Respiratory Flashcards
What is croup
subglottal oedema, inflammation and exudate
Barking cough with respiratory distrss due to upper airway obstruction
What pathogen causes croup
parainfluenza virus
Most common age group affected by croup
Age 2-5
6 months - 6 years
when do you admit a child
- moderate to severe symptoms
- RR>60
- <3 months old
- Pre-existing resp condition
- inadequate feeding
- resp distress
- hypoxia
What is considered mild croup
cough, no stridor at rest
minimal recession
no cyanosis
What is considered moderate croup
Frequent cough
stridor at rest
sternal recession at rest
What is considered severe croup
restlessness/agitation cyanosis signs of resp distress Asynchronus chest wall movement - resp failure RR >70 Tachycardia
What is the management of mild croup
- no hospital admission
- dexamethasone 0/15mg/kg one off ose
Return if stridor or recessions
What is the management of moderate/severe croup
O2 if severe: 15L then titrate
Dexamethasone 0.15mg/kg
2mg budesonide neb/5mls 1:1000 adrenaline neb
ENT if not maintaining airway
what patient info do you give regarding Croup
Very common viral infection which results in a barking cough due to inflammation of the voice box. you can get breathing symptoms due to inflammation and mucus in the windpipe. The cough is worse at night and is accompanied by coryzal symptoms. Peaks after 1-3 days then improves however, the cough can last a week
What is acute bronchiolitis
Commonest LRTI in babies usually under 1 year old
What pathogen causes bronchiolitis
RSV - respiratory syncytial virus
what are the signs and symptoms of bronchiolitis
- coryza precedes cough
- Tachypnoea
- apnoea
- fever
- res[iratory distress
- inspiratory crackles
- +/- cyanosis
What is the management of bronchiolitis
- O2 until sats >92
- Nasogastric feeds
- resp support - CPAP
- Ribavrin if immunocompromised or known heart/lung problem
What are the usual pathogens in infant pneumonia
Pneumococcus
mycoplasma
haemophillus
What is the treatment of pneumonia in children
- oral ABC: amoxicillan, co-amoxiclav
- advice on managing fever and dehydration
- identifying deterioration
What is whooping cough
Bordetella pertussis
What are the signs of Whopping cough
Apnoea
Whoop: Inspiration against a closed glottis (not always heard)
Worse at night or after feeding
+/- cyanosis or co-infection with bronchiolitis
How long do you keep your child off school with whooping cough
48hrs after first antibiotics dose
If no Abx, 3 weeks
Incubation period 10-14 days
What is cystic fibrosis - doctor
deltaF508 mutation: decrease in CFTR on membranes which decreases chloride leading to thick secretions
What is cystic fibrosis - patient
Cystic fibrosis is a genetic condition whereby secretions such as mucus in our windpipe are too thick which makes the little finger-like projections in our wind pipe that normally remove mucus and pathogen don’t work as well. This results in the windpipe being filled with thick secretions and increases susceptibility to infection. It also has an impact on other organs such as the pancreas
What is the genetic inheritence of CF
Autosomal recessive
1 in 2000
What is the presentation of CF
- newborn screening
- Newborn meconium ileus
- Recurrent pneumonia and clubbing
- Failure to trhive
- Steatorrhoea
what is steatorrhoea
pale, fatty, oily smelly stools
What are the investigations for Cf
Sweat test: Cl >60mmol
(<40mmol is normal)
NOT TO BE DONE ON DAY 1 Cl >65
What can cause a false positive in the sweat test
adrenal insufficiency hypothyroidism dehydration malnutrition atopic eczema
What can cause false negatives in the sweat test
oedema
poor technique
What might you see on CXR in someone with CF
- hyperinflation
- increase AP diameter
- bronchial dilatation
- cysts
- linear shadows
- infiltrates
What do you see in spirometry of someone with CF
Obstructive pattern
decreased FVC
Increased lung vol
Complications of CF
- GI obstruction if creon omitted/inadequate
- Impaired glucose intolerance with age: OGTT yearly >12
- Malabsorption
- Increased energy needs
- pneumonia
- infertility (male)
What is the management of CF as an infant
- chest physio TDS
- postural drainage and percussion
- Forced expiration when older
What is meconium ileus
Failure to pass stool or vomiting in the first 2 days of life. Will see distended bowel loops through abdo wall.
What is the management of meconium ileus
NG drainage, washout enemas, excision of gut containing meconium
What is the prognosis of CF
- most survive to adulthood
- median age 50 if born after 2000
- death from pneumonia or cor pulmonale
What are the RF for asthma
Low birthweight bottle fed male past lung disease FH Atopy Pollution
What are the differentials of asthma
foreign body pertussis croup pneumonia/TB hyperventilation Aspiration CF
What general advice do we give to parents of an asthmatic
- Annual review: Sx, exacerbations, time off school, inhaler technique
- Advice re smoke exposure
- record height and weight
What a red flags/indicators of other pathology in asthma
Failure to thrive Unexplained clinical findings Symptoms present from birth or perinatal lung problem Excessive vomiting or posseting Severe URTI Persistent wet or productive cough Family history of unusual chest disease Nasal polyps
Step 1 management of asthma
Low dose corticosteroid
Salbutamol inhaler
Step 2 management of asthma
Low dose corticosteroid + LABA or LTRA (>5). LTRA (<5)
Salbutamol inhaler