Respiratory Flashcards
What is rhinitis?
- URTI
- Very common
□ 5-10 per year - Winter months
- Self-limiting condition
- Prodrome to other illnesses
□ Pneumonia, bronchiolitis
□ Meningitis
□ Septicaemia - Review if not sure
- Typically lasts 11 days before they resolve but they may be a little longer
What is otitis media?
- URTI
- Pain and redness
- The drum is no longer red and shiny
- The drum is being pushed forward until it bursts and then it gets better
- On average lasts 3 days- 1 week
- Primary viral infection
- Secondary infection with pneumococcus/ H’flu
- Spontaneous rupture of the drum
What is the treatment of otisis media?
- Antibiotic treatment usually doesn’t help
- Oxidation, hydration, analgesia and nutrition
- Analgesia
What is tonsillitis/ pharygitis and how is it diagnosed?
- URTI
- Common
- Viral or bacterial
- Throat swab
What is the treatment for tonsillitis/ pharyngitis?
- Either nothing or 10 days penicillin
□ Ongoing swinging fevers and rash give penicillin as it suggest bacterial- you can’t tell from the throat - Don’t give amoxycillin
What is Croup?
- URTI
- Para’ flu I
- Common
- Child is well
- Coryza ++, stridor, hoarse voice, “barking” cough
- Croup usually comes on at 9/10 o’clock at night
- Treatment: oral dexamethasone
What is epiglotitis?
- URTI
- H. Influenzae type B
- Rare
- Toxic: high temp, high pulse, low BP
- Stridor, drooling
- Treatment: Intubation and antibiotics
What is the management of Lower respiratory tract infections?
- Make a diagnosis (easy)
- Assess the patient (easy)
□ Oxygenation, hydration, nutrition - To treat or not to treat (grey)
What are the common bacterial agents of LRTI?
□ Strep. Pneumoniae □ Haemophilus influenzae □ Moraxella catarrhalis □ Mycoplasma pneumoniae □ Chlamydia pneumoniae
What are the common viral causes of LRTI?
□ RSV □ Parainfluenza III □ Influenza A and B □ Adenovirus □ Rhinovirus
What is bronchitis?
- LRTI
- Common ++++
- Loose rattily cough
- Post-tussive vomit- “glut”
- Chest free of wheeze/ creps
- Haemophilus/ pneumococcus
- Mostly self-limiting
- Child very well, parent worried
- Symptoms have been going on for the whole winter
What is the mechanisms that cause bronchitis?
- Disturbed mucociliary clearance ◊ Minor airway malacia ◊ RV/ adenovirus - Lack of social inhibition - Bacterial overgrowth is secondary
What is the management of bronchitis?
□ Make the diagnosis
□ Reassure
□ Do not treat
What are the red flags for LRTIs?
- Age <6 months and >4 years
- No relapse-remission cycle
- Static weight
- Disrupts child’s life
- Associated SOB (when not coughing)
- Acute admission
- Other co-morbidities (neuro/ gastro)
What is bronchiolitis?
- LRTI
- A clinical diagnosis
- LRTI of infants
- Affect 30-40% of all infants
- Usually RSV, others include paraflu III, HMPV (human metapneuma virus)
- Nasal stuffiness, tachypnoea, poor feeding
- Crackles +/- wheeze
- There is no uncertainty
□ <12 months old
□ One off (not recurrent)
□ Typical history…
What investigations are carried out in bronchiolitis?
□ NPA (nursing in same ward) □ Oxygen saturations (severity) □ No routine need for ® CXR ® Bloods ® Bacterial cultures
What is the management of bronchiolitis?
□ Make sure oxygen, hydration and nutrition is ok
□ Maximal observation
□ Minimal intervention
How can you tell if it is pneumonia?
- Totally academic
- Word causes great anxiety
- You might call it pneumonia if
□ Signs are focal, i.e. in one area
□ Creps
□ High fever - Otherwise call it LRTI
What investigations are done for comunity aquired pneumonia?
CXR and inflammatory markers not routine
What is the management of community aquired pneumonia?
® Nothing if symptoms are mild ® Always review if things are getting worse ® Oral Amoxycillin first line ® Oral Macrolide second line ® Only for IV if vomiting
What is Pertusis?
