respiratory Flashcards
asthma signs and symptoms
polyphonic wheeze
coughing
SoB
diurnal rhythm
asthma DD
foreign body
croup
pneumonia
TB
asthma investigations
spiro - FEV1:FVC < 70%
CXR
asthma managment 5 step process
1 - inhaled short acting B2 agonist as required (salbutamol)
2 - add inhaled corticosteroid (beclamethasone)
3 - try inhaled long acting B2 agonist (salmeterol)
4 - increase steroid dose and try leukotriene receptor antagonist (montelukast)
5 - add oral prednisolone
acute asthma managment
O2 if needed
nebulised salbutamol (with ipratropium bromide)
hydrocortisone IV
magnesium sulfate IV
aminophylline IV (with ondasetron as causes vomitting)
viral induced wheeze common cause
respiratory syncytial virus (RSV)
recurrent and persistent wheeze caused by
IgE
reasons of failure to respond to treatment
Adherence (Compliance)
medication technique
Bad disease
Choice of drugs/devices
POSSIBLE RISKS OF LONG TERM Inhaled corticosteroids
slows short/medium term growth (doesnt effect adult height)
adrenal crisis
pneumonia aetiology new born
group B streptococcus (maternal) - Streptococcus agalactiae
pneumonia aetiology infants and young
streptococcus pneumoniae
haemophilus influenza B
RSV
pneumonia aetiology atypical
mycoplasma pneumoniae
use macrolide - Erythromycin
pneumonia aetiology considerations
viruses commoner in younger children, bacteria in older
consider mycobacterium tuberculosis in all ages
pneumonia signs
cough
fever
poor feeding
respiratory distress (tachyponea, cyanosis, grunting)
older children may get end respiratory crackles / bronchial breathing
pneumonia managment
O2 if signs of resp distress - admit oral amoxicillin (1st line) - IV for newborns
bacterial pneumonia diagnosis
<3years
fever >38.5
chest recessions
RR >50
pneumonia investigations
CXR - opacity throughout lobe or lung
croup (laryngotracheobronchitis) cause
95% viral
parainfluenza virus (1,2,3)
respiratory syncytical virus
croup (laryngotracheobronchitis) epidemiology
autum, <6 years
croup (laryngotracheobronchitis) signs
onset over a few days barking cough harsh stridor voice hoarseness worse at night
croup (laryngotracheobronchitis) management
mild - dexamethasone / prednisolone
cyanosed - ABC +/- O2
nebulised adrenaline if severe
bacterial tracheitis what is it
consider if croup does not improve with treatment
tracheal bacterial infection
thick mucopurulent exudate and tracheal mucosal sloughing not cleared by coughing
bacterial tracheitis cause
staph. aureus
bacterial tracheitis management
IV third-generation cephalosporin (eg, cefotaxime, ceftriaxone) and a penicillinase-resistant penicillin (eg, oxacillin, nafcillin)
bronchiolitis cause
RSV (80%)
also parainfluenza, adenovirus
bronchiolitis presentation
coryza dry cough wheezing inspiratory crackles tachypnoea
bronchiolitis RF
congenital heart defects make more severe
bronchiolitis management
O2 if SATS <92%
prophylaxis - ribavirin (for immunocompromised / heart defect)
Palivizumab - for immunocompromised, CCF
epiglottitis cause
haemophilus influenza B (99% reduction since vaccine)
epiglottitis presentation
DO NOT EXAMINE acute toxic fever >39 continuous soft inspiratory stridor drooling minimal / absent cough
epiglottitis management
cefotaxime IV
cystic fibrosis cause
CFTR mutation on chromosome 7
decreases chloride excretion into lumen with increased reabsorption of sodium into epithelial cells
less water excreted = less viscousity
CF presentation
recurrent respiratory infections
meconium ileus
failure to thrive
raised sodium sweat level
CF complications
90% chronically infected by pseudomonas aeruginosa
commonly infected by staph.aureus
CF management
physio
pancreatic enzyme replacement therapy
inhaled corticosteroids / B2 agonists
common cold (coryza) causes
rhinovirus
RSV
coronavirus
pharyngitis causes
usually viral: rhinovirus RSV coronavirus adenovirus
bacterial: group A b haemolytic strep
FeverPAIN score (/5) - higher score more likely to be bacterial URTI
Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)
centor criteria
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough
3+ = likely bacterial
sinusitis viral or bacterial
viral - symptoms <10days
bacterial - symptoms worse after 5 days or >10days
Chronic lung disease of prematurity
breathing machine injures babys lung Officially needing oxygen at 36 weeks corrected age Reduced lung volume Reduced alveolar surface area Diffusion defect
Apnoea of prematurity treatments
stimulation
caffeine
Periorbital cellulitis
Medical emergency
Staphylococcus aureus, Streptococcus pneumoniae
URTI followed by painful swollen eye
Proptosis - abnormal protrusion or displacement of an eye
Red colour vision: sign of optic nerve compromise
IV Abx
Incision and drainage of abscess – open or endoscopic
respiratory distress syndrome cause
deficiency in alveolar surfactant
prematurity major risk factor
respiratory distress syndrome prevention
maternal corticosteroids (beclamethasone / dexamthasone) to promote fetal lung maturation
respiratory distress syndrome management
O2
exogenous surfactant
bronchopulmonary dysplasia cause
complication of ventilation used for respiratory distress syndrome
lungs damaged by mechanical ventilation and long term O2 use
bronchopulmonary dysplasia presentation and sequale
persistant hypoxia
feeding problems. cerebral palsy
sinusitis cause
step. pneumoniae
h. influenza
moraxella catarrhallis
meconium aspiration syndrome
meconium stained amniotic fluid and respiratory distress
asthma management if under 5
1 - try SABA
2 - add low dose ICS
3 - add leukotriene receptor antagonist (montelukast)
4 - if still unresolved stop LTRA and refer to specialist
