Respiratory Flashcards
Where are all the infections (resp tract)?
Rhinitis
Where?
Features?
Prodrome to what other illnesses?
The nose
Self-limiting condition that occurs in the winter months.
Runny nose normally lasts 16 days
- Pneumonia, bronchiolitis
- Meningitis
- Septicaemia
How does otitis media erythema appear?
Bulging tympanic membrane
Normally lasts 9 days
Features of Otitis Media?
Causation?
What are complications?
Rx?
- Common, self-limiting
- Not “a bit pink”
- Primary viral infection
- Secondary infection with Pneumococcus/ H’flu
- Spontaneous rupture of drum
- Rx: Antibiotic treatment usually does not help so give analgesics and wait it out
How do we Dx Tonsillitis/pharyngitis?
- Sore throat
- Normally lasts 7 days
- Viral or bacterial?
- Do a throat swab
Tonsillitis/pharyngitis
Rx if viral?
Rx if bacterial?
- Either nothing (viral) or 10 days penicillin (bacterial)
- Don’t give amoxycillin
Which two URTI are very similar and must be differntiated?
Croup and Epiglottitis
How can we differentiate between croup (LTB) and epiglottitis?
Croup:
- Para’flu 1
- Common
- Child is well
- Coryza++, stridor, hoarse voice, “barking” cough
- Normally lasts 3 days
Epiglottitis:
- H. influenzae
- Rare
- Toxic
- Stridor + drooling
Rx for croup?
Rx for epiglottitis?
- Croup = oral dexamethasone
- Epiglottitis = intubation and antibs
What are common agents for bacterial LRTI?
- Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae
What are common agents for viral LRTI?
- RSV, parainfluenza III, influenza A and B, adenovirus, rhinovirus
How do we assess a patient with LRTI?
- Make a diagnosis (easy)
- Assess the patient (easy)
- Oxygenation, hydration, nutritional
- To treat or not to treat (grey area)
What is bronchitis?
Infection of the main airways of the lung - the bronchi.
SSx of bronchitis?
- Common ++++
- Loose rattly cough
- Post-tussive vomit - “glut”
- Chest free of wheeze/creps
- Haemophilus/Pneumococcus
- Mostly self-limiting
- Child VERY well, parent worried
Mechanism of bacterial bronchitis?
- Disturbed mucociliary clearance
- Minor airway malacia
- RSV/adenovirus
- Bacterial overgrowth is secondary
What are red flags for LRTI?
- Age <6 mo, >4yr
- Static weight
- Disrupts child’s life
- Associated SOB (when not coughing)
- Acute admission
Rx for persistent bacterial bronchitis?
- Reasure parents
- Do not treat
Bronchiolitis: What is it?
Infection of the smal airways of the lungs - bronchioles
Bronchiolitis: features? SSx?
- Affects 30-40% of all infants
- Usually RSV, others include paraflu III, HMPV
- Nasal stuffiness, tachypnoea, poor feeding
- Crackles +/- wheeze
- Normally lasts 16 days!
Who does bronchiolitis occur in?
- <12 months
- One off (not recurring)
Rx for bronchiolitis?
- Maximal observation
- Minimal intervention - there is no proven medications to work
Ix for bronchiolitis?
- Naspharyngeal aspirate (NPA)
- Oxygen saturations (severity)
What is pneumonia?
Lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid
SSx for pneumonia?
- Fever
- SOB
- Grunting
- Cough
- Reduced breath sounds
- Consolidation/fluid on xray
Also only refer to it as pneumonia if signs are focal, creps and high fever. Otherwise refer to it as LRTI.
Rx for pneumonia?
- Investigations
- CXR and inflammatory makers NOT “routine”
- Management
- Nothing if symptoms are mild
- (always offer to review if things get worse!)
- Oral Amoxycillin first line
- Oral Macrolide second choice
- Only for IV if vomiting
When is IV vs oral antibiotics used in pneumonia?
Oral antibiotics “win” 2:1
√Shorter hospital stay
√Cheaper
XFever for a few more hours
What is pertussis?
