drooling, soft insp. stridor, tripod position.
Acute epiglottis; management.
-Do NOT examine throat and get senior paeds, ENT and anesthetist.
- Mask O2, admit to ICU until intubation (urgent tracheostomy if needed). Tube may be removed after 24hrs.
-Abx = IV cefotaxime 3-5d
-Prophylaxis with rifampicin in the household.
Causes of acute stridor.
Croup (commonly)
Epiglottitis, bacterial tracheitis, foreign body, allergic laryngeal angioedema, smoke inhalation, trauma, hypocalcaemia, retropharyngeal abscess, measles, diphtheria …
Mechanism of asthma.
Hyper-responsiveness of the airways to stimuli leading to reversible narrowing of the airways.
Bronchial inflammation leads to increased mucous production, infiltration of cells and bronchial smooth muscle constriction.
DDX of severe asthma vs life threatening asthma
Severe = severe breathlessness, accessory muscles to breath, peak flow <50%, type 1 resp. failure with respiratory alkalosis on ABG.
Life-threatening = silent chest and cyanosis, poor respiratory effort, peak flow <33%, SatO2 ,92%, type 2 resp. failure with respiratory acidosis.
Complications of asthma
Medical acute = respiratory distress, pneumothorax
Medical long term = growth failure, S/E of medications
Social = medication cost, psychological…
S/E of common asthma drugs; salbutamol, aminophylline, MgSO4
Salbutamol = tremors, hypokalaemia
Aminophylline = seizures, SVT, tachycardia
MgSO4= hypotension, urinary retention, respiratory depression, neurological depression
Dosages of drugs in emergency Mx of asthma.
Salbutamol = 2.5mg/kg if <2yrs or 5mg/kg
Prednisolone = 1-2mg/kg PO
IV hydrocortisone = 4mg/kg
IV MgSO4= 50mg/kg
Aminophylline= 10mg/kg bolus followed by 5mg/kg infusion
Inhalers types (2)
Blue inhalers = relievers - salbutamol and ipatropium bromide
Purple inhalers = Flusal (Salmeterol + fluticazone)
Bronchiolitis; epi, aetio and pathophysiology.
Common serious infection up to 1yr. Rare later but can occur until 2yrs.
Aetio= RSV (80%), others (metapneumovirus, parainfluenza, rhinovirus, M. pneumoniae etc)
Patho= bronchiolar obstruction with oedema, mucous and cellular debris
Bronchiolitis; CF
Precedes with coryzal symptoms
Sharp dry cough
Tachypnoea
Subcostal and intercostal recessions
Hyperinflation of the chest
Fine-end inspiratory crackles
High pitched ex. wheeze
Cyanosis/pallour
Apnoea
Risk factors for bronchiolitis
Prematurity that leads to bronchopulmonary dysplasia
Underlying lung diseases such CF
Congenital heart disease
Preterm
X-ray changes in bronchiolitis
Hyper-luscent blackish lung fields
Horizontal ribs
Flat diaphragm
Hyperinflated chest
Indications for hospital admission in bronchiolitis
Apnoea
Persistent SatO2 <90%
inadequate oral fluid intake
severe respiratory distress
Management of bronchiolitis
Supportive;
-humidified O2, fluids, monitoring, ABx, hypertonic saline nebulisation, IVIG
Prevention = palivizumab monthly injections for babies at risk
BCG vacine facts
Given on the left deltoid before the child is discharged from hospital. the scar should be present by 6m; if not revaccination up to 5 years.
Prematurity and low birth weight are NOT CI for vaccination.
