Respiratory Flashcards
Cough DDx?
- Post viral cough
- Simple URTI
- Pertussis
- Asthma
- Allergic rhinitis
- GERD
- Congenital heart disease
- Cystic fibrosis
- Foreign body
- Psychogenic cough
- Habit cough/Tics
- Sinusitis
SOB DDx?
- Bronchiolitis/Asthma
- Croup
- Epiglottis
- Upper RTI
- Pneumonia
- FB
- Anaphylaxis/Angioedema
- Bacterial Tracheitis
- Congestive heart failure
SOB structure plz
-Can you describe what do you mean by breathing difficulty?
- Is he having noisy breathing? Croup
- Is it hard for him to take breaths?
- Does he stop breathing at a time?
- Timing
- since when
- on and off or continuous
- is it getting better or worse?
- any alleviating or aggravating factors
on Ex:
- GA : active/irritable/drowsy? Any drooling of saliva? Any tripod posture?
- PICKLED : Any cyanosis? Any sign of dehydration?
- Vitals and Growth Chart
- ENT : avoid throat examination
- Respiratory System: Do not miss stridor ( expiratory/inspiratory)
- CVS
- Abdomen
- Office test
Sore throat & rash structure
- HD stability
- Open ended question/ concern
-
Explore the sore throat
- Timing
- since when
- is it getting worse
- alleviating and relieving factors
- features- difficulty in swallowing or drinking
- Timing
-
Explore the rashes
- Timing
- Since when
- is it getting worse?
-
Timing
- Does the child have a fever?
- Fever
- have you measured
- have you given medicine?
- did medicine worked
- Fever
- Did the rash appear before or after the fever? (KP)
- Does the child have a fever?
- Character
- Site/ color
- Itchy or painful
- Warm on touch
- Rough on touch?
- Timing
-
ENT questions
- Runny nose
- Ear pain
- Lumps and bumps - LN
- Red eyes ( conjunctivitis is important for Kawasaki )
-
KEY POINTS
- Drooling
- Change in voice (Hoarseness or Hot potato voice)
- Difficulty in swallowing and drinking ( quinsy )
-
Respiratory questions
- cough - If (+) explore
- Dry or chesty
- Character - barking, whooping
- Noisy breathing
- Breathing difficulty
- cough - If (+) explore
-
Meningitis
- headache
- Sore neck
-
GI questions
- vomiting
- diarrhea
WELL BABY QUESTIONS
- alert or drowsy
- eating and drinking
- waterworks ( dehydration ) - decrease in the amount of urine and wet nappies
- Bowel motions
BINDS
- Immunization and social are important
- Social - contact Hx, Travel Hx, child care
Medications
Allergies - for Ab (KP)
Past medical History
- Hx of rheumatic fever in family? (KP)
PHYSICAL EXAMINATION
General Appearance ( GA)
- Rash
- describe the rash
- site
- **Blanching or non-blanching (non-blanching in scarlet fever )
ENT examination
- Throat examination
- Ear examination ( for red bulging TM for otitis media)
- Nose ( for turbinate swelling )
- Cervical lymph node
Neck stiffness ( for meningitis )
Respiratory examination
CVS examination
What are the KP in scarlet fever case?
- Drooling
- Change in voice (Hoarseness or Hot potato voice)
- Difficulty in swallowing and drinking ( quinsy )
Allergy - AB
Immunization
Hx of rheumatic fever/ FHx of rheumatic HD
Structure for Kawasaki Dx
- HD stability
- open-ended questions / concern
-
Explore fever
- Timing
- since when
- on and off or continuous
- is it getting worse
- Measured the temperature
- Has medication worked
- Timing
> Having 39° fever - giving PCM - not working
🔰FEVER DDx
ENT infections
- runny nose
- sore throat
- drooling
- pulling ears
- lumps and bumps - cervical LN
Respiratory infections
- cough
- noisy breathing
- difficulty breathing
GI infections
- vomiting
- diarrhea
- abdominal pain
UTI
- Crying on changing the nappies /crying on passing urine
MENINGITIS
- Rash
- Sore neck
- Headache - older kids
🔰KAWASAKI (@MHEART)
- M: mucosa- dry cracked lips, strawberry tongue
- H: Hands- edema, desquamation
- E: Eyes- conjunctivitis
- A: Adenopathy
- R: Rash
- T: Temperature
1. Rashes in the body
2. Redness, rash , peeling of the skin, crack lips
3. Red eyes
4. Lumps and bumps in neck
WELL BABY QUESTIONS
- alert or drowsy
- eating and drinking
- waterworks ( dehydration ) - decrease in amount of urine and wet nappies
- Bowel motions
BINDSMA
Past medical history
Structure for allergic Rhinitis
- open-ended question / concern
- Explore your presenting complaint - RUNNY NOSE
- Timing
- since when ?
- on and off or continuous
- has it getting worse
- seasonal or not
- Alleviating and aggravating factors
- Place or activity that triggers the runny nose?
- Eg: Going to park
- Place or activity that triggers the runny nose?
- Character of discharge @CCVO
- color - clear or yellowish greenish
- content - blood?
- volume
- odor
- Discharge is from one or both nostril?
- Timing
- Rule out infection
- fever
- sore throat
- cough
- pulling of ears
-
Allergic rhinitis
- eye - red itchy eye, watery eye
- signs - dark circles or lines under the eyes?
- Nose - itchy nose ? sneezing?
- lung - cough or noisy breathing
- skin - itchy rashes on the body?
- Complications
- Snoring
- Daytime tiredness - sleeps more during the day?
- Recurrent ear infections
- concern on hearing
- speech problem
- eye - red itchy eye, watery eye
- Environment factors - smoking, pets, carpets, fluffy toys, exposure to dust
- Medications - have you used any medications for runny nose - especially decongestants?
- Allergies to food
- Family hx - asthma, eczema , hay fever
WELL BABY QUESTIONS
- Alert or drowsy
- Eating and drinking
- Waterworks ( dehydration ) - decrease in the amount of urine and wet nappies
- Bowel motions - Greezy stools (Celiac disease)
BINDS
- birth - heel prick test ( for cystic fibrosis)
- immunization
- development and growth
- Social — Situation at home & school? child care ?
DDx for Glandular fever
DDx:
- Infectious mononucleosis
- Streptococcus tonsillitis
- Lymphoma/ leukemia
- Hepatitis
- CMV, toxoplasmosis
DDx for FIT
- Decreased caloric intake - diet
- Malabsorption - celiac disease
- Increased caloric usage -
- recurrent infection
- CF
- congenital heart disease
- Cows milk allergy
- Psychosocial factors of the family
Travel related infections in cough?
- typhoid
- Tb
- dengue fever
- malaria
- meningitis
- GE - amoeba, Giardia
Lethargy in children DDx?
- Infections: ENT, RS, GI, CNS
- Dehydration
- Anemia
- Hypothyroidism
- Type I DM
- Malnutrition
- Sleep deprivation
- Heart disease
- Mental health concerns
- Neurological conditions
- Chronic illnesses - genetic conditions
- Medications SE