- Whooping cough
- Common
- Vaccination reduced risk
- Vaccination reduces severity
- “coughing fits”
- Vomiting and colour change
Do you give antibiotics to a child with otitis media?
No unless age under two years AND bliateral OM give oral amaxycillin
Do you give antibiotics to a child with Bronchiolitis?
No
Do you give antibiotics to a child with Tonsillitis?
Yes (if you know it is strep.) give penicillin
Do you give antibiotics to a child with LRTI/ pneumonia?
No, unless 2 day history of fevere, cough and focal signs then give oral amoxycillin
Do you give antibiotics to a child with Bronchitis?
No
What is asthma?
- Chronic
- Wheeze, cough, SOB
- Variable/ reversable
- Responds to asthma treatment
- No uniform definition
What are the triggers of asthma
- URTI
- Exrercise
- Allergen
- Cold weather
- ETC.
What is the aetiology of asthma?
- Genes □ ~10 variants making modest contribution □ ADAM33, ORMDL3 - Interact with the environment □ Rhinovirus □ Exercise □ Smoking - Epigenetics
How is asthma diagnosed in children?
- 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 test irrelevant
□ Spirometry lacks specificity
□ Exhaled nitric oxide unproven
How is one able to tell if a child has asthma?
- Wheeze □ A must have □ Cough variant asthma does not exist □ Cough predominant asthma not uncommon - SOB at rest □ Lost 70% lung function □ Using their abdomen to breath - Cough □ Everyone coughs □ Dry □ Nocturnal (just after falling asleep) □ Exertional - Responds to treatment □ What has asthma symptoms and responds to asthma treatment? □ Asthma treatment= ICS for 2 months □ Remember "false positive responses"- holiday
What is the differential diagnosis for asthma if the onset is under 5 years?
□ Congenital □ CF □ Primary ciliary dyskinesia □ Bronchitis □ Foreign body
What is the differential diagnosis for asthma if the onset is over 5 years?
□ Dysfunctional breathing
□ Vocal cord dysfunction
□ Habitual cough
□ Pertussis
What are the goals of treatment in asthma?
□ “Minimal” symptoms during day and night
□ Minimal need for reliever medication
□ No attacks (exacerbations)
□ No limitation of physical activity
How is asthma monitored?
® Closed questions
® SANE
◊ Short acting beta agonist/ week (>2 days a week then asthma is poorly controlled)
◊ Absence school/ nursery
◊ Nocturnal symptoms (if you get it once a week)
◊ Exertional symptoms/ week
What are the classes of asthma medication?
® Short acting beta agonists ® Inhaled corticosteroids ® Long acting beta agonists* ® Leukotriene receptor antagonists* ® Theophylline ® Oral steroids ® *=add ons
Explain inhaled corticosteroids
◊ Very useful for diagnosis ◊ Very effective ◊ Very safe (when prescribed correctly) ◊ Adverse effects - Hight suppression (0.5-1cm) - Oral canditis - Adrenocortical suppression - Doesn't cause hypertension - Doesn't cause cataracts
When should you use a regular preventer in asthma?
◊ Diagnostic test
◊ B2 agonist >2 days a week
◊ Symptomatic three times a week or more, or waking one night a week
What should be used as a regular preventer in asthma>
Start with low dose inhaled corticosteroids (or LTRA in <5s)
What non-medication interventions should be done in asthma?
□ Stop tobacco smoke exposure □ Remove environmental triggers ® Cat, Dog ® HM?? □ Diet- evidence negative □ Alter humidity- no evidence ® Air ionisers increase cough □ Weight reduction- no evidence
What is the step-up step-down approach to treating asthma in children?
□ Start on low dose ICS
® Severe may respond to minimal treatment
□ Review after 2 months
® No routine test to monitor progress
® Stepping up easier than down
® Need an inhaler holiday when Easter comes round
What is the initial add on preventer?
□ Gets complicated ® Add on LABA or LTRA (BTS/SIGN) ® Add on LTRA (NICE) ® Increase ICS dose (GINA) ® Add on LABA but keep an open mind (clinician) □ Long acting beta agonist*** ® Do not use without ICS ® Use as fixed dose inhaler □ Leukotriene receptor agonist ® Montelukast only ® Rule of thirds ® Better adherence ® Granules for reluctant toddlers