WhoOping cough
What can prevent pertussis?
- Vaccination reduces risk
- Vaccination reduces severity
SSx of pertussis?
- “Coughing fits”
- Vomiting and colour change
Give a run through of all the resp tract infections and how they are managed:
What is asthma?
Clinical syndrome characterised by increased responsiveness of the tracheobronchial tree to a variety of stimuli - causing dyspnoea, wheezing and cough, which may vary from mild and almost undetectable to severe and unremitting.
SSx for asthma?
- Chronic
- Wheeze, cough and SOB
- Multiple triggers
- URTI, exercise, allergen, cold weather, etc
Dx for asthma?
- Wheeze
- Variability
- Respond to treatment
What are multiple hits causing asthma?
- Genes
- Inherently abnormal lungs
- Early onset atopy
- Later (env) exposures
Rhinovirus
Exercise
Smoking
Ix for asthma?
- All in the history!
- Examination unhelpful
- Unlikely to be wheezing
- Stethoscope never important (often unhelpful)
- •No asthma test in children
- Peak flow random number generator
- Allergy tests irrelevant
- Spirometry lacks specificity
- Exhaled nitric oxide unproven
What are important SSx for asthma?
Wheeze
SOB at rest
•Significant resp difficulty
–<30% lung function
- Airway obstruction
- “Sooking” in of ribs with wheeze
Cough
- Dry
- Nocturnal (just after falling asleep)
- Exertional
What is the approach to wheeze?
- Assess if genuine: if not it’s stridor/rattle
- If genuine: Watch and see OR trial treatment, if responds to treatment
- Asthma.
DDx for asthma? (onset under 5, onset over 5)
Under 5
- Congenital
- CF
- PCD
- Bronchitis
- Foreign body
Over 5
- Dysfunctional breathing
- Vocal cord dysfunction
- Habitual cough
- Pertussis
When is it not asthma?
- Under 18 months, most likely infection
- Over 5 years, most likely asthma
What should be the approach for pre-school cough?
What are the goals of asthma treatment?
- “minimal” symptoms during day and night
- minimal need for reliever medication
- no attacks (exacerbations)
- no limitation of physical activity
How can we measure control of asthma symptoms?
- Closed questions
- SANE
- Short acting beta agonist/week
- Absence school/nursery
- Nocturnal symptoms/week
- Excertional symptoms/week
What is the step up step down approach to asthma treatment?
- Start on low dose ICS
- Severe may respond to minimal treatment
- Review after 2mo
- No routine test to monitor progress (?)
- Stepping up easier than down
What are classes of asthma medications?
- Short acting beta agonists
- Inhaled corticosteroids (ICS)
- Long acting beta agonists*
- Leukotriene receptor antagonists*
- Theophyllines*
- Oral steroids
- * “add ons”
What is asthma ladder of treatment?
- Regular preventer - ICS
- Initial add on: preventer + LABA (if over 5) or LTRA (under 5)
- Additional add on therapies: if not respond to laba increase dose of ICS, if do respond to laba can also increase ICS, if not enough consider adding LTRA
- High dose ICS + SR theophylline
- Continuous use of oral steroids
How does asthma management in paeds differ from adults?
- Max dose ICS 800 microg (<12 yo)
- No oral B2 tablet
- LTRA first line preventer in <5s
- No LAMAs
- Only two biologicals
At what point do we start regular preventer?
- B2 agonists >two days a week
- Symptomatic three times a week or more, or waking one night a week.
What are adverse effects of ICS?
- Height suppression (0.5-1cm)
- ?Oral candidiasis
- ?Adrenocortical suppression*
- XHypertension
- XCataracts
What are two things to rmb about long acting beta agonist?
- Do not use without ICS
- Use as fixed dose inhaler
How can we make it easier for children to inhale these medications?
- MDI/spacer
- Dry powder device
Don’t use nebulisers
cool beans
Other management for asthma?
- Stop tobacco smoke exposure
- Remove environmental triggers
- Cat, Dog
