Respiratory Flashcards
Features common cold
Clear or mucopurulent discharge with nasal blockage
Self limiting
No required treatment: OTC analgesic
Cough may persist for 4 weeks following cold
Features Pharyngitis
Pharynx and soft palate are inflamed
Local lymph nodes enlarged and tender
Usually viral or group A haemolytic strep
Headache, apathy, abdominal pain, white tonsillar exudate, cranial lymphadenopathy
Mx Pharyngitis
Penicillin V 10 day minimum required- prevent rheumatic fever
Amoxicillin is avoided in case of EBV infection and possibility of rash
Features tonsillitis
Form of pharyngitis
Intense inflammation of the tonsils
Often purulent exudate
EBV or group A strep common
Features acute otitis media
Most common 6-12 months
Children prone as estaashion tubes are short, horizontal and function poorly
Pain in ear and fever
Tympanic membrane bright red and bulging with loss of normal light reflection
Acute perforation of the ear drum with visible pus
Most cases resolve spontaneously
Mx Acute otitis media
Amoxicillin once symptoms have persistent for 2-3 days
Regular analgesia for a week
Cx Acute otitis media
Can develop mastoiditis and meningitis
Recurrent infection leads to effusion (glue ear) requiring Grommets- can be a cause of reduced hearing
Features sinusitis
Infection of the paranasal sinuses
Frontal sinusitis is uncommon: only develop in late childhood
Maxillary sinus swelling may present with pain, swelling and tenderness
dDx Stridor
Croup Acute epiglottitis Bacterial tracheitis Foreign body Laryngomalacia
Features croup
6months-6years of age, occuring during the autumn
Characteristic seal like cough associated with tracheal edema
Inflammation of the vocal cords produces hoarseness
Onset or worsening at night
Mx Croup
Low threshold for admission in under 12 months
Oral dexamethasone/prednisolone
Nebulised adrenaline
Features Acute epiglottitis
Life threatening due to high risk of respiratory obstruction
Caused by Hib: Rare due to vaccine
Children aged 1-6 years
High fever, drooling (inability to swallow)
Do not perform any examination which will distress child and risk occlusion
Mx Acute epiglottitis
Direct transfer to ICU
Early intubation first line- tracheostomy if unsuccessful
Cultures and IV antibiotic AFTER intubation
Prophylaxis for household contacts with rifampicin
Feautures bacterial tracheitis
Rare but dangerous
High fever, very ill child, rapidly progressive airway obstruction
Copious thick secretions
Features Layngomalacia
Usually presents at 4 weeks
Obstruction due to anatomic malformation
Resoles with age
dDx Wheeze
Bronchiolitis
Viral episodic wheeze
Asthma
Features bronchiolitis
Aged 1-9 months
Typically RSV
Coryzal symptoms with a dry cough and increasing breathlessness
Indications for admission bronchiolitis
apnea, persistent saturations <90%, inadequate oral intake, severe respiratory distress
Mx Bronchiolitis
Supportive therapy: humidified O2 via nasal cannulae
Most recover within 2 weeks
Features viral episodic wheeze
Most preschool children with wheeze is due to viral illness
Always likely to narrow and construct in inflammation
Risks: maternal smoking, remturiy
More common in males
Typically self resolves by age 5
Features asthma
Diagnosis in under 3 difficult
Symptoms worse at night and with specific triggers
Normal examination of the chest normally, with wheeze presenting in acute asthma
Hyperinflation of the chest in chronic asthma
Typically history of atopy
Mx Asthma <5y
Short acting beta agonist
SABA + 8week trial of Paediatric moderate dose inhaled corticosteroid
-If symptoms doe not resolve consider alternative diagnosis
-If symptoms recur within 4 weeks when stopping ICR, restart low dose ICS as maintenance
-If symptoms recur beyond 4 weeks repeat 8 weeks trial
SABA + Low dose ICS + LTRA
Stop LTRA and refer
Mx Asthman 5-16y
Short acting beta agonist
SABA + Paediatric low dose inhaled corticosteroid
SABA + Low dose ICS + LABA
SABA + switch ICS/LABA for low dose MART
SABA + moderate dose MART OR fixed dose moderated ICS and LABA
SABA + high dose ICS OR theophylline trial OR referral
Steroid dosing in asthma
Low dose 200mcg budesonide
Moderate dose 200-400mcg budesonide
High dose 200-400mcg Budesonide
Features of cough
Dry cough with expiratory wheeze suggests narrowing of smaller airways.
Barking cough suggest tracheal inflammation, narrowing or collapse.
Wet cough associated with mucous secretion and inflammation of lower airway
Features whooping cough
Highly contagious
Paroxysmal cough with inspiratory whoop
Wrose at night
May induce vomiting after coughing
Child can go red or blue during paroxysmal phase with production of mucous
Vigorous cough can cause epistaxis and subconjunctival haemorrhage
Dx whooping cough
Culture pernasal swab
Mx whooping cough
Macrolide Abx
Isolation
Admission
Features pneumonia
Virl in younger children, bacterial in older children
Fever, cough, rapid breathing preceded by URTI
Most children can be managed at home
Cx pneumonia
Small effusions may occur- persistent fever >48 hours following antibiotics suggests effusion requiring drainage
Mx Pneumonia
Antibiotics: newborns broad spectrum IV; older infants amoxicillin; children>5 amoxicillin/erythromycin
Admission in pneumonia
oxygen sat <92%, recurrent apnoea, grunting, inability to maintain adequate feed/fluid
Features chronic lung infection
Chronic wet cough associated with persistent bacterial bacterial bronchiolitis
Persistent inflammation of the lower airways
Bacterial growth from sputum or bronchial lavage
Mx chronic lung infection
high dose co-amoxiclav
physiotherapy
Features bronchiectasis
Permanent dilation of the bronchi
Generalised bronchiectasis associated with cystic fibrosis
Focal bronchiectasis associated with severe pneumonia, congenital lung abnormality, obstruction by foreign body
Features Cystic fibrosis
meconium ileus, prolonged neonatal jaundice, growth faltering, recurrent chest infections, bronchiectasis, rectal prolapse, nasal polyps, sinusoids, allergic bronchopulmonary aspergillosis, diabetes mellitus, cirrhosis and portal hypertension, distal intestinal obstruction, pneumothorax, sterility in males
Ix Cystic Fibrosis
Post natal screening on heel prick
Sweat test showed raised sodium chloride 60-125mmol/L
Regular FEV measurement and physiotherapy to remove secretions
Mx Cystic fibrosis
Prophylactic flucloxacillin and rescue antibiotics for initial signs of infection
High calorie diet with overnight feeding and pancreatic supplementation
Features primary ciliary dysplasia
Congenital abnormality of structure and function of ciliary lining
Recurrent respiratory tract infections, severe bronchiectasis, recurrent productive cough, purulent nasal discharge, chronic ear infection
Associated with dextrocardia and situs inversus
